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Medical press and circular 








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THE 



anil Cirrular. Catah. isss. 


Being Sncoi^ioration of Joomalo tiittierto i^noton ao iBelKcal Ipreoo” 

anD "Z%f ^(Oical Cirettlar,” 


% ®e^yg |0ttrnal 

OF 

MEDICINE AND MEDICAL AFFAIRS. 

FROM JULY TO DBOEMBHR, 

1901. 


LONDON: 8 HENRIETTA STREET, STRANDj DUBIJN: 16 LINCOLN PLACE. 


Digitized by Google 





Jaa. 1, 1903. 


iKdex 


SnmmaeBt t« 

The Medlou Pim* and Otrralar 


INDEX. 


VOL. LXXn. NEW SERIES. (VOL. CXXIII. OLD SERIES.) 
JULY TO DECEMBER, 1901. 


A 


Abbey's effenrescent aalt, 101 
Abdomioal pain in typhoid fever, 
17 

Aberyatvryth, the health of, 6S9 
Able-bodied eoldien, 33S 
Abecesa 1a the left frontal lobe, 64 
AbKcaaa of the niednlla oblongata, 
466 

Abuse of out-patieBtdopartmente, 
316 

Abuse of acieitlQc literature, the, 
986 

Academical costumes, 698 
Academy of niedlciue in Ireland, 
479 

Accidental d*ath of a Cardiff prac- 
titloDsr, 659 

Acne, treatment of juvenile, 114 
Acquittal of a false doctor, 505 
Action against a medical man, 499 
Action for aland^, 174 
Active and Inert vaccines, 091 
Aente dysentery, 661 
Acute gaomnous appendicitis iu. 
a gna idia, 190 

Acute middle ear suppuration. 395 
Addresv, an, dir C. Nixon, 507 
Adenoid vegetations, SOS 
Adrenal tlierapeutics, 195 
Ailreiiisetnent craze, 498 
Advisory board, A.1I.S., the, 555 
.Etiology and consequences of 
movable kidney. 419 
.Etiology and pmpbylazit of enteric 
fever in South Africa, Dr. 
Btak»-Knoz, '307 

AgiUUou against expensive asy¬ 
lums, 393 

Alcohol and tuberculosis, Dr. 

TbOTxnrgood, 319 
Alcoholic poisooing, 875 
Alcoholiam and tubercnloels, Dr. 
Kelynack.lSS 

Alcohol and tube'culosis, 394 
“ A lethal c<^,'‘ 445 
Alleged cure of cancer by x-rays, 
611 

Alleged hospital neglect. 199 
Alleged mistaken diaguosls, 25 
Alopecia areata, 503 
A medical hero, 645 
Amendment of the medical acts, 
474 

Amputation in phlegmoels, 545 
Amyloid disease in immunised 
horses, 199 

Anieethetic fktalities. 533 
Anal pruritus, 343 
AnchDoetomum dnodenale, 574 
Anglophobia in continatal betlth 
reaorts, 498 

Anglo-Saxon energy and South 
African refuge camps, 551 
Ankyloetoma embryos, lOT 
Annual dinner of the Bri i-h medi¬ 
cal association, 173 
Annual moetiug of fellows and 
members of the royal college of 
surgeons of Xngland, 581 
Annual report of the royal college 
of surgeons of England, 517 
Annual temperunce breakfast, 77 
Another midwife scandal, 349 
Another suicide at a Kent county 
asylum, 963 

Another s'lrgeun “back from the 
war,’ Oil 

Antiseptic doormats, 639 
Antiseptic duel, the, 384 
Anti-typhoid inoculation in the 
army. Dr. Drury, 878 
Anti-typhoid serum, 560 
AnU-vacdnation trick, another, 
550 ' 


Anti-veoone in snake-poisoning. 
Dr. Parsons, 581 

Anti-vivisectionhts,take note! -47 
An unsolicited testimony, 703 
Apology for bacteila, Dr. bniith, 
5 « 

Apologv for bacteris, 553 
Apiieiidicitis and-trauuia, 190 
AppoinmenU—end of each No. ; ' 

Aran, the late Dr. Kean and fever 
ID, 33 

Are Rontgen-rays Intallible? 351 
Army and Indian medical serf ices,. 
838 

Army hospital accommodation in 
London, 132 

Amy medical school, pass lists, 
305 

Anny medical service committee, 
92, 176, 556, 702 

Arrest of a Wigan practitioner, 617 
Arsenical beer poisoning, daiiiagee 
for, 559. 

Arsenical dermatitis, 632 
Anonvalisation, 307 
Art of cooking, the, 365 
Art tlcial hospital debts, 443 
Arthrolysis, IS 
Ascites, 422 

Aspbyi^l factor In nitrous oxide 
amestheeia, Dr. Kirkpatrick, 
431 

Assault by a patient, 588 
Asinmption of false designations, 
69 

Asylum reports, 667 
Asylnms and asylum work, Dr. O. 
Woods, 182 

Attempted assassination of the 
President of the United States, 
293 

Aufcnltation of muscles, 468 
Australian medical officer’s experi¬ 
ence in Soutli Africa, 293 
Auto • intoxication, Dr. Kovacs, 
828 

Avenues for medical practice, Dr. 
Kyl(s, 486 


B 


Bacelli treatmentof footand mouth 
disease, 496 
Bacilli 111 sputum, 662 
Bacilli ofdysenteiY, 38 
Bacillns of syphilis, discovery of 
the, 23 

Bacillus tuberculosis, direct infoe- 
tiOD with tho, Ifr. S. Boyd, 
27 

Bacterial fiction of serum, 239 
Balneology, special instruction in, 
215 

Balzer, Prof., tinea tonsurans, 
877 

Banti's disease, 578 
Bardswell, Dr,, pulmonary tnber- 
culoels, 853 

Barlow. Dr., Individnallsm in 
medicine, 861 

Barker anatomical prize^ 452 
Bathing fatalities, 46 
Beard, Mr., sterilisatinn of flexible 
catheters by boiling, 3Sii 
Beauty making, 19 
Beer jioisoning seiiatlon, 176 
Beitet, 323 

Beri-beri at Liverpool, 703 
Birmingham consultative Instltn- 
Uon, 392, 554 

Birmingliam libel case, IT8 
Births - end of each No. 

Birthday honours 538 


Bishop, Hr., demonstration of 
clianges occurring iu uteri in 
which flbro-myoinata are pre¬ 
sent, 677 

Blake-Kiiox, Dr., (etiology and. 
prophylaxis of enteric fever in 
bputh Africa, 207 
Blennoirhtea neonatorum, 140 
Blood pmasure in fevers, 65 
Blue electric light, 330 
Bogusdoctor, t, 400, 458 
Boca ca41u.<), 5I0 
Bone-setters, 525 
Bone-setters and quacks, 318 
Boraclc acid, 891 
Botanist csnsnied, a, 25 
Boyd. Mr. H., dlrcc infection with 
the bacillus tuberculosis, 27 
Bristol nnlverslty college, 533 
British laryngolf^ical association, 
505 

British medical association, 128; 

annual meeting, 151 
Britisli medical association meet¬ 
ing, 1902, 248 

Britisli pharmacentlcal conference, 
50 

Broken ribs overlooked in hoipitel, 
222 

Bronchitis in children, Dr. Marfan, 
351 

Brouardel, Prof., prevention of 
consumption, 10< 

Browne, Mr., tlie Har ^eian lectures, 
636, 561, 595 

Buck, Hr., treatment of tubercu¬ 
losis by urea, 168 

Bnirooglis Wellcome and Co., 
fete of, 103 

Bntter commission, a, 50 
Buxton spa, 46 

Byers, Dr., nineteenth centnry 
progress in obetetrics and 
gyuiccology, 131 


0 


Cabnun and street accidents, 19 
Cechish congress, 64 
Gacodylie medication, lU 
Cesarean section, 42, 661 
^saroan section. Dr. Kerr, 484 
Cilcium carbide, 74 
Campbell, Dr., treatment of me¬ 
tritis, 325 

Campiior in the treatment of vari¬ 
cose nlcers, 73 

Can amesthesia be indncod during 
sleep? 78 
Cancer, 419 

Cancer clinic, proisiird, 813 
Cancer of the stomach, Dr. Itobiii, 
83, 188 

Cancer, the study of, Mr. Meldon, 
510 

Cape medical conncil, 424 
Capital punisbmant, 616 
Capo, Dr., x-rays in the diagnosis 
oftubereulosls, 161 
Carbolic acid as a dressing for 
biimH, 392 

Carbolic aciil in septic wounds, 358 
Carbuncle, «»0 
Carcinoni.’i, 3!)4 
Carcinoma ({■ii-slion, 445 
Caolisc drugs and tho vm.so-m»tor 
tnntment, Dr, Qottliub, 85 
Cardiac failure, acute, 23 
Oirdlac musculature, disease of 
the, 340 

Cardiac tuberculosis, 14 
Careless death certiticatioii, 424 
Cash value of a linger, 67 
Casumen, 588 

Digi 


Castel, Dr., epithelioma and syphi¬ 
lis of the fkce, 633 
Casting out the mote, 443 
Cavendish lectnre, tlie, Sir B. D. 

Fowell, 1 
Cedroii seeds, 843 
Centenarianp, 688 
Cnrebral syphilis, 439 
Certlflcation of lunetics, 250 
Change ofho<pital name, 675 
Changes in the staff at Bt. Bartho¬ 
lomew's hospital, 613 
Charing Cross medical school, 35 
Oharwomaii abortionist, e, 617 
Chemist-apothecary Aned, 99 
ChemisU and dniggisU’ exhibi¬ 
tion, 258 
Chime, the, 222 

Clilldren and the new beer regula¬ 
tions, 638 

Chinese lanndreesee, 967 
Chinosol, 334 

Chiver's Cambridge lemonade, 101 
Choice of direct repreeentetlves, 
the, 169 

Choledochotomy, 307 
Choree and aiaenic, 241 
Choreaand rheumatism, 44 
Christeanu, Dr, the vomiting of 
pregnancy, 803 

Christian tdeoce “testimony'’ 
meetlnn, 248 
Chronic endometritis, 116 
“ Chronic barmlees Innatics," 170 
Chtosic pelvic exndetion, 416 
Cigarette smoking, 176 
Cinnamon uid tnbsrcnloais, 140 
Coeies, Dr., iuTSsUgation into the 
presence of infective material 
IU dwellings ooonpied by con¬ 
sumptive persons, 184 
Cocaine in obstetric practice, 681 
Cocaioe poisoning, 123 
Cocainisation of the spinal cord, 

69 

Cold tub, the, 696 
Coleman, Dr., radical experiences 
in Boutb Aftlca, 800 
Cblar, snrgeon^en. von, death of, 

340 

Coll^ of preceptors. 120 
College of safe medicinn, the, 196 
College representation on the Q. M. 

C., 611 

Colmeris, don M., 25 
Combe lug of tnberculosis, Dr, 
Koch, 106, 118 
Compeiative medicine, 623 
Compensation for condemned meat, 

126 

Comiillmentary dinner to Bnrgeon- 
Ueneral Jameson, C.B., I'll 
Concentration camp mortality, 

641, 670 

Congress of tnberculosis, 45, 97 
Connectior. of iiaial disease with 
caterset, the 197 
Constipation, 415 
Constipation, Dr. Oldfleld, 853 
Consumption hospitals, 89 
Consumption of salt, the 368 
Contagionsnass of alopecia areata, 

97 

Contegionsnees of psoriasis, 558 
Continental climatic stations, 88, 

806 

Contract medical attendance, 479 
Contusion of intestines, 415 
CuoiH-T, Mr., inoperable cancer, 4^ y S\ 
Cupemau, Or , mo-iem methods of 
vaccination, 054 
CORRBBPONDBNCB. 

“ A lethal coin,” 451 
Anderson fund, tlie, 49, I2S, 678 
Attitude of pliarmaciste to i«tet. 
medicines, 74 

zed b> 


i> I* I 

oogle 


Th» Htdltayprom and CfrenlUp 


iNDEi. 


Jun 1, 1902. 


Banti’0 disease, 015 
Biological test. 207, 321, 345, 370, 
390, 449, 478 
Cancer, 450 

Cheltenlum meeting, the 99 
Chlorofoim death, 75 
Congress on tuberculosis, 202, 306, 
426 

Counter-prescribing, 47$ 

Covering a bone-setter, 585 
Cure of consumption, 502 
Damages for for prema.ure burial, 
685 

Deaths under chloroform, 558 
Degrees for London students, 530, 
557 

Diet in relation to the cause and 
cure of constipation, 450 
Difflcnlt7 of diagnosis in infections 
dlMises, 200 

Election of direct representativcee, 
S70, 503 

" Elusive'' secret of cancer causa¬ 
tion, the, 530, 658 
Femoral cystocele, 127 
Fish and Japanese lepers In Hawaii, 
700 

Goat, the treatment of| 296 
" Higher" dental degrees, 99 
Hydrophobia, the bvatinent of, 
290. 845 

Insanity angle*, 646 
Lachnanibes tinctnre, 320, 846, 
369, 420 

Latent cervical fracture," 201 
Leprosy, the cure of, 450 
Medical guild circular, the, 586 
Medical refonn, 340 
Misuse of the bronchitis kettle, 503 
b'omenclature of diarrhceal disease, 
128 

Plague, 586] 

Practical aspects of medical re¬ 
form, 672 

Prematnre bnrial, 645, 700 
Frofesaion and the public, the, 657 
Proposed new journal of obstetrics 
and gyntccolt^, the, 127, 177, 
201, 227 

School b.anl and vaccination, the, 
821 

Bcieiitiflo education, medical stn- 
den’s, 75 

^luggestloDs for the improvement 
of the human race, 099 
“ Snnday Times " and Sir J. Lister, 
75 

Total gaatrectony, 346 
Twin lc«-b«g(illnstrated), 321 
Undesirable proseentions, 127 
Unique case of emphysema. 897 
Untrustwor.hy sernui, 557, 585 
675 

Vacancy on the staff of St. Bartho¬ 
lomew's hospital, 646 
Veratmm vlrida in puerperal 
eclampsia, 251 
Vicissitudes of drugs, 615 
Virchow’s eightieth birthday, 75 

Ckironation ^ft to the hospitals, 
propoaed^ 499 

Coroners and post-mortem examin¬ 
ations, 226 
Cough, 71 

Coverings of scars, 662 
Cox, Dr., trained nurses In work¬ 
houses, 461 
Coxalgia, 245 

Cremai ion, a new plea for, 680 
Crematorium for variolous dead, 
401 

Crothere, Dr., toxic use of 
alcohol, 666 

Cruelty of foie gra*. the, 088 
Creosoted emuUien of cod-liver oil, 
504 

Criminal experiments, 653 
Crltchett, Q., knighthood for, 
627 

Crystalline immunising product, 
241 

CuUinan, Dr., inoculation as a pre¬ 
ventive against typhoid fever, 
186 

Cores for baldness, 040 
Cutaneous actinomycosis, 407 
Cylinderuria, 38 

Cystic ssrcoiiii of breast, Dr. H. 
Snow, 488 

Cystic sarcoma of the right ovary, 
Dr. Purcell, 512 
Cyats in ovarial remains, 116 

D 

Dad's qalnius pills, 604 


Damages for premature bnrial, 544 
Dangers of the streets, the, 219 
Dangerous zone for Intia-gluteal 
injections, 342 
Dawlisb libel case, the, 588 
Death from an overdose of mor. 
phis, 349 

Drath from fright l7), 123 
Death fromhsmorrhtge, 25 
Death from morphia, 505 
Death under anresthet'c*, 559 
Deaths under chlorofurm, 50, 77, 
849, 400, 452, 6-25. 588. 617 
Drath under ether at Leeds, 179 
Death in typhoid fever, 87 
D ath from poisoning, 153 
Death in a workhon>e, 506 
Deaths—end of each No. 

Decision on the sale of food, im¬ 
portant legal, 43 

Deformities of the elbow-joint. Dr. 
S. Lloyd, 81 

Degrees for London diplomates, 40, 
495 

Delirium tremens, 335 
Demonstration of changes ocenr- 
ring in uteri, Mr. Bishop, 677 
Dental hospital of London, 170 
Departure m mental hospital work, 
816 

Derby borough asylum, 687 
Detection of antimony, 69S 
Detectives and doctors. 422 
Diabetes, Dr. Lepine, .592 
Diabetes in infants. 440 
Diabetes in the dog, 140 
Diachylon, 174 

Diagnosis between appendicitis and 
typhoid, 190 

Diagnosis oftuberculosis, 125 
Diaphragmatic hernia. Dr. logals, 
56 

Did Napoleon die of cancel? 21 
Diet treatment of epilepsy, 518 
Difference of opinion, a, 21, 553 
DifTercotia) diagnosis of small-pox 
and chicken-pox, 424 
Difficulties of raodicino, the, 140 
Diffuse peritonitis complicating 
apMndicitis, Dr. Ochaner, 57 
Digitalis, the action of, 858 
Dinner to Dr. J. Takamiiie, 675 
Dionin*, 540 

Diphtheria antitoxin in scarlet 
fever, 93 

Diplococcus semilunaris, 610 
Disease transmitted by ants, 375 
Disinfection after cancer, 150 
Disinfection of cutting icstni- 
ments, 467 

Dlsinfectingstationsandtemponiy 
isolation houses, 241 
Disreputable adveitising In repu¬ 
table jouma's, ?50 
Disseiniuation of disease by the 
secretions of the month, 198 
Doctor t‘. medical guardian, 97 
Doctor infictiOD, the, 251 
Doctors on strike, 400 
Does anti-diphtheritic serum influ- 
enre diphtheria mortality ? 
664 

Douie.stlc filters, 497 
Double hydrosalpinx, Mr. Ryall 
404 

Dragon-fly, cultivation of the, 21 
Drastic anti-phthisical mnsurcs, 
017 

Drinking water and bad teeth, 42 
Drunkenness among women, 807 
Drury, Dr., anti-typhoid inocula¬ 
tion in the army, 378 
Drysdale, Dr. 0.,1iiwer birth-rates, 
411 

Dublin death-rate, 24, 128, 154 
179, 228, 349. 401, 452, 647, 640, 
708 

Dublin hospitals, the, 101 
Dublin sanitary association, 258, 
506 

Dublin nnivernity, 25 
Dublin university, imiss list.s, 583 
Duckworth, Sir I)., the personal 
factor in tuberculosis, 535 
Duration of preguancy, the, 24<> 
Durham university, pass list, 375 
Dysbasia inteniiittuns, IS 
Dysentery, 604 

Dysentery in asylums fur the in¬ 
sane, 198 


S 

East Ham Indecent assault case, 
708 

Bclatnpsla, 518 


Ectopic gestation illustrated}, Dr. 

Macnaughton-Jones, ,569 
Eczema, the management of, Dr.H. 
Waldo, 161 

Edinbuighasylum, 687 
Edinburgh graduation ceremonial, 
154 

Edinburgh university, pass list, 
479 

Educational number, 261-291 
Effect abroad of Prof. Koch's ora¬ 
tion on tuberculosis, 217 
Effect of diet, 475 
Effect of beat on blood stains, the, 
341 

Effects of lead on lead workers, 
520 

Bhrlicli’s theory. Prof. Gruber, 682 
Election of direct representatives 
to the general medical council, 
529 

Election of direct representatives, 
899, 606 

Electrical ozone and light treat¬ 
ment, 76 

Electric experiments on di%s, 690 
Elephantiasis, 681, 661 
Embolism of the pulmonary ar¬ 
tery, 87 

■'Eminent"hone-setter, an, 172 
Employers' res]>onsibllity, 423 
Empyema of ilie antrum of High- 
more, 838 
Enteric fever, 446 
Enuresis in children, 834, 357 
Epid einic j.iundice, 444 
Epidemic small-pox, 395 
Epilepsy and its phenomena, Dr. 
Foy, 230 

Epilepsy and memory, 295 
Epilepsy, treatment of, 844 
Epithelioma and syphilis of the 
face, Dr. Castel, 023 
Erroneous death certificate, 582 
Erythema builosum et gyratum, 
674 

Esvacli aperient water, 50 
Ether, death under, t05 
Etlisr V. chloroform, 813 
Ethics of public vaccinators, 579 
Ewart, Dr., time-saving methods of 
tTMtment in phthisis, 829 
Exanthema universale tuberosum 
et planum, 600 
Excess of smoke, 887 
Excessive cough in phthisis, 12.5 
Executive ability of medical men, 
the, 93 

Expectation and expectoration, 
124 

Explosion in a laboratory, an, 427 
Bxtirjiation of the vagina, 140 
Extra-mural schools of the Scot¬ 
tish universities, 441 
Eyelid symptoms in exophthalmic 
goitre, 194 


P 


Facial bones and paralysis, 807 
Facial presentation, 88 
Fads in inediciue, 72 
Fceces and flatus per urethram, 694 
False teeth for paujiers, 95 
Fall from a train, 400 
Failure of water supply, 2'29 
Fatal amateur prescribing, 425 
Fatal circumcision, 874 
Fatal counter-irritation, 559 
Fatal tattoo, a, 52ii 
Fatal treatment of aneurysm by 
the gelatine method, 247 
Fatality at a hypi.otic exhibition, 
04 

Fatty tumours and general adi¬ 
posity. Mr. J. Butchinson, 019 
Fee or inquest, a, 578 
Fermentative intestinal dyspepsia, 
888 

Femoral cystoeele, Dr.Racoviceano, 
91 

Fibroi'l tumours of the nlcrus, Dr. 
Noble, 79 

Fight wainsi malaria, 422 
Finny, Dr., dUsominuted .sclerosis, 

OS3 

Fires in oil-shops, 525 
First American practitioner, 609 
First Egyptian cougrass of medi¬ 
cine, 150 

First year of study and the general 
medical council, 068 
Flaws in registration, 440 
Folly of bolting food, the, 175 
Food preservatives, 677 


Foraniniiers of tuberculosis in 
synovial sacs, 198 

Foreign bodies in food at restau¬ 
rant*, 473 

Foreign bodies in the throat, 190 
Foreign students in Germany, 44 
Forgotten remedio*, 670 
Four yrars' iniioculation against 
the plague, 73 

Foy, Dr.,therapeutic note, 408, 540; 
eneral eiiiphysenia following 
racheotOTny, 333 ; detection of 
leculated fluids in the abdo¬ 
men, 84; epilep.vy and its 
phenomena, 23<> 

Free serum, 581 
Fiiedeiihelm hospital, 103 
French congress ofgynacology, 215 
Friendly microbe*, (539 
Functional disorders of the heart, 
802 

Fui uiiculosis,690 


a 


Gangrene of lower extremities, 140 
Gaol after the workhouse, the, 805 
Gastric hii-morrhage, concealed, 489 
Gastric ulcer and carcinoma, Dr. 
Murrell, 434 

Gastric ulcer. Dr. Robin, 465, 007 
Oastroectnsis of childhood, 193 
Gelatine as a htemostatic, 894 
Gelatine in therapeutics, 204 
General emphysema following 
tracheotomy, Dr. Foy, 338 
General medical council, 920 
General medical council and tlie 
royal college*, 934 
General mtdical council eltcticn— 
addresses by the candidatos, 
105, 470, 407, 524,583 
General medical couccil election 
and "service” voter, 555 
General medical council of educa¬ 
tion and regislration, GOl 
German enijieror and the study of 
cancer. 501 

Gift to the London college of 
physicians, 533 
Glandular fever, 646 
Glasgow' university, pass lists, 5 33 
Glover, Dr., the retirement of, 526 
Glucose in marmalade, 613 
Glycosuria and cigars, SIT 
Gononhival joint atfecticn, Hr 
Hunger, 625 

Gonorrhtea iu women, 240 
Good example, a, 819 
Gout and goutiuess, Dr. D. Walsh, 
406 

Governin-nt gTants for sciciilillc 
investigations, ll>6 
Government tax on quackery, 122 
Grants iu aid of scientific research, 
647 

Grave'., disease, 095 
Growth of the hair in the insane, 
200 

Gruber, Prof., Ehrlich’s theory, 

683 

Gunshot wound of the bladder, 37 
Gutter journalism, 426 
Guy’s hospital, 30!', 555 


E 


Hiemodiagnosis of appendicitis, 
Dr. Tullicr, 405 

Hn'inaturia in childhood, Mr. C. 
^ illiains, 429 

Halfpenny imi>act<!<I In the icsopha- 
gus, Mr. Kennedy, .598 
Eausar, Dr. A., statue to, 319 
Bamiful headache iiowdcrs, 205 
Baring, Dr., multiple papillomatA 
of larynx, 214 

Haireian lectures, Mr. Browne, 
536, 561, 595 

Baiveian society of London, 647 
Health of Belfast, 77 
Boltli of the king, 47l,4!i.5 
Health inatteis in Salford, 242 
Heat wave in New York, 40 
Help for the t..borcnluus i>ooi, 361 
Herbalist’s defence, a, 4.52 
Herbalists and the apothecaries 
act, 552 

"Herbalist'’ sentenced to dea'h, 
a, J28 

Heniia of theurinaiy bladder, 91 
Heron. Cr., tuberculin Ip htmiau 
tnoerculosls, 211 



iui. 1, iwi 


The K«dle*l erei and Clm’Ar 


Bwroin in ^ynwcolo^, 00 
Heta).S33 

“Bildier" dentnl degrees, 72 
Holiday funds and sick children, 
195 

Holloway ssBatorinm, 6S7 
Home omce and potteiy mnnofnc- 
tarere, 452 

Hoaouing the memory of a 
pliy*ician, 013 

Hoitoeks, Dr., the tnatmeot of 
miscarriage, 181 
Hospital Bbn>e, 220 
Hospitals at the fcoot, SIS 
Hospital '* scandal ” at dtochport, 
70 

Hot-air treatment. 690 
Hoosing of the poor, the, 14S 
Hoosing of the working clssse •, OO 
Hoosing problem, the, (HT 
How Cueltenham was saved from 
smalt-nox, 174 

Haggard, Dr., use of drugs in pul¬ 
monary tobnrcnlosU, 1S4 
Hntchinsou, Hr, J., wyoaul’s 
pbenemma, 403; vegetable 
pathtdogy, 4SI; fktty tunioun 
and geneim adiposity, 610 
Boman and bovine tuMrculosi*, 
Prot MeFadyean, 110 
Hydatid cyst of the liver, Dr. 
Peres, 904 

Hydrocele, Dr. Sheild, 231 
BygiWM of resUorant kitchens, 
the, 400 

Hype i pyr ex ia, 13 

Hypertrophie cirrhosis of the 
liver, 190 


1 


ietenia neonatoram, 682 
"Ideals in m^ieal education," 
M3 

Tdiog^k j^ngrene of penis, Mr. 

bnportant vaccination appeal, 501 
Improvamant in the general medi¬ 
cal cooncU, 475 

Improvement of the human race, 
5SS 

loadhquaey of the lance, 422 
lacoounentia nrinc, 140 
Increase of lunacy in Yorkshire, 
1« 

Indian army msdleal reform, 46 
Indiarabber corsets, 176 
Indian medical servioe, pass list, 
61, 229 

ladiaentions of "What's what,” 

Indivldaaliam In medidne, Dr. 

Bartow. 381, 808 
Ineliglbla aati-vaecioationist, 06 
lalhatQe poeomonJa, 226 
laf^ctloa nom toys, 554 
Inllnaaea of sdees on the etomoch. 
Ml 

lagala. Dr., diaphragmatic hernia, 
M 

Ihjnriaa fMgnad, 092 
IhJnttas of iohlta, Mr. Harsh, 
IM 

“• centre of speech, 

lamatae from Inebriate reforma- 
tac«H,010 

Inoaolation as a preventive against 
fever, Dr. CulTinan, 

Innenlatlon In antatfe fever, 251 
laeB*iabta cancer. Hr. Cooper, 

4» 

Inqoeat on a tnnmmy, 060 
faulty in Loadoa, 822 
laaail^ In tka aonntry, 639 
ItatnMttoB in ansHthnics, 638 
InrtiiiiBmilal fanperfhetions 72 
IntirtiMl abftrnetfon, Dr. Tcaven, 

I ntmji a t — of Prof. Koch, 124 
InMcirtitent ll«pli«g, 894 
IntnawMiitlw, recovery ftom, 14 
InrcMlptloa Into the presence of 
iaiMUvo material In dwalilngs 
oee^lid by consnuiptiTe per- 
anna. Dr. Ooatee, 134 
lat^ cdtha alactieB. 478 

of the hortes enn- 
, the, 124 
,401 
. ttO. «4 

,ttia,047 
le and gntdu* 

, 104,688,617 



I N D E 


Is CB icur increasing in fmiucDcy ? 
.521 

Is fat evolved from athumen, 6.3J 
la the "conscientious objector" n 
fool ? 393 


J 


Jellett, Dr., suppurating ovarian 
cyst, 59 

" Jelly a l.a lemco," 103 
Jenner society, llie, 172 
Jews and drunkenness, 608 
Jews as doctors, 671 
Journal of obstetrics, 570 
Judge on doctors’ bills, s, 06 
Judicious forecast, a, 150 
Juliieo, Dr., syphiUi without 
primary lesion,5 
Just punishment, a, 447 


S 


Kclloci, Mr. T. H., iia'vl and tlicir 
treatment,53; medical students 
and their duties, 3s2 
Kelyiiack, Dr., alcoholism nnd 
tuberculosis, 133 
Kerr, Dr., ca-sarean section, 4S4 
King, Dr , a study in heredity, 233 
Klrki«atr!ck, Dr., asphyxial faelor 
iu nitrous oxide antf‘sthesia,43I 
Knee-joint contractions, 115 
Koch V. alimentary tuberculosis, 
190 

Koch, Dr., the combating of tuber¬ 
culosis, 103, IIS 

Koch, Prof., and his critics, 172 
Koch’s theory in < ourt, 340 
Koplik's spoti in measles, 191 


L 


Laboratory scheme for tho Irish 
asylums, 633 

lachnsiiihes and consumption. 
Si:. 

Lady dentist Hoed, a, 210 
Lady doctorj not required, .50 
Lady doctor.s' opiiOrtunity, the, 146 
Lady iiu'dical candidate. 50k 
Lady medical otTicers, 21 
Lager beer, 473 
Last of the do; mn?:zleB, <169 
Latent fibroids, 445 
" Latent ’’ fracture of the spine, 144 
La'.est cancer cure fad, 573 
Lawson, Dr., temperature of 
phthisis treated ny open-air 
methods, 652 

Lay Indictment of the gonoral 
medical council, a. 225 
Lay pr'SS and canec'r cures, 610 
L. C. C. and soil p’pes, 474 
Lead and Li'nia, 632 
'-sadless giaz*, 4i6 
Locitliine, 62 

Leuka-mia .nid pregnancy, 416 
Leper mission, the, 19 
Lepine, Dr., diabetes, 593 
L»p<o*y, 343 
Leprosy in Itussia, 129 
Lesson of London and its water 
supply, 521 
Lethal coin, a, 424 
Let the hire be worthy of the 
labourer, 147 
L. G. B. rejwrt, 1900, 427 
L. Q. B. and vaccination prosecu¬ 
tions, 342 

Liability for domestic servants, 126 
Liability of sanitary oHieers, 125 
Lichen and lupus, ^7 
Life and character. Dr. Taylor. 383 
Life assurance for women, 47i 
Ligatorj of spleen, 3^8 
"Light" Slid other tieatmciits, 
the, liO, O'.e.i 

Light treatment of lupus, 523 
LITBRATUBE. 

Anwstliclics and their aciaiini.-tra- 
tioD, Dr. Hewitt, 373 
Anns and rectum. Hr. G(H.<l.sa11 
and Hr. Miles, 203 
Aphorisms, Dr, Italsigliati, 7iil 
Appendicitis, Hr. Lockwood, 101 
Arsenic, Hr. Wanklyn, 160 
Blood and blood-pressure, Dr. 
Oliver, 5SS 


Carica papaya, Mr. Kilmer, 374 
Chloroform, Dr. Lnwre. f,52 
Clinical pathology, Ur. l’i^g,610 
Coniuionweallh of cells, Ur. 
8purrell, 8'J7 

Dental snigery, Mr. Sewill, 373 
Determinative bacteriology, Ur. 
Chester, 5S7 

Diagnosis of diseases of the chest, 
Dr. Cabot, 75 

DiRicult labour. Dr. Herman, 374 
Di.seas;:s of tlie eye, Dr. B.arr, 253 
Diseases of tlie nose and pharynx. 
Dr. Ball, 587 

Diseases of the uo'e and throat. 
Dr. Hall, 203 

Disctses of the stomach, Mr. 
Bobson and Mr. Moyniban, 
-1.51 

Diseases of women. Dr. Phillips, 
372 

Elements of practical me Heine, Dr, 
Carter, 702 

Extra-phann.acoprcia, Ur. Martin- 
dale, 24 

" First-aid ’’ diagrams, 4-51 
General anatomy. Dr. Bichat, 203 
Healthy homes, Mr. Vaeli*r, 39S 
Hygiene, the science of. Dr. Fakes, 
252 

ImJex of symptoms, Dr. Leftwich, 
203 

Indian treatise on materia tiiedica, 
Mr. Ohosli, 319 

Intra-aiidomiiial siippuratioo, Mr, 
'lubby, 201 

-Manual of iiieiicino, Dr. AUchin, 
2l» 

Manual of surgery, Dr. Bose and 
Ur. Carleas, 397 

Medical jurtsprudeLce, Dr. McCal- 
liii, 531 

Meiiioics of Sir J, Paget, Hr. 8. 
Paget, 531 

Midwifery, Dr, Jellett, 587 
.Military hygleoe. Dr. Munson, 
347 

Minor surgery Mr. C, Heath, 532 
Mock-nursci, Mr. Gant, 203 
Nervous systtin. Dr, Opptiibelni, 
202 

New therapeutics, Dr. Clarke, 848 
Nursing profession, bir Henry 
Buniett, C.B., 616 
O]>hthalmoscoi>c, Mr. Hsrt.idge, 
616 

Oral sepsis, Dr. Hunter, 204 
Pathology and surgical treatment 
of tumours, Dr. Senu, 202 
Pathology, Dr. Auld, 374 
Physiology, Dr. behafer, 76 
Plasmon cookery book, 702 
Pocket Gray, Dr. Fsgge, 587 
Public health Drs Farkes and 
Kenwood, 24 

Practical gyna^ology. Dr. Uac- 
nanghton-Junes, 322 
Fuhl ic health laboratory work, Dr. 
Andrews, 397 

Purulent nasal discharges, Dr. 
Tilley. 674 

South African war surgery, Mr. 
Mskin, 43 

Stricture of the urnthre. Dr. 
Freyer, lOO 

Sumcal applied anatomy, Sir F. 
Trove*, 398 

Surgical ilisea^es of the kidney, 701 
Sypliilis, Ur, de Meric, TOO 
Text-book of medicine, Dr. Gibson, 
?9S 

Tbeniial witers of Bath, Dr. 
Baunatyne, 204 

When 10 operate io iuflaiiima'ion 
of the appendix. Dr. Hujlliii, 
203 

Llt*rary rotes and gossip, 90.271, 
532 

Liverpool, proposed university for, 
48 

Lloyd, Dr. S., defoniilties of tlie 
elbow-joint, 31 

Lecal govsrinneiit board and Prof. 
Koch, 2112 

Loculatcl Huids in the abdnmeu, 
detection of, Dr. buy, 84 
London hospit.al medic.al cullcus, 
874 

Loudon's milk supply, 617 
Loudon school ol tropic.at inediciue, 
448 

London small-i>ux epidemic, 693, 
675, 703 

London university, pass lists, 580 
Lower birth-rates, Dr.C. Drysdale, 
411 


Lotus arabious, 103 
Low-Hash oil, 226 
Luff, Dr,, pliarmacy and medicine 
355 

Lunacy in Forfarshire, 544 
Lunatics at large, 472 
Lupus, 574 
Lnxatio patelltp, 115 
Lysol poisoning, 519 


H 

Macclcsneld iiiHnniry dispute, 612, 
646,6<i7 

Slacnauglitoii-Jones, Dr., uterine 
myomata, 111; unusuil gyiue- 
tological casns(illu8trated), 457 
Magistrates and conscientious ob¬ 
jectors, 839 

Magnet as a means of removing 
metallic foreign bodies from 
the eye, the, 342 
Malaria, 39 

Malaria and house sanitation, 141 
Malaria curator cancer, 444 
Manchester as a school of medi¬ 
cine, 614 

Manebest r medicsl guild, 205 
Marfan, Dr., bronchltislachildren 
351 

Marsden, Dr., memorial to, 550 
Msrsh, Mr., injuries of joints, ISO 
Marriages nir.oii),* the deaf, 550 
Marriages-end of each No. 
McArdle, Mr., surgery of the skull, 
080 

MeFadyean, Prof., hunian and bo¬ 
vine tuberculosis, HO 
McKinley, death of, SIO 
ftlcKiiilry, President, ihe rase of 
ihe lute, Dr. Mann, 364 
MeW) emy, Dr., role of protozoa ia 
the causation of disease, 509 
Mechanical side of sur..ury, the, 146 
Uedicxl advice in the lay press, 609 
MeJical advertising tiuder the 
Pbaraobs, 223 

Medical aspects of President 
McKinley's death, 868 
Medical benevolent college, 77 
Medical bulletins, 392 
kledical club in Fails, 646 
Medical congress at Cairo, 317 
M<kdieal council, the general, 607 
Medicsl experiences iu South Africa 
Dr. coUmaii. 300 

Medical fees in legal proc{«diogg, 
010 

Medical gold medallists, I2S 
Medical guardian and medical 
officers, 171 
Medical hero, a, 589 
Medical man cliirged with fraud, 
402 

Medi al men and midwives,613 
51edlcal in jacles, 248 
Medical officer committed for 
trial, 479 

Medical ollicershlp at Sontliamp- 
ton, 340 

: Medical portraits in lay Jonniais, 

1J 3 

Medical practice at the Cape, 819 
Medical officership of the London 
school board, 496 
Medical reform, 319 
Medical regii ation of manisne 
343 ■ 

Hedicil research in Ireland, 196 
Medical service at Bt. Paul's, 401 
447 ’ 

Medical service of the London 
I chool board, 532 

Medical sickioss and accident 
society, 77, 427, 501, 647 
Medical students and their duties. 

Dr. Kellock, 382 
Medical suiciile, 533 
Medical tempenuico association, 
559, 589 

" Mctiicinal” vegetables, 551 
Medicine as a profession, 365 
Medicine as a piufussien, j>r. Bus- 
scU, 356 

Medico literary advices, 341 
Medico • p.sycUological association 
and Irish "auxiliary asylums," 
153 

Mi-dnllary uarcosis, 615 
Mela-oa neoiiatumiu, 218 
Mehiun, Mr., the study of cancer 
510 ’ 

Memorial to the late Dr. Archibald 
H. Jacob, 642 

Menageries and the spread of tu- 
bor«ulosls,671'^, 


iirbfix 


SomlemM* to 

The Ko()tca1 mse »od OireaUr. 


Jm. 1, 1902. 


Mentone lioteMceepers and con- 
atimptiveM, 983, 697 
Metropolitan A-sylnma board, 129, 
540, 576 

Mntliyl blue and methylene bine, 
866 

Methylated liniinente, 667 
Methylated spirit, 862 
Metntta, treatment of. Dr. Camp¬ 
bell, 825 

Uicro-orKMiisma in growing regeU- 
bins, 842 

Hidivife and medical attendant, 
817 

Midwifecommitted for manslaugh¬ 
ter, 503 

Hldwiree bill, 43 

Hlrban oil, 662 

Mirror writing, 194 

Miscarriage, the treatment cf, Dr. 

Horrocks, ISl 
Mixed metaphor, a, 199 
Modem casualty-room work, 149 
Moslem methods of vaccination, 
Dr. Oopeman, 654 
Modern progress in surgery, Hr. 
Taylor, 459 

HodibM Ormshy's ether inhaler 
(illnatrn'ed), 512 
“ Mononia,” the. Dr. Snow, 4 
More arsenic in l.iverpool beer, 96 
Moie ofTtcers for volunteer medical 
staff, 129 

Morp:-th asylum, 544 
Morphia ingastric secretions, 18 
Morphine and strychnine tabloid, 
101 

Mosquito models, 849 
Motor aphasia, 807 
Motor cars for consumptives, 696 
Motoring t>. horse exercise, 249 
Mortality among rde-maken, 630 
Mortality of children, 394 
Mortality of foreign cities, 77, 179, 
353, 349, 375,003, 691 
Mortality of operations for (pill- 
stones, 216 

Morquitos at Sonth Kensington, 

071 

Mumps in dogs, 528 
Munio'pal convalescent home, a, 
349 

Multiple papillomata of larynx. Dr. 

Baring, 214 
Mult'ple sclerosis, 241 
Murrain, 88 

Murrell, Dr, gastric ulcer and car¬ 
cinoma, 434 

Mushroom poisening, 315 
Myelitis acuta, 416 
Myelitis chronica, 64 
Myles, Dr., avenues for mehcal 
practice, 466 

Mys nriou< enteric fever epidemic, 

863 


M 


Ntevl and their treatment, Mr. T. 
H. Kellock, 58 

Nail-biting and neurosis of the 
skin, 816 

Naphthaline poisoning, 221 
>ai costs, 241 

Narcotising apparatus, new, 005 
Nasal refoimatlon, 121 
National association for the pre¬ 
vention of tuberculosis, 640 
National concern, a 119, 403 
Na'ional hospital forihe paralysed 
and eplleptlo, 41 

Navy medical tsrvice, i»ss Hat, 51 
Neanderthal akuU, 475 
Negro question in America, 490 
Neurasthenics, Dr. !6choBeld, 13S 
New books and new editions, 100, 
372,504, 674 

New departure in peDallslng the 
profession, 08 

Now general ans'sthestio, a, GSO 
Nrw-faid egtf, 425 
New “journal uf obstetrics and 
gyon'cology,’’ 104 
New symptom In epilepsy, 295 
New tabloids, 674 
New tract in the cord, 844 
New treatment of carcinoma, 519 
New war council, the, 478 
Next IntematioDid congress of 
medicine, 126 

Night aweataiu phthisis, 554 
Nixon, bir C., an address, 567 
Noble, Dr. nbroid tumours of tiie 
uterus, 79 

Nolan, Dr., residual lunatics, 157 


No Mentone for the phthisical, 544 
Non-notlflcation, 559 
North ludien school of medicine 
for women, 341 
Nosocomial nugrene, 89 
Notheagel, Dr, pylo'ic stanosts, 
506 

Notices to correspondents—end of 
'ach No. 

Kotlflcatlon of consumption, 5S1 
Notification of phthisis, 494 
Notification of small-poT, 420 
Notification of ay jihllis, 617 
Nudity cure, the, 696 
Nurse chsrged with libel, 805 
Nntriti «e value of alcohol, 815 


0 


Obesity and the Banting treat¬ 
ment, 140 

Obesity and politics, 249 
OBITUARY. 

Agnew, Bir J. W., 531 
Bennett, Dr. A. U., 530 
Buckley, Dr, B. C , 852 
Clark, Dr. A. 0.. 616 
Domenichetti, Inspector- Geoeral 
H.. 70 

Francis, SnrgeonGe'.eral G. R., 205 
Kelly, Ur. 4,228 
Ledwtth, Dr. M.. 531 
McCormae, Bir Wni. (illustrated), 
643 

Manley, Sargeon-Oeneral, 584 
Bigge, Mr., 128 

BobinsoD, Borgeon-Maior F., 128 
Smith Mr. H. B., 504 * 

Butheriand, Dr. H.,585 
Thudichum, Dr. J. L. W., 322 

Ohject-Iesson in vaccination, 007 
Octogenarian's violent death, 228 
Odohtologlcal society, 25 
Oldfield, Dr.,constipation, 352 
Old treatment for scarlatina, an, 
>04 

On the altar of science, 401 
Onychograph, 546 
Open-air tauatoria, 375 
Oi)eDliig of the medical schools, 
291 

OFERATINQ THBATRES. 
Cancir Hospital— 

Abdominal hysterectomy, 89 
Inguinal colotomy forcarcinoma, 
102 

Bubperitoneal hysterectomy, 575 
CuBuiKA Hospital p-or Wombn— 
Nephrectomy andappendt-ctomy, 
142 

Ovariotomy, 888 
Qbsat NoaruiRK Hospital— 
Renal calculi, 213 
Sarcoma ofoscalcis, 15 
Buppuntive periosleitis of the 
femur, 468 

Frbrch Hospital ani> Dispbx- 
8ABV — 

Abdominal hyst«TL’ct0my, 575 
Ory's HoePiToL— 

Excision of part of the stomach 
for carcinoma, 014 
Fracture and dislocation of the 
femur, 86.S 

Fracture of both bones of the 
forearm, 360 
Nephrectomy, 243 
Old-stanllng fraitnre of foxur, 
800 

Operation for pbyaica disability, 
034 

Spiral tractu e of the femur, 360 
Unusual case of appendicitis, 033 
Hospital tor Sick Children, 
Great Ormond Striit— 

Iliac ab-ceas, 439 
Prolapsus recti, 6iil 
KiNd S COLLKQK HfiSl-ITAI. - 
Excision urtowerjaw for sarcoma, 
1<)8 

Tumour of the brain, 191 
MiDDLtfiRX Hospital— 

Abdominal hysterectomy, 492 
1 apar-jtomy, 65 

NoRTH-WaaT London Hospital- 
Bennval of suppurating choles¬ 
teatoma, 243 

Royal Free Hospital — 

Removal of all the contents of 
the orbit for malignant growths, 
M7 

Ruptured hydro-nephrotis, 663 


Bt. Mart a Hosphal— 

Middle meningeal. htemorrhage, 
89 

1. Thomas's Hospital - 
Choledochotony, 14 
Epithelioma of the lip, 118 
Excision of the upper Jaw, 330 
Qastro-enterostomy, 512 
Mr, Battle's operation for femoral 
hernia, 117 

Tottenham Hospital— 
Hysterectomy for myoma, 108 
Intra-uteilne pregnancy, 606 
Wist London Hospital— 
Amputation at hip-joint for sar¬ 
coma of femur, 520 
Ileo-colostomy for mallgnaut dis¬ 
ease of the uecum, 062 
KcphroctOdiy, 835 
Two cases of nephrectomy, 809 
Westminster Hospitai.— 
Buppuni'ing of middle cir, 471 

Operation under iccilental hyp¬ 
nosis, 198 

Ophthalmia tieonatonim. 114 
Ophtlialmolc^ical curiosity, an. 343 
Ordnance maps and medical mtn, 
225 

Orgiiii and propagation of malaria, 
4S7 

Omi*rod, Misp, death of, 07 
Oithonltrophenylproploc acid, 3'6 
Otitis media aenta, Dr. Law, 481 
Ovaiian extract, 247 
Overlooked factor in ear disease, 71 
Oxalale renal calculi, 689 
Oxygen fallacy, an. 472 
Oxygen hospital, 50 


P 


Paiitherapeutists, 420 
Paralysis agitans, 18 
Parasitic theory of cancer, 94 
Parents' right of veto, 317 
Parish vaccination in Sweden, 894 
Parisian ri.edlcal school, 224 
Parsons, Dr., anti-veiicno in snake 
imisoniiig, 381 
Pasteur institution, 887 
Patliogenesis of insanity, Dr. F, 
Robertson, 160 

Pathogenet'e studies on phthisis, 
86 

Pathology at the Ijondon hospital, 
71 

Pathological lying and dreaming, 
223 

Pathological societyofMauchestar, 
015 

Pearse, Dr. W. H., type.s of indi¬ 
gestion and their corelatioiis, 
28; pnephtbisis and phthisis 
in relation to constitution, 236 
Peculiar people again, the, 675 
Fasts as iiiedlcAl advisers, 012 
Penbertby, Mr., tuberculosis in 
cattle, 82 

Penny a week for the doctor, 247 
Percy, Dr., hydatid cyst of the 
liver, 804 

Perfected gas fire, 847 
Perforaliou in enteric fever, 837 
Pennaiikanate of intash as an anti¬ 
dote for morphine iioisoniiig, 
444 

Perityphlitis, 21<i 
Perufcious anwmio in infancy, 891 
Personal factor in tuberculosis, Bir 
D. Duckwoilli, 535 
Personal. 22, 47, 74, 98, 126, 150, 
177, 200, 227, 319, 344, 366, 3U5, 
448, 475, 501, 528, 555, 583, 614, 
641, 671, 698 

Pertinent question, a, 407 
Fhantoni concentration camp blu 
book, 581 

Phanntcy and medicine, Dr. Luff, 
855 

Pharmacy am! meilicine, 363 
Phcnalgin capsules, 594 
riiotphorus necrosis, the causation 
or, 173 

Phototherapeiitice.SIS 
Phlbisis ut Bor.ciux,147 
Physically and mentally defective 
children, 554 
Physic an mulcted, 602 
Physiological labi-atory for Edin¬ 
burgh, new, 102 
Physiology of cycling, the, 606 
Physical ba.sls of melancholia, Ur. 
Turner, 137 

Placenta, the delivery of the, 441 
I Plague, the. 185, 622 


Plague and emall-pox in Olaegow 
48 

Plague at Liverpool and Glasgow 
498 

Plague at Naples, 374 
Plague at Odessa, 655 
Plagueattbe Cape, 123,472 
Plague in Bong Kong, 25 
Plague in India, the, 531 
Plastic operations on the ureter, 
70 

Plea for the dome>tlc servant, 393 
Poaching by public VACciaators, 
607 

Pocket atomiser, 558 
Poisons commitiee, the, 589 
Poisononsfiy-papen, 554 
Poiaonotu stockings, 803 
Police station medical cerUllcatei, 
70 

Political control of hospitils, 21 
Poor-law nursing, 816 
Popular theories of tobeicoloMs 
prevention, 148 

Portrait idvertlsement, the, 07 
Post-mortem riaks, 250 
Post -2 ectel dermoids, 608 
Potatoes and dlabe'.es, 661 
Potency of acid ^e alkalo'd*, S8 
Powell, Sir R. D., the Cavendish 
lectnres, 1 

Practical aspects of medical re¬ 
form, 635 

PiH'phthlsls and phthisis In rela¬ 
tion to constitution, Dr, 
Fearte, 236 

Pregnancy following myomectomy, 

250 

PreseuUUon to a medicil iniD, 

6 S0 

President’s address at the British 
phannaceatical conference, 
149 

Prevention of consumption. Prof. 

Brouardel, 107 
Prevention oi fogs, 607 
Prince of Wales's household, 642 
Privacy of medical examinations, 
123 

Probable origin of tbe heat wave, 
74 

Prognosis in disnara, 579 
Progrets In obstetrics and gjmeco- 
logy, Dr. Byers, 131 
Prolapsus uteri. 438 
Fiophylaxis of Dliiidiiess, 223 
Propo tiOD of alcohol in variona 
Mveragea, 452 

Proposed cancer congress, the, 147 
I’ropos d natisnal journal of ob¬ 
stetrics and gynwcology, 90 
Prosecution of a medical man, 205 
Prnrilus, 224 
Pruritus Tulvie, 380 
Pssndo-tebes, Dr. Byllaba, 9 
Pseudo-tabes, 582 
Psorospermosis cutis, 492 
Psychic troubles in heart disease 
891 

Pyschology of assasaination, 810 
Peyehotopograpliy and Flechslg, 
205 

Ptomaine poisoning, 822, 555, 688 
Ftomvine poisoning or diphtheria, 
559 

Public analysis, S87i 
Public and tbe medical profession, 
814 

Public baths and eye affections, 841 
Public endowment of cancer re¬ 
search, 175 

Public slaughter housss, 580 
Pnaiperal eclampsia, 632 
Pne<i>eral infection, 63 
Puerperal neuritis, 21<> 

Puerperal psychotis, 335 
Pulmonary affections, 87 
Pulmonary phthisis in general hos¬ 
pitals, ^ 

Pulmonary luberculoele. Dr. Bards- 
well, 853 

Pulverised bone ash, 344 
PorcelJ, Dr., cyatic sarcjmaof the 
right ovary. 512 
“Puigatol," 807 

Purser, Prof. J. M., n-sigiialioii of, 
421 

Pursuit uf health. tiOS 
Pyloric cancer, 549 
Pyloric stenasis caved by liydio- 
chloric acid, Ur. Koihiitgel, 508 
Pyocyaiico-plasiuin, 468 

Q 

Quack advertisemantsi 094 x 
Quacks and their foes, 500 I ^ 



Jsn. 1,1903. 


INDEX. 


Quek propagtnifk, 563 
Qoack^ fa Oannan^, 293 
^bJm IdlomcnKy, 18 
^iBlna, thn hUecUon of, 444 
Qnliiiiifl tmtment or typhoid 
ferer. G05 


Babagliati, Mr., submucoos myo* 
BiMtomy by hysterotomy, ii23 
Badioeraphy sod the luedioal pro- 
tedon, $90 
Baiiway hygiene, 41 
lUOway tabeveotilation, 443,697 
R.A.M.C.. 201, 818, 860 
Bamny, Dr., traumatle nicer of 
the ooraea. 649 
Rate-snuported hospitals, 5.^1 
Baaschbnnd bacilli, the, $35 
Baynand's phenomena, Mr. J. 

Hatch nson, 403 
Reciprocity with Italy, 05 
Becnrring tuberculoua peritouitis, 
61 

Bad-tapeiam and the wonnded. G13 
B».atection of Sir W. Tn>ner, 638 
Refami In soldiem' dresa, 175 
Befonn oftbe army medical depart¬ 
ment, 45. 867, ^0, 418 
Befoems in the R A.lf.0., 668 
Bemarhable charge, a, 4u3 
Beaarkable etat^ent,637 
Benal diabetea, 491 
BMrganiaationoftheaiiny medical 
sarrice, 17 

Repnted deterioration of the nee, 
the, 6S7 

Residual lunatiea. Dr, Nolan, V)7 
Reaignatlon of Sir W. Tnrrier, 609 
Reonecltation In ehlotofonn nar- 
eoeU, 148 

ReauBcitatiMi of the Paris post¬ 
graduate medical school, 806 
Ringwonn in schools, 447 
River pollution, 470 
Road to min, the, 349 
Robertson, Dr. F., the patho- 
geneeU of Insani^, 160 
BuIm, Dr,, cancer of the stomach, 
83, 188; gastric nicer, 455, 507 
Boleof protosoa in the causation of 
disease. Dr. MoWeeney, 509 
Bootgen society, the, 50 
Boaebery, Lord, on a noble profes- 
aion, 66 

Boyal B<Memy of medicine in Ire¬ 
land, 448 

Brqral appointments, 55,129 
B^al ooUegea of physicians and 
•nrgsona, Lonuon, pass lists, 
229, 479 

Bc^al eoU^es of pbysleiana and 
snrgaons of Edinburgh and 
Realty of phyaiclaaa and sur¬ 
geons of Olaagow, pass list, 7. 
108,155,179, 453, 505, 703 
Boyal coUsge of physicians and 
royal coUega of snrgeona. In¬ 
land, pass list, 51, 129,458,506, 
533, 650, 647; fellowships, 642 
Boyal college of surgeons of Eng¬ 
land, 45, 505, 702 

Bcml collega of snrgeons, Ireland, 
102, 461,129, 703 

Boyal commission upon tnbar- 
cnlOila, 293, 811, 589, 702 
Boyal example, a, 561 
Bnptnnd spina blflda Inmbalis, 
Dr. Clark. 464 

Rnptnn of tnbal pregnancy, 488 
Rapture of the utenu,492 
Baial medical ^cershipa of haalUi, 

Pa a ael l, Dr„ medicine as a profes- 

siOB, 866 


BnSdle nose, 491 

daddlavocth system of modi cni 
relief, the, 223 

8a6^ ^g ^gatar (Illustrated), 

Sangninal knwel, 167 

Me of cocaine, 126 

Ma^of diuge medical gradnatee, 

Ms of poisons by phannacenticsl 
osqaaliDed assistants, 640 
Sale of practice action, 606 


The MsdfiaF^I^* iSd oirenMr. 


Salochinlne, SOS 

Sanitation in amy medical reform, 
469 

Sanitary bedding, 174 
Sanitary iasi>ectort‘ association, 
297 

Sanitary institute, the, 200 
Psnitary messnies in Indie, 636 
Sarcoma of the choroid, 21S 
“Save me from royfrienda,'* 1.50 
Scarlet fever In Birmingham, 98 
Scarlet fever in Midlands, 340 
School boards and sanitation. 193 
Scholleld, Dr., nenrastbenics, 138 
ScientiQc education, 145 
Beientifle Investigation of “ con¬ 
sumption cures,'’ 365 
SdenUsta in a balleoo, 612 

SCOTLAND. 

British association for the advance¬ 
ment of science, 344 
Camerie tmst, 896, 476 
Class for midwives, 672 
Death of two prominent Scotch 
pzactitionere, 529 
Decrease of students at Bdlnborgb 
nnlreisi^, 502 

Drinking clubs in Bdinburah, 584 
Bdlnbm^ sick children noepital, 
642,672 

■dinbnrgh rectorlsl election, 672 
Edinborgh university general coun¬ 
cil, 4T6 

Election, general medical council. 
502, 656 

Election of a direct representative, 
642,672 

Fonlis, Dr., death of, 448 
Gartnavel ssylnm. 845, 395,529 
Oeoetal couucil of Glasgow nnlver- 
eity, 556 

Olaigow royal inflrmary reeoii- 
■traction sclionie, 47 
Glasgow sonthem medical society, 
899,449,658 

Glasgow western Inflrmary, 642 
New anatomical schools, 345 
New fever hospital at Bathgate. 
642 

Pass and pluck, 449 
Plague in Glasgow, 502,529, 556 
Prevention of tnbercnlosis. 584 
Rectorial celebrations in Edln- 
bnrgh, 584 

Sanitary assodation of Scotland. 
320 

Slander action, 98 
Tail. Prof., the late, 47 
University court of St. Andrews. 

672 * 

Will of Dr. Jas. Dunlop, 98 
Toons, Prof, J., resignation of, 
696 

Seaside mnatoria for children. Dr. 
Weber. 299 

Septic endocarditis, 807,887 
Serlons admission, a, 580 
Serious charge against a msdical 
mam 589 

Shield, hydrocele, 281 
Shorthand fbr medical men, 427 
Slclmees and Its prevention, 

Signal success of the revolt against 
the Flannery elsnses, 145 
Bingen' nodalee, 866 
Small-pox, 421 

Small-pox and the asylnms board, 
665 

Small-pox at Childs' hll], 129 
Smsll-pox epidemic, 425 
Small-pox epidemic in Olaagow, 196 
Small-pox ^demlc is London 86 
239, 840, 441, 478, 537, 588. 613. 
641, 668 ' • i . 

SmalJ-pox In Philadelphia, 640 
Small-pox In the Metropolis, 813 
SmlU^ as a core for melancholia, 

Bmi^, Dr. T., an apolz^ for 
boctar^ 540 

Snow, Dr. H, the "monoma," 4 
Society fbr nllef of widows end 
orphans of msdicsl men, 70,427 
Society of apothecaries of undon 
pass list. 61, IM, 329, 849, 427. 
458, 589, 708 

“Solold “ mins test oases, 658 
Spsolflo blood changes alW nrine 
iojection, 807 

Sparmotoxln and reproduction, 446 
Spinal affiMtloo, lif 


Spinal auesthesla by cataphoreais, 
43 

Spinal coeainisation, 671 
Spinal symptoms of tea intoxica¬ 
tion, 46 

Spitting uuisance, 672 
Splenectoiiiy for rupture of the 
spleen, 661 

Sponges in abdoiiilnsl wounds, 19 
St. George’s hospital medical 
school, 479 

S':. John of Jenitalem, 51 

St. Mary’s hospital. 25; extension, 

452 

St. Petersburg and sanitation, 317 
St. Thomas's hospital bouse ap- 
poiutmsnt^, 822, 647 
St, Tbomas'.s hospital medical 
school, 875,899 
State supply of vaccine, 525 
Statistical fallacies in regard to 
lunacy, 15 

Sterilisation of Qsxiblecatheters by- 
boiling, Hr. Beard, 380 
Sterilisation of milk, the, 200 
Htlll more penalJalug, 95 
Stomach, surgery of the, 605 
Stricture, rare form of, 14 
Btody in heredity, a. Dr, King. 
233 

Submneous myomectomy b* hys¬ 
terotomy,Mr. Rabegliati, 622 
Substituting brandy, 675 
Succession value of public appoint¬ 
ments, 095 

Sudden deatli from cardiac disease, 

893 

Suggested alteration of title, royal 
medical benevolent coUe^. 7i 
Seggested electro • tbeiapeutio 
society, 670 
SnicldsI rffmts, 14 
Snieide at a Kent county asylum, 

Suicides in the French srmy and 
navy. 818 

SniLmerdlarrhcea, 197 
Summer trains de Inxe, 102 
Snperheatsd air in otitis media. 

894 

SnpplaotiDg stitchee, 690 
Bup^nrating ovarian cyst. Dr. Jel- 

Supia-pubic prostatectomy, Mr. 
Wallace, G53 

Bni^oon charged with ftand, 400 
Burgeon’s fees reduced, 675 
Surgery of the skull and Its con¬ 
tents, Mr. McAidls, 681 
Surgery of the large inteetine. 537 
Surgery of uteriiie pr<dapee, 41 
Boigioal Instruments, 505 
Surgical Interference in sppendicl- 
tie, 849 

Smgical overvl^t, 101 
Surgical treatment of ascites, soo 
470 

Syllafaa, Dr., pssndo-tabes, 9 
Synthetic formation of uric acid 
467 

Syphilii and general paralysis, 16 
SrphUis as a non-venenal disease. 
Dr. Bnlkl^, 0 

Syphilis without primary l«lon. 
Dr. Jnllien, 5 
Syphilitic paralysis, 87 


Tabes of married couples, 606 
Tannlgen, 87 

Taxation of costs of medical wlt- 
neessB, 615 

Taylor, Dr., life and character, 888 
Taylor, Mr., modern prc^iress in 
snrgsry, 459 

Teaching of materia medica, 886 
Ttehnlqne of posterior cmliotomy. 
Dr. Tweedy, 594 

Temperature of phthisis treated by 
open-air methods, Dr. Imwson. 
652 ’ 

Tendon transplantation, 94 
Test apparatus for fecss, 662 
TestsviD's sign, 199 
Tetanus, 467 

The Queen and the nnnes, 97 
Therapeutic netea. Dr, Foy, 463,540 
Therapeutics of superheated air. 
661 

Thmnaon, Dr., tnbeicaloaa lam- 
gltts, Ul ' 

Thorowgood, Dr., alcohol and 
tnbercalosii, 218 


Time-saving methods of trratmsnt 
in pblhlxis, Dr. Bwart, 829 
Tinea tomutaiis, Prof. Balzer, 877 
Tons^fllotomy resb. Dr. Wingiave 

Tonus of the bowel, 519 
Total gastrectomy for carcinoma of 
the stomach, Mr. O Hara,805 
Town children and holiday fuod 
infacUon, 244 
Toxiemis of bnrni, 47 
Toxicity of esutphor. the, 199 
Toxic effects of cantharides, the. 73 
Toxic insect powder, 617 
Toxic use of alcohol, Dr.Crothsrs. 
566 

Trained nnrset for Irish work¬ 
houses, 471 

Trained nurses in workhonse« Dr 
Cox, 461 

TRANSACTIONS OF SOCIETIES. 
Acapimv ot MlDICINl JK Iri 

LAWD— 

Aneurysm of the aorta, 627 
Dennatitis gangrenosa, 570 
Gastrectasis, 627 
Glycosuria, CS 4 
Hemicborei, 684 
Tntracrauia] haemorrhage, 057 
laparotomy for intestinal ob¬ 
struction, 543 

Paranoia hallucinatoria, 570 
Posterior vaginal cmllotoiny, 599 
Farconui of the knee, 628 
Snppunting ovarian cyst, 598 
Snrgleal section, opening address 

Uncommon cause of sudden 
death, 685 

Zonular cataract, 627 
BRITISB GYW.«C)OLOaiCAL SOCIRTV— 

Artificial Mrnm In ptolonaed 
operations, 571 
Cases and spMimeDB, 683 
Clutnges occurring in uteri, 684 
Complications and degeneration 
of fibroid tnmours of the uterus 
118 ’ 
SxliiMtions of specimens, 9, 113 , 
511 

Posterior vaginal cmllotomy, 10 
Prophylaxis in gynmcology, 571 
Post cedematous myoma, ll 
Uterine fibroids, 10 
BomsH LAarwcOLooicAi., Bhiko- 
UtOICAL AMS OtOLOOICAL AbSO- 
CUTIOM— 

Csses, 515 

Clinical Soemr or Inindon— 
Acute clntussusception, 465 
Ascites dependent upon cirrhosis 
of the liver, 414 

Oaneation of movable kidney 655 
Congenital absence of both 
clavicles, 405 

Displaced strangulated femoral 
hernia, 418 
FngUitas oesium, 566 
Olena'd's disease, 466 
Hydrops arUculi, 465 
Intreonnial aectloa of ths 
•scond and third division of 
tbs trigeminal nerve, 569 
LsosUasU oseea 4C5 
Mitral inoompetency, 650 
Ope ntive treatment of eaneer of 
the pyloric portion of the 
stomach, 512 

Painful condition of the twelfth 
pair of ribs, 413 

Pleating tumour of the sacrum, 

Bight-sided hemiparesis, 464 
Wounded Joints, 414 
iSniKBtmoB Mxoico-OHnt usoical 
SoacTT— 

Alcohol in its medical and sden 
tifle aspects, 86 
Angioms of the scalp, 541 
Oases, 658, 686 
Chloroma, 641 
Lnpns, 541 

Motor localisation in the Inmbo- 
shoial rs^on of the cord, 544 

HAavDAN 80 CIXTT OF London— 
Htematnria in childhood 466 
Hnnsnal cases of movable kidney, 

Laxtnoolooioal fleo inry np 
London— 

Bilatsiml abdoatorparalyaia, I 2 

Cooglc 




INDEX. 


Cites, 11. 80, 571 
Bxternel operation on the frontal 
sinnte*. 12 

Tumonts o'the pharynx, 88 
I.ivBRpooLMEnicAL Institution— 
ineuriamal variz, 543 
Case*, 059 

Empyema aii'1 ascites, 02S 
Katemal nharynsio • resophago- 
tomy, 600 

FInsen treatment of lupus. 509 
Fourteen foreign •’ortl's, 659 
Hi-rolne hydrochloratc, 629 
Intellectuu progress and genius, 

4^9 

Malarial poisoning, 599 
Mycosis, itOO 

Personal factor in taborculosis, 
543 

Bing atricture of the elgmoid 
flexure. 54S 

Satnre of the fractured patella, 
C20 

Vomiting a gall-stone, 028 
Kortr or Bnoland Obstetbical 

ANOOyN.eoOWKJICAL SOCIKTV — 

Ciusarean section twice per¬ 
formed, 400 

Cancer of the cervix, 400, 086 
ComplicatiODs during i>regnniicy 
ano labour, 687 
Profuse hydroperitoneum, 680 
Kpecimens shown, 686 
OwTETRiCAL Society of London— 
Fretaldiformlty, 026 
Donbtfnl sex, 026 
Ftbro-myoma of the broad liga¬ 
ment, 514 

Gonorrhceal pelvic peritonitis, 
614 

T.eukieinia and pregnancy, 3S6 
Buptnred tubai gestation, 626 
Sloughing fibnxd of the left 
uterine cornu. 615 
Specimens, 34, 885 
H]>ontaneoas rupture of tlie 
iiteroB in placenta prrcvla, 85 
Tubal mote (I*, 514 
Vaglno-abdoin'.nal hysterectomy, 
626 

OPHTRALMOLOOICaL SOCIETY OP 
THR United Kisgdok— 
Blindness from sodium uli- 
oylate, 62 

Mild sympathetic irido-cyclitis, 
02 

Sbeffield MiDico-CiiiRUnaicAL 
Society— 

Consumption and formic alde¬ 
hyde, 661 

Cases, 515, 572, 000 
Headaches dependent On eye 
conditions, 000 

Hydetidiform degeneration of 
choroid, 601 
Specimen, 600 


Society for the Study 07Diska8E 
IN Children— 

Cases, 572 

Cerebral diplegia, 489 
Diffuse lymphoma, 4S9 
Endocarditis. 61 
Meningitis, 62 

Syphilis finn‘mitted to the third 
generation, 61 

Tuberculosis of the choroid, 61 
Tuberculous meningitis, 572 
West London 5lEDTC0-CiitRuRai- 
c*L Society— 

Clinical evening, 060 

Traumatic cardiac hypertrophy, 
632,682 

Traumatic scarlatina, 98 
Traumatism of the <11011, 661 
Transhision of lambs'blood 93 
T^tment of a'cldents under 
chloroform, 245 

Tribute to a victim of aclencs, 401 
Tiichinosis, 20 

Trichloracetic acid. Dr. Foy, 309 
Trigeminal neuralgia, 689 
Triplet abortion, 64 
Tuberculin In human tuberculosis. 
Dr. Heron. 211 
Tuberculoe's, 63, 662 
Tubercu1''8l8 by urea, treatment Of, 
Mr. Birch, 163 

Tuberculosie, British congress on, 
141 

Tuberculosis congress, 116 
Tubcrculasis in cattle, Mr. Pen- 
bertliy, 32 

Tuberculosis prophylaxis, 0!>0 
Tuberculous an'mals after treat¬ 
ment by hetol, 38 
Tuberculous laryngitis, Dr. Thom¬ 
son, 331 

Tuberculous tieritonltis, 13, 5S, 308 
TufBer, Dr., h.Tmo-diagnosis of 
appendicitis, 405 
Tumour of the spinal cord, 189 
Turner, Dr., the physical basis of 
melancholia, 137 

Tweedy, Dr., modem technique of 
posteriorcceliotomy, 594 
Two cases of congenital elevation 
of the scapula, Mr. Jones, 6.54 
Types of indigestion and their wide 
corelatioiis. Dr. W. U. Poarso, 
28 

Typhoid bacillurit, 814 
Typhoid fever in Belfast, 196 
Typhoid from oysters, 588 
Typhoid in flermany, 400 
Typhoid in Paris, 544 
Typhoid in 8. Africa, 129 
Typhus, 3S7 

U 

Ulster medical society. 539 
Unconsclentions objector, 400 


Underground bakehouse legisla¬ 
tion, 175 

Undesirable pTosecut'ons, 95 
Unexplained death of a medical 
student, 617 

Unlve-sity of Aberdeen, pass lists, 
129 

Uolverxity college, 400 
University of Ireland, pass lists, 
51. 453 

Unnecessary oi>e’atIon, 610 
UnreAistered resident medical 
officer, 4$ 

Uoremunerative honours, 17* 
Unsuccessful claim for damages, 
609 

Untrustworthy serum, 526 
Vnusuil gyntecologicai cases (illus¬ 
trated), Dr. Macnanghio.- 
Jones, 457 

Uric acid, the origin of, 578 
Use of anipsthetics, instruc ion In 
the, 20 

Use ofdmga In pulmonary tuber- 
culos's. Dr. lluggard, 184 
Us dess exhibitions, 040 
Uterine myomata, Dr. Mac- 
nanghton-Jonee, lU 
Uterise prolapse, complete, Dr. 
Wiggiii, 638 


V 


Vacancles-end of each No. 
Vaccination and sinall-pox, 524 
Vaccination league, a. 44S 
Vaginal puncture, 545 
Vaseline injections, 662 
Vosogen in the treatment of tkin 
diseases^ Dr. D. Walkh. 9 
Vegetable pathology, Mr. J. 

Hutchinson, 431 
Vegetarlaolsm and phthisis, 124 
Velociphilla, 44 

Ventilation of tubular railways, 600 
Veratmm viride, 824 
Verminous jiolico cells, 222 
Viavl fraud 22 

Vicissitudes of drugs, the, 577 
Victoria university, the failure of, 

48 

Victoria university fellowships, 453 
Victoria’s eightieth birthday, 421 
Visit to Bovril, a, 153 
Vital statistics, 102, 179, 253, 349, 
875, 401, 533, 075. 703 
Vomiting of pregnancy. Dr. 
Chriateanu, 308 


W 


Wage limit, 176 

Waldo, D'. H.. the management of 
ecicms, 101 


Jan. 1, 1908. 


Wallace, Mr., enpra-publc prosta¬ 
tectomy, 653 

Walsh, Dr. D., vasogen in the 
treataent of skin disease, 9; 
gout and gontiness, 408 
Wanted, a sumptuary edict, 360 
Wanted—a test for dninkaaness, 
364 

War against malaria, 875 
Warehouseman vaccinated, a, 170 
Washing the pharynx and larynx, 
191 

Water cress, 394 
Water in butter, 866 
Water supply, 447 
Weber, Dr., seaside sanatoria for 
children, 299 

Well-diiectoi prosecution, 874 
Welshmen on the hill-top, 365 
West London modlco-chiriirgical 
society, 452 
Westmeatn tragedy, 50 
Westminster hospital medical 
school. 400, 452 
Wet nurses, 425 

What are the marks of a bite ? 195 
What did Mr. Chamberlain really 
mean ? 171 

What is a sanatorium? 171 
White cross league, the, 289 
Whooping-cough, Dr. Maguire, ISO 
W hnoping-cougb, 804 
Widernofer, Baron, death of, 10.8 
Wigein, Dr., complete uterine col¬ 
lapse, S.3S 

Wilful negligence, the penalty of, 

William Smyth memorial fund, 
6ii9 

Williams, Mr. C., bcematuria in 
childhood, 429 

Wiiigrave, Dr., toneillotomy rash, 
213 

Women residents in iiospltals, 552 
Woods, Dr. O., asylums and asy¬ 
lum work, 1S2 

Work of the metropolitan asylums 
bmrd, 143 

WorkhoDso dietary, 393 
Working of the inebriates act, 524 
Writers' and pianists' cramp, <’>05 


X 


Z-rays as a means for the early 
diagno.sis of tuberculosis, Dr, 
Capo, 161, 504 

X-rays aod malingering, 150 


Zymotic disease in London, 875 
458,559 


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**8ALUB FOPmJ SUPBEMA LEX.” 


VoL. GXXIII. 


WEDNESDAY, JULY 3, 1901. 


Na 1. 


%hz Cabettbieh lecture 

OH 

ACUTE CARDIAC FAILURE, {a) 

Bj Sir RICHARD DOUGLAS POWELL, Bart, 
K.C.V.O., M.D. 

“ Acittb hearfc ^nre ” u, 1 admit, a misleading 
phrase, suggesting, perhaps, some separate disease ot 
the oi^an, bat of coarse it onlj implies the oolmina* 
ticn in ten^rary or permanent arrest of the cardiac 
function oi a Tariety conditions damaging to 
textare and exhansuTe to nerve power or masoular 
energy. 

We cannot perceive aright the heart and its 
mechanism, nor appreciate duly its modes of failure, 
nnless we bear st^dily in min d the fact that it is 
but a part, differentiated for special reasons, of a 
complete cardio^vascular tubal system containing 
the blo^ The tubes are not nassive tubes sluiced 
by a central force pump; on the arterial side tbe 
powerful rhythmic pulsations of tbe heart are so 
modified and restrained by the elastic and muscular 
action of tbe vessels as to ensure a safe and adequate 
stream of blood throughout the body. Whilst on 
tbe venous side the position of valves, the action of 
adjacent and often ensheathing muscles, tbe impetus 
of lymph and cbyliferous tributary currents, and the 
constant but rhythmically increased thoracic aspira* 
•tion, help to maintAiw the blood movement. 

I need only hint at the large influence of the 
nervous system which has in course of evolution 
become so specialised with regard to the heart and 
vessels. The cerebro*spmal nerves, the sympathetic 
system and a department of tbe nervous system— 
tbe vaso-motor nerves—in touch with the preceding 
and yet under guidance from a separate centre, all 
take part in controlling the heart’s doings and in 
reg^ting the blood supply to each organ, according 
to its functional requirements, wbicn vary from 
time to time. Finally, there is held in the tightening 
and relaxing grasp of this complex tubal apparatus, 
tbe blood itself, a living tissue, whose constant 
variations, both chemical and physical, in health and 
disease, affect the facility of the capillary flow and 
influence the tonicity and nutrition of the circulatory 
apparatus. Cmiwe look into this complex mechanism, 
Htueb I have so barely sketched, in which physical, 
chemical, and vital agencies are so intimately min- 
gled, without a feeling of wonder that it should hold 
good unceasingly to the allotted term of life, and 
that so few lives should be brousht to a premature 
close through heart failure P A chapter on compen* 
satory adaptations has yet to be added to our text 
books on medicine for our better understanding of 
many such problems. 

With such an infinite number of contributory 

(a) Dvlivrnd before th* West Londca Medico-Cblrorginl Sodetj 
OB JoiM 31st, 1901. 


factors, acute cardiac &ilnre cannot be a simple 
question, and if I, bound by tbe stem limits of 
and the more compelling umitations of my ability, 
approach it from the more concrete, clinical, and 
practical side, it is from no want of appredation of 
the manifold intrioaoiee of the subject, and it u irith 
a very hnmble sense of onr indebtedness as praotioal 
men to those who by patient labour in the laboratory 
have givm ns so lai^ an insight to help us to solve 
tbe problems that come before us in onr daBy work. 

A most obvious cause of heart fmlnre is direct in> 
jury, excluding, of coarse, extern^ wounds, as, for 
mstanoe, the very rare ooourrenoe in which a healthy 
man, daring some sudden effort, raptures one of bis 
aortic cusps. The whole cardiac mechanism is sad- 
denly put out of gear, severe prfficordial pain dis¬ 
orderly action and fmntoess ensue, to be followed by 
other signs of perturbed circulation. In the only 
case of this injury that I personally remember seeing, 
almost immediately there was a smart heemoptysis, 
no doubt from the over-distended left ventricle ob¬ 
structing the return from the lungs. Under the 
only treatment possible—very complete rest—the 
heart, at first surprised and only very imperfectly 
able to deal with the altered mechanism consequent 
upon the spoiled condition of its main valve, gradu- 
ftily Bteadied down. Tbe left ventricle enlarged and 
increased in power, and a small, rapid and irr^nlar 
pulse was gradually altered to that having the oh^ 
ractoristic features of aortic regurgitation. This 
alteration of pulse marked the adaptation of the 
heart to its new conations in a manner precisely 
similar to that which we observe in a case of aortic 
regur^tant disease, in which dilatation of heart and 
mitral inadequacy having arisen, the irregular mitral 
characters of tbe pulse change under rest and treat¬ 
ment to those proper and normal to a well-compen¬ 
sated aortic regurgitation. 

The displacement of a clot from a systemic vein is 
a common cause of acute anginal heart failure and 
is attended with urgent dyspneea, an irregular, flut¬ 
tering pulse and very variable heart signs. Tbe 
condition is indeed one of asphyxia of tbe heart, and 
it either terminates rapidly in death or tbe clot is 
further dislodged and propelled into the lung, when 
the cardiac symptoms quiet down and those of 
another order commence with luemoptysis significant 
of pulmonary infarction. Here ag^ we can only 
recognise what is happemng and r^eve suffering and 
ensure quietude by tubcuteneous morphia. Be it 
remembered, however, that these cases are by no 
means necessarily fatal; if the clot passes on to the 
lungs recovery ensues in a fmr proportion, and tbe 
prognosis in each case mnst be oonsiderw on ite 
separate merits. 

Next to such injuries to the heart, of which 1 have 
given right-sided and left-sided examples, we mnst 
glance at cardiac failnre from over-taxatiem. 

There are two factors always at work, althongh in 

Dic;:;ized by Google 




2 Thi Vwpfn*f. Pbi 88. ORIGINAIi OOMMUNIGATIONS. Jolt 8, 1901 


different proportione tn different caaee, in pro- 
dnoing cardiac failure from great or prolonged 
exertion, viz., direct fatigue of the neiro^muecular 
tisBue of the heart and a poisoning of the blood of 
antometabolic source. 

Speaking of young pecmle and healthy hearts, 
acute cardiac distress is, oi course, xery common in 
these days of athletic competitions, strenuous school 
exercises, hard bicycling, &o. It is indeed surprising 
that actual heart failure so rareljr occurs; but few 
of us baxe an opportunity of witnessing such an 
attack. Fatal cases are rare but have been recorded, 
but for the most part we can only obeeire the after 
effects of incomplete heart failure. 

While gentle exercise calculated to raise the blood 
pressure within the coronary circuit is thus to be 
adrised, caution is necessary that no cardiac fatigue 
be induced. The periods of exercise should be of 
short duration. In old people witb atheromatous 
Teasels, cramp in the legs is readily induced by any 
fatigning exercise, in consequence of the imperfei^ 
nutntional change allowed by the narrowed arteries, 
and similarly we may get cramp in the heart muscle, 
that is apt to proxe fat^. It is also to be noted that 
the cramp of fatigued muscles does not necessarily 
come on at once, but is frequently pos^ned untU 
the night. Hany a fatal at^k of angina pectoris 
has thus been prematurely induced by some oxer* 
fatigue orexcitement in the day. 

A^ong the concomitants of heart disease or 
failure during xiolent exercise, as running, xomiting 
is one of the most common; a boy will tml you that 
at the end of a long race which has oxer-taxed him, 
he will cast himself panting upon the ground and 
xomit. 

Among tire after effects one of the most constant 
is ansmia, and both of these phenomena—xomiting 
and ansmia—may be regarded as bearing witness to 
a changed condition of the blood consequent upon 
tiie accumulation of products of metabolism which 
takes a not unimport^t part in the mechanism of 
heart failure. I would remind ^ou that gastro¬ 
intestinal attacks, xomiting or diarrhoea, are not 
uncommon occurrences in those who, habitually 
leading a sedentary life, suddenly take to exhausting 
exercise. There are other more certain proofs of 
altered blood in those who haxe died from exceesixe 
exercise and in hunted animals, of which increased 
liqnidness of the blood, absence of post-mortem 
clotting and darkened colour are among the more 
obxious. 

In estimating the consequences of oxer-taxation of 
the heart from xiolent or prolonged exertion, in 
young people especially, there are one or two points 
of practicu moment to be obserxed. A glspce at 
Beneke’s (a) tables will show that the bean of the 
child is somewhat precociously dexeloped. Accord¬ 
ing to Beneke, whilst the height doubles in the first 
sexen years, the heart xolume increases nearly fixe 
fold. In the second sexen years things go more 
quietly, the height increasing by one-third and the 
heart xolume by one-fourth, but the practical effort 
of this dexelopmental actixity must continue on 
through these years. 

This cardiac precocity is in accordance with what 
I beliexe to be a fact which I haxe long obserxed and 
pointed out in clinical teaching, xiz., that the heart 
of the child—say between six and twelxe year^—is 
relatixely hypertrophied, t.e., the apex beat is some¬ 
what to the left of the normal and the impulse rela¬ 
tixely strong. This is the case especially with boys, 
and, in my experience, holds gooa with a consider¬ 
able proportion of them. I haxe regarded it as due 
to the ceaseless actixity of children and to a dexelop¬ 
mental precedence of heart to chest and lung 

(a) •' Die Alt«ndlapodtiOD/’ 1879, p.^ 


capacity. The practical point is that I do not regard 
a &ght extension of the apex beat within the nipple 
line, unaccompanied by co^rmato^ signs, as neces¬ 
sarily a morbid condition in a child. I look for the 
exidence of cardiac oxerstnun rather in an extension 
of the upper margin of dulness in the mid-stemo 
nipple line with an unduly perceptible beat at the 
ensuorm base, and a hesitathig action of the heart, 
an irregularity in rhythm and force. These 
signs in association with languor, antemia, brMth- 
lessness on exertion, and sometime a sharp ptun at 
the heart which I haxe heard described as a " beastly 
pain catching the wind,” caused by a slight effort, 
are suffident for diagnosis. Ton may ^t others, 
such as murmurs: you often do get a hsmto murmur 
oxer the pulmonary area, but murmurs are by no 
means essential, or to be expected. 

A cardinal point—and the only one I shall touch 
uiK)n—to be borne in mind with regard to young 
boys and girls is their special aptitude for short 
spells of actixe exercise, but their complete unfitnew 
for prolonged, fatigning, monotonous exertion. This 
is almost the rexerse condition applicable to older 
people, and it is one often forgottra, not perhaps so 
much at schools as at home. Athletic fathers, robust 
elder brothers, proud of the sporting alertness and 
eagerness of young boys, xrill often keep them out on 
long bicycle, golf, or shooting expeditions, and may 
thus cause graxe damage to the young and rapidly 
dexeloping heart. 

The treatment of acute failure of heart from oxer- 
strain inxolxee a period of a few weeks’ complete :wt 
and often many months of careful supervision. 
Young people make a rapid and generally a complete 
recoxery, provided no actual lesion has been pro¬ 
duced. The younger they are the more ready and 
complete the recoxery. In youths and young men a 
degree of irritability of heart is often to be obseiwed 
for many months, even for some years, the pati^t 
suffering from attacks of palpitation and cardiac 
pain on slight fatigue or exertion and often at night. 
Quiet exercise must be resumed after a time, and it 
is, in my opinion, better to allow interesting exer¬ 
cises, wiwin measure, such as croquet, level cycling, 
golf and easy tennis, rather than more formal courses 
of training. But each case must be considered on 
its merits. In some cases of cardiac oxerstrain in 
young people it will be found that a feeble lung 
capacity has led through imperfect pulmonary cir¬ 
culation to the heart distress. In such cases well 
ordered respiratory exercises will best help the heart 
by developing the lungs and fortifying the thoracic 
aspiration in aid of the circulation. Well-planned 
sea voyages or sailing trips from the ooast are 
peculiarly advisable for adults, provided strict in¬ 
junctions against smoking and stroi^ alcoholic 
drinks are given. 

Another form of fatigue heart failure is that fre- 
quentlx met with in acute disease. It is too long a 
story lor me to go fully into now. I haxe dealt with 
it with some minuteness elsewhere, (a) as met with 
under one of the most common of ciroumstancM, 
viz., in acute pneumonia. It is met with al 80 _ in 
enteric fever, in acute bronchitis in old people, durmg 
a severe asthenic paroxysm and in other conditions, 
such as functional tachycardia. The heart failure in 

I these conditions may come about with a gradual 
quickening day by day of the pulse until it b^mes 
flutttering, confused, running, representing Utile 
more than peristaltic movements of the heart. In 
other cases, and this more commonlx in plethoric, 
fleshy large-framed people, with a pulse at first not 
unduly quick, with considerable tension and accen¬ 
tuation of the second sound, the failure occurs quite 

^ (ci) LumleiAu Lectitras. *‘On Treatment in Diieoaee and Dii- 
orders cf the Heart,” Lecture lU. * 

Cjooglc 



JlTLT 8, 1901. 


ORIGINAL COMMUNICATIONS. 


Thi Mbdioaz. Fuse. 3 


nddenly, attended with rapid breathing, pallor and 
<mno«», Bwe^dng; ooUecting mnoons ratuee in the 
ooeet and almoet imperceptible ronning pulse. 
XTndw strong stamnlation ana the snbontaneous nse 
of stiTohnine, the patient may rally and all the con¬ 
ditions improve, bnt relapse often, and in elderly 
pe^le almoet always tabes place. An attack such 
as I speak of oconmi^ in an old person with bron¬ 
chitis or pnenmonia is almost of mtal aagury; the 
senile heart cannot recover the fatigue, and hence 
when the pulse mounts up to 120 in old people re¬ 
covery is rare, unlees the rapidity be attribut^le to 
fmcuonal die^rbanoe from some temporary cause. 
Wi^ a sound heart in younger people no condition 
is too desperate for possible recovery. 

Now to discuss the treatment of heart failure under 
these varying circumstances would be to discuss the 
whole management of the illnesses in anestion. There 
are a few factors, however, in sjpecial concern with 
heart failure in acute disease, which should be looked 
for as in^cations for trea^ent, viz., (1) maloxy- 
genated and otherwise contaminated blood supply to 
heart muscle and nerve; (2) excessive weight oiDiood 
burdening the heart; (3) exhausted innervation from 
sleeplessness and physic^ cardiac fatigue; (4) posi¬ 
tive obstruction to the flow of blood through the 
lungs; and (5) chan^ in the texture of the heart 
muscle incidental to roe disease and especially to the 

S yrexia. Now the flrst two indications are un- 
oabtCNlly met by depleting the blood volume from 
the venous side by attention to secretions, the occa¬ 
sional use of mercurials, careful limitation of the 
food taken in place of the over-feeding often to be 
observed, and in some cases a small blood-letting. 
The timdy employment of oxygen inhalations at 
intervals through the day is a remedy of great value 
which ensures an improvement in the aeration of the 
blood sent to the left ventricle, and so direct to the 
coronary veeaels. It is by no means necessary to 
employ oxygen inhalations in the majority of cases 
of pneumonia, of which disease I am now especially 
speaking, but in all severe cases the cylinder should 
be at hand to anticipate the threatened heart 
failure. 

Nob. (3) and (4), exhausted innervation and pul¬ 
monary obstruction are met with in pneumonia, 
advanced typhoid and asthenia especially. Strychnia 
is the mort powerful cardiac tonic we know, and 
eubcutaneously used is the b^t remedy for heart 
^ilure. In these oases, however, a frequent con¬ 
comitant symptom is ballooning of the- abdomen, 
and it is both dangerous and in^cient for the pur¬ 
pose required, to give strychnia in such cases by the 
stomach. In asroma, pneumonia, and in enteric 
fever, it is often possible in combination with the 
free use of oxygen and the occasional injection of 
strychnia to give a sufficient subcutaneous dose of 
morphia to procure much-needed sleep. When the 
heart threatens to fail in asthma the paroxysm must 
be thus shortened. In bronchitis, on the other 
hand, under no circumstances can morphia be so 
given. I have often observed cardiac exhaustion 
threatened in asthma through the want of small 
administrations of concentrate and assimilable food 
essences at intervals to support the patient. Alcoholic 
stimulants are, of course, often necessary, the dose 
b^g adapted to suit the individual case. (5) The 
changes incidental chiefly to pyrexia in the heart 
muscle as a cause of failure are mostly to be con¬ 
sidered in the prolonged fevers and will be best 
warded off by a judicious mitigation of the pyrexia. 
I would only observe on this h^d that in cases where 
there is labouring action of the heart and a tendency 
to cyaaosU and stagnation of surface blood, I have 
observed much bemr results from hot water than 
from cold water sponging or cold applications. The 
surface circulation is more facilitated, heat is rapidly 


lost and the skin functions encouraged, all tending 
to lighten the burden of the heart In the after 
treatment of pyrexial diseases, in which there b«^ 
been prolonged rapidity of heart or any sign of heart 
failure, a chief re^rd has to be paid to restoration 
^m cardiac fatigue. Thus our level sea 
country resorts ars preferable to hilly places, and 
exercise can only gr^nally and tentatively re¬ 
sumed. 

I can only glance at speciflc poison failure of heart 
in diphtheria, phosphorus poisonix^, malignant 
amemia and the like, m which the cardiac nerves are 
directly poisoned, and in most cases a rapid fatty 
chanm in the heaH fibres ensues. These cases arc 
mostly fatal with the exception of the influenzal 
cardiac affections among which symptoms of slowii^ 
and increased rapidity of heart are met with, also 
some most intense forms of a.TigiTn»., usually vaso- 
motory, and attacks of dangerous syncope may 
occur, yet the prognosis is, even in severe cases, so 
far as my ei^rience |foes, as a rule, favourable. 

Of anginal heart failure I have no time to speak at 
length. I would only urge that from a treatment as 
well as from a scientific point of view, we must re¬ 
gard angina pectoris as in the largest class of oases 
a functional msease—a cai'dio-vascular neurosis. In 
many cases it is dependent upon disorderly action of 
the vasomotor nerves, and is associated with a sound 
heart {anaina pectoris vasomotoria). In many other 
cases we have a similar mechanism, but with, in the 
background, an unsound heart—aortic regurgitation, 
aneurysm, senile fibro-fatty hypertrophy, coronary 
disease and the like {angina pectoris gravior, or 
secondary cardiac angina). In numeric^y a com¬ 
paratively small class the anginal failure is the 
consequence of cardiac degeneration, secondary to 
coronary disease, sometimes to coronary throml^is 
or syphilitic disease, viz., syncopal angina or primary 
cardiac an^oa. 

It is obvious that aU the causes of excitement, 
direct and reflected, of the sympathetic and vaso¬ 
motor nerves must be looked into in dealing with the 
larger proportion of these cases, whilst on the other 
hand, any special form of cardiac lesion must ^ 
appropriately dealt with. In accordance with what 
has been above stated, the immediate remedies for 
the cardiac attacks are, in the majority of cases, of 
the antiroasmodic and sedative class, amyl, trinitrine, 
opium, directed against the arterial spasm, which is 
so important a factor in the attack. When we are 
assured of the presence of coronary lesion, the em¬ 
ployment of regulated exercises, combined resistance 
and respiratory exercises, and, in old people espe¬ 
cially, the regulated use of oxygen inhalation will 
help to maintain cardiac nutrition for at least a time 
lo^er. 

There are two conditions leading up to heart 
f^ure which I have not touched upon, ana yet which, 
from the remedial point of view are of immense im¬ 
portance, but they have been fully handled by my 
colleague, Dr. Mitohell Bruce, in his recent Lettso- 
mian Lectures. One is typified in the middle-aged, 
plethoric man who, working hard, lives too well and 
takes little exercise. This man gradually acquires a 
fatigued and over-burdened heart, over-weight wtih 
the neavy volume of blood it has to propel. He may 

g t a spring or summer cleansing once a year at 
omburg, Harrogate, or Carlsbad, with no inter¬ 
mediate precautions he drifts along often into 
irremediable disease of heart, or kidneys, or both. 
His first introduction to the physician is often after 
an attack of breathlessness and cardiac excitement, 
or failure occurring on some unwonted exertion, after 
which he remains perceptibly short-breathed. His 
cardiac area is extended, partly from a slight yield¬ 
ing, bnt mainly from prsscordlu and interstitim fat. 
The first sound is weaxmied often to extinction, the 


C 



4 Thk Uxdioal Pbbm. ORIOII^AL GOMMUNICATIOITS. Jult 8, 1901. 


seoo&d sound labouring; there may be slight albu¬ 
men or a little sugar in the urine. If taken in time 
and placed under fluids taken chiefly between meals, 
a great curtailment of alcohol and smoking, and well 
arranged exerciee, with insistence on deep, full in¬ 
spirations from time to time whilst walking in the 
fresh air, such a man will be restored to hemth and 
practically rescued from some early catastrophe in 
the form of heart failure, in acute illness, or from 
drifting into chronic cardio-vsscular disease. A few 
weeks’ change away whilst getting inured to the 
treatment is of great value, and such oases will 
derive especial t^eflt from Kauheim or modified 
Oertel tr^tment. 

The other class of cases I would refer to in associa- 
ticm with two causative factors, viz., nicotine and 
^ilep^. I may bring my remarks to a point and a 
oonolusion by a brief sketch of a case in ulusb^tion. 

A captain in an infantry regiment was invalided 
home from South Africa, on account of attacks of 
heart failure. He was a married man, set. 37, bad 
never had syphilis, but was an inveterate cigarette 
smoker, and a li^e free with alcohol. In July, 1900, 
while mounting a hill he felt ^stressed, and on 
return to camp fainted, and a^r this he was unable 
to exert Umself without some distress. In Sep¬ 
tember, having escorted some prisoners from 
Durban to Cape Town, without sickness or fatigue or 
any hardship, he on arrival was about to get ready 
for dinner and in the act of taking a glass of wine 
Jtdtters, when he suddenly fell down unconsoione and 
pulseless, so that a doctor who saw him immediately 
thought him d^. He remembered nothing until he 
woke at 2 a.m., feeling very faint and ill. There was 
no preceding sense of fainmees, no pain and no con¬ 
vulsion. On a later occasion, while feeling very well 
he suddenly fell unconscious for a quarter of an hour. 
He has had one similar attack since his return home 
in November. He was subjected to a course of 
Nauheim treatment without benefit. His complaint 
was, besides these attacks, of almost daily attacks of 
car^ao pain, especially induced by any exertion. 
Dr. Walker, unuer whose care be came subsequent 
to the Nauheim course, by rigorously restricting the 
tobacco and regulating bis diet and stimulwts, 
materially relieved these symptoms, and when 
I saw the patient with Dr. Walker in April 
the cardiac dimensions, position and sounds 
were normal, and the pulse, although feeble and 
rather quick, presented no other special feature. 
On inquiry into this gentleman’s family history 
nothing caraiac was elicited, but it was ascertained 
that his brother was a deaf mute and his second son 
was the subject of very frequent and severe attacks 
of petit mal. This case was primarily, no doubt, one 
of angina heart failure in association with excess in 
nicotine, and as such belongs to a class of frequent 
occurrence, but the instantaneous attacks of uncon¬ 
sciousness were suggestive of at least an associated 
neurosis of an epileptic character. I have met with 
one other very striUngly similar case in a younger 
man, also an excessive smoker, and I have a less full 
recollection of another case in connection with excess 
in cocaine. 

1 have from time to time been consulted about a 
lady who has long been the subject of night attacks 
of an epileptic character, and who has recently 
developed marked and rather severe attacks of 
angina, with heart failure of an alarming degree, 
many of which attacks usher in a mild epileptic 
seizure. In her case the pulse of late years has 
become extremely slow, and she has presented some 
symptoms of myxoedema. It is remarkable that in 
uiis case the amyl class of d^gs are useless, but 
strychnia gives immediate relief both to epileptic 
and cardiac phenomena. 

Cases of cardiac hesitation with pulse of uneven 


rhythm, not amounting to intermittency and pre¬ 
senting occasional attars of fluting, are not very 
I infrequent among children, young boys, especially 
between the age of six and puberty. Tney are easily 
tired, and are generally anemic. It is quite excep¬ 
tional to find them addicted to any secret vice. 
There is nothing abnormal beyond altered rhythm 
and vacillating force to be found in the heart. The 
distinction between this form of heart failure and 
petit nud is often difficult, and I am strongly inclined 
to regard the two conditions as allied. Bemoval 
from any mental pressure, an outdoor life and 
arsenical tonics, generally result in gradual recovery. 

I have endeavoured in this addr^ rather to sug¬ 
gest lines of thought and methods of treatment, 
feeling that yon are as competent as I am to give a 
practical therapeucio interpretation to whatever of 
my suggestions may meet with your acceptance. 

THE “MONOiaA." (a) 

By HERBERT SNOW, M.D.Lond., Ac., 

Senior Aotiag-Sorseon, Canosr Hoepitel, Brompton. 

I HAKDLT think any one will dispute the claim of 
our former President, the late Lawson Tut, 
whatever may have becm his personal defecte, to be 
regarded as the most original and brilliant gynieoolo- 
gist of modem times. One of his most importwt 
contributions to that science seems to me in some risk 
of oblivion, at least, I do not remember any allusion 
to the point since the publication of his work. And 
although the case 1 have to report was unfortunately 
not successful, 1 feel sure that apart from its ofm 
intrinsic interest, the Society approve of My- 
thiw g tending to rescue a question of much practi<w 
significance from unmerited neglect. 

It will be remembered that Lawson Tait’s expe¬ 
rience led him to distinguish, and to insist strongly, 
on the clinical difference between two s^ies oi 
uterine myoma. He laid down two fundamental 
distinctions to be^n with. The ordinary prevalent 
fibroid tumour is generally multiple when first en¬ 
countered ; and, if not, speedily so becomes as time 
advances. The rarer, the “ soft CBdematous myoma,” 
is invariably a solitary tumour, and remains single 
to the end. In the second place, while the former 
may never attain any considerable size, and may 
even diminish in bulk after the menopause the 
latter always steadily continues to increase until the 
patient is “ released by art or removed by death.” 
That is to say in other words, while the common 
myoma is a benign new growth the rarer “soft 
CBdematous myoma ’’ is one truly malignant.^ 

Then Lawson Tait further drew certain minor dis¬ 
tinctions, into which I am not sure we can unreser¬ 
vedly follow him. Thus he stated that removal of 
the appendages promptly terminated the growth, 
and the attendant meDorrhagia of the common 
myoma, while that operation bad no effect on the 
rarer variety. The former arises only during the 
menstrual epoch, the latter prefers the old, though, 
as in my own case, it may Mgin earlier. The ordj- 
, nary myoma tends to diminish in bulk after the 
j climacteric; the latter is wholly unaffected by this. 

I The former often involves menorrhagia; the latter is 
rarely attended by undue loss of blow per vaginam, 

and has no influence whatever on the menses. 

One of Mr. Tait’s cases ultimately involved a Imd 
protrusion through the umbilical aperture. I had 
an opportunity of examining microscopic sectioM 
I from two others. One showed only non-et^ted 
I muscle-fibre; the other, the abundant nuclei and 
I small spindle-cells which denote a myo-sarooma. In 

I .■ I - •• 

j (a) Paper read at the Brititli OTnecological 8oci6t7» Juo# ISth^ 





JOI.T 3. I90i._ ORIGINAL COMMUNICATIONS. Th» Midioai. Faibs. 6 


such matters, as I have often insisted, the clinical evi* 
denoe of mali^nanoj is far more trustworthy than the 
report of a microecopist who has never seen the case. 
Toe malignant process is commonly limited to cer* 
tain areas, which may be neglected when a thin sec¬ 
tion is out for the miorosoope; or may escape notice 
even when therein included. 

The following is a brief note of the case in ques¬ 
tion:— 

Lucy J., set. 47, married, but for several years 
separated from her husband, was admitted into the 
Cancer Hospital, Noven.ber 27th, 1900. She had 
previously, in 1895, undergone an operation there for 
CTstic degeneration of the mamma. Since then 
there had been menorrhagia. There had been one 
child bom at foil term, one miscarriaire, one prema¬ 
ture birth. Had noticed enlargement of the abdomen 
one year. Has lost much weight in the past eight 
months, though still stout and rather flabby-loohine. 
At the menstrual periods there is much pain, but 
that has always be^ the case. The loss, however, 
is like that of a confinement.” 

The abdomen was found distended by a central 
round mass, mobile, exhibiting ill-defined fluctua¬ 
tion like that of a tense cyst. A consultation of the 
staff was held according to rule, and while the 
majority regarded the tumour as solid the possi- 
bUity of a thick-walled ovarian cyst was admitted. 

Abdominal hysterectomy, after Dr. Heywood 
Smith’s method, was performed on November 30th. 
The divided cervix proved exceptionally vascular. 
On the following day all was well, as the tem¬ 
perature chart suflBciently indicates. There was no 
vomiting, and not even a headache. And here I can¬ 
not forMar quoting the acute remark subsequently 
made to me by the excellent nurse in charge of the 
case, that “ she was always better pleased when they 
vomited well after an abdominal operation, for other¬ 
wise it seemed as though they had to get rid of the 
bile afterwards, and were thus thrown back.” 

On the morning of the second day an enema of 
glycerine and peppermint water was given according 
to my invariable rule, and the bowels acted freely. 

On the afternoon of the third, going into the ward, 

I found that the abdomen was disten^d and that the 
patient was vomiting. Another enema was imme- 
^tely ordered. The Mwels acted, the patient passed 
flatus, and felt much relieved. 

At about four o’clock on the following morning, 
however, she again began to vomit, and this time the 
ejecta were fel^ I was sent for at eight. Another 
enema was administered, and preparations were 
made for re-opening the abdomen. The patient, 
however, sank rapidly, and died at 12.30. 

At the autopsy was found enormous distension of ' 
the stomach and intestines; with two perforations 
of the ileum about ten inches above the ileo-ceecal 
valve. The peritoneum was perfectly healthy, and 
all the surgical conditions in every way satisfactory. 
No adhesion, kink, or other source of obBtru^tion 
could be detected. There were three inches of fat 
on the abdominal wall; a condition pointing, I 
think, to rather free indulgence in alcohol, which I 
regard as militating strongly ag^st recovery in 
such cases. 

It must surely be an almost unique event for a not 
aged woman to go on for several days after a 
cmtiotomy, having her bowels well moved more than 
once, and then to collapse suddenly from intestinal 
distension and rupture, without any mechanical 
source of obstruction whatever. 

The microscopic section exhibited shows, over 
almost the whole area, the orsanio muscle-fibre of 
an ordinary myoma. A very minute region, how¬ 
ever, displays the heaped-up leucocytes and abun¬ 
dant cell-proliferation denoting a cancerous degene¬ 
ration. 


Apart from the very unexpected and peculiar 
ending?, I should direct the Society’s attention to the 
following points:— 

I I. The existence of this progressive and maliimant 
1 growth, for which I venture to propose the new term, 
“ Monoma.” 

II. The importance of differentiating it from the 
comparatively harmless myoma, by this or some 
other distinctive word. For, here, there can be no 
question of tentative measures or of delay. The 
disease is malignant, and once recognised should be 
immediately removed. 

III. The important question of diagnosis, hitherto 
neglected, and as yet unsettled. The presence or 
absence of va^nal brnmorrhage, as insisted on by 
Lawson Tait, is untrustworthy. With that event 
alcoholic habits have much to do. Age also is an 
uncertain factor. 

If we encounter a solitary rounded, dcmghy, central 
uterine tumour which is growing rapidly, while the 
patient is losing weight, if we find an indistinct fluc¬ 
tuation, so that we doubt whether it is not an ovarian 
cyst we are dealing with, and. if there has heen much 
recent trouble and anxiety, then I hold we are justi¬ 
fied in diagnosing a Monoma, and in advising prompt 
excision. 

To the naked eye the tumour will, after removal, 
present a superficial resemblance to the common 
benign form. But its solitary condition, if any size 
has b^n reached; the division of the cut surface into 
lobules, between which are connective-tissue tra- 
beculsB infiltrated with serum ; the presence of soft 
areas, into which one can easily push one’s finger; 
the greatly hypertrophied uterine wall, simulating 
pregnancy; differentiate it. 

Under the microscope the malignant portions will 
show very numerous leucocytes, with cancerous pro¬ 
liferation of the muscle-nuclei; while the non-malig- 
nant will display only the phenomena of well- 
organised muscle. But here special supervision must 
be exercised over the proceedings of the pathologist. 
Otherwise the section will probably be taken from 
the tough, well-organised areas; while the softer and 
more vascular, upon which the accuracy of his report 
will mainly depend, are prone to escape. I fancy the 
thin section here exhibited, and over the cutting 
whereof no such supervision took place, will exem¬ 
plify the error which might so readily arise. For you 
see only a very minute portion of malignant tissue at 
one edge of the section, its bulk being composed of 
well-oi^nised muscle-fibre. 

TWO CASES OF SYPHILIS 
WITHOUT PRIMARY LESION. 

By Dr. L. JULLIEN, 

Suutwn to the St. Lazare Hoapltal, Paris. 

Clinicai. experience sometimes throws more light 
on morbid processes than experimental observation. 
The cases which I am about to relate are in contra¬ 
diction with generally received views, but they are so 
well authenticated and so unquestionable, so closely 
in accord moreover with modem ideas on the evolu¬ 
tion of the vims, that we can only bow to facts and 
record them fot the benefit of our theories. 

On June 9th, 1899, two medical men, a surgeon and 
his assistant, operated on a woman for a pnesteraal 
tuberculous tumour. After excising the tumour and 
scraping the base, they proceeded to insert the 
sutures. The needle did not work very well, and the 
surgeon, in endeavouring to withdraw it from 
the edges of the incision, ran it deeply into 
the end of his index finger. The needle being 
flat, with sharp edges, made a rather extensive 
wound which bled freely. His assistant, .in 


6 Tui Msdical Pbiss. 


ORIGINAL COMMUNICATIONS. 


JULT 3, 1901. 


re|>eatmg the manoeuTre, did exactlj the same 
thing and wonnded himtielf in the same place. 
On Jane 17th, on chan^ng the dreesingB for 
the first time thej noticed a slight ulceration 
with bright red edges at the orifii^es of entry and 
exit of each suture. These appearances suggested 
the idea of syphilis, of which noting in the patient’s 
history had previously transpired. On the following 
day she developed a generalised roseola, and on 
examining the genital organs they forthwith dis¬ 
covered a syphiloma in the region of the fourchette, 
xmdergoing cicatrisation. The inguinal glands were 
enlarg^ 

On July 5th, twenty-six days after the inoculation, | 
the surgeon was suddenly seized with fever, shiver- ^ 
ing, and a general feeling of discomfort, and kept. 
his bed for twenty-four hours with a temperature of 
39^ 0. (102'2° F.;. At the same time the site of the 
puncture became painful, the end of the fin^r became 
swollen, and the scar of the puncture displayed a 
tendency to reopen with some trifling superficial 
iiloeration. On the thirtieth day a roseolar eruption 
made its appearance. On July 16th the scrotum 
became covered with moist papules, and two days 
later plaque* formed on the tongue. He then began 
to complain of arthralgia, which, throughout the 
month of July, rendered the loins and wrists painful. 
On the 26th we noted palmar papules, since which 
time the disease has followed its impla(»ble course, 
though in a mild form. 

The assistant displayed no sira of infection until 
the thirtieth day, but on July 9th he, too, was seized 
with fever. Nothing abnormal was at any time 
noticed at the site of inoculation, the scar whereof 
remained intact, and the roseola did not appear until 
the thirty-third day. I need riot go into the details 
of tbe subsequent history of the attack, which fol¬ 
lowed the usual course. I wish, however, to insist 
particularly upon the conclusions which we are justi¬ 
fied in drawing from these data, conclusions which 
are fairly obvious. 

1. The blood of a syphilitic subject is infective, a 
fact with which Pellizzari had already acquainted 
us, but we did not know for certain the epoch at 
which it becomes infective. Tbe present observa¬ 
tions prove that the infectivity exists prior to the 
occurrence of the secondary symptoms, since tbe 
surgeon and his assistant were inoculated nine days 
before these made their appearance in the patient. 
Assuming an average period to have elapsed Mtween 
the primary lesion and the secondary symptoms, the 
patient must have had her chancre some thirty days 
before. 

2. In these two cases the inoculation accidentally 
took place into the blood itself, and the evolution of 
tbe ^sease skipped the stages which usually g^ve 
time for a focus of infection to develop at the point 
of inoculation, giving rise to a syphiloma, thus im¬ 
pregnating the lymphatic system, which is always 
the first to suffer. Here the lymphatic period is 
done away with, the organism is taken by assault, 
without being enabled to avail itself of the glandular 
barriers, which are swept aside from the onset. As 
a matter of fact our confrere* sought in vain for evi¬ 
dence of glandular enlargement in the areas corre¬ 
sponding to their wounds. The glands only became 
perceptible at tbe period of efflorescence, concomi¬ 
tantly with the mucous manifestations, whence tbe 
early supervention of the constitutional manifesta¬ 
tions. 

This mode of invasion of syphilis, which was 
theoretically studied by Professor Oltramare, of 
Geneva, and was clini<4lly demonstrated by Yer- 
ch^re, of Paris, who only succeeded in obtaimng the 
reco^iition of his cases with considerable difficulty, 
has never, to my knowledm, received such con¬ 
clusive confirmation. I new hardly insist on the 


far-reaching importance of these observations both 
from the purely practical and scientific points of 
view, and 1 thank my unfortunate confrere* for 
having permitted me to take careful notes of the 
details. 


SYPHILIS AS A NON-VENEREAL 
DISEASE: 

WITH A PLEA FOR THE LEGAL 
CONTROL OP SYPHILIS. 

By L. DUNCAN BULKLET, A.M., M.D., 

PhyBiclui to the New York Skis and Cancer Hospital; Consnltins 
Fbrsiclan to the New York Hospital, &o. 

Advxnciko civilisation has recognised one after 
another of the contagious or infectious maladies which 
afflict mankind, and toe arm of the law has come in to 
protect the defenceless, and we no longer have the 
wholesale sweep of epidemics which occurred before 
health boards were organised and given control of these 
matters. This is often accomplished at the sacrifice of 
toe comfort and, it would often seem, the rights of indi¬ 
viduals : but the principle of the '* greatest good for toe 
greatest number” prevails, and those who unhappily 
may become afflicted with any of the maladies coming 
under the jurisdiction of the headth boards are often 
obliged to sacrifice all personal interest for the benefit of 
those around them. 

Why is it that syphilis, which has always been recog¬ 
nised as an intensely contagions disease, in certain of 
its stages and manifestations, has, to such a great 
extent, been allowed to pursue its unbridled course, 
attacking alike the innocent and those guilty of sexual 
transgression ? Why is it that thousands, yes hundreds 
of thousands of innocent and trusting wives and helpless 
and blameless children have had to suffer for the sixur of 
others ? Why is it that syphilis has thus been allowed 
to spread its ravines unchecked by the hand of advanc¬ 
ing science and broad philanthropy? 

I need not answer these questions, for I am convinced 
that all my hearers know full well tbe reason. But, 
thanks to the light of accumulated knowledge and ex¬ 
perience, the shame which has too often checked 
discussions of the subject, and hampered the efforts of 
many who, from time to time, in various countries, have 
tried to stem the tide of this disease, need no longer 
have an influence. 1 hope to give yon facts and show 
yon reasons which will n^e every one present feel and 
know that the disease (syphilis) should and must now 
have a check put upon its rava^ -and my plea will 
rest, as tbe title of my paper inmoates, upon the vast 
“army of inttoeents” who plead for protection from a 
disease which may attack them when least expected, and 
may often extend its malign effects through years, and 
even to succeeding generations. 

It is not a litUe interesting to note that when the 
disease burst out with such frightful severity in toe 
years 1494 and 1495, at a date closely following the 
discovery of America, and about toe time of the invasion 
of Italy by Charles VIII. of France, it was not by any 
means considered as a venereal affection, but spr^Ml so 
greatly among families and in neighbourhoods that it 
was regarded as a form of pl^n^e; many laws were 
therefore enacted for the proteccisn of the community 
against what was considered as a new disease which had 
appeared among them. Also later, even in tbe sixteenth 
and seventeenth centuries, we find laws regarding those 
afflicted with syphilis, prohibiting them from the use of 
public baths, and even preventhig them from coming 
into genial assemblies, Ac., and some of the measures 
taken to hindw toe spread d the disease were harsh in 
toe extreme. 

I will not attempt, in an^ way, to go into the Imal 
aspect of toe case, either historically or practically, for 
time and space would fail me on an occasion like this; 
legal action will follow when once the public is oon- 
vin^ that there is a danger which can be tons 
avoided. 

Mention was made of legal restrictions of the disease 

C 



July 3. 1901. 


ORTGINAIj communications. Thi Mst>ical Pbmb. 7 


ejraroued long ago. in order to oall attention to the feot 
that vhen syphilis was regarded as a general malady 
not necessarily connected with the seznal act, there was 
great attention paid to its control; bnt now, in later 
years, since it hu been regarded more and more as a 
rener^ disease, it has been ignored and left to porsne 
its deetmctive way nnoheoked by sanitary oonto>l. The 
height of the folly onlminated in the silly ^[^tation in 
England which terminated In 18S1, with the repeal of 
the '^Conti^onB Diseases Acts.” which had wrought 
snch beneficent resnlts from 1664 till 1881. 

As already intimated, the pendnlnm of knowledge 
swung the^her way, and during the last twenty-fire 
ysaia or so, a mass of tecta has been steadily accumu¬ 
lating, which again calls attention to the aspect of the 
innocent infection by syphilis, and which demands that 
the thoughts of those who make laws for the protection 
of the public shall be again turned to the disease. The 
data rrferring to this “ Syphilis in the Innocent,'* the 
present writcn has been coUecring for the past ten years, 
and has recently embodied in a Tolume, to which 
farther reference will be made in our discussion of the 
fobjecL 

The basis of our present ailment is as follows: as 
long as syphilis is regarded ezolusiTely as a Tenereal 
disease, it is and will be extremely difficult to obtain 
adequate legislation for its control; whereas, if it can 
he shown to be one from which the general and innocent 
pnblio should be protected, there will be little difficulty 
in meeting and solTing the question; it is the hope of 
the writer that the present paper, with the discussion 
which may follow, will be the means of such agitation 
as will re^t in the ultimate adoption of laws which 
will in a measure control syphilis in this country. 

In order, therefore, to properly understand and appro* 
date the task before us, it will be necessary to enter 
into some details in regard to the present extent of 
syphilis, its modes of propagation in times past, in* 
duding many episodes which were called epidemics, on 
account of ^e large numbers innocently affected in a 
brief period, and fiully to the modes of propagation of 
the disestee in late years, by other tiian unlawful 
Tsnereal acts. These matters I will endeavour to present 
as concisely as possible. 

WouLD-wna Distribtttion or Stphilu. 

A word first in r^^ard to the general distribution of 
syphilis in the worlA Many have written horn tawM* to 
tisw as to the antiquity of syphilis as a disease, even 
from the most ancient times, and bones exhumed here 
and there have seemed to show that it has prevailed for 
ages, as also records in Chinese literature point back to 
ito existence at least 2,000 years B.C. But for practical 
pnrpoeos, most studies of ^philis go back only four 
hundred yean to the period mentioned, 1494 and 1495, 
and as all know, it was charged that the followers of 
Columbus brought the disease to Europe from the 
western lands. Since 1494 the disease has spread, 
apparently d« novo, until now, according to the best 
writers, there is hardly a Mrtion of the inhabited globe 
where it does not exist with more or less vimlenoe. It 
is stated that in Buasia at least ooe-qnaiter of the in¬ 
habitants in some villages ate infected, and all writers 
agree that there it is mostly spread in an innocent man¬ 
ner, mainly in family Ufe, as will be mentioned later, 
for proetitntion is almost unknown in tiie villages. 

In Great Britain and Ireland it i«evails widmy in the 
great cities and ports, favoured W the neglect of all 
le slti c U ons on prostitution. Dr. Holland in 1864 esti¬ 
mated tiiat in the United Kingdom there were at least a 
million and a half parsons infected with syphilis each 
year. 

J^an and China are so full of it that Dr. Eldridge 
states that it is very exceptional to meet a male Japanese 
who will not acknowledge that at some time he bM had 
syphilis, and in the Fremsh Hospital at Tien-Tsin, China, 
almost 30 per cent, of all oases were of tbia disease. 
Time teils even to touch on its prevalence in various 
other countries, tat as stated More, syphilis exists 
almost universally, and, according to the beet authorities, 
it is steadily on the increase. 

There are no data to determine the extmit of its pre* ‘ 


valence in the United States, but any one temiliar with 
dispensary and hospital work in this oouatry will vouch 
for the very great amount of it seen in daily life. The 
statistios collected by the American Dennatologioal 
Association, relating to some 300,000 cases of skin 
disease, give a percentage of 11*6 due to syphilis. Some 
years ago Dr. Sturgis collected the retnw from the 
public institutions in New York City, and estimated 
that the numbers newly infected there with syphilis 
could not be far from 60,000 each year. 

Time would fail me even to hint at the mass of 
material which has been brought to light in regard to 
the modes and methods by which syphilis has been 
innocently given to individuals, even up to the present 
time, and often in spite of great care being exercised. 

The three great classes or divisions of the subject to 
which I wish briefly to your attention are: 1, 
marital syphilis; 2, hereditary syphilis; 3, extra^nital, 
innocent syphilis. 

Mabital Syphilis, 

The subject of marital syphilis has been very fully 
discussed by a number of writers, and all acquaint 
with the subject know well that this mode of infection 
stands prominent in connection with the innoeent ac¬ 
quiring of the disease. While men oooasiooally coutiaot 
syphilis innocently in lawful wedlock, even indeed from 
wives who have acquired it in nursing a'syphilitio child, 
or in some other innooent manner, it is principally the 
wives who suffer, from the sins of their bnsbantls, fai^ore 
or after marriage, and on them falls a laige share of 
burden of “innooent syphilis.’* 

Fournier, of Paris, recently made some studies from 
the oases of syphilis coming to him in private practice. 
He found that fully 26 per cent, of aU females whom 
he had seen in private practice had contracted the dis¬ 
ease innocently and undeservedly, and in the discussion 
of his paper, Bioord thought that that proportion was 
too low. Of the married females in Fourniers practice, 
he found that in 75 percent, of the oases the disease was 
unmistakably traced to the husband. In my own 
private ptactioe I found that in fully 60 per cent, of 
the females the disease was acquired in a perfectly 
innocent manner, while among the married fei:Met the 
percentage of innocent infections would be 86 per cent., 
or more. Surely, then, there is reason in the plea that 
something should be done to prevent the wboleoide in¬ 
fection of these innocent victims of marital syphilis. 
But if this aspect of the subject is dark, that of 
hereditary syphilis is yet darker, and calls even more 
strongly for relief. 

HxBBDrriBY Syphilis. 

The literature of hereditary syphilis is very large and 
the facts related to it are weU taown to the profession. 
Time and space will allow of bnt the briefest mention. 
We may for a moment first refer to the effect of the 
poUon upon the Tiability of children bom of syphilitic 
parents. I cannot do better than refer to some very 
striking tables given by Sturgis in an appendix to 
Diday*B work on “ Infantile Syphilis.** They are from the 
recoup of births of syphilitic children at the Moscow 
Hospital, Bnssia, from 1860 to 1870. During these 
years there were 2,002 such births, and 1,426 deaths; 
that is, 71 per cent, of the children bom there of 
syphilitic parents died. Other writers are in accord as 
to the very great death-rate among thoee bom of 
syph^tic parents. 

It is to be remembered also that syphilis is the cause 
of innumerable abortions, and also produces sterility, 
both in the male and female. If, therefore, the effects 
of syphilis were limited solely to destruotioD of life in 
the newly-bora, or in the products of oouoeption, there 
would be a strong reason for the intutanotion of 
measures to check the spread of the disease, from its loss 
of life to the state. Bnt this is only a portion of the 
ills wrought by syphilis in oonneotion with generation, 
and it would be better that children of syphilitic 
parents should thus fail of life, rather than be bom with 
an inberitanoe which often proves a curse. 

Extbaoxiittal Syfeilib. 

The third division of onr subject^ namely, extra- 



ORIGIN A.L COMMUNrCATIONP, 


JULT 3. 1901. 


8 Thb Mxdioal Fb1B8. 


genital infection, or ayphilie acquired qoite apart from 
any sexual relations, is one of the most interesting lines 
of investigation possible, and has been illustrated by 
thousands of recorded cases, reported by many hnndre«u 
of observers. I may remark that nearly 200 cases of 
this kind have fallen under my own personal observation 
and care. A slight classification or the facts may help 
ns to a better understanding of the vastness of the sul^ 

J 'ect, and its very, or most, important bearings upon the 
lealth of the community and the dangers from syphilu. i 
The oases referring to the different meth<^ of ^ 
acquiring syphilis accidentally, apart from sexual life, 
as actually observed at the present time by every one 
who has opportunities and experience in this line, may ' 
be grouped under three main catalogues: 1. Those 
relating to domestic and industrial life. 2. Those re¬ 
lating to the nourishment and care of children. 3. 
Those relating to professional pursuits in the care of the 
sick. 

Under the first we find the instances of tranv 
mission finally classified into almost fifty groups, relat¬ 
ing to the most different phases and aspecte of domestic 
and social life. Not only has syphilis actuallv been 
given by spoons, knives, forks, cups, glasses and jugs, 
but it also has been oommnnicatM by tobacco pipes, 
cigars,’dgarettes and even by trochee or candy passed 
from mouth to month ; also by shirts, drawers, masks, 
tasters, bandagep, lint, towels, sponges, combs, tooth- 
rushes, syringes, sick.chairs, Ac. Among those who 
have acquired it in industrial life, that is, innocently in 
connection with their occupation, we may mention glass- 
blowers, assayers, weavers, musicians, conductors (by 
whistles), servants, cooks, furriers, upholsterers, shoe¬ 
makers, and others. 

The second class, representing syphilis acquired 
through the nutrition or care of children, includes literally 
thousands of cases where the disease has been inno¬ 
cently acquired by suckling syphilitic children at the 
breast, and innumerable cases where the nurses and 
attendants have acquired it by contact with the syphil¬ 
itic secretions of ii^ants and where diseased children 
have communicated the disease to each other. 

In the third class, relating to professional body ser¬ 
vice, in connection with the care of the sick, we find 
three divisions: (1) where the operator is the victim; 
(2) where the operator is the sypbilifer, or gives it from 
himself to a patient; and (3) where the operator is the 
medium of conveying the disease from one patient to 
another. 

Under the first class we find hundreds of cases where 
physicians, surgeons, and midwives have become infected 
m the prance of their calling. LargeJnnmberR of cases 
are on record where breast-^awers and wound-suckers 
have acquired the disease. 

In the second class we find many records of those 
who have had syphilis giving the msease to others by 
body service, as in talcing, circumcision, vaccina¬ 
tion, dc. 

In the third class the operator acts as a medium, con¬ 
veying the poison from one patient to another. Here 
we find a sad array of cases of infection by skin-grafting, 
vaccination, through dental instruments, by wet-cup- 
ping, the use of the Eustachian catheter, &o. 

Lkoal Cohtbol or Stpuilis. 

I have thus hurriedly, and necessarily very briefly, 
run over a few of the points relating to our subjert 
illustrating the propriety of my ”plea for the legal 
control of syphilis based on its fre<]^aenoy in the inno¬ 
cent”—the details necessary to a fnU understanding of 
it would take many, many pages, and occupy as many 
hours. I beg now to present a brief argument for, and 
a statement of the method and mode of, the legal con¬ 
trol of syphilis which I think feasible at the present time. 

From what has preoeded it is readily understood that 
syphilis is a disease which inflicts great injury upon the 
puDlic health; for it imperils not only those who have 
been guilty of sexual transgressions, but also those who 
are quite innocent, and it is upon the basis of protec¬ 
tion for the latter that I believe action should be taken. 

While syphilis occurs most frequently as a " venereal 
disease,” its prophylaxis or legal restraint by no means 


relates to the restriction of venereal diseases; the limi¬ 
tation of the spread of nphilis should be considered 
from a much broader and higher standMint. namely,, 
from that of defen^ng the public health and that of 
individuals against a malady which affects the innocent 
and guilty alike, and which comes to the innocent not 
only when its dugers are anticipated, but also when 
they are least suspected. 

In the matter of legal protection against syphilis,, 
therefore, the subject of prostitution becomes a secondary' 
consideration. The question is not one of “ regulating- 
prostitution,” or of inspecting, licensing, or legalising 
the “ social evil,” or of prote^ng those eng^;ed in it. 
We approach it from a higher ground, and seek to have- 
some restriction put on a disease which is dmigerous 
and communicable, and which might at any time attaclr 
any one in a wholly innocent and unexpected manner. 
That the spread of syphilis can be checked is self- 
evident, as has been conclusively proved by the fact 
that all the epidemics to which reference has been 
made were averted when the cause was recc^^nise^ 
and sufficient measures introduced to preventthe further 
transference of the poison from one person to another. It 
is also abundantly shown in certain instances where 
foreign governments have in some places enforced 
stringent measures looking in this direction. 

We know positively that the poison does not and can 
not develop de novo, but that it is always communicated 
from one individual to another. We know also that 
within a certain period syphilis ceases to be conta¬ 
gions in each individual; so that if no new infection 
is introduced into a community, and the members of 
that community are guarded against acquiring the 
disease from one already infected until that safe 
period is reached, the malsidy will cease to exist. 

Such precautions are exercised both by the pnblic- 
and by individuals against other cont^ous diseases, 
such as small-pox, scarlatina, measles, diphtheria, yellow 
fever, do., is it not eminently proper that syphilis 
should be placed in the same category, and protection 
should be afforded to the innocent agau^ it ? Syphilis 
counts its victims, guilty and innocent, by thousands 
where other diseases count hundreds. More deaths are 
ultimately caused by syphilis tha.n by small-pox, while 
the injury to health, and interference with life work is 
infinit^y greater in the former in the latter. The 
conclusion is absolute: syphilis should be placed, like 
other contagious diseases, under the control of the health 
authorities. 

. The first step toward accomplishing such control 
would undoubtedly be found in placing it among other 
contagions diseases which come under the jnris^ction 
of the health officers; indeed, the wonder is that it has 
not been so placed loi^f ago. 

If syphilis were first recognised as one of the great 
contagious diseases, against which it is the duty of th» 
government to protert the community, the details of 
that protection would follow in time, as they have in 
regard to other contagions diseases; as the public became 
aware of the dangers arising from sypUlis, and the 
benefits accruing from its rest^tion, there would be no 
difficulty in securing proper laws relatingto the subject. 
The suggestion, thwefore, is most earnestly put forward 
that the time has certs^ly come when rae dangers 
of syphilis, and especially the dangers to innocent per¬ 
sons should be fully and fairly recognised and met. It 
is too late in the history of soienoe and of humanity to 
stigmatise the disease as “venereal,” and on that account 
to withhold scientific protection from thousands of inno¬ 
cent sufferers. Among babies, nursing women, persons 
infected in dental and surgical operations, and in dozens 
of other innocent manners, syphUiscan no more be de¬ 
scribed as venereal than any other contagions disease. 
The time has come to place it under the control of the 
proper health officers, and to make it quite as criminal 
to tranmit typhilit v>iitingly, as it is to communicate 
small-pox, scarlatina or diphtaeria. It is believed that 
if only syphilis can be included on the list of contagious 
dis ea s e s which the health boards can control, proper 
legislation will followslowlyas the profession and public 
b^me more enlightened as to the real nature of 
syphilis and the real danger of the public from it. 


C 



Jttlt 3, 1901. 


TRANSACTIONS OV SOCIETIES. 


Tbs Midioal Pbsss. 9 


CUttical JRecorbB. 

VA80GEN DT THE TEEATMENT OF SKIN 
DISEASE 

By Datid Waish, U.D., 

Hon. PhTiicinBi Western Skin Hoq>ital, London, W, 

Thb Tsloe of a good exoipient is so nnirersally reoog- 
nieed by all dermatologists that there need be no apology 
for publishing the records of a few cases in which a 
new of that kind has been need. Before 

making any trial of vas^fen, with various preparations 
of which the following oases were treated, it was asoer* I 
tained that actual absorption took place when rubbed ' 
for a long enough period into the skin. That property is 
specially desirable in cutaneous medication, and in the 
case of vasiogen is attributed in part to its peculiar 
ability to form a stable emulsion with the secretions of 
tile skin and of wounds, as it does with water. On the 
whole it may safely be said that the preparation is 
worthy the careful attention of practitioners who are 
<9allad upon to treat diseases of the skin. 

S. O., female, single, st. 2-4, confectioner, complaining 
of a ra^ of several weeks* duration. There were soa^ 
tered over arms and body a number of patches, fawn* 
coloured or faint pink; slightly scaly; a little irritating 
at times; growing rapidly from a small spot to (usually) 
a ringed round or o^ patch the sise of a shilling or a 
crown. Patient had a similar attack a year i^. The 
scalp was affected with a mild, dry seborrhcea. Oeneral 
health good except a little dyspepsia at times. The 
rash disappeared uter about six weeks’ treatment with 
Taeogen, io<^e, and oreolin baths. 

E. M., female, set. 31, m., no children, complains 
of rash on hands of six weeks’ duration; similar 
attack a year previously. Bheumatio fever in family. 
Genoral health good. Three Angers of the left hand 
were in an ecsematons condition, (&y and desquamating, 
oxcept one small patch, which was moist and excoriated, 
a-nd one nail had been shed. The attack came on after 
washing and was di^nosed as a dermatitis, due to an 
irritant applied to a rheumatic subject. Under the 
application of a diluted vasogen iodine ointment (3ij. 
later increased to 3iv. to the 3j. of vaseline) immediate 
improvement took place. Some fresh crops appeared a 
montii later, but at the end of two months the hand was 
cured. [The treatment cf eciematous conditions by 
iodine certainly deserves farther attention.] 

E. G., female, wt. 41, m., Ave children, three mis* 
carriages. Complmning of roughness and cracking of 
akin of palms for the last thrM or four years; hands 
have got well in summer, except this year. Has 
avoided soda in washing sinoe the bands were attacked. 
At Arst the conditions improved under sulphur vasogen 
externally, and a soda and gentian mixture. After a 
month the patient was treated locally with mercury 
vasogen, and internally with a potassium iodide mix¬ 
ture. The hands then improved steadily, and were 
nearly well when patient ceased attendance at the 
hospital. 

A. E., femtie, et. 24, confectioner; all hair of head 
lost rapidly, and partially of eyebrows. Phthisical 
family history and patient has had hip disease. The 
scalp was treated with a stimulant application of 
vasogen siooum with cantharides and ammoniated 
mercury. The patient volunteered the fact that the 
ointment disappeared after prolonged rubbing. After 
some weeks a growth of Ane downy hi^ appeared over 
some ps^ of scalp, comprising alwut one-Afth of the 
total area. 

E. 8., male, st. 52, clerk, has suffered for two years 
from an affection of palms. Five years am he was 
treated for eczema of races and leg. Good family and 
personal history. The palms showed a chronic 
desquamative dermatitis, extending slightly down the 
Angers and f^ing into healthy skin. Patient showed 
^tue p rogress under ordinary treatment, but has 


improved steadily under vasogen iodine, and at the 
time of writing has a full prospect of recovery. [In 
other chronic palmal eczemas a similar treatment has 
proved satisfactory.] 


PSEUDO-TABES AFTEB POLYNEUEITIS. 

By Dr. Stllaba, 

Of Bennes. 

I HATS recently had under observation four cases of 
pseudo-tabes dorsalis after an attack of polyneuritis. 
This disease is sometimee known as ‘'neuro-tabee peri* 
pherica”or “ ataxic polyneuritis.” 

The Arst case was that of a compositor, et. 62, with a 
gallinaceous or ” stepping gait" and sUghtly ataxic; 
patellar reAex and ^mberg symptom lost. On the 
other hand, the pupils were normal, and the sensibility 
of the large nervous trunks was quite intact, which 
justiAed the diagnosis of pseudo tebes following an 
attack of polyneurosis, which came on with great pain 
in both lower extremities. The cause of the neuritis 
was due, I believe, to sn advanced state of arterial 
sclerosis, which is not uncommon in the aged, and has 
been termed by Schleeinger, Oppenheim, Ac., “poly¬ 
neuritis senilis.” It has, however, been objected that 
tiie vascular sclerosis could never reach such a degree as 
to produce pseudo-tabes. 

My second case developed after an attack of typhoid 
fever. Tne patient, set. 28, was a merchant, and four 
years ago scored from a severe attack of typhoid, 
bleeding from bowel, three months’ fever with fr^nent 
recunenoee and great decubitus. All the limbs became 
paralysed, so that he had to be fed during four subse- 

? iuent weeks. A year after the commencement of the 
ever the patient developed the gallinaceous, or “step¬ 
ping gait,” with paresiB of the lower extremities and loss 
of ^tellar reAex. Electric treatment improved the con¬ 
dition, but has not cured it 
The third case was that of a diabetic female, est., 40, 
who, daring treatment for her disease, developed pseudo- 
tabes, followed, after the lapse of one year, by paresis of 
the lower extremities, distinot ataxia, and loss of patellar 
reAex. There is alM extensive ^turbanoe of the 
sensibility, with Bombers sjrmptom, which is not un¬ 
common in diabetes, according to Williamson occurring 
in 60 per cent of diabetics. The polyneuritis diabetica 
is not dus to the hyperglyosemia, but rather to the toxic 
products of a morbid metabolism, which m^ resemble 
the aceton production, though not identical therewith. 

The fourth case succeeded arsenic poisoning, which is 
not a common occurrence. After taking arsenic, sensi¬ 
bility in the extremities was affected. Along the 
course of nerve trunks the sensibility was greatly 
exalted, while the Bomberg sjrmptom was very pro¬ 
minent, the nails falling off and the patellar reAex 
disappearing. The most interesting point in this case 
is the “ perverse dissociation,” viz., that although the 
sense of touch was quite lost in both hands and feet 
sensation te pain and heat was quite intact. 


^rattBactioiiB of §odetie0, 

BRITISH GTNiECOLOGICAL SOCIETY. 
MeXTXKO HELD JOHS 13 tH, 1901 . 

The President, Makbill Moulltk, M.A., M.B.C.P., in 
the Chair. 


Exhibition of Spxcihxns. 

Mb. W. H. Nbwnhah, M. A., M.B.,phyBician-aooonohear 
Bristol General Hospital, showed a Fibro-myoma. which 
consistedoffour distinot tumours, growing from one base, 
one of the four having become quite calcareous in parts. 
The ^tient, E. F., st. 40, Arst seen in consultation with 
Dr. Ferrot^ was suffering from a large abdominal 
tumour which caused difficulty in micturition and 
defsecation. She had always bad excessive hemorrhage 
at the menstrual periods, but daring the last three 
years this was acoentnat^ and was acoompanied by 
great pain. The uterine sound only passed three ixwbes. 


10 Thb Medical Pmm. TRANSACTIONS OF SOCIETIES. 


JpLT 8, 1901. 


bat the tomoar compIetel 7 blocked the pelvis. On 
Febmarjr 2lBt, 1901, the ebdomra was opened and the 
tnmonr removed by intra<peritoneal hysterectomy. 
Both ovaries were left behind, and the nterine arteries 
were not seonred nntil the tumoor had been removed. 
There was no hsemorrhage. The patient recovered 
without a single bad symptom, and leh the Bristol 
General Hospital on March 18th, 1901, or twenty-five 
days alter the operation. At the present date she is in 
perfect health. 

Dr. MACNAuaHTON-JoNis showed a specimen of Ectopic 
Gestation. The patient, st. 80, had been nine years 
married; eight years since her last pregnancy, during 
which period the catamenia were quite regular up to 
November 24th, 1900. She had been treated on different 
occasions for retroversion of the utems and prolapse. 
The symptoms of sudden, with periodical heemor* 
rhage, and violent pain, subsequently, and the 
formation of a large swelling behind the uterus, 
indicated ectopic gestation. Abdominal coeliotomy 
was performed on April Ist, when a large adherent 

£ station sac of the right tube was removed. On bring- 
g it through the enlarged abdominal incision a portion 
ruptured, allowing a quantity of horribly fcetid and 
septic pus to escape. The peritoneal cavity was 
thoroughly cleansed out with weak formalin solution, 
and the edges of the wound wiped with a stronger one. 
Drainage by iodoform gauze was employed. From the 
symptoms, on the fourth day, it was found necessary to 
re-open the wound, when the peritoneal cavity was seen 
to be free of any aooumulation, but the margins of the 
wound were infected throughout its entire extent, the 
slough being in the muscle and fascia. The patient 
died on the seventh day. 

Mr. Tabostt had made a careful examination of the 
specimen, proving it to be one of tubal gestation, with a 
secondary sac between the gestation sac and the wall of 
the dilated Fallopian tube, in which the foetid pus had 
aconmnlated. This lay next to the bowel, with which 
doubtless it had formed adhesions, thus aooounting for 
the infection. The gestation sac contained a fcstus cor¬ 
responding with the stige of development at the end of 
the second month. The suppurating cavity repre¬ 
sented that part of the dilated ampulla of the tube not 
occupied by the geetatioo sac. 

Dr. MACNAnoHTON-JoKxs Said that if such an acci¬ 
dent occurred with him ^r^in he should feel inclined, 
having protected the bowel, to char the edges of the 
infecim parietee with the thermO'Cantery, and then 
make a clean section of the edges of the wound at 
either aide before uniting it. In this case the peri¬ 
toneum had clearly resisted the infection, which was 
limited to the parietal structures. 

The PBBsiDEtrr said that, when in an extra-uterine 
foetation the fcstus bad become putrescent or any extra- 
vasated blood had become septic, the operation described 
by Dr. Maonaughton-Jones was almost invariably fatal. 
If the septic condition were recognised before operation, 
the vaginal route should be adopted, and the patient’s 
life would then probably be saved. In the absence of 
evidence of sepsis, the operator naturally selected the 
abdominal route. 

Mr. Fubnxaux Jobdan said that, no doubt, as Dr. 
Macnaughton-Jones had suggested, the adhesion of the 
sac wall to the bowel, and its becoming thin at that 
particular point, accounted for the infection of its con¬ 
tents. An interesting point, exemplified by this speci¬ 
men, was that such a condition might remain quiescent 
for two or three months, or longer. The foetus had 
evidently been discharged when the patient had the fint 
attack of pain and hsemorrhage. Mr. Fumeaux Jordan 
then described the following case, in which the history 
was very similar to that of Dr. Macnaughton- Jones* pa¬ 
tient. A lady was twice curetted in America forsuppo^ 
retention of the placenta after abortion. She then gradu¬ 
ally improved, and menstruated regularly for two years, 
when intense pain set in, in the abdomen. About ten 
days after its onset the abdomen became enormonsly 
distended, and the patient was found to have a high 
temperature. The swelling reached well above the um¬ 
bilicus, and extended a little way into the pelvis, not, 
however, into Douglas's pouch. On opening the abdo¬ 


men Mr. Fumeaux Jordan found a sac embedded in 
adherent bowel and omentum. On separating the adhe¬ 
sions two pinte of very foetid pus esca^. The fmtus 
corresponded in size to the duration of pregnancy prior 
to the abortion already referred to as having taken 
place in America. The patient, who was for some time 
in a very critical condition, ultimately recovered. 

Dr. Hbtwood Smith asked if there were any indica¬ 
tions, before operation, that supnaration was present, 
and farther whether it might not be feasible to avoid 
putrescence by employing abdominal injections. 

Mr. Skbnb Kxith showed 

FIVI BPICIMIMS OF CTKBINB FIBBOID8, THBBX OF WHICH 

ILLU8TEATBD IN A 8TB1KINQ UANNIB THl VABIABLE 

BAPIDITT WITH WHICH THB8I TtJMOUBS OBBW. 

The first specimen consisted of typical sub-peritoneal, 
intra-mural, and submucous growths, removed from a 
patient, set. 28. Pain, fever, and hsemorrhage had 
necessitated confinement to bed during the six weeka 
preceding the operation. Four months prior to the 
removal Mr. Skene Keith had performed perineorrhapy, 
and at that time there were no irregularities on the sur¬ 
face of the uterus, which he palpated without difficulty,, 
and which appeared, from its size and consistency, to 
be subinvolnt^ only. The second specimen, removed 
from a patient, set. 34, had been discovered at the 
confinement four years before the operation. The tumour 
which constituted the third specimen weighed eight 
pounds. It had been removed from a woman, set. 28, 
and, although probably of only two years* duration, was 
far larmr tfajui the previous specimen. Interest 
attaohea to the fourth specimen because the patient had 
three years previously derived marked, though tem¬ 
porary, benefit from treatment by Apostoli's method. 
Failure to obtain permanent r^ef from electrical' 
treatment was explained by the. submucous position of the 
tumour. The tnmonr iu the fifth specimen, removed 
from a patient, set. 45, was of a fibro-cystio nature. The^ 
body of the utems, which was shown, contained two 
polypi. The weight of the growth was 14 lbs. Com¬ 
menting upon the exhibition of such specimens by sm 
advocate of Apostoli’s treatment, he said that the con¬ 
ditions had materially altered since he visited Paris to- 
see Apostoli in 1887. At that time the published results 
in hysterectomy showed a mortality of over 30 per cent., 
or one death in three, though his father only lost one 
patient in twelve; but even with this lower morWity it 
was not considered justifiable to advise operation unless 
the patients were really very ilL The mortality to-day 
was less than 5 per cent.; though in some instances thie 
figure was exceed, t.g., at the Samaritan Hospital, 
where for the last two years there was a mortality of 
10*6 per cent. At the same hospital the death-rate^ 
after ovariotomy, for the same two years was 16 6 per 
cent., and in the year 1899,19 6 per cent. 

Dr. Hodosok, in oomparing the abdominal and 
vaginal routes for operation, questioned the possibility 
of rendering the vagina permanently aseptic. It 
might be rendered temporuily so, but was liable to 
berome subsequently infected from the rectum, or by 
discharges from the uterine cavity. He doubted the 
possibility of distinguishing by touch between the 
various internal organs, allude to by Dr. Alexander in his 
paper, if adhesions existed. Referring to Dr. Alexander's 
statement that it was rarely neoesssary to employ 
sutures to close the v^inal wound, Dr. Hodgson said he 
thought that they sho^d, at least, be employed to keep 
the edges of the peritoneal opening accurately together. 
In the majority of vaginal operations the operator wa» 
working in comparative dukness; and, subsequently, 
adhesions were mnoh more likely to ooour. These con¬ 
siderations lead him to believe tl^tthe abdominal route- 
should be that of selection. 

Adjouroed discussiou on Dr. Alexander’s paper on 

POSTBBtOB VAOINAL CCBLIOTOKT IN OPEBATIONB FOB 
PELVIC DISEASES, 

which was read at the previous meeting, and appeared 
in this journal on May 22Qd. 

Mr. Fubneaux Jobdan (Binningham) said that Dr. 
Alexander’s paper was of pMuliar interest to him, as he 



JULT 3. 1901. 


TRANSACTIONS 


Ixad long advocated the adoption of the v^inal route in 
•nitable oases. He did not v^ard the question as one 
of operation per vaginam vtrtut operation per abdomen. 
Semoval bj the vagina was to be regarded as an addi* 
tional method of treating disease, wbioli, in certain 
cases, was devoid of many of the dsingers attending re* 
movaJ by the abdomen. It wm not possible to lay down 
hard and fast rules. The route adopted should be deter¬ 
mined by such considerations as the relative sizes of the 
tumour, the pelvis, and the vaginal canal, the nature of , 
the dii'Tfir*. and the condition of the abdominal walls. 
He approved of the use of the clamp te secure 
the pedicle of a cyst or a Fallopian tube, and had 
never seen harm result from its employment. He had 
in one «*«> of acute suppurative peritonitis, in which 
there was such distration of the abdomen that 
breathing was seriously hampered, made an incision 
into Honglas’ pouch without the administration of en 
anesthetic. Three pints of pus escaped, but the 
woman, who was dying at the time, lived only a few 
hours afterwards. With the exception of this case, 
which was only technically a vaginal coeliotomy, 
though he had performed this operation over siz^ 
times, not only had he no deaths, but he had never 
seen trouble follow. The patients were able both to 
get up and to resume work earlier than were those in 
whom an abdominal incision had been made, and did 
not have to wear a belt. These were considerations 
of importance to poor women. lastly, the absence of an 
ab^minal scar was an advantage should the patients 
subsequently become pregnant. The vagina could be 
rende^ aseptic to the same degree and as easily as the 
abdominal wall, an opinion substantiated by the results 
obtiuned when the vagina was availed of for the removal 
<rf disease. Those who denied the possibility of render¬ 
ing it aseptic should bring forwa^ or quote cases in 
support of their contention. If those opposed on theo¬ 
retical ground to removal of disease hy the vagina 
would give the method a trial they would be convinc^ 
of its value. 

Dr. Macitauohtom-Jonxs said that the first point in 
selection of the route was the dis^oais. There must 
ever be a proportion of cases which could only be 
operated upon by abdominal coeliotomy, and others in 
which on every ground preference should be g^ven to 
the vaginal route. The indications for and against one 
or the other had been times out of number discuss^ 
«d nauseam. Given a case suitable for operation by 
vaginal ooeliotomy, whether we looked to the facility of 
operation or post-operative consequences, both in the 
rUks and prevention of these, as also ready drainage 
when required, it certainly was the method for selec¬ 
tion. This fact, however, in no way touched the 
advantages claimed for, and which were indisputably 
appertaining to the Trendelenburg method, in the 
greater control of parts, certainty in technique, and 
exposure of the operative field. He preferred ligatures 
to clamps in the vaginal operation. 

Dr. A.LIXANDKB, in reply, said that he did not think 
proximity to the rectum a valid objection against 
vaginal cceliotomy. The field of operation was as close 
to the rectum in abdominal ooeliotomy as in vaginal; in 
fact it occupied the same place. The vnlsellom forceps 
effectually closed the os uteri, and provided against 
infection from that sonroe daring the operation. After 
the operation the vagina was packed with antiseptic 
gauze, which not only kept it sweet but drained away 
any discharge as it was formed. As to dealing with 
adhesions, they were as a general rule easily separated 
by the finger, and it was generally possible, by mani¬ 
pulating the speculum, to actually inspect the field of 
operation, so t^t we were really not working any more 
is the dark than in abdominal cceliotomy. Stitches were 
not necessary. The wound was closed eSeotnally by the 
falling back of the nteros and the bladder, and the edges 
came together so accurately that there was no overlapping. 
Dr. Alexander was glad to hear that Ur. Jordan agreed 
with him as to the use of clamps instead of ligatures. 
The tissues to be dealt with were generally so soft that 
it was impossible to catch them and poll them down by 
forceps without running the risk of tearing them away 
from their attskchment^ whereas the clamps coold be 


or SOGIRTIRS. Thx Mkdical Fbbss. H 

applied without any such disturbance, and the preven¬ 
tion of hemorrhage wm certain. He did not agree with 
Dr. Uaonaughton-Jones m to the ease with which a 
bleeding vessel coold be fonnd in these operations. 
The bleeding point in vaginal cceliotomy lies high up at 
one of the extremities of the broad ligament, and 
probably could not be reached and tied without opening 
the abdomen. It was therefore absolutely necessary that 
all possibility of bEemorrbage shonld be prevented 
at the time of the operation, and this was done 
most effsctnally by obmps. In vaginal cceliotomy, 
the possibility of hernia was completely avoided, 
and although the present method of perform¬ 
ing abdominal cceliotomy guards more effectually 
than the older method against its ooourrenoe, 
still the possibility of hernia wm always present, and 
in all probability ^k place much more frequently than 
surgeons admitted. He noticed that it was always the 
most recent method of operating that wm supposed to 
prevent hernia. The truth really wm that all me^ods 
tailed, and that a considerable amount of time was re¬ 
quired to show whether hernia would occur or not. In 
sloughing ectopic gestation snok m the oase Dr. Uac- 
nanghton-Jones had read, the vaginal route would cer¬ 
tainly have been much safer, and dthough the sac could 
not have been removed by that route, still the dangerous 
contents of the sac could first have been drained with 
safety, and then the shrunken tumoor could have been 
removed by the abdominal route. In fact this wm the 
course adopted in a similar oase described by Dr. 
Alexander in his paper. 

Dr. Hxbbbbt Snow then read a paper on 

SOFT CEDSMATOUS MTOICA, 

which will be found in another column. 

Seferring to this paper, Mr. Chas Btall, F.B.C.S., 
mentioned a oase of '* single soft myoma uteri,'* 
which he had removed by abdominal hysterectomy. 
Case. — D. F., surgical nurse, st. 37, admitt^ 
into the Cancer Hospital suffering from a rapidly 
enlarging tumour of the abdomen. History of 
present trouble. — She had first notfoed the abdominal 
swelling seven months ago, since when the abdo- 
I men ha dsteadily enlarged, though there had been no 
I pain until quite recently, and then only a slight 
dragring pain in the right inguinal region. The men- 
struij periods had become more profuse, lasting seven 
or eight days, and occurring every three weeks. There 
hu bMn marked loss of flesh and strength, but no great 
ansemia. On examination .—A large, smooth, and solid 
tumour wM fonnd rising ont of the pelvis and connected 
with the atoms. Bimanual examination showed a large 
mass projecting into the mucb of Dous^ and 
the tumour was fonnd to nave little mobili^. A 
soft single myoma wsa diagnosed, uid hysterectomy 
was recommended because of the rapid growth. 
Operation, January 29th .—The abdomen wm opened in 
the middle line, and the nteros and tumour were drawn 
out of the wound with the aid of a myoma screw. After 
securing the broad ligaments, the utorus wm amputated 
about the level of the os internum, the peritoneum wm 
sewn over the cervical stump, and the abdominal wall 
sutured in three layers. The tumour wm s soft single 
myoma of the sub-mauoas variety, and occupied the 
posterior uterine wall. The uterine cavity was con¬ 
siderably enlarged, and the sound could be passed for 
six inches. The patient made an uneventful aud un- 
interrapted recovery. 

LABTNGOLOGICAL SOCIETY OF LONDON. 

Mbbtino hbld June 7th, 1901. 

The President, Mr. Cbbsswkll Babbb, F.B.C.S., m 
the Chair. 


Casbs and Bfbciubns Exhibited. 

Db. F. db Havillano Hall showed a case of 
“ Uioeration of the Larynx (? tuberculous) ” in a man, 
eet 46. There wm no history of venereal disease or 
other previous illness. The affection commenced with 
loss of voice about twelve months ago, accompanied by 
cough and some expectoration, but no htemoptysis. 


C 


12 Thi Mbdical Pbebs. 


TRA.N'SA.OTIONS OF SOCIETIES. 


JntT 8, 1901. 


There had been oonsiderable loss of flesh, and there 
were riinis of consolidation at both apioes. Tnberole 
bacilli bad been found in the sputam. He had been 
treated with iodide of potaarinm with bat little, if any, 
improvement. 

I>r. St. Claib Thomson considered the case one of 
tnbercnlons aloeration in a syphilitic subject, with which 
opinion Dr. de Havilland Hall concurred. 

Dr. St. Claib Thomson showed a case of mali^rnant 
growth of the larynx. The anterior fonr.flfths of the 
right cord was occupied by an oblong growth with an 
irregular mammilated surface. The anterior third of 
the left cord was also infiltrated. Ihe point chiefly 
raised by Dr. Thomson was whether the whole of the 
right and the anterior third of the left cord could be 
removed without fear of stenosis. 

Sir Fblix Sbmok said that he had several times 
excised both vocal cords without any subsequent stenosis, 
and he thought the growth miirht be freely removed in 
this case. 

THB EXTBUNAL OPEBATXOK ON THS FBONTAL SINCBBB. 

Dr. St. Claib Thomson also showed a case of frontal 
sinus snppnration fourteen months after the external 
operation, uid 

Dr. Hebbebt Tillbt showed three cases demon* 
strating the result of the external operation. The 
completeness and permanence of the cure of the 
nasal suppuration doe to frontal sinus suppuration, and 
the fact that the external scar was trifling and did not 
increase with time, were well illustrated by Dr. Thom* 
son's case. Dr. Tilley's cases were shown to demonstrate 
that if the radical operation were effectively carried out, 
there was no reason why the recurrence of the discharge 
should take place with lapse of time, as had been sug* 
gested at a previous meeting. These cases had been 
operated on fourteen, nine, and six months ago. respec* 
tively, and there was still no trace of purulent discharge 
into the nostrils, 

Mr. W. G. Spbnceb asked what percentage of these 
cases was bilateral. He had notio^ that most of Dr. 
Tilley’s oases were unilateral, and he wondered whether 
this was due to the performance of an early radical 
operation on the one side preventing the empyema from 
burning bilateraL 

The Pbbsidbnt tbouiirht that the main point of inte¬ 
rest was the exact nwiiceil operation which should be 
undertaken, and said the Society would be glad to hear 
the remarks of the exhibitors on the point. Two points 
had been clearly established: first, that an attempt 
should be made to stop the discharge by washing out the 
sinus from the nasal cavity; and secondly, that if 
radioed operation were demanded, it was usually neces¬ 
sary to previously remove the anterior end of the 
middle turbinate. 

Dr. Thomson, in reply, said that in his case the an¬ 
terior end of the middle turbinate was removed sixteen 
days before operation, by which efficient drainage had 
been secured. At the time of the operation the 
frontal sinus was found full of pus and entirely 
lined with degenerated polypoid mucous membrane. 
He had kept the wound open for eleven weeks, seeing 
that nnsatisfsctory resulto and even fatal cases had 
been put on record. Another factor in the treatment of 
his case was that the fronto-nasal duct bad been cleared 
out but no drainage tube inserted. 

Dr. Tillbt, in reply to Mr. Spencer, said that in 
twenty-three cases of frontal sinus empyema with which 
he had to deal, ton cases had been bilateral. 

Dr. Hvbbbbt Tillbt also showed two cases of 
thyrotomy for malignant disease of the vocal cords, 
in which the operation had been performed five and 
three years ago respectively. The patients were now in 
perfect health, and in one the voioe was quite good. 

Dr. Fubniss Fottbb showed a case of infiltration of 
the left cord in a man, set. 28, which was thought to be 
tuberoalouB. 

Dr, Mackenzie Johnston showed a specimen of a 
cheesy mass found after removal iu an adenoid growth. 
The mass was about the size of half an almond. 


Dr. Johnston also showed a specimen from a case of 
sarcoma of the tonsil with a microscopic slide. In this 
case an extensive external operation had been performed. 
By dividing the lower jaw and tying the external 
carotid, the whole disease had been got successfully away 
without marked haemorrhage. The patient made an 
excellent recovery and was at present perfectly well. 

Dr. Donelan showed a sketch of an aneurysm of the 
aorta, in which paralysis of the left vocal cc^ was the 
only physical sign daring life. 

Dr. FrrzoBBALD Powxll showed a case of separation 
of the upper lateral cartilage of the nose in a male, st. 25. 
The patient received a blow on his nose, which was fol¬ 
lowed seven months later by an abscess of the septum, 
which was opened uid drained. From this time 
falling-in of the nose took place from the separation of 
the callages. He oonsidered the case of interest as a 
comparison to one shown by Dr. Frederick Spicer at the 
previous meeting, which the latter considered to be due 
to the pressure of polypi. 

Mr. W. G. Spenceb showed a case of chronic ulcer of 
the septum which, as it bad lasted over a year and had 
shown signs of healing in parts and of extension in 
other parts he considered must be due to lupus or 
tubercle. Dr. Mackenzie Johnston, Mr. Pabkbb, and 
the Pbbsidbnt thought the ulceration was of a simple 
nature, and could see no signs of tubercle. 

Mr. A. Hudson showed an apparatus for vibratory 
massage which he had foxmd Itoneficial in diseases of 
the eye and ear, and suggested that it might be useful 
in the pharynx and larynx for bringing about absorp¬ 
tion of inflammatory thickening and for the stimulation 
of muscles in cases of paralysis. 

Sir Felix Sbmon showed three cases of 

BILATERAL ABDUCTOB PABALTSIS 

in tibes dorsalis. In the first case the illness b^^n 
three or four years ago with pains and "pins and 
needles " iu the feet and " choking attacks *' at night. 
Stridor at night was noticed three years ago, and for the 
last three months in the daytime also. On examination 
of toe larynx, marked double abductor paralysis, almost 
complete, was found. There was inspiratory inward 
movement of the vocal cords. Tracheotomy became 
necessary. 

In remarking on this case Sir Felix Semon said 
he wished to draw particular attention to the 
fact that since the performance of tracheotomy 
the inspiratory inward movement of the vocal oor& 
had oea^. This fact he held to be important in con¬ 
nection with the question whether such inspiratory 
inward movements were due to a purely mechanic^ 
cause, viz., to the rarefication of the sir below the 
obstruction during inspiration—a view held by the 
older laryngologists, and by the speaker,—or whether it 
represented an active inward movement of the vocal 
cords due to the fact that, during respiration both 
abductors and adductors were simultaneously inner¬ 
vated, and that the abduotors having been paralysed, 
the innervation of the adductors alone prevailed. This 
view had been advocated by Hosenbach, Burger, and 
others. If it were correct, one would naturally expect 
the inspiratory movement to continue even aiter the 
performance of tracheotomy. The disappearance of the 
movement in the present case was held to point strongly 
in favour of the mechanical theory. 

In the second case the illness began three years ago 
with a heavy feeling of the feet. About five months ago 
the patient first had choking attacks at night. The 
larynx showed abductor paralysis on both sides, with 
paresis of the internal thyro-arytenoid and the 
inter-arytenoid muscles. In Case 3 the illness 
began with gastric and rectal crises two and a-half 
years ago. Ten months ago the patient had choking 
attacks at night, and soon after noticed the change in 
his voioe. On examinatioB of the larynx considerable 
bilateral and asymmetrical abductor paralysis was 

oogh 


a B B M A K T. 


Tn Mxdical Pbzm 


JPLT 3 , WOl. 

dfranct. 


[raOlC OPK OWN COBBUPONDBNT.] 

Fabis, June SOth, 1901. 

Htpxbptbixia. 

At the Jtme meetiog of the Sooiete de Pediatric M. 
Gamon reported a very mtereetin^oase of h^per-pyrezia 
ooenriiig in an infant, the temperature running up to 
1O0'4^ F. without any appreciable cause. If anything 
the child’s stools were too frequent and too large. After 
a few days the child died, and the autopsy rerealed a 
large collection of fsces in the sigmoid fiezure of the 
colon. 

The question naturally arises. What caused thehyper- 
{^rezia? 

Up to the time when the child’s bowels oommenced 
to act rather freely the child complained of no inoon* 
▼muenoe or pain, and when a gradually rising tempera* 
tore called for ezamination there was nothing found that 
could account for it. Even on making the autcq)^ the 
▼isoera were found to be quite healthy, and there was no 
lesion throughout the whole extent of the alimentary 
canal. 

We are inclined to think that ptomaines formed in the 
sigmoid flexure and colon generally and were absorbed, 
producing at first their well-known toxic action of 
porging and finally paralysing the heat centres, and 
thus through hyperpyrexia producing death. 

Unf<atnnately there was no discussion on the case, for 
the night it was brought forward bad been fixed for tire 
discussion of a different matter. 

It is interesting to note that the general practitioner 
of the past dreaded any tendeni^ to purging in children, 
and treated their little patients with a dose of castor oil, 
rhubarb, and a little solution of opium in the early 
stages of the disease. 

His treatment was empirical, but it was empiricism 
based on years of observation. 

TbOUBLX AHBAD IN PXBSIA. 

The 8t. Petersbuig Si«domo»ti, which keeps a keen 
eye upon alt matters in Persia, says that the Shah is very 
ill, and that he is not allowed to visit France this year 
(although his health was so greatly improved at the 
Contrezeville Springs during his last visit) owing to the 
jealousiee of his visier and his chamberlain. The Shah’s 
previous trip to Europe was so expensive that there is 
no money to spare, and the Grand Yisier does not wish 
his master to go iscogsifo, as he would then be under 
the infiuenoe of his enemy, the Chamberlain, and so his 
Majesty must suffer. 

Prince Oukhtomsky's organ describes the heir to the 
throne, Hohammed-Ali-Mirsa, as entirely uneducated, 
voy ferocious, opposed to all reform, and a deadly 
enemy to all foreigners. 




[Fbok Oub Own Cobrxspondxnt.] 


Bsaux, Jans 29th, 190L 
TubbsccIiOUb PBarroMiTiB. 

In the Znt$eh, /. Chir., 69, 8 and 4, Hr. J. Lanper, 
assistant in the Berne klinik, contributes a paper on 


this subject. It consists of a rq>ort of twenty*two 
oases observed in Eooher’s klinik. Fourteen of theee 
were operated on, the remaining eight only having in¬ 
ternal treatment. Sixteen of the patients were men, 
six women, and two children under fifteen years of age. 
Of the fourteen oases operated on, in most the peritonitis 
was of the serous form; in four it was purulent, and in 
three the dry adhesive form was met with. Operation 
mostly consisted in opening the abdomen; in three 
cases the tubes and ovaries were found and removed. 

Of the fourteen oases operated on, ten recovered, equal 
to 70 per cent.; the other four died vrithin a year, and 
whether tuberculous oomplicataon arose elsewhere was 
not known. No intestinal fissures were met wiUi. 

For the occurrence ci recovery after opening the 
abdomen, the following factors were supposed to be 
responsible:—(1) Bemoval of the exudation, (2) improve¬ 
ment of the circulation and consequently resorption, 
(8) separation of adhesions, and (4) the removal where 
possible of the primary cause of the affection. Eight 
cases were not operated on from some cause or other, 
partly on account of complications in other parts* 
Four of these died and four recovered. In one case 
tapping seemed to have a favourable effect, aud was 
recommended in sdl cases not suitable for further opera¬ 
tion. Of the oases operated on and recovered seven of 
them had remained well for over four years. 

In the Zeiitek. f. Kl. Med. Prof. Siegel discusses 
Thx Intlubncb or Morphia on Gabtbic Sbcbxtion. 

The experiments made were in agreement with those 
performed on animals, and were to the effect that mor¬ 
phia exeroised no inhibitory influence on the gastric 
secretion, but that, on the contrary, its principal in¬ 
fluence lay in exciting the secretion, even if the effect was 
not immediate. Only at first morphia appeared to 
check the secretion slightly, but the slight check was 
soon more than made np by a considerable increase. 
Whether the long continued use of morphine tended in 
the end to lessen the secretion, the writer’s own ex¬ 
perience did not allow him to decide. In bis experi¬ 
ments on dogs, even when continued for several days, 
he never observed any diminution of the secretion. At 
the most the intensity of the stimulating effect in that 
direction was not so marked. The invest^tions make 
it dear that to give morphia in cases of ulcer of the 
stomach in the expectation that the acidity of the 
stomach will be diminisned by it is a mistake. On the 
oontiary, it appears desirable to bring into view mid put 
into use the drugs that are known to have an inbibitoiy 
effect on the secretion. Whilst atropine and belladonna 
arrest the secretion in a marked manner, morphia 
increases it. Morphia may therefore be given io affec¬ 
tions of the stomach only in oases where hyper-secretion 
wiU do no harm. When, however, excessive secretion is 
likely to be harmful, belladonna preparations are to be 
preferred, as in addition to the pain-relieving properties 
they also assist in checking secretion. 

At the Congress for Surgery, Hr. J. Wolff, Berlin, read 
a paper on 

Abthboltsis and Bxssction or thx Elbow-Joint. 

In consequence of the unsatisfactory results of resec¬ 
tion of the joint, the speaker had, in 1895, proposed 
arthrolysis for bony and firm fibrous anchylosis. He 
had performed the operation in nine oases. It consisted 
in cutting through or chiselling off, or in the removal 



AUSTRIA. 


14 Thi MiDtcAi. PEtee . 

otherwise of all bony or fibrous st ru ct u ree pre¬ 

sented free moremMit of the joint. In the case of an 
actress operated on in July of last year Howling per 
primam was complete in eleven daya The passive 
movemrata then b^nn were, however, so painful, that 
the patient in the coarse of a few weeks declined 
to persevere. In September, therefore, a plaster dress¬ 
ing was applied, which was left fiexible near the 
joint, and the arm was gradually brought to a 
condition of the utmost possible flexion mid ex¬ 
tension. From now active and passive movements 
were piaetioable. At present any difficulty or awkward¬ 
ness of movement was scarcely noticeable, and the 
patient was able to follow her calling. When 
the disease in the joint was tubercnlous, however, 
the ends of the joints so far as they were diflnofted had 
to be resected, and now the question arose whether the 
resection was to be typical or partial. Some operators 
preferred total r e s ect ion in adults, but in children 
arthrotomy, so as to avoid arrest of growth. In a 
patient, et. 31, typical resection was performed twenty- 
eight years ago, and when tiie arm was hanging loosely 
but little shortening appeared. Both humeri were of 
the same length. Ollier had observed an increased 
growth of the humerus after resection. The ulna also 
was highly developed. The case showed that even for 
children total resection might have its advanti^ies over 
arthrotomy. The functions of ^e arm were good 
flexion and extension were performed over a normal 
area and with normal power, and the patient'was able 
for all her work. 

In a case mentioned by v. Eiselsbrag of a girl, set. 17 
with double anchylosis of the elbows, a good result was 
obtained in the left elbow, but bony anchylosis still con- 
tinned in the right. 


JluBtria. 

[fBOV OUa OWN OOaUSPONDBKT.] 

VtxssA, Jons 2Sth, 1901. 

SuiciDAi, ErroBTs. 

At the meeting of the Prague Medical Association 
many interesting and important subjects were discussed 
and cases exhibited. Among the latter was a shoemaker, 
et. 46, who had mutilated with a trimming 

knife 12 cm. long a 4*7 inches. There was one long 
cut across the mamma, a stab in the seventh left inter¬ 
costal space passing through pleura and diaphragm 
causing pneumothorax; another out 1*6 centimetres 
below riba into the stomach at the fundus, the contents 
of stomach passing into peritoneum when admitted; 
and, lastly, a wide opening across the abdomen through 
which protruded four metres of intestine, omentum, and 
mesentery, covered beyond recognition with straw, pitch, 
dirt. Ac. 

The stomach was first stitched, the omentum re¬ 
sected, the bowel replaced, the whole abdomen washed 
out, and proper drainage provided for by gauze stripe. 

On the third day post-operation symptoms appeared 
in the form of circumscribed peritonitis. The abdomen 
was ^ain opened and an abscess discha^^; the 
abdomen was allowed to remain open for twenty days, 
when granulation became generaL Six weeks later a 


.Tult 3, 1901. 

plastic operation was performed that healed in fonrtemi 
days. 

Bxcovnr fbox Intussubcxption. 

Jedlicka demonstrated a case where intussusception 
assumed a peculiar form of recovery. On many occasions 
the patient had suffered from fits of constipation and 
obstruction of the boweL In one of these attacks 
a metre of the bowel came away, which gave r^ef. 
Four years later an abscess formed in the abdomen, 
which was opened, but owing to the subsequent stenosis 
laparotomy was performed, when the bowel was found 
to be invaginated. This had been perforated in a 
peculiar manner through the mesentery and not through 
the intussusoepted bowel as might be expected. One of 
the convolutions was greatly dilated and was resected. 
Inside the part removed was found a stercoral abscess. 

Babb Fobh or Stbictubx. 

Jedlicka brought forward another female on whom he 
had operated for volvulus with supposed strangulation. 

On the second occasion there was strangulation, with 
an adherent tumour on the appendix, which extended 
as a peritoneal band to the sigmoid flexure. In the 
third operarion, which was within three weeks after the 
second on account of obstruction, a recent adhesive 
peritonitis had occurred. Becovery took place after 
jejuno-oolotomy was performed. 

Cardiac Tubbbculosis. 

Hlava showed a pathological preparation taken from 
a young man, set 85. The myocardium of the right 
axuriole was greatly enlarged, while the esrdia was filled 
with a mass of tuberculous nodules, with caseous masses 
in the walls and peiicardium, while the lymphatic 
glands were greatly enlarged. 

©perathig theatres. 

ST. THOMAS'S HOSPITAL. 

Cholbdochotokt. —Mr. Battle operated on a woman, 
set. 36, who was suffering from painful attacks in the 
region of the gall-bladder. She bad been under his 
care at the hospital two years before for a movable right 
kidney, and the operation for this condition had been 
very snooessful. It was principally undertaken for 
pain, and as she had obtained relief from that pain, 
she came to see if something could not be done for her 
present illness. For a month or two at intervals she 
had had severe attacks of pain, oommenoiog in the liver 
region, so intense that she had been doubled up with 
them and vomited, whilst on one or two occasions she 
thought that there had been some “ yellowness of the 
eyes " afterwards. Examination of the hepatic region 
showed nothing abnormal. She was kept in the hospital 
under observation for a fortnight, during which time 
she was permitted to get up and walk about, but no 
pain was oomplrined of. At the end of this time 
she was so anxious to have something done that it was 
decided to explore, on the possibility of there being a 
i gall-stone present to account for her symptoms. At the 
operation an inmsion was carried through the rectus 
muscle over the position of the gall-bladder, and 
this last was examined: it was small, about the 
size of the end of the thumb, and contained 
some inspssiated bile near its fundus, but no definite 
ctdoulus. Four inches from the surface, however. 

Digitized by -ooglc 


JCLT 3. 1901. 


THE OPERA.TING THEATRES. 


Thv Ubdical Pkxbs. 15 


• naall stone could be felt, blocking tbe 
ejstio duct, and it seemed probable that this was the 
cause of her symptoms, the gall-bladder and duct 
behind it being abnormally thickened. The lower 
aspect of the gall-bladder and duct was attached to the 
large iotestiae and omentum by a fold of peritoneum, 
possibly the result of some old inflammatory attack, and 
tbe stone oonld be fdt with the finger on either side of 
this. The resident assistant^nrgeon, Mr. Comer, 
held tile stone between two forefingers and 
pro a no d it forwards and to the right so that it came 
within reasonable distanoe and oonld be removed. 
An inmaion was made over this, and it escaped through 
tbe opening time made, a small quantity of bile which 
followed it being received on the ganze with which the 
tna of opersktion was packed. The duct was steadied 
in the same position by Mr. Comer until it bad been 
sntnred, Lembsrf s sutures being inserted. The wall of ' 
the cystic dnot was vary hard, as well as thickened. 
Before tiie stone was out down upon an attempt was 
made to move it towards the gall-bladder, but it could 
not be shifted. The oaloulns was abont the 
sue of a horse bean and rounded in shape; it 
presented no facets. The wound was closed fully, 
no drainage being employed. Mr. Battle remarked 
that it was evident this stone was the only one, 
and as its impaction in the cystic dnct was quite 
capable of causing symptoms, it was fair to presume 
that the operation would fully effect its object. The 
attacks of which the patient complained were typical of 
gall-stone colic, but the poeition of the stone oonld not 
be exactly ascertained beoaose the question as to 
jsondioe was donbtfally answered. The cessation of the 
pain whilst in the hospital was, he thought, probably 
the result of tbe rest and regular dieting, therefore it 
was posaible to make definite observation whilst she was 
waiting. 

GREAT NORTHERN HOSPITAL. 

SaaooJiA. OP Os Calcis (^eontinuation cau on 
p. 612, Jnne 6th, 1901).—Mr. Pstton Bxalb operated 
on the same man from whom he had previously re 
moved a myeloid sarcoma occnpying the whole of the 
inten(w of the os calcis. At the previous operation be 
wu unable to do more than scoop oat the growth. The 
latter reonrred within three weeks, and having r^ard 
to the feet that it was limited entirely to, and 
had replaced the cancellous tissue in, the os calcis, and 
that it was a myeloid sarcoma, and therefore not likely 
to exceed ite present limits, it was thought desirable to 
remove only the entire os calcis. A vertical inoieion was 
made over the heel extending upwards abont three 
inches, and for the same distance along the sole: the 
sttsohmentof the tendc^Achillis wai divided and the peri- 
osteom with attached ligaments separated as far as pos¬ 
sible from the bone; tbe posterior half of tbe os calcis was 
thenrsmovedandthecalonneo-astiagaloidligamencibeing 
next severed, the upper articular sorface together with 
the cartilage, which was qnite normal, was taken away ; 
then the anterior snrfsoe articulating with the cuboid 
•ns separated from the latter bone by dividing and 
stripping off the oaloaneo-cnboid ligamente. Tbos the 
whole of the os calcis was removed. The cavity was 
then well washed out, the raggel ends of tbe ligaments 
were cut off, and the tendo-Achillis was satnred to the 
plantar fascia by memu of strong oatgnt Tbe wonnd 


was finally oloeed with the exception of about one inch 
below, and throngh this the large cavity was stnffod with 
cyanide ganze. Mr. Beale said that this operation 
appeared to him to be adequate, beoanse the growth 
had not extended throngh the compact bone of the os 
calcis at any point, moreover the cartilaginons artionlar 
surfaces were perfectly normal. It had been said that in 
a case of myeloid sarcoma it was only necessary to remove 
the growth itself, that is the actoal cancellons bone, 
and, in the case of a long bone, tbe ooutents of tbe 
mednllary cavity, bnt Mr. Beale had seen many oases in 
which proceedings of this kind had been carried out 
even with the sabsequent application of pare carbolic or 
strong chloride of zinc solution, and yet the growth had re¬ 
curred ; he|believed, therefore, the right course to adopt in 
cases of myeloid sarcoma was to remove the whole of the 
bone in which the growth was in contact, after having 
carefully stripped off the periostenm, by this means 
farther r^urrenoe was always avoided ; moreover it en¬ 
sured the formation of more or less new bone to take the 
place of that which had been removed. 


BseZSTKKBD FOR riAMSlUSSlOX A.BS 01 D. 

'^Ehe fxtss anb dKratlar. 

Pnblitked vnry Wedamdsy morning, Pnoe 6d. Post free, Bid. 


AOTSBTIBEimrTS. 

PoR On IwsBRTio* i—Whole Pice. £5 Os. Od. | Hilf Pife, 
£3 lOi. Od.! Qoirtar Plfe, £l Be.; Ono eiflith, ISs. 6d. 

PoR A SsBisB or l«BSRTio«B t—Whole Pice, thirteen ineertione 
(weekly, fortnichtly, or monthly), it £8 10s. Od. ( twenty.stx 
insertions (weekly or fortnichtly) it £8 Ss. Od.; flfty-two 
ineertions (weekly) it £8 enoh. Hslf Pice, thirteen insertions 
st SSs. I twenty.slx it 88s.: fifty-two Insertions it 80 b. enoh i 
()nsrter-psce. thirteen Insertions it 18 b. twentj^ix insertions 
st IBs.; fifty-two insertions st IBs esch. 

BmiU innonnoamsnts of Prsetioes, , Books, 

|[ 0 .—Seven Unee or under, 4s. per insertion; Bd. per line 
beyond. 


^he anb Circular. 


8ALD8 POPULI SUPRSMA LBX.” 


WEDNESDAY, JULY 3, 1901. 


STATISTICAL FALLACIES IN REGARD TO 
LUNACY. 

The statistics of insanity, though at first eight 
somewhat arid reading, are, in reality, replete with 
interest. From them can be extracted without much 
trouble a number of conclusions which throw an 
interesting if often fallacious light on the cansation 
and ino'dence of mental disorder. Statistics are 
notoriously susceptible to skilled manipulation, and 
are even more apt to mislead when made use of by 
the unwary or hasty. Let ns consider, for instance, 
the influence of celibacy as a cause, or shall we say, 
as a predisposing factor in the cansation, of insanity. 
We find on looking through the Bethlem Hospital 
returns for last year that out of a grand total of 228 
persons of both sexes suffering from some form of 
mental disease, 130 were single and only 83 
married. These figures, taken alone, would 

Digitized by ,ooge 



16 Th> Mxdical Prbss. 


LE4DING AETIOLES. 


Jolt 3, 1901. 


appear to jostiff the assumption that celibates are 
more prone to mental disturbance than the married, 
bnt, as we shall show, the difference in the incidence 
is more apparent than real. Taking the total number 
of admissions we find that they comprised 142 
females and 84 males. Of these, there were ninety- 
four single women and only thirty>8ix single men, 
whereas, among the married, the proportions were 
forty-three males and only forty females. Of the 
patients who remained under treatment thirty-four 
married men almost balanced thirty-one married 
women. One obvious conclusion from these returns . 
is that celibacy in the female is a more potent factor 
in the determination of insanity than it is among 
males. Bnt is the comparison a just one ? Celibacy 
in the female, we may take it, really implies approxi¬ 
mate chastity, whereas in men we doubt if that can 
safely be advanced. The male celibate probably 
indulges his sexual appetite less frequently than his 
married brother, and presumably only goes astray at 
intervals, in deference to physiological stimulation. 
For the purpose of our argument we will assume 
that we are dealing only with persons who are pre¬ 
disposed by heredity or defective general health to 
some form of mental breakdown, and such subjects 
are, from this point of view, better off single than 
married, because in the latter state there is always the 
possibility of excessive sexual indulgence, plus the 
added senseof responsibility associated with the main¬ 
tenance of a family. On theother hand, there are many 
reasons why the single state should weigh more 
heavily upon the unmarried female than upon the 
bachelor. The absence of physical and mental ex¬ 
citement, within healthy limits, in the life of the old 
maid, her naturally emotional temperament, ex¬ 
asperated by greater amenability to religious and 
other sources of psychical disturbance, render those 
already predisposed thereto exceptionally prone to 
disturbance of mental equilibrium. The influence of 
religious belief in respect of the incidence of insanity 
is another point which is of interest, though the 
statistics are subject to so many sources of fallacy as 
to be valueless from a scientific point of view; 
moreover, whatever the conclusion one may draw 
from the figures, it is always open to the 
critic to object that the religious factor was the re¬ 
sult, and not in any sense the cause, of the break¬ 
down. Of the 226 patients already referred to, 155 
were registered as members of the Church of England 
as against thirteen Baptists and Roman Catholics 
respectively. We need not insist upon the incon- 
clusivene^ of any deduction establishing a special 
proneness to insanity among the members of a par¬ 
ticular church. Nor are the returns of the “ cured ” 
more trustworthy from a statistical point of view. 
Of the 155 members of the Church of England only 
sixty-two were discharged during the year as “ cured,” 
and of eight Wesleyaus none recovered their mental 
equilibrium. There do not seem to have been any 
agnostics or freethinkers, unless we accept the entry 
of nil in two instances as evidence of an absence of 
religious belief. 


SYPHILIS AND GENERAL PARALYSIS. 

Thb etiology of general paralysis remains obscure 
in spite of the great advances that have characterised 
recent scientific knowledge of disASSAW of the 
nervous system. The malady has been recognised 
only within the limits of the last hundred years, 
and so far as can be gathered from the experience 
of experts it has of late increased rapidly in inci¬ 
dence. Possibly, however, that conclusion may be 
to some extent attributable to improved diagnosis, 
but after making allowance for a margin of error in 
that direction, there is no doubt that a greater pro¬ 
portion of patients suffering from general paralysis 
are now admitted into lunatic asylums, and that 
the tendency has been for the disease to develop at 
an earlier age-period, so as even to include childhood. 
From whatever point of view we regard the con¬ 
dition, its progressive nature in spite of treatment 
renders its study one of the most important within 
the range of modem medicine. For that mutter 
general paralysis may be ranked with cancer and 
mycosis fungoides as members of the happily 
diminishing group of the incurable and deadly ilk 
that affect mankind. We know that it is definitely 
connected with certain predisposing conditions, such 
as a neurotic family history, injuries to the head, 
dissipation, mental worry, alcoholism, sexual indnl- 
gence, and other exhausting influences, but above 
all, syphilis. The conviction of the importance of 
syphilis as a causative factor in general paralysis 
has grown stronger and stronger, although it must 
be admitted that there are still missing links in the 
chain of complete proof. Statistics on the subject 
must necessarily be received with caution, for as 
every medical man knows, it is often extremely 
difficult to get a history of syphilis, direct or in¬ 
direct, in many undoubtedly syphilitic manifesta¬ 
tions. However, it may be broadly stated that the 
brunt of general paralysis falls upon men rather 
than women, upon soldiers rather than upon priests 
and women of the better classes and upon the popu¬ 
lation of cities rather than of the country. In other 
words, the malady is found most prevalent where 
there is the greatest amount of syphilis. The method 
of the action of the syphilitic taint upon the 
brain is unknown, although it is possibly or 
probably to a great extent due to vascular affections 
leading to chronic inflammation and disturbance of 
nutrition. A similar want of precise knowledge 
must be pleaded with regard to locomotor ataxy, in 
which syphilis is now generally regarded as a common 
if not exclusive cause. In both diseases of the 
nervous system there must be some localising condi¬ 
tions, inasmuch as many persons suffer from syphilis 
whereas comparatively few develop either general 
paralysis or locomotor ataxy. In this way we are 
once again faced with the wisdom of the homely 
proverb which teaches us that prevention is better 
than cure. Do away with syphilis and you do away 
with the two disastrous and iocurable nerve 
maladies in question. So far as syphilis is 
concerned a good deal of adavnoe has been 
l^niTized I 



Jttlt 8, 1901. UOTBS OU OUBiBENT TOPICS. Th* Midical Puss. 17 


made in the ecientifio treatment of the dis¬ 
ease, bnt a great deal remains to be done bj 
way of social reform. The Contagions Diseases 
Act was nndonbtedly a step in the right direction. 
The scientific sanitarian may confidently look for¬ 
ward to the time when syphilis will not be sown 
broadcast among oar population in obedience to the 
prudery and prejndices of a set of worthy but mis 
goided sentimentalists. 


ABDOMINAL PAIN IN TYPHOID FEVER. 

Thb significance of pain in typhoid is known to 
all clinicians. But the difficulty of defining the 
thing signified by the pain has been so appreciated 
by writers that practically no attempt has been 
made by writers on typhoid fever to attempt a 
differmitiation of its many varieties and meanings. 
Louis’ *‘]ieeherehe$ fur la maladie conttue sous le 
nom de gaalro'enterite,’* found it difficult to dis¬ 
tinguish between pain in typhoid that told of 
impending death and simple flatus. Jenner was not 
more successful, and even the classic work of 
Murchison and the great monc^irraph of Liebermeister 
make no attempt to guide the student in 
the interpretation of this frequent symptom 
of this very common disease. Within the past few 
weeks it has been seriously proposed to open the 
abdomen, and if necessary the intestines, and seek 
the cause. Indeed, as a writer has proposed, in 
cases of pronounced meteorism an incision into 
the head of the colon and washing it out would 
he a perfectly justifiable operation. Tympanites 
cannot, however, account for more than a small 
percentage of cases in which pain is a marked sym¬ 
ptom, and even with the aid of the surgeon, the cause 
will remain unknown in many cases. This is in 
part, at all events, due to the fact that the 
alimentary canal is so richly supplied by the 
sympathetic nervous system, of the physiology of 
which there is still much to be learned. The whole 
quesUon has been very ably dealt with by Dr. Thomas 
McCrae (New York Med. Jour.) who urges that “ It 
is not necessary to establish the importance of an 
accurate knowledge of this system.” As the author 
says, the question of the cause of pain may arise 
quite suddenly, and may be associated with other 
symptoms of a deceptive character, which so mask 
the symptom of pain that a perforation may be unde¬ 
tected and a life lost that prompt surgical interfer¬ 
ence might have saved. From the record of 
some five hundred cases of typhoid in the 
Johns Hopkins Hospital, he found that pain 
occurred during the course of the attack in 
32 per cent, of the cases; of these the pain was 
due in some cases to conditions apart from any 
special lesion of the disease: hysteria, lung con¬ 
ations, bladder, abortion, labour, and menstruation. 
In another group of cases the pain was due to con¬ 
ditions of the gastro-intestinal tract apart from com¬ 
plications : vomiting, constipation, diarrhosa. Besides 
these the symptoms were found in abdominal condi¬ 
tions apart from specific bowel lesions: appendicitis, 


peritonitis, cholecystitis, liver abscess, painful spleen, 
phlebitis. The specific intestinal complications asso¬ 
ciated with pain were hemorrhage and perforation. 
And in other cases no discoverable cause was found. 
The physician is fortunate when hemorrhage and 
perforation give rise to pain, and when his patient 
possesses sufficient consciousness to tell of its 
presence. Of thirteen oases of perforation the 
author found the lesion to be attended with a definite 
sudden onset of pain in two of them; but in three 
cases the pain was complained of some days before 
the perforation. Considering the gravity of the 
symptom all nurses should be instructed to imme¬ 
diately summon the medical attendant in all cases 
of abdominal pain. And we think that in serious 
cases of typhoid opiates, as likely to mask pain, are 
to be avoided. 


Jlotcs oit (Eurnnt ^xrpicB. 

The Beoig^anisation of the Army Medical 
Service. 

A ” COMMITTEE of experts ’’has been nominated for 
the purpose of considering a scheme which Mr. 
Brodrick has drawn up for the future organisation 
of the Army Medical Service. This committee com¬ 
prises the names of Mr. Howard H. Tooth, M.D., 
F.R.C.P., St. Bartholomew’s Hospital; Mr. George 
H. Makins, F.R.C.S., St. Thomas’s Hospital; Mr. 
Alfred D. Fripp, C.B., F.R.C.S., Guy’s Hospital; Sir 
F. Treves, K.C.V.O., C.B., F.R.C.S, Ijondon Hos¬ 
pital; Mr. Alexander Ogston, M.D., Scotland; 
Lieutenant-Colonel Keogh, M.D., C.B., R.A.M.C., 
Ireland; Mr. B. C. Perry, M.D., F.R.C.P., Senate of 
London University; Surgeon* General Hooper, C.S.I., 
President of the Medici Board, India Office ; and 
two officers who will be named by the Commander- 
in-Cbief to represent the Army, The secretary will 
be Major H. E. R. James, R.A.M.C., and the chair 
will be taken by Mr. Brodrick himself. These names 
convey an assurance that the purely medical aspect 
of the service will receive due attention, though 
xmtil we are in possession of the actual terms 
and scope of the reference it is impossible to 
gauge the precise significance of this important step. 
Some objection has been taken to the inclusion of Sir 
Frederick Treves, but we hold, on the contrary, that 
his experience will be of the greatest value, for he is 
as alive as anyone to the requirements of the service. 
It is doubtful whether the committee will be enabled 
to report before the end of the present session of 
Parliament, but, as Mr. Brodrick aptly observed, it 
is much more impoi*tant that they should come to a 
correct conclusion than that they should be hurried 
in the performance of the duty assigned to them. 
On the other hand, the subject is one which has been 
exhaustively discussed for many years past, and the 
general lines on which reform will have to be carried 
out are pretty well agreed upon—a higher status, 
more liberal remuneration, and more considerate 
treatment at the hands of those in power. It need 
certainly not take long for the committee to formulate 
D:q:::zed : 




NOTES ON OUERENT TOPICS. 


18 Thb Mbdical pRses. 


July 8, 1901* 


its co&cluBioQs, but it may take Kr. Brodrick some 
time to bring these concloaions to a practical issue. 
We are justified in hoping that this great question 
vill now be dealt with on a statesmanlike basis, and 
that the future Army Medical Service will be placed 
on a footing worthy alike of its members and of the 
• interests confided to their charge. 


The Treatment of Paralysis Agitans. 

In a former number we noted an additional method 
of diagnosing the onset of paralysis agitans, and now 
it is of interest to find a contribution on the sym¬ 
ptoms and treatment of this dieease by Dr. B. L. 
Williamson in a recent copy of the Manchester 
Medical Chronicle. Recognising that in the light 
of our present knowledge there is no treatment 
which can cure or even permanently arrest the pro¬ 
gress of the disease, he has devoted a considerable 
portion of his article to a consideration of certain 
measures he has tried for the relief of the more 
troublesome symptoms. He strongly recommends 
that a patient sbouldremain in the open air as much 
as possible, and has found that driving in an open 
carriage, in some cases, produces a temporary 
cessation of the tremor. He has tried a 
latge number of drugs, but has foimd all of them 
practically useless with the exception of hyoscine, 
hydrobromate, duboisine sulphate, and hyoscyamine 
which he believes are of decided value. In using the 
first of these drugs he suggests that the initial dose 
should not exceed gr. dissolved in 3ij of chloro¬ 
form water. The quantity may be increased gradu¬ 
ally up to xhs ^ some cases, when no toxic 

symptoms have appeared, he has given as much 
as 7 ^ gr. or •jiy gr. by the mouth. Dr. Williamson 
always uses Merck's hyoscine hydrobomate, obtained 
directly from Darmstadt. If hyoscine fails to relieve 
the tremor he suggests a trial of duboisine sulphate 
by the mouth) or by hyoxyamine sulphate 
gr.), but as a rule these are not so efficacious as 
hyoscine hydrobromate. 

Dysbasis Intermittens Angiosclerotica. 

Thbbn are not wanting in literature instances of 
persons, generally past middle life, who complain of 
being unable to walk more than a short distance by 
reason of what they describe as “ cramp in the legs.' 
That remarkable clinical observer, Charcot, thought 
that the condition was practically one of sclerosis of 
the arteries of the lower extremities, and the con¬ 
dition appears to be associated with vascular spasm. 
The usual history in these cases is that after a short 
period of repose the sufferer is able to resume his 
promenade. Putnam {Boston Medical and Surgical 
Journal, February 2l8t, 1901) has just published 
the details of an extremely interesting example 
of this affection, called by some intermittent 
claudication, and sometimes referred to as in¬ 
termittent lameness. The name which Putnam 
applies to this symptom-complex, “ dysbasia 
intermittens angiosclerotica,” though somewhat un¬ 
wieldy for general use, certainly indicates very 


accurately the peculiar difficulty experienced in 
walking, the intermittent character of the attack, 
and the pathological relation of the disorder. In 
this curious malady it has been found that the thera¬ 
peutic use of electricity and baths has not been 
followed by any beneficial effect, and in the case 
quoted it is worthy of note that upon the patient, of 
his own initiative, taking to kneading his calves 
every night and morning marked improvement fol¬ 
lowed. 


Quinine Idiosyncraay. 

Idiostnckasies have long been known and recog* 
nised. Montaigne refers to them, as do Aaiatus, 
Lusitanus, and Spigelius, and many other authors, 
but they one and all looked on them as curiosities of 
medical experience until M. Lorry published his 
“ Tractatus de Morbis Outan^e ” in 1777. The great 
importance of recognising rashes due to idiosyn¬ 
crasies came in time to be recognised, and under 
the title " Antipathies ” Milligan and other writers 
collected numerous examples. But until Prince 
A. Morrow's great monograph, “ Drug Eruptions,” 
few medical men had any idea that drug rashes so 
closely simulated the exanthemata. Among the 
more generally used drugs Dr. Morrow (^ves a for¬ 
midable list of the eruptions that follow from the 
use of quinine, from the well-known pamphlet of 
Jean Baptiste Chevallier (1835) up to 1877. He has 
shown that in the majority of cases the rashes 
assumed a scarlatinoid, or, as more modern writers 
might say, “a fourth exanthem ” form, “ followed by 
desquamation of a brannyor lamellar character,” and 
of course liable to be mistaken for scarlatina^ 
particularly as the tonsils are not infrequently 
inflamed, and the temperature rises to 102° F., and in 
some cases was as high as 104° F. or even 105° F. 
Of recent cases the most interesting aie those g iven 
by Dr. H. A. Hare {Therapeutic Gazette) :—“ A man 
fifty-three years of age, was ordered a pill containing 
about one-sixtieth of a grain of arsenious acid and 
two grains of quinine three times a day as a tonic 
during convalescence from a severe illness. Within 
twelve hoitrs of the administration of the first pill he 
developed an intense erythematous rash all over his 
body, with intense itching and puffiness of the skin 
about the face. At the end of five days with the 
subsidence of the acute injection of the skin, marked 
desquamation took place O'^er all portions of the body 
with the same freedom as is frequently seen in severe 
scarlet fever, and six weeks afterwards the skin on 
the palms of his hands and the soles of his feet was 
still actively desquamating. No sooner had the 
symptoms appeared than the patient asked if he 
were receiving quinine, and on being told that he was 
getting the drug, he immediately recognised the 
cause of his difficulty, stating that be always had a 
similar affection when this drug was administered, 
even when it was givmi in remarkably small quanti¬ 
ties.” For this patient’s daughter, a woman of twenty 
years of age. Dr. Hare prescribed a pill of iron, arsenic, 
and quinine, and she, too, developed ” a general rose 
Dinirized: 


JtTLT 8, 1901. 


NOTES ON CUBBENT TOPICS. 


Tbb Medical Pbbss. 19 


raab all orer her body,” which was followed hy an 
actire deeqnamation of the palms of the hands and 
soles of the feet. Where a quinine idioBjnorasy 
exists eren the topical application of the alkaloid 
will produce an eruption. Delioux de Sarignac 
reports a case in which the application of a pomade 
containing quinine produced intense pruritus and an 
eruption of lichen. As quinine has now practically 
become a domestic remedy, it is well in all suspicious 
cases to inquire if the patient with an ill-defined rash 
has been taking the dmg. 

Sponges in Abdominal Wounds. 

In the case of a surgeon who was sued for mal¬ 
practice, because the head-nurse of a hospital who 
was personally in charge of the sponges at an 
abdominal operation foigot that one had not been 
remored before the wound was closed, a verdict was 
given acquitting the surgeon of blame, but the matter 
has aroused further interest because it is now sought 
to prove that the hospital employing the curse is 
responsible. He would be a rash man who counted 
upon the Law Courts acquitting a surgeon who was 
aware that a nurse assisting at an operation was in 
any way careless, but it certainly would be manifestly 
unfair to hold an operator responsible for the acts of 
a duly qualified nurse on the ground that she was 
technically the surgeon’s agent. A new terror will 
be added to the life of a hospital surgeon if he is to 
be held accountable for whatever may happen to his 
patients in consequence of the shortcomings of the 
nurses on whom he must depend in bis work. 

Cabmen and Street Accidents. 

A FEW days ago a well-known actress found lying 
in the street a child who had been crushed by a 
grating. She h^ed a cabman, whose first question 
was not unnaturally who was to pay him his fare for 
taking the child to a hospital. The point being 
settled, the little sufferer was removed to the desired 
haven of safety after a delay of four or five minutes 
due to the discussion about payment. In a subse¬ 
quent interview published by a London newspaper 
the lady in question raised the point as to the 
duties of cabmen in case of accidents. Clearly 
enough there is no law that can compel the 
driver of a cab to carry persons gratuitously, 
no matter what their physical extremity may 
be. That fact occasionally leads to exhibitions 
of callousness in the streets of London that 
would be worthy of Chiuese cruelty in its most 
cynical form. A man may be picked up writhing and 
half dead after being run over by an omnibus or 
other vehicle, and the first question asked him by 
the bystanders is probably whether he has any 
mon^ to pay for a cab. The police are empowered 
to carry off in a cab any person who is ill or 
has met with an accident in the streets. The hos¬ 
pitals certainly do not pay for cabs that bring 
patients to their doors. From the point of view of 
the cabman, there is much to be said against his 
being made the vehicle of compulsoiy charity. As 


a rule he has hard work to make both ends meet, 
and his employer would make no allowance for time 
tpent in carrying disabled persons from one place 
to another. Again, the cabman is answerable for 
any damage done to his cab, and he would be liable 
to any amount of mischief from persons picked up 
in the street. Some years ago when a woman jumped 
from the suspension bridge at Clifton and fell in the 
mud a cabman passing by refused to take her to the 
hospital because of the damage the mud with which 
the unfortunate woman was covered would do to his 
cushions. The best plan would be for the hospitals 
to pay fares in all clearly suitable cases. The public 
would certainly not grudge the money spent for so 
necessaiy a purpose. 

The Leper Mission. 

It would be not easy to imagine any mission 
framed upon a more absolutely ideal Christian basis 
than that which has been organised to the lepers of 
India. It is to be feared that the extent to which 
that loathsome disease prevails in our great Eastern 
dependency is not generally recognised by the domi¬ 
nant nation here at home. In 1898 the Indian 
Government passed an Act providing for the segre¬ 
gation of mendicant lepers, and forbidding lepers to 
handle food or to carry on trades dangerous to the 
community. It has recently been resolved to en¬ 
force that measure in Bengal, presumably as an 
experiment to test the feeling of the native popula¬ 
tion. In Nepaul it has been stated that a person 
found to be suffering from leprosy is sometimes 
buried alive by the Brahmins, and in Sumatra at 
times the relatives of a leper bum him to death 
in his house, pushing him back into the flames 
should be attempt to escape. The mission does not 
confine its energies to India, but does good work 
also in China and Japan. It has no less than six¬ 
teen centres of work, and supports twenty-seven 
asylums or settlements, and in this way does its best 
to care for about a million lepers said to exist in the 
countries above mentioned. In India the housing 
and food of an adult leper can be provided at the 
modest rate of £5 a year. As a preventible disease 
leprosy be banished from the face of the earth 
by the strenuous application of modem preventive 
science. Unhappily, it seems likely to linger for 
generations in India, which under present conditions 
is the favoured home of cholera, enteric fever, 
plague, and other specific scourges of mankind. 

Beauty Making. 

The desire for beauty on the part of the female is 
one of the most deeply-rooted characteristics of the 
human race. That it is answerable for a vast amount 
of folly and frippety goes without saying. Unfor¬ 
tunately the door is thrown open thereby for the 
host of harpies who batten upon the foibles and 
weaknesses of mankind. In this way abound 
myriad sx>ecialists in baldness, in the destraction 
of superfluous hair, in the removal of fat, wrinkles, 
freckles, moles and blemishes of all and snn&y 
Digitized by ‘C 'C 


20 Thb Mxcical Pebss. 


NOTBS ON CURRENT TOPICR 


JULT 8, 1901. 


kinds. To a certain extent the treatment of many 
facial defects, such as an everted eyelid or a die* 
filling birthmark or scar falls within the limits of 
legitimate surgery. But the value of such pro* 
cedures is ascertainable upon a moderate and well* 
defined basis. The claims of the quack, on the other 
hand, are boundless, and would be ridiculous to any 
but a woman whose judgment was swamped by an 
overwhelming desire for sexual attractiveness. A 
New York lady, so it is announced in the Daily 
Exprt$8, has brought an action for £12,000 damages 
against some operators who undertook to restore the 
youthful contour of her face, to make a dimple in her 
chin, to raise the drooping eyelids, to draw back the 
skin and make it smooth on the forehead, to redden 
her lips, and straighten and point her nose. It will not 
surprise any practical surgeon to learn that a series of 
operations to fulfil that extremely lat^ order resulted 
in making the lady plainer than ever, with the addition 
of numerous scars. It is to be hoped that the pub* 
lication of this distressing case will stay, for a time, 
at any rate, the hand of the professional beauty 
maker. 


Instruction in the Use of Ansesthetics. 

These are rumours that instruction in the 
administration of anaesthetics is soon to be in¬ 
cluded in the curriculum, and one’s feeling 
must be that of mild surprise that this im¬ 
portant detail should hitherto have escaped adequate 
treatment. The difficulty in the way of ascer¬ 
taining the practical knowledge of the candidate in 
this direction does not account for the fact that no 
questions are usually set on the subject. We do not 
hesitate to affirm that a certain proportion of the 
deaths from anmsthetic narcosis which it is our 
melancholy duty to chronicle from week to week are 
more or less attributable to the fact that practitioners 
have, for the most part, to learn to give chloroform 
as best they can in actual practice. The 
basis of such teaching will of course be an 
intimate knowledge of the physiological effects 
of anesthetics in large and small doses, but 
the various methods of aidministration must 
alco be taught, and every candidate should be 
required to show that he is familiar with the use of 
some kind of regulating apparaius. The reluctance 
of most practitioners to employ any apparatus is, we 
believe, largely the result of their ignorance of its use, 
yet in this direction, in all probability, lies the secret 
of safety in ansesth^ia. No apparatus yet devised 
can avert risk in the hands of the careless and 
inexperienced, just as no measure, however accu¬ 
rately graduated, is of itself an obstacle to a poisonous 
dose of a drug being dispensed. On the other hand, 
death under chloroform when such an apparatus is 
resorted to, is the rarest of occurrences and 
almost without exception those which it falls to 
our lot to record, have followed the old-fashioned 
practice of pouring the drug on to a towel or mask. 
Apart from the risk of inducing fatal narcosis, im- 
p^ect aneesthesia militates against the success of 


the surgeon, who is seriously handicapped when, in 
addition to the problems requiring his immediate 
attention, he is hampered by difficulties of this kind. 
No doubt when the subject comes up for considera¬ 
tion before the General Medical Council a sufficiently 
comprehensive schedule will be devised, and a notable 
lapsus in medical training will thus be remedied. 

Triohinosis. 

A CEBTAIN Professor Joseph Leidy, about fifty 
years ago, in cutting a slice of cold ham to make a 
sandwich, noticed a number of little specks, and, as 
the Journal of the American Medical Associaiion puts 
it, the fact that Leidy’s scientific curiosity got the 
better of his appetite gave rise to a special occupa¬ 
tion which now gives employment to over 50,000 
persons, which resulted in the prohibition of Ameri¬ 
can pork into Germany for a period of nine years, 
entmled on American exporters a financial loss 
estimated at millions of dollars, saved hundreds 
of human beings from disease and death, 
inaugurated an elaboiate system of public 
hygiene, and gave a mighty impulse to the study of 
the etiology of disease. It is a curious fact that 
during the exclusion of American pork from 
Germany there was an annual average in that 
country of 454 cases of trichinosis, but since the re¬ 
admission of American pork in 1892 the annual 
average has only been 149. In the opinion of so great 
an authority as C. W. Stiles, the total prohibition of 
German pork in Germany and the compulsory use 
of American pork would probably do more to 
eradicate triohinosis than does their elaborate system 
of microscopic examination. In Germany there is a 
widespread custom of eating raw pork, and a feeling 
of false security is fostered by reason of the Govern¬ 
ment employing an enormous number of trained 
observers to microscopically inspect the commodity. 
It would be wiser to educate the consumers so that 
they would of themselves abstain from partaking of 
pork that was not thoroughly cooked or cured. Out¬ 
breaks of the disease in this country have brought 
the subject of trichinosis into prominence, and the 
recent address of C. "W. Stiles before the Phila¬ 
delphia Pathological Society, published in Yoiume 
IV. of their “ Proceedings,” should receive the very 
closest attention of all who are interested in the 
public welfare. 

Gold Blindness. 

Htpebmetkopic members of the dental profession 
who are also astigmatic are in some cases liable to 
lose the power of distinguishing gold-filling from the 
tooth on which they are working. This form of 
retinal asthenopia appears to be due to abnormally 
rapid exhaustion of the visual power, and the trouble 
is noticed to occur when the eyes have been kept 
fixed upon a small gold stopping for a length of 
time, the warm yellow colour of the metal tending 
to exaggerate the preexisting defect. In addition to 
inability to distinguish the filling from the tooth 
dentists who present this defect cannot recognise 

Digiiized by Google 



July 8, :001. 


NOTES ON CURRENT TOPICS. 


Ths Hbdical Pbbbb. 21 


clearly ttie oontoor of the hole they are stopping. 
In the Canacftan PraetUioner for June it is 
pointed out that age does not pre^spoee to this 
affe ct ion nor does youth exclude it. The primary 
cause of this parricular form of bhndness 
indeed is probably the excess of yellow rays 
from the gold metal. After a few days* rest the 
sufferer is enabled to resume work as before, but re¬ 
currence frequently takes plaoe, and the intervals 
during which work can be carried on become shorter 
and shorter. The treatment suggested by Hr. L. 
Webster Fox is, first to correct any error of refrac¬ 
tion, to examine carefully into the general health of 
the patient, and to advise that nothing tight be worn 
round the neck. The last direction is necessary in 
consequence of so much dental work having to be 
done with the bead bent. The inteose white light 
wbi<di accompanies the fusing of gold plates con¬ 
tains an excess of yellow rays, and it is BU{^;ested 
that this constitutes the causative factor in the dis¬ 
order. 

A Difference of Opinion. 

The best way, when there is a difference of opinion 
between practitioners in regard to a case, is for them 
to have a fresh examination when both are present. 
It can be but seldom under such circumstances that 
they will f^ to arrive at a common accord. Unfor¬ 
tunately, this course is not always practicable, nor is 
it usually resorted to even when it is. A regrettable 
difference of opinion became manifest at the West¬ 
minster Police Court last week in reference to the 
mental condition of a refractory young woman. The 
medical officer of the prison and the divisional sur¬ 
geon both arrived at the conclusion that she was 
insane, and she was sent to the workhouse infirmary. 
There the medical officer decided that she was sane 
and discharged her, thus placing the magistrate in 
a somewhat difficult position. True, this difference 
of opinion testifies to the conscientiousness with 
which the various medical officers fulfil their respon¬ 
sible functions, but it interposes grave difficulties in 
the administration of the law, and means ought to 
be found of settling such questions without throwing 
the onus of deciding the sanity or otherwise of the 
accused on the magistrate, who is hardly fitted to 
decide which view is the correct one. 

Lady Medical Officers. 

The question of appointing a woman to the post 
of resident medical officer at the infirmaiy gave rise 
to an animated discussion last week by the Birken¬ 
head Guardians. The Board had on a previous 
occasion declared by a large majority that they 
preferred a resident medic^ officer of the male 
sex, and had advertised de novo for one, 
but, as they only offer £130 per annum, not a 
single application was received in response thereto. 
Thereupon the Board resolved to appoint Dr. Eva 
K*CalJ, at present Assistant Medical Officer at the 
Salford Union Infirmary, at a salary of £120 for 
a trial period of twelve months. We hope, without 
being over sanguine, that this lady will decline the 


reduced scale of remuneration, because nothing i9 
mure calculated to m aintain the hostility of the pro¬ 
fession to female competitors than the willingness 
with which they, or some of them, play into the 
hands of parsimonious boards. We note that the- 
lady’s male colleague will be expected to take all 
the “ objectionable ” cases off her hands, but no men¬ 
tion is made of any arrangement which will rid this- 
gentleman of cases which he himself may find 
objectionable. If ladies elect to compete in the 
medical field it must be in accordance with the- 
principle of a “ fair field and no favour.” 

Did Napoleon Die of Canoer? 

The belief is very general that the cause of death 
of the great Napoleon was cancer, and it is generally 
believed that cancer was in the family. Dr. Baudouin 
has lately published in the Qcaette Medicah de Forte- 
some clinical remarks on the death of Napoleon I., 
and the conclxuion he arrives at, apparently on per¬ 
fectly reasonable grounds, is that the great Emperor 
suffered from an ulcer of the stomach, which caused 
death by perforation. Undoubtedly hsmatemesis-- 
was present as a symptom, and at the autopsy there 
was no hypertrophy of the liver nor any ugns of 
cancer, but a gastric ulcer which had perforated was- 
found near the pylorus. The whole controversy 
exemplifies very clearly the extreme difficulty of cor¬ 
recting a 'mistake of this kind. It will be remem¬ 
bered that Napoleon’s last illness was of about four 
years’ duration, and this time would fit in with the- 
diagnosis of canoer, though it is xmdoubtedly true 
that a competent authority diagnosed chronic hepatic- 
disease and later abscess of the liver; but Dr. 
Baudouin believes this to have been a peri-hepatitis 
due to extension from the existing ulcer of the- 
stomach. — .■ ■ 

The Cultivation of the Dragon-Fly. 
Accosdino to the reports of an experimenter, 
the time occupied by one dragon-fly in consuming 
800 mosquitoes extends over sixty minutes. It ia 
not stated forwhat length of time this useful fly can 
continue its process of destruction, but we learu that 
the proposal has been mooted to breed dragon-flies 
on an extensive scale with a view to finding out if' 
their numbers cannot be so increased as to justify 
the hox>e that the mosquitoes, which play such an 
important role in the propagation of certain diseases, 
may be sensibly decreased. 

Political Control ot Hospitals. 

The superintendent of one of the most important 
hospitals in New York has suspended nearly 200 
attendants, from March let up to May let, for intoxi¬ 
cation. The male and female attendants apparently 
celebrate the advent of their pay-day by indulging 
unduly in alcoholic beverages. It is certainly an in¬ 
tolerable injustice that the political system of New 
York should be responsible for the appointment of 
drunken and disorderly attendants to an institution 
where their vicious behaviour inflicts on the suffering 
sick the additional misery of being compelled by 
their misfortunes to remain in an abode that must 
D:s:;:zed 1 C 


22 The Mbhioix. Pbbss 


NOTES ON CURRENT TOPICS. 


JTTLT 8, 1901. 


appear at times to be, in more senses than one. a per* 
feet Bedlam. A writer in the Poti’GTodwiU, for this 
month, very properly says that if ward nnrses are 
appointed because they belong to a politioal organi* 
sation, and can be relied upon to vote the *' strught 
ticket,” then a fitting motto to be placed over the 
wards would be “ All hope abandon ye who enter 

here.” - 

Acute Cardiac Failure. 

The subject which Sir Bichard Douglas Powell 
chose for the subject of his Carendish Lecture, which 
we publish elsewhere, is one of reiy present interest. 
There is a general impression that heart disease is 
more prevalent now than formerly, but this may be 
due to the close study which has been made of cardiac 
lesions, especially those which supervene suddenly 
and determine acute and even fatal symptoms. Our 
readers will find in this lecture many useful sugges¬ 
tions in regaird to the prevention and treatment of 
this disastrous category of lesion. The public have 
still to be educated to the understanding that athletic 
pursuits, this frequent cause of cardiac breakdown, 
cannot safely be indulged in to an unlimited extent' 
by every lad indifferently, and ought always to be 
conducted under some sort of medical supervision. 
There is often no warning of the mischief that is being 
wrought, and its extent often only becomes appre¬ 
ciated when the harm has been done, hence the 
necessity for practitioners to use their influence to 
avert impending disaster. The conditions under 
which injury to the heart may result in the young 
differ in many important respects from those which 
menace subjects more advanced in years. For in¬ 
stance, the young are more apt to suffer from the 
effects of prolonged strain, while the elderly are 
more exposed to risk in connection with sudden 
strain even of short duration. In these days of 
cycling, touring, and other forms of family holiday 
exercise, this difference is one to bear in mind, and It 
would be a good thing if the lecture in question 
could be divested of its technicaliti^, and popularised 
so as to admit of its being read and understood by 
the public. ■ ■— 

The Viavi Fraud! 

Notwithstanding recent convictions, the agents 
of this abomination appear as active as before; after 
exploiting England and Ireland, Scotland is now 
en tour, and a few days ago advertisements appeared 
in the Glasgow newspapers with reference to lectures 
to ladies which were to be delivered in the city. At 
one of these lectures we are informed that about 
thirty ladies were present, and they were treated to 
afternoon tea. The lecture was delivered by a 
female who spoke of the Viavi remedies (?) as “ food 
for the ovaries.” She fully explained the menstrual 
function, and went into detail with regard to the 
various disturbances in connection with it. In such 
cases the capsules and ointment required cost 
£3 lOs.! Recently an action against the Viavi 
Company by a lady who had been induced 
to undergo the treatment resulted in a ver¬ 
dict with £50 damages and costs on the 


higher scale. The Judge, in commenting strongly 
on the case, said ” it was the most important that 
had ever come before him.” In another case, where 
an inquest was held on the body of a child aged seven 
years and 10 months, a box of ointment had been 
used which cost £1 16s. It would seem that this 
Company, which has already acquired consi derable 
unenviable notoriety, pays their ^^nte 50 per cent, 
on the sales effected. Perhaps it should be men¬ 
tioned that the person representing this Company in 
Glasgow, which remunerates their agents so gener¬ 
ously, has been recently engaged in the laudable 
work of promoting and assisting with other 
charitably disposed Glasgow folk in supplying the 
poor in courts and alleys with soul-inspiring musio. 

The death is announced of Mr. James Stalker, 
M.II.C.S., L.B.C.P., formerly of Liverpool, who suc¬ 
cumbed to fever contracted in the discharge of his 
duties as medical officer of the Colonial Medical 
Service on the West Coast of Africa. 

The Secretary of the Royal College of Surgeons 
of England announces that the additions made to 
the Museum during the past year will be exhibited in 
the Cotmcil Boom on Thursday, Friday, and Satur¬ 
day, July 4th, 5th, and 6th. Fellows and Members 
are invited to attend. 


PERSONAL. 

SuBOEON-CoLOKSL SiCNDEBS, Boyal Army Medical 
Officer at York, has been appointed Administrative 
Medical Officer of the Madras Presidency. 

Da. ISAUBA.BD Owen has been offered the poet of 
Principal of the University College of South Wales, 
left vacant by the death of the late Professor J. V. Jones. 

The Ea.bl of Bosbbbbv will take the chair at the 
twenty-eighth festival diimer of the Boyal Medical 
Benevolent College on Tuesday, July 9th. at the Hotel 
CeciL -— 

The professional jubilee of Dr. A. B. Mackenzie, of 
Fortrose, N.B., was celebrated at Bosemarkie last week, 
when a large number of medical men assembled to do 
honour to the occasion. 

Db. F. W. Hewitt has been appointed Emeritus 
Lecturer on Ansesthetics at the London Hospital, on his 
resigning the post of Instructor in Anesthetics which he 
has held for fifteen years. 

The baronetcy conferred on Dr. William Selby Churota, 
President of the Boyal College of Physicians of Londoxb 
which has already been announced in these columns, 
was officially gazetted on Friday last. 

Wb understand that Mr. Hy. S. Wellcome, principal 
of the firm of Burroughs Wellcome and Co., has offered 
to present the Gordon Memorial Collie at Khartoum 
with a bacteriological and analytical laboratory. 


Db. Hobbbuboh, Medical Officer of Health for Muesel- 
bu^h, N.B., was the victim of a violent assault a few 
days since at the hands of three miners, who have since 
been fined £1 each. Such a mild sentence U well calcu¬ 
lated to sneouraysr l»» autra. 

Digitized by 


Google 



JjTLY 8, 1901. 

Trs Hok. Eli^ Oaxpbvll Sc^lstt. 3f.D., daughter 
of Lady Abinger, sailed last we^ in the transport 
** Assays ** for South Africa, having been appointed by 
the Colonial Offioe one of the doctors to the Sefugee 
Camp in the Orange Biver Colony. 


Thi Miptcai. Pbms. 23 

All honour is due to the Bev. Wm. Farragher for his 
energetic and oonrageons action, but his efforts to pre< 
▼ent future mischief must be unavailing unless the 
guardians, or in their default the Local Oovemment 
Board, show that even poor islanders cannot be neglected 
with impunity. 


SPECIAL ARTICLE. 


Tbs Hon. Mrs. Talbot, who was specially deputed 
by H.B.H. Princess Christian to perform the tash, for¬ 
mally opened the St. John’s Hospital, BCorden Hill, 
Lewisham, on the 24th ult., with the support of the 
Bishop of Southwark. 

Lb. Eva. M’Call, Assistant Medical Officer to the 
Salfcwd Union Infirmary, has been appointed Assistant 
Beeident Medical Officer to the Birkenhead Union In¬ 
firmary. There was opposition to the appointment of 
a lady doctor, but an advertisement offering a som^ 
what higher salary broi^ht no application from the 
male element 

Ths important poet of Medical Superintendent of the 
Banstead Asylum, Surrey, is about to become vacant. 
Attached to it is a salary of £1,000 per annum, with 
house rent and taxes free, and other privilegee. The 
appointment is under tiie control of the Asylum Com¬ 
mittee, London County Council, particulars of which 
will be found in our advertising colnms. 




[VBOX OtTB OWN COBBBSPONDKNT.J 


THE LATE LB. KEAN ANL FEVEB IN ABBAN. 

Tex neglect to provide a doctor for Arran when the 
late Lr. Kean was lying ill from fever oonteaoted in the 
discharge of his duty was brought before the Galway 
Board of Guardians by a letter from the Local Govern¬ 
ment Board in response to complaints made by the Bev. 
M. Farragher, the energetic psrish priest of the iehuid, 
who alone seems to have bera alive to the seriousness 
of the emergency, and the inhumanity of leaving the 
sick doctor and isl^ders for a week without medical aid. 

Who is to blame ? In defence of the guardians it is 
stated *'in justice to the guardians and to every 
member we md everytiung we could do to meet the oir- 
cumstanoes though often at great trouble, and, for all 
that, have got this anonymous writer. A special meeting 
was for the occasion, and two hours after we 

got the summons we met.” Bemarkable celerity, the 
guardians met in two hours, and seem to think that they 
deserve special credit for only this and nothing more; 
yet as the outcome of this ” great trouble ” and special 
activity, the islanders are left for a week witfaont mMical 
aid. Admitting that all the board of guardians could 
do at the time was to authorise the employment of a 
doctor, surely their duty does not end there, and they 
cannot disclaim responsibility. It was their business to 
see that their orders were ob^ed. 

Then there is the future to be considered; it is 
reported that fever still exists in the islands; it is pos¬ 
sible that again there may be a sick doctor, and the 
guardians being content to say "We did all we oould, 
we met at two hours* notice,” it is probable that the 
doctor and islanders will again be left without medical aid. 
Blame attaches itself to the guardians for not holding a 
searching inquiry ha to how it happened that no doctor 
was provided; but that apparently is just what they will 
not do. As their champion at the Botfd remarked, they 
" don’t want to twist the matter and bring ” anyone 
into it. This attitude is a distinot encouragement to a 
repetition of the " nnoertain state of affairs,” as tbe 
episode has been enphemistioally termed, and tbe 
guardians do not seem to appreciate the gravity of 
Mving a fever-stricken community completely out off 
from medical aid. except that rendered by the dispensary 
medical officer without a doctor. 


Article. 


LI8COVEET OF THE BACILLUS OF SYPHILIS. 

A coHUtTNicATiov of the g reatest importance was read 
by Lrs. Justin de Lisle and Louis JoUien before the 
French Academy of Medicine yesterday (Tuesday), giving 
the result of their resesrohes bearing on tbe speeifio 
bacillus of syphilis. This they claim to have disoovered, 
and if their observations are confirmed tbe discovery may 
fairly ^ described as one of supreme importance. 

These observers remark that although tbe blood of 
syphilitics has been found sterile by most previous in¬ 
vestigators, it is on this finid neverthelees that they 
oarri^ on ^eir observations, because they felt oonvinoed 
that a constitutional disease like syphilis must 
necessarily infect all parts of the organism. They 
chose for their investigations oases of reoentiy 
acquired syphilis in which no speoifio treatment 
had bean resorted to. The blood experimented 
with was withdrawn direct from a vein under the 
strictest antiseptic precautions, and both tbe blood and 
the serum were then examined under tbe- mioroeoope. 
They found therein a rounded, gnnnlar, highly-refractile 
body, oapf^le of traversing a Cbamberland filter, pos¬ 
sess^ of marked mobility, of a kind already notio^ by 
other observers. These bodies, however, never gave any 
result either in cultivation* or by inoculation, a result 
which, they point out, should not excite surprise, in view 
of the recognised fact that the coagnlalM blood of 
syphilitics is incapable of conveying infection. This 
destruction of infective power is probably due to the 
preeenoe in coagulated blood of a strongly aati-baoterial 
substance, alexine. In order to obviate the produotiouof 
this subst^oe they made use of blood plasma for their 
investigations, as well as of blister exudation, pro¬ 
duced either in the ordinary way by means of oan- 
tharides, or by means of Mayor’s hammer. In the plasma 
they found on eeveral occasions a form of bacillus pre¬ 
senting tbe following obaractoristios: It is polymor- 
phooB, varying in shape from a short bacillus measuring 
from 6 to S m. in length, and from 15-100 to 3-100 of m. 
in width, to that of a long thread with somewhat 
' rounded ends, not swollen into sledge-hammer shape. 
This organism is very mobUe and moves freely in the 
field of the miorosoope. It takes all the usual stains, 
but it must not be dried in tbe flame or at a tempera¬ 
ture above 60^ C. The best stains are aloohol-ether, a 
solution of osmio aoid, or a saturated aqueous solution 
of oorrostve sublimate, acidulated by tbe addition of 
acetic aoid. It does not take the Gram stain. 

Bouillon inoculated therewith becomes turbid in 
twenty-four hours, and in the course of four or five 
days a slight cloud forms which does not spread or 
berome thicker. Gelatine is slowly liquefied. When 
stabbed into gelatine it gives rise neither to the cone 
nor the extinguisher, the liquid in the tube is flaky, 
and of a greenish hue. The gelatine is not colour^ 
and its surface remains even. On gelatine e» boite 
colonies appear in from four to five days, of a rounded 
outline with irregular margins, and of a greyish hue. 
In from twenty to thirty days the whole of the gelatine 
is liquefied. On ordinary gelose and on glycerinated 
and peptonised gelose it gives rise to a creamy, moist 
layer of a faint green tinge. It grows freely on 
glyoerinated potato in the form of a whitish layer 
which is not dry or scaly and oolleote at the bottom of 
tbe tube. On soUd serum it remaias invisible, and does 
not cause liquefaction. It grows freely in amniotio 
li quid. It does not coagulate milk, but precipitates 
the caseine, leaving a fatty layer on the surface, with 
an alkaline reaction. It produces neither pyocyanine 
nor iadol. Most oultnies have a disagreeable, but not 
fmtid odour. 



LITEBA.TURE. 


24 Tai MxDtCAZ. Puu. 

The organism incteasee in length with the am of the 
onltoie, and in fire or six dajrs b^mee thread>^e. In 
ten da^B it becomes graunlar and aasames the appear¬ 
ance of the rounded bodies referred to above and met 
with in plasma, but if at this stage it is inoculated in 
fresh cnltnre media it reassnmes its primitive charac¬ 
ters. In Idiirty days they are all granular and 
apparently dead, and reinocnlations remain sterile, 
though, with certidn precautions and within certain 
limits, the organism can be brought back to life. The 
most resistant part of the vims appears to be concen¬ 
trated in these bodies. 

Gninea-pigs into whoee peritoneal cavity these cul¬ 
tures were injected died in from ten to fourteen days 
with paralysis, emaciation, and abortion. Young 
animals sucoumbed in twelve hours. Injected beneath 
the skin it determines the characteristic symptoms, 
viz., loss of hair and the formation of an indurated, 
ulcerated pfooM, with enlargement of the neighbouring 
lymph^o gumds. Post-mortem, the urine is albu¬ 
minous, the spleen contracted and the liver and kidneys 
often the seat of fatty degeneration, the blood being 
invariably sterile In the fn^. death supervenes in 
thirty-six hours. The sterility of the blood of animals 
after death recalls the fiust t^t no case has ever been 
recorded of syphilitio infection by post-mortem wound. 

A three days old culture of this organism, placed in 
contact with the serum of a syphilitic subject with 
secondary symptoms, determined marked agglutination, 
a phenomenon which is not produced with the serum 
of a healthy subject. The inoculation of the cultures 
in syphilitic subjects remained in every instance 
without result. Lutly, ttie alexine contained in the 
serum of an animal subjected to repeated injections of 
syphilitic plasma became fixed by this organism, this 
reaction being due to the intervention of a substance, 
the special ae»iitit«r, engendered by vaccination. 

Sn resume this organism has been found in syphilitic 
subjects presenting external manifestations of the 
disease in every case of syphilis examined and in no 
other oases It agglutinates the serum of syphilitic 
subjects smd not that of healthy subjects. Experimental 
inoculation in animals determines special symptoms 
comparable to those observed in man. It fixes the 
special alexin of animals vaccinated with syphilitio 
prodnots, its cultures are without effect on the subjects 
of syphilis and, lastly, as with syphilis in man, the 
miciobe dies with its host 

On these grounds they affirm that this oi^anism is 
reaUy the pathc^enic organism of syphilis. 


ICitcraturc. 

PAKKES AND KENWOOD ON PUBLIC 
HEALTH, (a) 

This is one of the latest, and it may be added one 
of the best, of the modem handbooks deeding with public 
health. Both authors are well-known authorities on the 
subject, and their plan has been to take Dr. Louis 
Parkes’ book, which has run through five editions in 
ten years, and enlai^ and bring it up to date. Some 
parts of the work we are familiar with,bnt others appear 
for the first time. The aim has been to furnish 
a manual for the nse of medical men studying for 
the various health diplomas, but there be no 
doubt that it will be almost equally popular among 
the profession generally. One chief feature is 
the ease of style, whereby all essential information 
is clearly set forth, as it were, currmte ealamo. Yet 
the work has been conscientiously and carefully done, 
indeed, the accuracy is most exemplary where such an 
enormous mass of details is under consideration. In a 
future edition a little more space might perhaps be 
bestowed with advantage npon the important subject of 
meat and meat inspeotion. Bhenmatic fever is men¬ 
tioned under the oommnnicable diseases with tiie remark 
that “there is good reason for believing that this 

(a) ‘'HTgienesnd Pablic Health.” By 1/Oais Parkee, M.D., Leo- 
torer on Imblic Health at St, George'e Hospital Medical School, 
Ac., Ac.: aod Heniy Kenwood. H.B., Aasietant Profeeeor of Pnbho 
Health, Unirenity CoU^, Ac., Ao. London: H. K. Lewie. 1901, 


Jolt 8, 1901. 

d i B ooflo is a specific disease and quite distinct in its crigizk 
from ordinary rhenmatiem. Most authorities are in¬ 
clined to thiz^ tiiat the specific l»cterial origin of rheu¬ 
matism has passed the region of doubt. Canoer, w gwiti^ 
which is also alluded to under oommnoioable 
might perhaps be more fully dealt with as regards the 
theories of its parasitic origin. The authors may be 
oouKratnlated on having produced an excellent book 
which covers the mnud closely enough for all practical 
purposes within the modest limit of 782 crown octavo 
pages. The publishing and editing of the volume leave 
littie to be desired, while, last but not least, the price of 
the book amounts to the extremely moderate sum ot 
twelve shillings. 

MAHTINDALE’S EXTRA PHABMACOP(EIA. (o> 
Wb gladly welcome a tenth edition of Martindale 
and Westoott," as the excellent work before ns is nsually 
termed. The fact that this is the second edition which 
has been published since the revision of the Fbarmar 
oopoeia in 1898 shows the high place which it holds in 
the opinion of medical men, and entirely relievM tha 
reviewer from the necessity of writing an extensiva 
review. Since the issue of the ninth edition, a new 
edition of the German Pharmacopoeia bera pub¬ 
lished, as well as an Indian and Colonial Addendum to 
the Pharmacopoeia of 1898, and a Supplement to the 
Anstriau Pharaaoopoeia. In preparing the pr oe ont 
edition, the authors have, “from a pharmaoentioal 
point of view, made aoarefnl stndy of all these, prepared 
abstracts from them, and noted the cnrrmit utei»tur» 
on our subjects." We note that the authors are rather 
sceptical as to the value of the Indian and Colonial 
Iddeodum“Many of the pharmaceutical prooeseM 
in this Addendum appear not to have been tested 
practically .... Some of the drugs, if intiro- 
dnoed on their own merits, might prove of service, 
but we question if many of them will meet with any 
general recognition even in India or the Colonies.” 
There appears to be a misprint or a possible souroe of 
confusion in the head-note to the Therapeutic Index of 
Diseases and Symptoms:—“ The remedies .... 
added in the fifth, &c., editions, are printed in italics 
. . . . those now added are printed in italics." 
If thi« is the case how is the one class to be distin- 
goished from the other. As r^ards the valne of such 
an index there will probably be a difference of opinion. 
It may be of use to many medical men, but to us it 
always appears to be a doubtful advantage in a work of 
this kinA An index which might be added to the worii 
with great advantage is an index of dru^ arranged 
aocormng to their physiological action—carminatives, 
diaphoretics, anthelmintics, expectorants, Ac. To such 
an index no exception could be taken, and it would be 
found to be of the greatest value. We trust that the 
authors will see their way to make this addition to the 
eleventh edition of their most valuable work. 

Dublin Death-rate. 

In the Dublin registration area, for the week ending 
June 22nd, the deaths, which are five over the average 
number for the corresponding week of the last tw 
years, represent an annual rate of mortality of 21'3 in 
every 1,000 of the popnlatioo. Dnrine the twenty-five 
weeks ending on the same date the death-rate averaged 
29'6. In the case offour infanta under one year old the 
cause of death was uncertified, there having been no 
medical attendant during the last illnese. Eighteen 
deaths of infants under one year old were certified. The 
annual rate of London for the week was 13'8, Glasgow 
19‘9. Paris 20 5, New York 17 8. 

The PreUmlnary Examination of tha Boyal Colleges of 
Physicians, 1902. 

Wb observe from an announcement in another column 
that material changes have been made in the course f.>r 
this examination for next year. Intending candidates 
can obtain all particulars from the secretary, Mr. Green- 
wood Pirn, M.A. _ 

g *‘Tbe Extra Pbarmacoperia.” By William Hartmdale, 
8., F.C.S , lata President and Examiner of the Pharmacentical 
Society, and W. Wynn Westcott, M.B.Lond., D.P.H., H.lC'a 
Coroner for North East London. Tenth Edition. London: B. E, 
Lewis. 1901. Pp. 32 and 688. 



JuLT 3.190i. 


MEDICAL NEWS. 


Thb Msdical Pbsss. 25 


(^Eebkal ^ctos. 

CbarliiK Croes Hospltel Hedical School. 
Pkovissok Cli?fobd Allbutt, F.R.S., distriboted 
the scholarships, medals, prizes, and oertidcates to the 
students at Chsf ing Cross Hospital Medical School on 
Wedneeda 7 last. The Dean (Mr. Herbert F. Waterhouse) | 
read the annual report, in which reference was made to : 
the serrioes in the South African War of eighteen I 
former students. Dr. Clifford Allbutt, in the course of . 
an interesting address, attributed his own choice of the 
medical profession to an inordinate curiosity. Curiosity, 
or the desire to know things, was discouraged by our 
mediseral methods of education, which taught abstrac¬ 
tions in preference to concrete things ; but a child who 
•did not show curiosity was probably an imperfect develop* 
ment. Medical students incessantly cultivated the 
plant of curiosity. Learning from b^ks was not the 

S neration of knowledge, but an aocumnlation of doubt* 

1 value, and there was no more unfortunate relation 
between pupil and teacher than the former's belief in 
tile latter’s infallibility. The scientific method of ex¬ 
perimentation made the physician or surgeon not more 
reckless, but more carefod ; and in this respect there had 
been a great improvement during the last thirty or forty 
years. Heavy bleeding and heavy purgatives were grave 
experiments, which formerly were made with an ignorant 
reMinees, but nowadays the complicated and delicate 
machinwy of the human body was more carefully 
treated. A genius was a man who saw something which 
had not been seen before, and that might happen to any 
them. 

St. Mary's Hospital. Paddington. 

Db. Chbadls, senior physician o^the hoepital.preeided 
at the distribution of prizes of the students of 

the medical school. Dr. Caley, the dean, in his report, 
smd that during the past, as in the previous, year many 
eemior students had volunteered for service in South 
Africa, with the result that sixty-two members of the 
medic^ school had been with the Imperial Forces, of 
whom four bad died of wounds or disease. Sir Michael 
Foster, M.P., who subsequently distributed the prises, 
•chola^ips, Ac., delivered an interesting address ^iefly 
with reference to the University of London. Parliament 
had provided in a omde form stacntes for the new 
university, hot they were dry bones which could be 
rattled. 'Ihey had no life in them nntil they were 
clothed with flesh and blood. With regard to blood 
they ail knew that an eeseotial quality in blood were 
smi^ round discs of a yellowish colour. (Laughter.) 
The University of London needed a large and ample 
transfusion of that sort of blood from without. Passing 
to the “ tissues,” Sir Michael pointed ont that London 
was a great manufacturing, oommeroial, and industrial 
centre, and it was for the new University of London to 
show that university and practical knowledm were 
associated, and always ought to be associatea. That 
was espei^ly so with regard to the medical part of 
university edncaiion, because medicine had a very dlose 
relation with the pra^cal life of the people. 

University of Dnhlln. 

At a meeting of the Senate of the University of 
Dublin, held on Jone 27tii, the following medical de^-ees 
were conferred:— 

Doctores in Medicina.—Alfred Lewis Bertram, Alfred 
Heathcote Copeman, Joseph Dawson Crawford, Edward 
Johan Farmer, Harold Freeth, Ernest Blake Enox 
{atip oond.), Frauds Carmichael Purser, Alfred Jacobs 
Sice-Oxl^, Arthur Rhodes. 

Baccalanrei in Medicina.—Alfred Lewis Bartram, 
Alfred Heathcote Copeman. 

Baccalanrei in M^idna, in Chirargi^ et in Arte 
Obstetrida.—Gerard Irvine Davys, Cecil Edward Finny, 
Harold Freeth, Thomas William Harley, Francis James 
Stiong Heaney (B.Ch. stipoond.); Ernest Albert Wil¬ 
liam Henley, John Willi^ Hilliard, Arthur Norman 
TTftltmia , William Davenport Kelly, Ernest Samnel Moor¬ 
head, Thomas W. Myles, Thomas George Fei^oson 
Paterson Jlichard Atkinson Stoney (B.Ch. etip. oond.); 
Charles John Swayne, James Aithnr Thompson, Jasner j 
Robert l^rreil. 


Thb following prize and scholarship have been 
swarded:—Medical Travelling Prize, T. G. Moorhead. 
Medical Scholarship.—Anatomy and Institutes of Medi¬ 
cine Scholarship, William Bozwell. 

Don Mignel Colmerlo. 

Thb death is announced (El Siglo Medico) of Don 
Miguel Colmerio, Professor of Natu^ History, Madrid, 
member of the Royal Academy of Medicine and other 
scientific societies. To the care and liberality of Don 
Mignel the Spanish are indebted for the present high 
state of perfection of the Botanic Ghurdens of Madrid, 
acd to his many recommendations to the Government 
and his urgency they are largely indebted for the plant¬ 
ing of trees in the principal stiWa and squares of their 
chief towns. 

A Botanist Censnred. 

A Lxbdb botanist, who had supplied pennyroyal pills 
; to a woman who snbseqnently aborted and succumbM to 
peritonitis, has been “ censured ” by the coroner, and 
advised to abstain in fntore from dealing with medicines 
of this class. Whatever the abortifacient valne of this 
drag may be, there seems to have been little doubt as 
to the intention with which they were procured, and it 
is odd that the jory did not emphasise the " intent.” 

Plague In Hong Kong. 

Dubiko the week ending June 22nd there were 
155 oases of babonio plague with 152 (!) deaths in 
Hong Kong. 

Alleged Mistaken Diagnosli. 

An action was tried in the King's Bench Division last 
week in which Messrs. Stocks and Croesman, practising 
in Wandsworth, sued a licensed victnaller for feea for 
professional attendance. The claim was resisted on the 
ground that the plaintiffs had failed to di^nose a dis¬ 
location of the shoulder, the result of a bicycle accident. 
Inasmuch as it was not denied that a carnal examina¬ 
tion of the joint had been made soon after the accident, 
and seeing that the defendant snbseqnentlv suffered 
from alcoholic delirium, daring which the dislocation 
might very well have been occasioned, the jnry returned 
a verdict in favour of the plaintiffs for the amonnt 
oliumed, they having, in their opinion, “used ordinary and 
reasonable skill in treatment.” 

Death from HnmorrhM* after Operatlou. 

An inquest was held on the 25th nit. on the body of 
a child who had died from bsemorrhage conseqnent upon 
removal of the tonaila at the Clini^ Hospital, Man¬ 
chester. It transpired that the child was discharged 
from the hospital on the day following the operation, 
and t^t the bleeding set in on the following day. The 
child was taken to the hospital again a week later, but 
it was not thought necessary to detain him. It was 
admitted that eome risk attended the practice followed 
at the hoepital, bnt it was pointed ont that if any com¬ 
plication of this kind occorred it was the duty of the 
parents to call in a local practitioner, a step wUoh the 
parents in this instanoe had apparently failed to take. 

Odontologlcal Socletr of Great Britain- 

Thb following members have been elected as Officers 
and Connoillors for the year 1901-1902:—President.— 
W. A. Maggs. Vice-Presidents. — Resident: A. S. 
Underwood, F. J. Bennett, W. H. Woodmff; non¬ 
resident: G. Bronton (Lee^), W. S. Woodbnm (Glas¬ 
gow), W. B. Bacon ('iSinbridge Wells). Treasurer.— 
C. F. Rilot. Librarian.—H. &ldwin. Curator.—J. F. 
Colyer. Editor of Transactions.—H. Lloyd Williams. 
Honorary Secretaries.—J. H. Mnmmery (foreign), A. 
Hopewell Smith (Connell), W. Rnshton (Society). 
Councillors.—Resident: J. & Reinhardt, H. G. Read, 
G. Northcroft, R. Wynne Rouw, J. Mansbridge, M. F. 
Hopson, Morton A. Smale, B. D. Pedley, J. Percy Smith; 
non-resident: D. Corbett, jnnr. (Dublin), Bees Price 
(Gla^w), G. O. Whittaker (Manchester), T. Mansell 
(Birkenhe^), W. A. Rhodes (Cambridge). W. Glaishy 
(York), J. J. H. Sannders (Barnstaple), E. A. Bogne 
'New York), J. F. L. Pike (Sheffield). 




26 Thb M»dioal Pbsss. JTOnCBS TO COBRE8PONOBNT8. Jolt 8, 1901. 


4t0tice0 to 

Corrt0]ionbmt0, ;$ltort XttttxSf ice, 

l^r CokEisPonEvra reqnlrinir • replj Is this oolnmn we per* 
iealwly reqneeted to mika om of e dittincHv* iignatura «r 
MtiaU, ud ftTOid the pieotioe of stvainr thenuelTee “ Beeder," 
**Snbecriber,” "Old Sabeerlber," Ao. Voeh oonfnaiOB will be 
epwed bj etteotloii to **»<■ role. 

WHEN DOCTOBS D I F FEB I 

FooB medical men Kare eTidence laat week in a caee at the 
Bromptos Connty C'>ait in respect of a claim for dama^ee bjr a 
woman who had sostained a sprained ankle, caos^, she allecr^ 
by falling thionyh a defective pavement light. The medical evi¬ 
dence in effect waa:— 

First Doctor: All Mrs. Sealy requires is rest. 

Second Doctor: Needs two months’ massage treatment at two 
guineas a week. 

Third Doctor; Think Vrs. Sealy ia auffering from dropsy 
rather than from the effects of the accident. 

Fourth Doctor: All Mrs. Sealy requires la plenty of exercise. 

The Jury: £50 damages. 

JCKiOB Assistakt will find vacancies advertised in our present 
issue such as he seeks, under the Lradon County Council and the 
Aeylnms Board. 

Staiist,—U p to Jnne last, 479 medical officers and nine consult¬ 
ing surgeons, 385 aur geons and 441 nurses were despatched to the 
front. Yon will find fuller details in the Beport of the Hospit^' 
Commission. 

THE INDIAN SCEDICAL SEBVICE. 

The Pioneer of India, of Jnne 28th, in referring to the medical 
services, says the nroTOsal to absorb the Indian Medical Service 
in the Ar^ Hedicad Corpa is distinctly unpopular with the 
Indian Servioaa, and would excite deep end widespread dissatisfac- 
tion. _ 

Jiarg for the SScek. 

ENGLAND. 

WEnimsDAT. Jolt 3ed. 

Obsteteical SociBTT 07 l<OEDo;r (20. HanovsT Square).—8 p.m. 
Sp^imens will be shown by Dr. Lockyer, Dr. Alcock, Dr. nir- 
baim and othera Paper: Mr. J. F. Maxwell: On Spontaneous 
Bnpture of the Uterus in Placenta Pimvia. 

THtraspAT, Jolt dra. 

Boetoee Bociktt (20, Hanover iSqnare).—8,30 p.m. Annual 
General 11 eetlng for the Election of Omcera, Ac. Mr. G. Bowron 
will show; An Uscillometer for measuring the Current and Oscil* 
latiuns in the Secondary Circuit of an mduetion Coil or riiniUr 
Apparatus. 

Botal Collbob or Boboboes.—E xhibition of specimens added 
to Museum during past yew, in the Conncil Chamber. 

Fbidat, Jolt Sth. 

West Loedoe Medico-Cbiboboical So cib ti (West London Hos¬ 
pital, Hammeramith Bead, W,).—6 p.m. Ordinary Meetiug. 
S.lSp.m. Annual General MeiFtlag. 

OraTHALKOLoeiCAL SoCixtt or the Ueited Eieoook.— 8 p.m. 
Caaea. 8.30 p.m. Papen:—Hr. 8. Snell: A Case in which Blmd- 
neas waa ooCMoned br the Internal Adminlabatton of Salicylate of 
Soda.—Mr. J. B, Lawford: Further Notea of a Ca»e of Melanotic 
Sarcoma of the Conjunctiva.—Major H. Herbert, I.M.8.: Con- 
insetival Bridge andPonches; Union of Betrotarsal Folds.—Mr. : 
S. Stephenson: Wound of Byeball with ProlajMe of ilris, Enuclea -1 
tionof Eyeball Twenty Days after Accident, followed Fifty.three 
Daya later by Sympatheoc Disease of the other Eye, Perfect' 
Becovery. 

Satubdat, Jclt 6tb. j 

PATHOLOaiCAL SoctBTT OT LoEDOE (Department of Pathology I 
of the Univeriity of Oxford, South Pwaa Bead). 3.30p.m. Labo- ' 
ntory Meeting. Dr. Bit^ie : The Belation of Beeiatanoe to ! 
Tetaana Toxine to Antitoxio Power of Serum.—Dr. Martin: In- j 
hlbition of Growth of the Typhoid BaoiUna.—Dr. Haldane: Hsmo-1 
gloUnometer.—Dr. Poynton and Dr. Paine; Arthritis pr^uced bv 
Diplococcua Isolated from Bhenmatlc Fever.—Dr. P. Stewart: I 
Di^neratioos follow^ Transverse Lesion of the Goi^—Dr. I 
Waters : Demonstration of Tumours,—Mr. Barnard : Calcified I 
Aneurysm of the Renal Artery. I 

Tubsdat, JuLTPra. j 

BoTAL Medical Beeevolbet Collbob.— 7 p.m.: Festival Dinner 
at the Hotel Cecil. 

SociETT roa THB Stddt or Iebbrjett (11, Chandos Street. 
Cavendish Square).—^.m. Quarterly Meeting. Papers T. N. 
Kelynack, MId.. and W. Kirkbv, F.L.8.: On Arsenical Poisoning 
from Beer Drinking in its Relation to the Study of Inebiiety, I 


,|i4r)rointin£nt0. 

AnaTBS. Habold, M.D., B.S.Lood., M.R.C.S., L.D.S.Eog., Aasist- 
snt Dental Surgeon to the Dental Hoepital of London. 

Caddt, Adriae. M.B.Lond., L.B.C.P.L(>nd., M3.C.S., Resident 
Medical Officer to the Parish Inflmiwy, Brownlow Hill, 
Liverpool. 

OAurBBLL, P. E.. H.B., C.M.Edin., Medical Snperintendent of 
Caterbam Awlnm, Surrey. 

Cbieioe, L.A.X, M.B., B.Ch.R.U.I., Medical Offloer of Blessing- 
ton No. 1 Dispenaan District in the Naaa Union. 

Eahe^ K. 8. B., L.B.C.P.Lond., M.B.C.S.Eng., District Medical 
Offloer 10 the Honiton Union. 


EuBica, F. W., M.D.. C.M.Edin.. Pathologist and Bacteriologist 
to the Corporation of Bradford. 

Fabbaot.Cbableb, L.B.C.P.Lond., M.B,G.8., Medical Officer for 
the St. Jamee's District bv theTsnaton Board of Guardtajis. 

Gbuoobe, WiLLiAH, L.B.C.P.IrelM L.F.P.S.GlBsg., D.P.H.Camb.. 
Medical Officer of Healto of IVing. . 

Hill, Cbablbb A.. U.6., B.A.Cantab., D.P.H.Viet., Senior Asaist> 
ant Physician to the Liverpool Hospital for Consomp^n. 

Hood, N. L.. M.D., D.C.Cantao., Honorary Surgeon to the York 
County Hoepital. 

Lb Faeu, G, E. H., M.B.Aberd., Aasistant Medical Offloer to the- 
Dert? Borough Awlum. 

Mooeb. 8.0., M!b., Ch.B.Vict., D.P.H.Eng.Conj., Medical Offloer 
of Health of Huddersfield. 

Rat, j. H., H.B.. Ch.H Viet.. F.R.C.S.Eng., Assistant Surgeon to 
the Manchester Children's HospitaL 

Bixmbr, j. F., M.B., Ch.B.Vict., Third Assistant Medical Offloer at 
leaveeden Aayinm, Hertfordshire. 


9acanne0. 


Bailieborongh Union.—Qualified Midwife. Salary £2Sj>er annum. 
Imme^te application to Hugh Clwke, Clerk of Umon. (Sea 
odvt) 

Carlow Union.—Temporary Medical Officer. Salary £3 3a per 
week. Immediate application to the preeiding Chainnau. 
(See advt.) 

County Aayinm, Cwmarthen.—Junior Assistsut Medical Offloer. 
unmarried. Salaiw commencing at £130, with furnish^ 
apartments, board, washing, and attendanoe, without stlmn- 
limts. 

Coimty Borough of Bnrton.upon.Trent.—Medical Officer of Health 
and Public Analyst. Salary at rate of £350 per annum for the 
Medical Officersmp and £50 per annum for the office of Public 
Analyst, and authorised disbursements. 

Cumberland and Weetmorland Asylum. Gwlands, Cwll«le.-~8enior 
Assistant Medical Officer, nomanied. Salary £150 a yew, 
risiiig to £180, vrith board, lodging, Ac. 

London County AwlBOi-~~JiiniorAsaisitont Medical Officer. Salary 
£150 perannum, with board, apartments, washing, fto. Candi¬ 
dates most not M above thirty years of ac^, and be qualified in 
medicine and sorgery. Forms of application to be obtained of 
the Clerk of the Asylums Committee. (See advt) 

London County Asylum, Banstead.—M^cal Superintendent 
Salary £1,000 per annum with house, rate*, taxes, and water 
supply fres. Forms of application to be htd of the Clerk to 
the Anyloms Board, Lon^nCouiityCounciL (See advt) 

Metropolitan Awinms Board.—Assistant Medical Officers (an> 
married) at the Fever and SmaU-pox Homitals. Salary £100 per 
annum, risiog to £200, with board, lodging, attenoanoe, and 
washing. Also Assistant Medical Offloer (unmarried) at the 
Asylom, Caterham, Snrr^. Salary £150 per annom. rising to 
£1^, with xatioDS, lodging, attendance, and washing. (Sm 
advt) 

North WalesCounties Lunatic Asylom. Denbigh.—Second Assistant 
Medical Offioer. Salary oommenelng at£120 per annum, with 
board, residenoe, and washing. 

North.Westem Fever Hospital, Lawn Road, Hampstead.-Locum 
Tenena. Salary at rate of £160 per annum, with board, 
lodging, and washing. 

Owens College, Mancheetor.—Senior and Junior Demonstrator in 
Phyiiology. Stipends £150, rising to £200, and £100 riaiw to 
£150 lespeotively. 

Plymouth Borough Asylum.—Assistant Medical Officer, onmanied. 
Salary £150 per annum, rising to £200 per annom, with lar- 
ntsbM apartments and board and washing. 

West Biding Asylom, WaUsley, new Sheffield.—Third Avslstant 
Medical Offloer, Salary £150. with board, Ae., rising to £200. 
Alio Fifth Assistant Medical Offloer. Salaiy £140 per annum, 
with bca^, Ac., rising to £160. 


#irth0. 

Hills,—O n Jnne 25th, at New Bridge Hense, Upwell, the wife of 
W. 0. D. Hills, M.R.C.a£ng., QkC.P.Lond., of a dauhter. 

Keep.— On June 24th, at WorkjMp, Notts, the wife of O. Lajus 
Kemp, M.D.Lond., of a son. 

Keaoob.- On Jnne 2ra, at Camden Road, London, N.W., the 
wile of H. V. Enaggs, M.R.C.8,, of a daughter. 

Maerieotoe.— On June 24th, at Belmont, Mnswell Hill Road, 
Highgate. the wife of Frank Mannington, F.B.C.a£ng., of a 
daughter. 

Wtedkax.— On June 27th, at Goring-on-Thames, the wife of T. 
Lancelot Wyndham, L.HC,P., L.B.C.8., of Bromley, Kent, of 
a daughter. 


Bablow—POES roBD. —On Jnne 27th, at Stanford Parish Church, 
Kent, Herbert Cecil Bwlow, M.B.Lond., L.B.C.P., M.B.C.8.. 
of St. Ives, Famborough, eldest son of the Rev. T. Disney 
Bwlow, of Blaby, Leicester, to Muriel, second daughter of the 
late Rev. W, Ponsford, late rector of Stanford, Kent. 

Dtball—KE ioar.- On June 27th, at St. Mark’s Church, North 
Andley Street, London, W., Brennsn Dyball, M.B., B.S., 
F.B.<^8., of 47, Queen StreeL Exeter, to Evelyn Maud, 
youngest daughter of Uir Henry £. Knight, of 41, Hill Street, 
Mayfair, and Stain Hill Pwk, Hampton. 

Gallwbt—Gobdoe. -On Jaite22nd, at St Patrick's (^atch, Soho 
Square, by the Rev. Dean Vera, Ciolonel Sir Thomas Gallwey, 
B.A.M.'C., to Hand Margaret Howard, widow of the late 
Captain C. W. Duff Gordon, Royal ArtlUeiy. 

Watsoe—Babbie.— On June 27th, at St. Anwew’s (Aareh,Boch. 
ford, George Trustnun Watson, M.A., M.B., B.C.Caatab., 
F.B.C.S., of Hastings, to Dorothy Nora, eldest daughter ol 
Hugh Rankin. Esq. J.P., of Boohiord, Essex. 


Ik Redial and tfimtat 

*‘8ALUS POPULI SXTPBEMA LEX.” 


VoL CXXIII. WEDNESDAY, JULY 10, 1901. No. 2. 


<S)ri$inaI (Eorntramicatums. 

REMARKS ON THREE GASES 

ILLUSTBATING 

DIRECT INFECTION WITH THE 
BACILLUS TUBERCULOSIS, (a) 

By STANLEY BOTD, M.B.Lond.. P.R.C.S.. 

Snigeoa to CbMia^ Cross Hosoital and thn Biompton Hospital for 
ContumptioB and Diseases of tbe Cbest. 

Cashs of direct infection with the baoillua tuber* 
<niloeis are very interesting, but they are by no means 
■common. In many cases there is nothing to do but 
tbeor^ as to how infection takes ^lace. Por 
example, bacilli are found in the bronchial glands; 
on searching through the Ixmgs very carefuBy, and 
through the mucous membrane of the respiratory 
passages draining to the bronchial glands, no lesion 
may be found. How, then, did the bacilli get to 
thew glands? It is inferred that they passed 
through the mucous membrane of the pulmonary 
^act somewhere or other, leaving no primary lesion 
at their point of entr^, or if there was any little 
disturbance during their passage, that it completely 
anbeided, and left no post^moitem evidence. In the 
'following cases there is no need to theorise at all: I 
'the inoculation of the bacillus tuberculosis at cer¬ 
tain points in man is clear, and in one of the cases 
the course of the disease be followed most 
admirably. 

The firrt case now shows nothing beyond a normal 
scar. It was that of one of the nurses, who, in 
Kwh or April 1900, was carrying a tray of used 
apittooBS; she fell, and a broken spittoon made a clean 
cut on her left wrist in front of ^e radial artery. It 
healed readily, but not soundly. In about a fort- 
might the dressing was taken off, and a scab was left, 
when this was removed a little central hole was 
found in the scar, and from and around this, redness 
and infiltration of the skin slowly spread. The sore¬ 
ness then became more marked, and the centr^ hole 
temained until August. At that date she had an 
area of thickened skin the size of a fourpenny piece, 
Ted, dry, and somewhat wartv cm the sunaoe, with a 
well-d^&ned edge. The glands were not affected, and 
there was no evidence of spread of the infection to 
the lymphatics of the forearm; the whole case would 
be summed up by saying that she had an inflamma¬ 
tory thickening of the akin at this spot. On cutting 
it out completely, and bringing the edges together, 
the little wound healed by first intention, and she is 
now perfectly well, and has had no trouble since. 
Hicroecopio sections showed that the disease was the 
result of infection by the tubercle bacillus. 

The next case, a lady whose age was about tfairl^- 
five, had been suffering for many years from chrome 
pkthisiB in the right lung. Dnring an exacerbation 


of her phthisis—with much expectoration, which she 
always received upon a handkerchief—she caused a 
slight abrasion with a lump of sugar on the extensor 
aspect of the first phalang^ joint of the right index 
finger. That abrasion never healed, and, although 
no miorosoopic examination was made of any of the 
parts removed, the clinical course renders it practi¬ 
cally certain ^at tiiis was because tubercle Daoilli 
were inoculated from the handkerchief upon the sore. 
For some months no attention was paid to the 
sore; finally, she saw a surgMU, who rang the 
changes on ood-liver oil and iron, and iron and 
cod-liver oil. That went on for a nonaider- 
able time, and no improvemmit took place; on 
the contr^, the disease was spreading in a most 
characteristic way. The first thing noticed was, 
that some months after the infection a considerable 
swelling formed somewhat acutely in the situation of 
the intenial supra-ooudyle glands. Probably there 
was a mixed infection of the glands, septic or pyo¬ 
genic as well as tuberculous. No suppuration 
occurred, however, and after a time these swellings 
subsided, though not completely. Next she notio^ 
an elongated patch of infiltration just below the 
elbow, over which the skin was adherent and red- 
deimd round the radial lymphatics. Next a similar 
patch formed on the dorsum of the hand, over the 
second interosseous space, which ulcerated slightly. 
The last result the patient noticed was a small mobile 
lentil-like subcutaneous nodule on the ulnar side of 
the olecranon prooess; it seemed obviously to be in 
some lymphatic vessel. She had in addition two or 
three enlar^d lymphatica behind the pectoral 
muscle. Tins case shows tiie way in which tubercle 
spreads by the lymph path from an evident primary 
lesion to the first and second group of glands above it, 
and, what is uncommon in the skin and subcutaneous 
tissue, there were here and there in the coarse of 
the lymphatics small foci of tuberculous lymphan¬ 
gitis, due. to arrest and growth at these spots of 
bacilli. It is interesting to note !tbat they md not 
appear until after the lymphadenitis, which probably 
slowed the circulation in some lymphatic vessels. 

Under ether the edges were excised and the base 
of the primary lesion scraped, pure phenol was 
applied, and the wound dressed with iodoform. All 
affected glands, patches, and nodnles were excised. 
Everything united by first intention except the 
finger; tlmt did not heal, in spite of frec^uent and 
free applications of pure oarbolio and iodoform. 
Ultimately it was completely excised. It then healed 
slowly but soundly—some sixteen months after the 
first operation. During most of this time fresh 
little Aot-Uke nodules kept appearing along the 
course of the radial lymphatics. One by one they 
were excised under cocaine, seven or eight such 
operations being done. Ouoe or twice an operation 
was repeated for recurrence in loco, possibly because 
the fii^ excision was incomplete, for after the pro¬ 
duction of cocaine csdema all evidence -of the httle 
Di'' ’ zed : 


(a) DsUnred st tha Hospital tor Commption ud Diicsset of 
^ha eSheat, Bromptoii. 






28 Th> Hsdioal Pbibs. ORIGINAL COmMONIOATIUNS. July 10, 1901. 


nodule, to sight or touch, was lost. The patient, 
fortunately, was pluohy and determined, for the 
course of treatment was long and especially trying to 
one in feeble health. She has now been free from 
recurrence for more than eighteen months, although 
she has had pleurisy and some advance of her chest 
trouble. 

The lessons to learnt from these cases are (1) 
That timely excision of tuberculous sores is the pro¬ 
per treatment, and (2) that with patience and 
perseverance the disease may be arrested even where 
it has got a long start. It is, however, only fair to 

{ )oint out that in the second case the patient, though 
iable to tubercle, was evidently resistont in a fairly 
high degree. 

The next case is one of direct infection of a tendon- 
sheath with tubercle bacilli in the person of the post¬ 
mortem porter (set. 62) in this hospital, wnose 
duty it is to st^n the sputum for examination. 
After employing a steel pen to spread some 
sputum known to be virulent, upon a cover- 
glass, he left it projecting beyond the edge' 
of the table, and brought his hand forcibly 
against its point. The nib was driven into the ' 
proximal end of the flexor sheath of the ring fin^mr. j 
This occurred in the middle of June, 1900. He ! 
immediately tried to run fuming nitric acid into the 
wound caused by the pen, and no doubt he disinfected 
the surface by that means, but not the depths. A 
hard lump gradually formed in the palm, and ex¬ 
tended down alon^ the ring finger, which became 
flexed, stiff, and panful. He was treated by means 
of a palmar splint, and was sent to Brighton for 
some weeks, but he got no better. The finger became 
contracted, and the middle and little migers also 
were coming down into the palm. A long, low, 
tense swelling occupied the whole length of the 
flexor sheath of the ring finger. The diagnosis was 
obvious; it was a case of tuberculous teno-syno- 
vitis. The treatment was equally clear. The man 
had had the advantage of the best hygienic con¬ 
dition which could provided for him; he had 
been to the seaside with nothing to do except 
to look after himself and get well, but he had 
got steadily worae. The complete removal of 
the disease was urgently necessary. Six months 
after the operation extension of the finger is some¬ 
what limited by the long longitudinal scar on its 
palmar aspect, but he has fair and very useful move¬ 
ment, and he is perfectly free from recurrence. The 
prognosis of tul^rcle gets worse as age increases, 
and therefore this result may be considered very 
satisfactoiy. A section of the granulation tissue 
removed shows giant^cell systems ” in large num¬ 
bers and great perfection. 

TYPES OF INDIGESTION AND 
THEIR WIDE CORELATIONS. 

By WILLIAM H. PEAESE, M.D.Edin., 

Senior PhjrsiciaD, Plymouth Public Dispenaary. 

In an out-of-door dispensary view and treatment 
of disease, though we lose the advantages and con¬ 
trol of the diet, of the exact administration of drugs, 
of the minute watching of the course of cases, and of 
the final post-mortem revelations which hospital 
practice gives, yet, on the other hand, we see disease 
over a wider area, in its inception, evolution, and 
gradations ; we see disease in the delicacy of blend¬ 
ings and corelatiotts; a dispensary clinique takes us 
towards the springs of the more finu forms or 
streams—the nomenclatured diseases. A love for 
the out-patient room of the hospital will not a little 
aid in teaching tbe student—^^oung or old—the 
largeness of tbe field of medicine, and prevent a 


calamitous conviction of the completeness of hi» 
knowledge. A geologist or botanist does not, m 
general, expand to bis sciences if he confine his work 
to books and museums; he is greatly benefited and 
expanded by wide field excursions; the out-of-door 
clinique may be looked on as a field excursion into 
the regions of disease. 

I do not know any field more educational and ex¬ 
panding toward wide and just generalisation than, 
that presented by the very complex and widely co- 
related symptoms which come to us under tbe name- 
of Indigestion. 

This is not only true in relation to symptoms and 
their varied corelations, but no less so in relation to 
the profound and varied physiology and pathology of 
tbe great organic vital tract, extending from the- 
moutn to the rectum. The veiy foundations of tho 
living cell and animal are involved. But although 
we cannot yet solve the complex bio-chemical 
problems involved in Indigestion and in its dis¬ 
turbances. yet a great and good empirical know¬ 
ledge and practice may be attained. 

I propose to view Indigestion on the side which is- 
resent^ in actual practice, and not to attempt the- 
ifficnlt and complex bio-chemical study. For this- 
purpose 1 have gone over my notes of fifty-four cases- 
occurring during the past five years. 

Niemeyer says :—“ Jaksch and others have given 
us statistics of its (chronic ulcer of the stomach) fre¬ 
quency at different ages, and in different employ¬ 
ments, &c. In the accounts of 2,330 post-mortem 
examinations, Jaksch found round ulcers mentioned 
fifty-seven times, so that to about every twenty 
bodies there was either an ulcer or a cicatrix. Mil¬ 
ligan, Brinton, and others, come to similar con¬ 
clusions.” 

Such a proved frequency of ulcer of the stomacb 
will always compel the most serious attention to- 
seeming trivial complaints in young adults, involving 
pain at the epigastrium after taking food, vomiting: 
after eating, &c., but, on the other hand, tbe great 
number of young women who come with epigastric- 
pains after eating, and which are relieved by vomit¬ 
ing, and tbe rapidity with which most of such casea 
recover has forced me to view the greater proportion 
of the seeming cases of ulcer of the stomach as 
neuroses, and I have been the more forced to this 
view be<^u8e such seeming chronic ulcers of the- 
stomach have wide and varied general corelated or 
associated disturbance of other fiinctions. The epi¬ 
gastric pain and vomiting bring the patient, but the 
doctor will at once see that there oftra exists a wide 
and varied disturbance of different functions, which 
appear to be in part the foundation or essential co- 
relatives of the stomach trouble. The rapidity of 
recovery of many, under a treatment not mainly 
directed to the stomach, but toward correcting or 
balancing general condirions, seems to confirm my 
impression that often these cases, with tbe most 
pronounced symptoms of pain at the epigastrium 
after eating, and which is relieved by vomiting, are- 
neuroses. 

In young women, at the period of the full evolution 
of their toing, we can never afford to overlook tbe 
waywardness of a great variety of neuroses, with 
symptoms as “vaiiable as the shade by the light' 
quivering aspen made.” 

I will shortly summarise the symptoms of the^ 
series of cases now under analysis; we shall be- 
carried, both in the causation and corelations of 
Indigestion, not a little away from the stomach into 
wide genersbl conditions; and such should have a due 
influence on our treatment. 

Type Pain .—In the fifty-four cases, most 
refent^ the pain to the epigastrium only, eight to 
the epigastrium and back, eight to the epigastrium 


JULT 10, 1901. _OBIGIKAL communications. Th* Mk>i<ui. pRMg 29 


and left infra^axillary region, two to the epigaatrinm 
and sternum, three to the sternum onlj, and one to 
the left I.A.B. onl^. Such a wide area of pain, and 
involring nerve distribution from the medulla, the 
dorsal spinal cord, the great solar plexus, do., 
carries ns into wide corelations, and helps to correct 
that narrowing finality of pathology which the 
words gastric moer tends to foster. 

Thir^-five smd that the pmn came on immediately 
after eating, two in five minutes, seven in ten 
minntee, one in fifteen minutes, five in thirty 
minutes, and three in one hour after eating. 

Of those recorded, the ^n lasted half an hour in 
three cases, one hour in six cases, two hours in nine 
cases. hours ’’ in three cases, and all day in five 
cases. 

Vomiting was present in thirty-four cases; ten 
vomited blood, twenty-two “ bitter ” (bile P), and nine 

sour.” Twenty cases said that vomiting gave 
relief to the pain, four said that the pain was re¬ 
lieved by belching wind, two said that the pun went 
off by it^lf. 

Ail the fifty-four patients were females: thirteen 
cases were in those between 14 and 20 years of age, 
nineteen between 20 and 25, ten between 25 and §0, 
three between 30 and 35, four between 35 and 40, two 
between 40 and 45, and three between 45 and 50. 

We know that gastric ulcer mostly occurs in young 
women; but on the other hand, when we remember 
the vast “ potential *' of “ energy ” involved in the 
stomach and its related nerves and glands, trans¬ 
forming in the earlier stages crude food into living 
bioplasm, and doing this throughout a whole life¬ 
time,—we shall be prepared to expect the nerve 
centres of the stomach to show a great variety of 
neuroses; we might furly expect that the symptoms 
of gastric ulcer and of the varied neuroses would 
often commingle and not be distinguishable with any 
certainty. 

Fourteen of the cases showed other well-marked 
neuroses or neuralgias; two were ansemic, one had 
urticaria, and five bad a family history of phthisis. 
I have on former occasions shown that Indigestion is 
corelatable and often atavic with phthisis. 

The menses were natural in twenty-two cases, 
absent in four, scant in four, profuse m one, con¬ 
genitally absent in two. 

There was tbns not mnch disturbance of the 
menstrual function, not mnch corelation between 
the Indigestion—ulcerative or neurotic—and the 
menses. 

The bowels were costive in twenty-nine cases, 
extremely costive in two, natural in thirteen. By 
costive is meant an action once in from three to five 
or six days. This costiveness seems to be very 
fundamental in snch cases; it is remarkable that the 
great organic tract should be deficient in eneigy and 
runction in young women, coincident with the evolu¬ 
tion or development of the body in general, with the 
evolution of the sexual and nervous systems, with, in 
short, the evolution of the fuller being of the indi¬ 
vidual. The deficient action of the organic primm 
vise, thns coincident with and corelating with 
the general full evolution of the individual, 
has ite roots in the widest general conditions, 
in the conditions of the blood, cells, and nerve 
energy of the general bioplasm and nervous system ; 
on the other hand, the deficient action of the great 
glands and organs of the prims vise reacts injuriously 
on the whole system—blood, cell-contents, and nerve 
centres; the costiveness, the inadequate action of the 
primae vise is part of a vicious circle; other parte of 
that circle are the Indigestion, the feecal smelling 
breath, aneemia, palpitations, Ac.; in somewhat 
figurative language, the whole system seems poisoned 
by a somewhat suspended metabolism oi the or¬ 
ganism. The word “ costiveness ” is apt to close our 


froui the wide and deep generic cansation and 
corelations of the symptom. 

^ In alaigeprorortionof the caseswheretbe Indiges- 
tronis associated with sluggish prims; vus and anssmia, 
the ancient pU. aloe, et fer. taken at bedtime, or on 
alternate nights, as needed, followed in the morning 
by a moderate draught of Carlsbad or Fredrickshali 
water, will effectually restore the patient, and 
the indigestion and seeming ulcer of the stomach 
^11,. in many cases, vanish. I usually advise 
the juice of a third or half a lemon to be drank in 
warm water at bedtime, or the lemon juice may be 
squeezed over the food at meal times. The lemon 
juice is far best taken without sugar, (a) 

I am not here stating orthodox rules for the treat¬ 
ment of ^tahlisbed gastric nicer, but indicating 
general principles applicable to a great proportion of 
those with epigastric trouble and its corelated con¬ 
ditions. 

Wasting.—0\it of the fifty-four cases, two were 
appredably wasted. Even in chronic cases, with 
vomiting of food nearly every day for a year, the 
patients have not been appreciably wasted. 

Duraiion of Gases. —Two had been ill, off and on, 
for six years, two for five years, one for four years, 
three for three years, one for two and a-balf years, 
three for two years, one for one and a-half years, 
and eighteen ^r one year, one for eight months, 
six for six months, one for four months, eight for 
three months, one for two months, six for one 
month, and one for one week. 

Intervals of Acuter Attacks. —Acnter attacks in the 
course of chronic cases usually happened with in¬ 
tervals of from a few weeks to from three to six 
months. Thirteen bad had former acuter attacks; 
eleven of these bad had two or three or several acuter 
attacks. 

I cannot, with a confident finality of diagnosis, 
assert that the above-stated series of cases were 
“ chronic gastric ulcer ’’; the neurotic type was 
often very obvious, and one is far more impressed 
with this view when in contact with the patients, 
than any description can convey ; there exists, if I 
may so term it, a peculiar aura round about neurotic 
cases which no words can express, but which is very 
light-giving in diagnosis. The true Artist catches a 
something in the scene which is the soul of his 
picture, but which cannot he described; and so it is 
with the evolving neurotic young woman; the essen¬ 
tial diagnosis lies in a general estimate of many 
symptoms, which the physician instantly observes, 
and rapidly and rightiy gener^ses. The right 
diagnosis and treatment of many cases of Indiges¬ 
tion in young women, will make one feel the force of 
Herschel's words that, “ humility of pretension 
and confidence of hope l^ome the true philosopher,” 
and physician. 

As examples of rapidly relieved cases, A. P., f., 
set. 40, said that for two years she had suffered pain 
at the epigastrium after taking food; the pain came 
on one hour after eating, and lasted two or three 
hours: then she vomited and found ease; the vomit 
was bitter; she was very costive. ] ordered a mixture 
of his. carb., soda bicarb., and Isctopeptine; also 
Fredrickshali water in small doses, to be drank 
dilated with warm water, daily before breakfast. In 
three days she was well, and has remained well. 

Miss C., Eet. 25, a schoolmistress, said that for 
three jears she had suffered pain at the epigastrium 
after taking food; the pain came on one hour after 

(«) EMt«rn people ere br more iatellisest tben ere Weetem is 
metters of food eod drink. It is quite common in tbe Weat to find 
iediee wbo think—eiten, elu I nerina been told so -tbet the 
“ maoous membrene of their stomechs ere so delicetethat thej 
dere not eet mw fruiU or adequate vegetablee! It ie difAcnlt to 
conoeivea Kativeof IndiarefuBingrto use Itme jaloe, tamarind,or 
other fmlts. Tbe experience of tboumndsof Tears has made tbe 
IfatiTe wine in manr m the great matters of health and life. I 



30 Thh Mbdioal Pbiss. 


ORIGINAL COMMUNICATIONS. 


JULT 10. Idol. 


eating, lasted one hour, and was felt also in the back; 
the pain frequentlj passed off with belohins of wind; 
«he suffei^pain mbo intheriabt supraorbital nerve; 
she said ^at she had been ansemic a few years ago. 
Menses regular, not costive. I ordered a mixture of 
muriatic acid, quinine, tine, calumb, and tinct. 
zingib. fort. Meeting this lady three years after¬ 
ward, she told me that she was quite well in three 
days with the use of the medicine, and had remained 
well since. 

The first case was probably mainly relieved by the 
Fredrickshall water restoring an activity of the 
whole tract of the priime vi». The complex yet har¬ 
monious molecular constitution of the natural 
mineral water seemed to have given, through the 
great intestinal tract—the fundament^ pnma? via?— 
a renewal of active “energy” to the oioplasm of 
the whole system. In the second case per¬ 
haps the mineral acid, tinctures, and quinine 
stimulated the actions and functions of the 
stomach; but here, too, the drugs must have 
acted through the whole bioplasmic and nervous 
systems. It appears to me wiser to submit to such 
vague and general hypotheses than to assert a dog¬ 
matic and verbal finauty of a bare chemical thera¬ 
peutic action and cure, or one based on a germicidal 
cure. The Indigestion in neither of the cases was 
an affair of the stomach; we have to cast our view 
far around in biology and pathology for the true 
connections and cor^tions of the most “ simple ” (P) 
cases. Nor should I exclude, in the relief of such 
cases, the “ mental therapeutics ” of the physician 
who brightly lifts the mental modes of the patient 
into the re^m of hope. 

These two cases are taken from a long list of 
similar ones. I should in such, and other cases in 
general, tell the patients never to look at the often 
pernicious printed sheet of what they may, and may 
not eat, for these printed diet sheets too often tend 
to keep the patients' mind in a state of anxiety, sus¬ 
pense, and needless worry. As a very gener^ rule 
the patients should eat what they most fan<^, and 
what they find to agree, not excluding vegetables, 
potatoes, fruits, and often with great advantage they 
m^ take pickles and malt vinegar. 

I would illustrate the generic type of Indigestion, 
and the general involvement of the whole system by 
an abstr^t of a few cases. 

L. C., f, et. 15, had never menstruated; was a 
tall, pale mrl; for over a month she bad suffered 
pain at the epigastrium, coming on half an hour 
after eating, and lasting one hour; the pain usually 
“ went off of itself,” but on some days she vomited. 

G. T., f., set. 35, had very profuse menses, which 
*\ppeared every two weeks; extremely costive. For 
k .>ur months has had pain at the epigastrium, which 
lasts two hours, immediately after eating; then 
follows bitter vomit. 

In these two cases the indigestion corelated with 
disturbed menstrual function, and both cases were 
probably neuroses. 

S. G., f., set. 45, had had a lai^ family; had 
nursed her children; was a fine-limited and mentally 
superior type of woman. For six months had suf¬ 
fered from severe pain at the epigastrium after eat¬ 
ing, the pain extended around the left side and over 
the lower dorsal vertebrse. Under ammon. bromide 
and t. cinchome co. she was quite well in three weeks, 
and has remained well for two years. Liberal and 
varied diet was allowed. In lieu of a restricted 
milk diet, or of any “ special brand ” of whiskey, 
vrine, or stout, I order^ her to take a walk out 
daily in the sea-breezv park. 

M. G. M., f., set. 47, had pain at the epigastrium 
immediately sifter eating, and which Ism^ from 
three to foiu* hours; then she vomited “ sour;” always 
costive menses; appear once in about six or eight 


weeks, never had bleeding piles. She said that she 
never suffered indigestion until she received a great 
shock, her son being killed in a railway accident. It 
is impossible to exclude the “ shock ” as a veiy real 
part of the complex and wide corelations of this 
woman’s “ indigestion.” The case seems light-giving 
and suggestive as to the great place of nerve influ¬ 
ence. 

M. F., f., set. 27, an intelligent, well-grown, single 
woman, said that for several years, on and off, Ae 
had “burning” at tbe epigastrium “like a coal of 
fire.” Is well, now and then, for weeks together. For 
two years past the epigastric pain and burning have 
been pretty constant; the painful sensations are 
worse after food. She says that the “ burning ” at 
tbe epigastrium is a good deal relieved if she make 
her corset press in and “ support ” that region. Is 
not costive; menses regular. I have treated this 
case on varied orthodox drug paths without much 
benefit; she also has at times oeen on a restricted 
milk and rice diet. I have also used vrith her the 
most encouraging “ mental therapeutics.” 

I dare not “magisterially assert on nature” in 
this ca8e;bnt am more inclined to view the symptoou 
as neuroses rather than “ chronic ulcer.’’ 

A. N., f., 8et. 28, a refined and intelligent woman, 
of nervous temperament, said that she did not “ run 
off” till she was six years old; she had suffered 
pain at the epigastrium and in the left side of the 
abdomen during the past eight years. Seven 
years ago she was tinted in a London hos¬ 
pital for gastric ulcer. The pain comes on at 
once after eating and lasts all day; the pain also 
comes on when sbe Mts up in the morning. Is cos¬ 
tive ; vomits “ sour,” and sometimes “ bitter ”; has 
sour taste in her mouth ; has never vomited blood; 
belches with flavour of rotten eggs. She is worst at 
the monthly periods, but is quite free from “indi- 

S etion ’’ when pregnant; has had three children. 

uring eight months I treated her with various 
drugs — bismuth, lactopeptine, and cocaine; also 
with combined muriatic acid and pepsine; also 
bynin. The bowels were kept open by piL 
rheL oo., and sometimes by Carlsbad water. 
Tbe diet was societimes restneted to milk, rice, 
custards, &c.; at other periods a freer diet 
of fish was given. The patient would now 
and then be better for a week or two, but re¬ 
lapsed. My eight months treatment was unsuc¬ 
cessful. It is fair to say that this woman had 
chronic gastric ulcer or gastric catarrh, but these 
words or names are apt to nave an unjustly narrow- 
ins influence on our pathological conceptions. Her 
rickety childhood, her refin^ type, physically and 
mentally, the indigestion being worse at the monthly 
periods, its absence during pregnancy, all point to 
the widest and most generu neurotic case. Tb )i^h 
obliged to carry out tbe orthodox treatment, I £d 
not omit more general means, such as making her 
go out for a walk daily, and sending her off for some 
weeks for change of air. The case certainly enlarges 
one’s view of the wide corelations of indigestion, 
neurotic orulcerative,and does away with thenarrow¬ 
ing limits which names are apt to impose. 

M. £., f., set. 19, a well-nourished, spirited country 
girl, came for pain at tbe epigastrium lasting two 
hours after eating, then sbe vomited “ bitter and 
sour,” with relief to tbe pain; very costive, menses 
regular. Sbe said that she had suffered “ indiges¬ 
tion ” for two years, and that it followed aftw a 
“ fit.” She never suffered prior to tbe fit. Another 
young woman, set. 20, had been three years under 
different medical men, including three months in 
hospital on an exclusive milk diet. She vomited, 
more or less, frothy blood two or three times a week. 
No treatment gave relief. Sbe said that her illness 
commenced shortly after hei tonsils were excised. I 


JuLT 10, !90i. I 


OEiaiNAL COMMUNICATIONS. Th, Mmioai, P™ 31 


shonld be very far from pooh-poohing a possible 
cassation between the excision of the tonsils and her 
^®®®<l’i6nt stubborn disorder of the functions of the 
stomach. The tonsils hare great, and as yet un- 
raown corelations to the entire system, nerrons and 
btoplasmic. I think that the beautifnl guillotine is 
far too often used. 

A woman, »t. 25, had noticed a oorelation between 
her frequent attacks of nrticarca and the epigastric 
trouble. 

The foUowing case lately under observation seems 
bght-^ving. B. S., f., set. 34, a refined and con- 
ecientious type of woman, said that for three years 
she bad suffered pain at the epigastrium, which 
came on one hour after eating; it was a “ sinking 
sad “ gnawing ” pain; now and then the pain was 
sharp, and extended round the left side and over the 
lower dorsal vertebr®. The pain lasted two or more 
hours; the pain went off associated with rumbling 
m the bow^, the pain could be relieved by eating 
or lying^ down. Costive, and occasionally vomitis 
“ bitter. ’ I ordered a mixture of acid. mur. dil., n\^ 
XV., liq, morph, mur., ni_ v., glycer. pepsins, ni_ xii., to 
be taken three times a day after meals. She could 
take any food she preferred, and take tea if she 
liked. The patient was entirely relieved before the 
end of a week's treatment, and bus remained well. 

Trousseau taught us the value of small doses of 
morphine in cou^ination with muriatic acid. But 
to venture an hypothesis, may I say, as an explana¬ 
tion of the success of such treatment, that the mor¬ 
phine would allay pain and binder secretion, thus 
rrating the secretory cells and their nervous mecha- 
nism. HeanwhUe, the muriatic acid and p«psine 
would cany on digestion, and the organism would 
not suffer from the defective nutrition consequent on 
the non-digestion of sufficient food. 

Improved nutrition would react on the secretory 
cells and help their recovery, so that they could soon 
resume their normal activities. 

The examples will, I hoTO, be of use in showing the 
width of pathological rmations of “Indigestion”; 
treatment also must embrace a wide general view; no 
disease, more than epigastric indigestion, opens to 
our view the widest corelations and interdependence 
of function, both in health and its disturbsnce— 
disease. 

Daring over twenty years’ wide observation I have 
not known of a case of fatal gastric ulcer. 

Treatment. 

In a hospital we see disease in its more final stages 
and forms; in hospital cases and practice, gastric 
nicer is usually ea^y recognisable, and, no don'bt, 
the orthodox treatment of the day, rest, opium, 
exclusive milk diet, ice, &c., is called for, and in our 
present light, right; but in dispensary practice we 
often see disease in its evolution and growth, in the 
delicate deviations of its onset, and in the wide 
deviations of its earlier roots. Thus it happens that 
orthodox and routine rules of treatment will not be 
a measure of, or meet the conditions of, the varying 
types of cases which nature presents. 

In thirty-four of my cases of indi^iestion I began 
treatment with muriatic acid, quimne and pepsine; 
the greater proportion did well, bnt in tbirt^n of 
the above I had to abandon the treatment and to 
give bismuth, sodm bicarb, and lactopeptine; even 
then, in eeveral, I failed to give relief. Halt extract 
was given under both classes of treatment. In 
eleven, 1 began with and continued the bismuth, Ac., 
treatment. I have seen, in a few cases, a rapid 
relief both from the acid and bismuth treatments, 
but in some oases there was much failure to relieve 
the patients. 

A paramount aim was to greatly stimulate the 
whole primaB vi« by the pil. aloe et. fer., or by a 


mineral water, by a digestible but varied diet; by 
the use of lemon juice as a drink. In a few that I 
kept on an exclusive milk diet, temporary benefit 
would happen, but in general the pauente were not 

cured” by a milk diet, the relief of the pain would 
be for a week or two only. I incline more to a light 
^d varied diet—fish, tie best vegetables, and fruits. 
I am sure that lemou juice, drank daily in cold or 
warm water, is a mighty good thing, ^th for the 
yoxmg and old. The semi-scoibutic, ansemic, vitally 
expended Native of India will beseech that he be 
given lime juice or tamarind; under its use his ulcera¬ 
tive chronic diarrhoea and dysentery will often cease; 
DIB whole system will be benefited, and thus, 
his bowel complaints will cease, and, presumably, the 
extensive ulcers of his big gut beak It is a most 
bmited view of pathology and of therapeutics to 
treat the Natives’ dysenteric-diarrhcea by remedies 
directed to the bowels only; bis dysenteric-diarrhoea 
has a deep-down genei-ic base; similarly, the young 
women of the poorer classes io South Britain, whose 
action of the primse vise, as shown by costiveness, by 
the f»cal foetor of the breath, by the often coexisting 
anaemia, by the indigestion, by the chlorosis, &c., 
must be tested on the widest general principles. 

Both [in the Natives of 5idia suffering from 
extreme loss of appetite, anaemia and often chronic 
diarrhoea, and with young Europeans suffering from 
epigastric pains, sluggish action of the primx vise, I 
have a great many times put them on the right path 
towards recovery by yielding to their fancies for 
sp^ial food; “sours,' vinegar, pickles, lime 
juice, tamarind, &c., may often be given with great 
advanta^, especially when asked for. I have often 
s^n patients who have been kept on a strict and 
limited diet, e.g., milk, mutton, Ac., and who have 
been debarred fruits, vegetables, onions, tea, 
Ac., get well almost at once on giving them a 
greater liberty. I never ignore the possibilities 
of neurotic influences in ’'indigestion.’* and aim to 
look all round for the cormations and greater 
channels of the case. 

No one would lose sight of the beautiful researcbes 
of the bio-cfaemiste and physiologists on the great 
organs and glands of the organic tract; hut there 
is another field for the observant practitioner, viz., 
the experience of mankind throughout the ages, and, 
when judiciously interpreted, the expressed desires 
of our patients. Empiricism, submissively observed 
and c^efully studied and sifted, is often a right 
path for safe practice. 


THE 

OPERATIVE TREATMENT 

OF 

DEFORMITIES op the ELBOW-JOINT 

RESULTING FROM 
TRAUMATISM, (a) 

By Dr. SAMUEL LLOYD, 

Of New York. 

Three things were recognised iu fractures into 
the elbow-joint: First, it is not always possible to 
tell, even xmder an ansssthetic and with the most 
careful examination, just what the joint injury is. 
Secondly, it is not always possible to replace the irag- 
ments, even approximately. Thirdly, anchylosis wul 
result in certmn oases in spite of any plan of teeat- 
ment that may be adopted. 

All fraotnres involving, or in the vicinity of the 
elbow-joint, should be examined under amesthesia, 

(a) AbMnct of Mper nad befora th* N«w York Aeademr of 
MMlcine, Aprili IWl. » * 

CjO^i^gle 


I 



32 Thi Midio^ Fsbs8. 


ORIGINAL COMMUNICATIONS. 


July 10, 1001. 


the frajpients |>laced ia apDosition, and the limb 
dreesed in a poeition that enables the operator to re¬ 
tain them in place most efficiently. Personally I 
prefer flexion. I am decidedly opposed to passive 
motion, so much advocated by the older sut^^ns, 
believing that this caused an increase of callus and 
consequent diminished range of motion. Any passive 
motion in an elbow-joint, until after the ^ne is 
firmly united, is meddlesome surgery. If, when the 
splint is removed, motion does not return promptly 
by active motion (an attempt on the part of the 
patient to use it regularly), toe deformity should be 
examined. If moderate passive motion succeeded, 
then we have to do with simple adhesions. If the 
joint does not yield under an anmsthetic, then 
the difficulty is probably due toobstructing callus or 
to a displaced fr^ment. I believe the ankylosis or 
limitation of motion to be due to bone and not to 
fibrous adhesion s, p rovided there have been no septic 
complications. T^ile my first operations and con¬ 
clusions antedated the use of X-rays, they have been 
corroborated by an extensive use of the X-ray. 

The overproduction of callus is a constant dai^r 
in the direction of producing anchylosis, and is 
increased by any motion of the fragments during ; 
the period of union. Provisional callus is objection¬ 
able. The bone unites in the same manner as the 
soft tissues, with but little granulation tissue, if 
firmly held toother. 

The X-ray has been somewhat disappointing in 
solving all the difficulties of fracture work, since it 
gives only a shadow of the real object. The X-ray, 
however, so frequently illustrating dislocation com¬ 
plications has emphasised the necessity of using an 
aniBstbetic in the first examination of fractures aiwut 
the elbow-joint. 

The maiority of cases of anchylosis of elbow 
following tractare being due to bony displacement or 
to callus, if non-operative measures are not successful 
in i*emoving these causes, something should be done 
to put the Mnee in proper position. In compound 
fractures we are all agreM as to what should be done 
—viz., enlarge the wound and suture the fragments 
in position. 

It is, however, on simple fracture that I would 
dwell more particularly. At first eight cutting into 
the joint ana manipulating the structures about the 
joint, including the capsiue, would appear likely to 
result in ^most, if not absolute, fixation. Such has 
not been my experience, and I hold that the fear of 
attacking a joint surgically is largely a relic of pre- 
aseptic times. 

I am enabled to illustrate the different fractures 
occurring in vicinity of the elbow-joint by a series of 
skiagraphs of cases I have operate upon. One is a 
snpra-condyloid fracture of the humerus where the 
dimculty was found due to both callus and displace¬ 
ment. The arm had been treated at an angle 145 
degrees, the condyles being carried backward while 
the shaft of the bone was drawn forward. 

In flexion the coronoid process of the ulna struck 
upon the mass of callus mIow the more prominent 
projection of the shaft, while the ulna rested upon 
the sharp end of the diaphysis in the complete 
flexion. This boy had a useless arm. The project¬ 
ing portion of the diaphysis was chiselled off and a 
new coronoid fossa was cut ont with a curette untU 
complete flexion was possible. The result was re¬ 
markably satisfactory. In spite of the extensive 
dissection necessary to reach the anterior surface of 
the humerus and the consequent lacerating and 
bruising of the capsule and synovial membrane, 
flexion was obtained almost to the full extent. The 
other skiagraphs further illustrate varieties of fra<y 
tures about the elbow-joint, complicated with callus 
and dislocation, upon which I Imve operated gene¬ 


rally with success. I may sum up the management 
of fractures of the elbow in the following words:— 

(1) Exsmiuation and reduction under ether. If 
the latter is impossible, and it is evident that dis¬ 
ability will result in consequence, immediate incision 
and dissection until the fragments can be forced into 
poeition and wired or sutured. If, however, this is 
still impossible, the fragments should be removed. 

(2) If anchylosis or marked limitation of motion 
results and does not prove to be doe to fibrous bands, 
operation should be undertaken and everything 
opposing the proper movemeut of the joint should be 
cut away. 

When I performed my original operation in 1894, 
I was unable to find any records oi previous opera¬ 
tions of the kind, but now there are many. I may 
mention as repotting cases, AUes, “ Annals of Sur¬ 
gery,’’ 1897; Wight, ibid, 1893; ^emm Sammbeng, 
*'Klin Tortrag,’^ Sept, 1893, recognised possibili^ 
of the operation. 

The open method of treatment was advocated 
much earlier in irreducible dislocations of the elbow, 
and it seems strange that it was late in coming into 
more general use in fractures. 

In aU m^ cases, twenty^one in number, the pos¬ 
terior incision similar to that made for excision of 
the joint was employed. This answered well for 
manipulation of the olecranon fossa of the humerus 
or the injuries to the condyles. The difficulty of 
clearing ont the coronoid fossa and managing the 
anterior displacement was greater. I varied the 
incisions according to the injury. The capsule 
should be as carefully opened and sutured as the 
peritoneum. One can scarcely be too radical in 
removing bone; it is better to try for both flexion 
and extension than to stop short of removal of any 
obstruction. After removal of bone I flush the joint 
with hot normal saline solution, suture the capsule 
carefully, and close the woxmd without drain^pe. 
Best in flexed position for one week, then massage 
and active motion. 

TUBERCULOSIS IN CATTLE : 

ITS SPREAD AND PREVENTION, (a) 
By Mb. J. P. PENBEBTHT, F.B.C.V.8., 

Profeaaor of M«>dloine is the Bojal Teterinary Collie, London. 

Tex leotnrer remarked that during the past twenty 
years mnoh eoientifio knowledge of that disease bad 
bMo acquired, but the applio^on of eoientifio know¬ 
ledge was not likely to he far in advance of public 
opinion. The value of educating the public on that 
snbjeot could soaroely be over-eetimated, for sdenoe had 
done its share by demonstrating its preventibility and 
the means of prevention, but the snppreeaion of that 
wiOTftCft to human health and agrioaltnral prosperity 
most DOW remain with the pnbl^, whom it ^ecto. It 
was now for the social economist and the legislator to 
apply the knowledge science had placed at his disposal. 
It was, however, “the man in the street” whose ex¬ 
pressed opinion set in motion the cnmbersome machinery 
of 80(^ economy and legislation, and fie was firmly 
convinced that it was to the education of tiie public they 
must look for the removal of that deadly enemy. A 
single case of suspected plt^e, cholera, or small-pox, 
was reported with the ntinort ^aority throughout the 
length and breadth of the land, and stringent meosores 
were inunediately adopted for preventing its spread. 
Diphtheria, mtasles, scarlet fever, Ac., were all provided 
for by law as they might reasonably expect, Tnber- 
oulosis claimed annually for its victims in Great Britain 
and Ireland about 70.(^ human beings—one-tenth of 
the total mortality in these islands, and yet. until 
within recent years it was allowed to pass nnohalleneed, 
and was still practically nnlegislated for. That inaction 

(a) Abstract of leotnre delivered st Abardeeast tbainstanoe of 
the Comsittee oa Tnberoalocls. 





JvLT 10» 190]. OSTOINAIj GOMMXJNIGATIOlfS. Thx UsDiciiL Pbbss. 33 


bad renilted from aeTonl oaoses, the chief of which was 
the inndioQS prc^rem of the maladj, want of knowledge, 
and. beTond ml, the abeenoe of any evidence that it was 
preventible. Sdentafie men, as witnessed by their wcork 
and words, politicians, as proved by the appointment 
ot committaes and Boyal Commissions, recognised the 
danger and indioated the methods of prevention, and 
evmi the law, by certain apol(^es for a<^on, had taken 
eognisanoe of tnese mattm; bat nntil the public were 
educated to the danger and the poesibility of ewape, 
that desired safety would never be acoom{dishe<L Th^ 
main obieot there that day was to consider the effect 
of the flesh from tuberculoas on the health of 

He was sure tiiat all who reaUsed that there was such 
a duger would deem it a privil^e to do his share in 
trying to avert it. It was, however, important that 
tb^ be convinced of the dan^^, and, as far as possible, 
of its degree. They in Great Britain were not credited 
with beu^ an impetuous people, their reason must be 
app e aled to, but with scdid ba^ of action, their sense 
of justice would rise to the ooosaion. It was under that 
cmviotaon that he would venture to proceed to acuzsmy 
eonsideratiiMi of the subject, or, particularly, that part 
it oonoemed with the Am of tubaroulous animals. The 
malady, which assumed various forms, and was known 
by many names, was invariably caused by the entrance 
into the body of a very minute germ or microbe^ now 
almost familiarly known as the tubercle bacillus, and 
though oertain states of the system and other oircnm* 
stesM might be oonontisl to its growth, development, 
and power to produce tiie dieesso there, without toe 
tubewe germ there could be no tuberonlosia. That 
germ was always derived from some man or animal 
affected with the disease. The same germ produced 
tuberculosis in man and animals, and it might enter 
the body of either in toe dost, in food and drink, and 
evso throngb a wound in toe sldn. Though very many 
species of animals, indnding horses, cats, dogs, 
f^bita, Ikc., wore liable, it was much more common in 
toe domesticated whose flesh is used for food— 

among cattle and pigs. Of cattle by Ux toe larger 
number of oases were found in dairy oows, eepeoially 
toe older ones. Indeed, the main factor in brin^g 
about that inoidenoe was the oongr^^ting for long 
periods indoors. Sheep which Imul a life iu the 
open air are very rarely affected. Cows in mild 
climstos, such as Jersey where honsing is little 
known, enjoy oompaxative, if not complete, fre^ 
dom. In ^t, overcrowding, with bim ventila¬ 
tion and lack of sunlight in ™imi ud animals, is 
aooonntablo for toe oocurrenoe of a high peroentege. 
But observation had over and over i^ain proved tost 
neither overcrowding, want of ventilation, nor general 
insanitary oondittons alone induced tuberculosis. The 
tubenmlous was the prime—the only—factor in 

providing the oesontial tuboi^ germ, and if we desire 
to prevent tuberouloeis in cattle we must remove tnber- 
enloeis from hetltby animals. Aooording to a variety 
of cireumstaDoee associated with the mode of entry, the 
state of the oonstitntion in general, or of oertain parts 
of toe body, the germ settled in some situation, and 
there it grew and indnoed the disease in the part. It 
becaioe localised, and they might take it that at first 
tubmcalosis was a "localised disease,*' and experience 
had told them that it nsually remained so for a long 
time. The tubercle bacilli traded to remain in that 
part, and for some time other parts were free. In infec¬ 
tion it might be, and oommoniy was, that the germ or 
geruu eettied only in one spot or xesting-plaoe, and that 
for a longer or Bb<»ier time only was “ tnberculons.** 
It might be that at that or a snbeequent infec¬ 
tion germs from without might have found several 
restmg-idaoes, and induced tuberouloeis in several 
different parts of the body. The condition was, 
however, according to present interpretation, still 
“localised tuberculoa's.** While, however, the germs 
were active in any of these positions, they were 
more or less rapidly increasing in number, destroying 
toe healthy struct ure of the part, and extending in that 
way BO as to produce large tuberculous lesions, whonoe 
to^ might gain entrance to a vessel, and so get to the 


heart, from which they were discharged into the blood 
stream, -and, it was believed, sent over the system. 
When that was the case toe so-oaUed “geoe^ised 
tuberculosis ’* existed, and it was usuaUy regarded that 
under suoh conditions it was unsafe to say that any 
part of an animal was frra from taberde germs. More 
recent experiments, however, went to show that when 
such an oocurrenoe took plane the great majority of the 
hacillf were arrested in the longs, throogh which all 
blood from the heart must pass. That produced in both 
the lungs innnmerable ■ ">^11 tnheroles, the so-osdled 
“miliary tubercnloeis." From that fact the lungs 
yielded the strongest and probably the only trustworthy 
evidraoe of “generalised tobei^osis.*' Absence of 
tnbpronlosis in the other organs of toe b^y in the 
experiments referred to, at any rate forcibly sugges^ 
that even in the so-called “generalised tuberculosis** 
there was not a general disMbntion of the germs 
throughout toe body of the Mimsi It might, however, 
not be inferred from this that tubercle germs might 
invade the body in no other way thsn by the blood 
stream. Their tendency was to spread by the lym¬ 
phatics to the glands, and there, or on their way, toey 
might be arrested and set up tuberonlosis, and so 
oontaminate many parte, some of which are removed 
easily, and others cannot be so removed. There was 
little tendency for the germ to rest and grow in the 
muscle or lean floeb, but the lesions might be so 
numerous and closely associate with the ^ble parts 
of toe oaroase that they could not be separated wito 
certainty. That might apply to one lesion or many. 
When toe lesion was in oonneotion with the outer world, 
as sometimes hai^ens when the lungs, udder, toToat* 
intestines, &a, were theirseats, the tnber^e serms might 
be thrown off by the and so beoome a danger 

to others. They were then capable of living outside 
toe body for a long time, though they did not multiply 
there under ordinary oironmstenoes, and be conveyed to 
healthy animals by dust or fo^ It was, however, well 
known that they were killed by subjection to high tem¬ 
peratures, and a very short exposure to a heat of 180 
degrees F., i.e, 32 degrees under boiling point, de¬ 
stroyed them. The general effect of toe tnborole 
germ on the oonstitation of the affected, apart 

from too destrootion of the portion it invade^ was 
usually marvellously little. It was not unoommon to 
find the most extensive tuberculosis in oattle in prime 
oondition and apparently p^ect health. It wotUd be 
thus seen that toe flesh of might contain toe 

germ, and as it was a truism “ that any or animal 
toking the tubercle bacillus into his system nins a risk 
of beaming tnberculous,** there was a oertain amount 
of danger assoriatod with the oonsomption of flesh from 
taberonlous animals; a danger of whioh they nrgently 
deeire to form a jost estimate. Though granting that 
the conservation of human health outweighed 
every other oonsideration, it need not obecure 
the fact that the prevalence of the disease in 
our herds of cattle, pigs, Ac, caused an enor¬ 
mous drain on the resources of the stockowner. 
The most moderate computation indicated that between 
20 and 80 per cent of dairy oattle veie affected, and in 
a lesser degree than young stock. The danger to the 
health of man through drinking milk, a zral danger 
indeed, soarcely came within the scope of that lecture, 
but the stock-owner had every iudooement to rid his 
herds of tnberoulosis. In the natural order of things, 
however, sooner or later, this 20 or 80 per cent of tuber- 
onions oows, and the smaller proportion of other oattle 
and the pigs so i^eoted whioh did not suooumb, came 
to the batcher and the meat trsde. It was that eaor- 
mous impost ^ioh had to be faced, and considered by 
the conservators of pnbiio health and the vendors of 
meat. The prevalence of tuberouloeis in oattle was 
brought to light in the slaughter of cattle for pleuro¬ 
pneumonia. 

In 1888 a Departmental Committee sat, and going 
beyond the scope of their instruction, recommended tha^ 
owing to toe dinger to ooosumers fleeh, all carcases 
in whmh existed a trace of tuberoolosis should bo oon- 
flsoatod and destroyed. The application of the tuber- 
ooliu tost yielded evidenoe of an even higher peroenti^ 


C 



34 Th* Mh)ical Pb»m. TRANSACTIONS OF SOCIETIES. 


JULT 10, 1901 


of tuberculona cattle, end with that evidence there wac 
perhaps little wonder, that that portion of the medical 
world and the poblic, who interested themselves, should 
become excited, and that an idea shonld prevail and 
extend that tuberoalosis in man was a cattle dise^, 
communicated to him by eating meat and drinking 
milk, and that the responsibility for the hnman mor¬ 
tality rested with the Board of Agriculture. Owing to 
the want of system, uniformity and proper returns, the 
Commissioners were unable to form an opinion as to the 
results of the application of their proposed 
standard, so were compelled to have recourse to some 
returns for foreign countries. In Saxony, where the 
inspectors are all veterinary surgeons, ^d the inspec¬ 
tion rigid and discriminating, tuberculosis was found to 
exist in 22,758 carcases (being 27 48 per cent, of the 
whole numbers slaughtered). The whole of these, 
according to the practice of some authorities in this 
country, would have been confiscated and destroyed 
without compensation. In Saxony they were dealt with 
as followsOf the total number 22,758 showing tuber¬ 
culous lesions, 21,062, or 92 per cent., were passed as fit 
for food; 1,256 carcases, or 5i per cent., were disiwsed 
of in the f^eibank as inferior meat, at a fixed cheap 
rate ; andthe remainder, 440 carcases, or 2 per cent, of the 
whole number pronounoed tuberculous in a greater or 
less degree, were condemned as unfit for food and 
destroyed. The report of the chief sanitary inspector 
of London states that 30 per cent, of the cows which 
were examined under his authority contained tuber¬ 
culous lesions, and ho found that only 6 per cent, had 
to be condemned as unfit for human food. The other 
24 per cent, the tuberculous lesions were removed 
and the flesh was allowed with safety to go into the 
market. He went on to advocate a system of public 
slaughter-houses and the marking of foreign meat. On 
the question of compensation to owners of condemned 
the Commission were unable to come to a 
unanimous conclusion, but he thought it probable tlmt 
many present would endorse the views of the minority 
that the owner should receive oom^nsation on certain 
conditions, and he did not think their demand would be 
regarded as extiav^jant by any who believed that the 
principles of compensation should be applied to tuber¬ 
culosis Though scientific investigation and common 
observation went to prove that the danger arising from 
eating the flesh of tuberculous animals was much 
over-estimated, no one could deny that the edible parts 
of tuberculous animals might contain the tubercle 
germs rarely as this may be. No proof was required 
that inspection of meat was necessary, and, if necessary 
for large communities, it was necessary for the more 
scattered population. It should be uniform. It has 
been clearly shown to be wanton waste to destroy but a 
small portion of the flesh of most tuberculous animals. 
Indeed, it had been said there were grave doubts as to 
whether flesh cooked in the ordinary fashion ever 
induced tuberculosis in man. A greater danger wm 
undoubtedly associated with milk from cows with 
tuberculous udders. Other countries, Belgium, 
cbusetts. Ac., have adopted extreme measures, probably 
without counting the cost or measurmg the possibilities, 
and have had to withdraw. When it was for a moment 
considered that a laige proportion of our six milbon 
cattle was tuberculous, that of our two and a half 
million cows probably more than 800,(^ were ^ec^ 
in a le«Bet or greater degree, they sho^d realiM the 
enormity of such an undertaking. To withdraw all our 
milch cows reacting to tuberculin from our dairies 
would paralyse the dairy industry, arrest breeding, send 
the trade abroad, perhaps never to be recovered. And 
after such an attempt there were grave r^ons for sup- 
nosing that some tuberculosis would still exist, while 
the wBt would be immense. He shared the opmion 
that the disease might be very matenally reduced, if not 

eliminated, by rational precautionary measUTM. HewM 

under the conviction that no Government would be 
cajoled into giving full oompenMtion. In toe “^^ime 
in^ the absence of compensation from the State, it 
Smeared to him a system of mutual msursmoe should 
bo^nted in which contributions should be m^e by 
toe fanner who sells the tuberculous animal, by the 


local authority representing the consumers' benefit in 
health, and by the butcher, who may or may not take 
the risk into consideration in bis dealings, but whose 
burdens wonld be thereby lightened. 


^ransactionB of gorictice. 

OBSTETEICAL SOCIETY OF LONDON. 
MSBriMO HXLD JuLT 3 rD, 1901. 


PxTBB Hobbocks, M.D., President, in the Chair. 

Spbcivins. 

MBNBTBUAL MBMBBANB IN BXPOLIATITB BND01I1TEITI8. 

Db. Cuthbbbt liOCKTBB showed a specimen of a men¬ 
strual membrane passed by a single woman, at. 19. Her 
periods bad been normal till six months previously, when 
they began to be profuse, and shrsds were passed; but 
the patient had no pain. After curetting, no more 
membranes were pa'sed. He thought the condition was 
beat described as exfoliative endometritis. 

Bemarts on the specimen were made by the President, 
Mr. Alban Doran, and Dr. Eden. 

CTSTIC COBPOS LUTBUM. 

Dr. Eichabd Alcock (Goole) showed this specimen. 
The patient had had septic endometritis following 
labour, and for ten months afterwards suffered greatly 
from severe pain on the left side. Abdominal section 
was then performed, and the ovary of that side was re¬ 
moved. It co.-itained a cyst the size of a plum, on 
puuotnring which fluid escaped under considerable ten¬ 
sion. It proved to be a cystic corpus Intenm; in its 
collapsed state it surrounded a considerable portion of 
the ovary, the section suggesting one across the empty 
right ventricle. Dr. Alcock suggested that the septic 
endometritis after labour might have led to the corpus 
Inteum becoming cystic, instead of undergoing its normal 
involution. 

Mr. Alban Doban said that Dr. Alcock’s explanaiiou 
of the origin of this ooipus Intenm cyst was ingeniona 
and interesting ; it might quite well be the correct ex- 
planati(Hi. Certainly, suppurating cysts of the c^^os 
Intenm were known to reeult from septic perimetritis. 

Bemarks were also made by the Freeiaent and Drs. 
Spencer and Eden. 

oabcinoxa of thb ovabt. 

Dr. Faibbaibn showed a specimen removed from a 
patient by Mr. Bland-Sntton. The pedicle was twisted. 
The contents of the cyst were soft, and somewhat sng- 
fteeted a dermoid ; but microscopic examination showed 
that it was a case of carcinoma. An interesting point 
was that the tumour had a thick capsule, which wia 
quite intact; the growth was therefore well ciroum- 
wribed, snd the prognosis was good. The patient had 
suffered from menorrhagia and metrorrhagia for some 
months. 

Dr Abthub Gilxs said that the case possessed con¬ 
siderable clinical as well as pathological interest, espe¬ 
cially from the point of view of diagnosis. He saw the 
patient in the out-patient department, and the history of 
hemorrhage going on for some months, without any 
very obvious cause, and of marked pain in the left side, 
together with the presence of a well-d^ed tumour 
to toe side of the uterus, led him to diagnose extra- 
uterine gestation, and this was the view generally takra 
when she was in the hoepitaL An element of doubt in 
the diagnosis was introduced by the mobility of the 
tumour; he had, however, known exceptional ca^ 
where the tumour in a case of extra-uterine gestation 
was mobile, even though of considerable size. 

Dr. CtJLLXNQWOBTH Mud, in reference to Dr. Giles’s 
observations on diagnosis, that in his experience a con¬ 
siderable h»morrha^ was not oharaoteristio of ectopic 
geetation 5 the blood generally came away in a dribble, 
snd was not arterial, but dark, and resembled menstrual 
blood. He had often found this distinction of service 
in arriving at a diagnosis. .. ■ 

Some observations were also made by the fresidan;^ 
Mr. Alban Doran, Dr. Duncan, and Dr. ^raey. 

0 



J01.T 10. 1901. 


TRANSACTIONS OF SOCIETIES. Th. Midical Peiss. 35 


INCOMPLETE TUBAL ABOBTION. 

Dr. Faibbaibk also showed this speoimen, remoTed 
by Dr. Cnllin^orth. It was a partial expulsion of a 
fcetos, four inwes long, thiongh the flmbriat^ extremity 
of the Fallopian tobe. The after>ooming head of the 
totns was retained within the tnbe. 

Dr. ELeemav said that it was an interestiog question 
what became of the tubal mole in the pre-operatire days ; 
no specimens found in museums dat^ back more than 
a recent period. He presumed that a mole left to 
nature became absorbed He operated a few days ago 
on a patient, and removed a recent mole from one side; 
on the other side the tnbe was occluded, and adherent 
to bowel, and contained a gnmmons fluid. He believed 
tiiatthis represented an older mole that had become 
mmnly absorbed. 

Dr. William Duncan agreed with Dr. Herman that 
a mole irhen left alone became absorbed. Be operated 
recently for double hydrosalpinx on a patient whom he 
had seen elevmi years before. She then had a tubal 
gestation which was not operated upon at the time. At 
the operation no trace was found of the former tubal 
pregnancy. 

.Alter some remarks by the President and Dr. Drum¬ 
mond Bobinson, Dr. Cullimqwobth gave a brief account 
of some clinical features in the case. 

CAECINOMA or THE UTERUS SUBSEQUENT TO DOUBLE 
OVABIOTOMT. 

Hr. A. C. Butleb-Smtthe showed a uterus, the seat 
of carcinoma of the cervix and pyometra, removed from 
a patient who had had a double ovariotomy performed 
eighteen years previously; a large multi-locular cyst 
having bera removed on one side, and a cystic ovary the 
sise of a Tangerine orange on the other side. 

Dr. Hebman stated that he had had a case of oarci- 
nomaof the cervix occurring sixteen years after he had 
performed double oophorectomy. 

Dr. Herbert Spenceb mentioned that two other such 
cases had been recorded in the Society's Transactions. 

Further observations were contributed by Hr. Alban 
Dman, Dr. Amand Bonth, and Dr. W. Tate. 

Dr. William Duncan showed (1) a myoma with a 
large cystic cavity; (2) a myomatous uterus studded 
with a very large number of small fibroid nodules. 

SPONTANEOUS BUVTUBB OP THE UTBBUS IN PLACENTA 
PBJKVIA. 

A paper on this subject wae contributed by Dr. J. 
Pbsston Maxwell, of China. It was the record of a 
ease snooeesfnlly tinted by gansc^paoking ^m the 
vsmina. 

Dr. F. H. Chajcpnets remarked that this was a valu¬ 
able record of a rare occurrence, the small sise of the 
child and the absence of oanses for rupture being 
especially notable. He had no doubt that Dr. Maxwell 
d<me the right thing; for in cases where the child 
bad not got into the peritoneal cavity, ganze pacddng 
had been found to give the best resolts. 

Dr. Hebman b^eved that there was very little 
diffexenoe in tbe oonsistenoe of the ntems in cases of 
placenta pievia and in other cases; it had been said 
that a cause of “ spontaneons" ruptore of the uterus 
was fatty degeneration of its mnsole fibres; bnt he did 
not believe that the existenoe of fatty degeneration of 
tbe ntems was established, or that it was a cause of rup¬ 
ture. Dr. Helme had shown that there was no fatty 
degeneration in the cases he examined; they were not, 
however, human uteri. 

Dr. Dbummond Bobinson said that he had had an 
o pp cr tu Dity of examining two homan involuting uteri, 
and had found no fat at ^ 

1^. Hbbbbbt Spenceb said that he had examined 
•erenl nteri where spontaneous rupture bad ooourred, 
and had found no fat. He was glsd to find that Dr. 
Maxwell practised ganse packing, for his experience was 
eotixely in favour of this mode of treatment, except in 
the ensee mentioned by Dr. Champneys. 

Dr. Amand South had seen a case like the one 
recorded in the npers in the ooontiy; the woman, who 
WM at the eighth month, had been in labonr for a day 
or two and 1 m had several hsmorrhagee. He found a 


plaoeuta prsvia and performed a podalio version. In 
the course of the night the foetus came through with a 
rush, and the uterus was tom through. Unfortunately, 
the patient died of septiosmia within a week. The 
cervix in this case did not appear to be specially thin, 
but rather presented the characters of a spasmodically 
contractile and ondilatable cervix. 

Tbe disonseion concluded with a few remarks by the 
President. 

EDINBUBGH MEDICO-CHIBUEGIOAL SOCIETY. 

Meeting held Jult 3bd. 

Mr. A. G. Millbb, President, in tbe Chair. 

Db. Sims Woodhkad, in opening a discussion on 

alcohol in its medical and scientific aspects, 
first alluded to the difficulty which existed in coming to 
any conclusion on the whole question of alcohol—a 
question which it was scarcely possible to approach with¬ 
out bias in one direction or another. We had to con* 
sider alcohol as a poison, as a drug, and as a food. It 
was, as all knew, a readily oxidisable substance, and was 
completely homed np in tbe body. Hence it was a pro¬ 
ducer of energy, and was therefore regarded by some as 
a food substance. Tbe quantity of Moohol required to 
yield the requisite number of calorics was, however, so 
great as to 1 m a poisonous dose. It could not, therefore, 
be regarded as strictly comparable to other foods. It 
had bran shown that the nutrient part of alcohol did 
not combine with the protoplasm of the cells of tbe 
body, as in the case of other foods, hence it differed 
totedly from these in its properties. It was even doubt¬ 
ful whether it acted as a residuary food, and it seemed, 
like phosphorus, to have so powerful an affinity for 
oxygen that it diverted to its own use oxygen which 
wonld normally go to protect the body proteids from 
waste. In this respect it closely reeemblM the toxins 
of certain oxganisms, which have a similar attraction 
for oxygen, its action, however, differs from that of 
the proteid toxins, because in process of time a certain 
amount of immnnity is acquired a^nst the latter, 
while the most prolonged action of alcohol produces 
not the least immnnity, on account of the almnce of 
any proteid reaction against it on the part of the 
cells. Alcohol was undoubtedly onmulative in its 
effects, and when circulating in the body along with 
another toxic agent, both their actions seemea to be 
intensified. This was seen in the case of arsenical 
neuritis following beer-drinking, and in other condi¬ 
tions. One of the most important effects of alcohol was 
nudonbtedly in predisposing to the s^ifio infections 
diseases, and this had now b^n the snbjeot of a great 
deal of experimental work by Abbott and others. It 
had been experimentally demonstrated that alooholised 
rabbits were much more snsoeptible than normal to the 
poison of erysipelas, (diolera, and anthrax. This had 
been confirmed as the result of obeervatioDs made at 
Lille with the poisons of hydrophobia and tetanus, and 
it had, moreover, been proved that it wae quite 
impossible to produce in an alcoholised rabbit 
any marked degree of immnnity gainst the toxins 
of these diseases. As regards the vims of hydrophobia, 
the experienoe of the Paatenr Institute quite ooiocided 
with these experiments. In all these casee toxic doses of 
alcohol were employed, and objection might justly be 
taken to this, bnt a series of observations in Fraenkel’s 
laboratory in Halle, in which tbe dosage of alcohol per 
kilo was less than that used systematuMy in the treat¬ 
ment of phthisis at Davos, had led to the same conclu¬ 
sions. Tbe animals were much more snsoeptible to the 
toxinee of diphtheria and tubercle, and, in particular, it 
was impossible to produce in them any high d^ree of 
immnnity. These experiments were conducted with the 
greatest care, and he thought that we were not justified 
in disregarding their teaching simply because they had 
to do with the effects of alcohol. Its use in phthins, 
especially, seemed questionable, both because immnni- 
ciation of the patient—toward which all the efforts 
of the tffiysic’an should be directed—was rendered 
more difficult of accomplishment, and the risk of 

C 


JPLT 10, 1901. 


36 Th« Medical Pbess. TRANSACTIONS OP SOCIETIES. 


secondary infection consequently increased, and because 
it appeared irrational to administer a substance whose 
affinity for oxygen was so great in a disease where the 
respiratory capacity was already taxed to its utmost. 
Passing to the effect of alcohol on certain organs, Dr. 
Woodhead recalled his experience in the postmortem 
room of myocarditis and fatty degeneration of the heart 
in cases of acute alcoholism. He also deemibed recent 
obserrationewhich had been made on the changes in the 
nervous system caused by aloohol->changes exa^ly com¬ 
parable to those resulting from the actions of other 
toxins—such as alterations in the staining of the 
Nissl’s bodies, shrinkage of the dendrites, and the like, 
and said that if these were definitely prov^ they would 
constitute a great advance in our knowledge of the 
pathol(^ of alcoholism. Another important action of 
alcohol was that on the thermogenetic centres. It was 
found, for instance, that while it was impossible by the 
application of external cold to reduce the temperature 
of a normal rabbit more th^ 8^ C., yet if the animal 
were alcoholised the temperature could be reduced from 
SS-?** C. to 19 8o C. 

Professor T. B. Fbaskb said that a large part of the 
difference of opinion as to the therapeutic value of 
aloohol, as well as to its dietetic position, turned on the 
question of dosage. Everyone knew that in large quan¬ 
tities, or in too frequent dosee, aloohol was deleterious; 
but in small dosee it had definito and valuable actions, in 
respect of which it could be replaced by no other drag. As 
regards its food valne,it had bera most conclusively proved 
that only the very smallest percentage was excreted, 
and that nearly all was burned up in the body. It was, 
therefore, impossible to doubt that it was an energy 
producer, and this vexy affinity for oxygen to whic^ Pro¬ 
fessor Woodhead alluded as undesirAble, was, in fact, one 
of its great advantages, because in the crisis of an acute 
illness, when ordinary food could not be absorbed, we : 
could by the use of idcohol supply material from which I 
energy sufficient to tide the patient over the period of 
greatMt danger could be dmved. In small doses its 
action upon the heart was of the very greatest value. It 
acted as a direct cardiac stimulant, which was easily and 
rapidly absorbed, quickening and strengthening the 
heart, and, most important of s^, as the effect of the drag 
passed off the heart returned to Its former state without 
the oconrrenoe of any interval of depression. Nuother drug 
at our disposal bad this action. Alcohol also dilated the 
blood vessw, and thereby flushed the tissues with blood 
and restored their vitality. Passing to its other uses, 
alcohol in small doses stimulates the flow of saliva 
without interfering with its digestive power, improves 
the appetite, increases the peptic secretion, and excites 
gastric peristalsis. It was therefore a stimulant to 
primary di^stion, and in the widest sense of the word 
a true tonic remedy. As a producer of energy it had a 
nutritive value equivalent to that of fat. Its antipyretic 
action was well known and often extremely beneficial; 
it acted in this way by increasing the loss of heat, not 
by diminishing its pr^nction. In reference to what had 
bmn said as to ite effect in increasing the sn»oeptibility 
to specific infections diseases, he thought that it must 
play an extremely unimportant part compared with 
other factors. In plague, for iimtance, the mortality 
among the Hindu population, which never touched 
aloohol, was almost M per cent., while among Europeans 
it was not more than 30 per cent. 

Dr. Cloubton said that the place of aloohol as a 
cause of mental disease was undoubtedly extremely 
important. It was the most common factor noted in 
the admissions to the Edinburgh Boyal .^ylnm—over 
25 per cent, of all oases. But, after all, as a cause of 
insanity the neuropathic constitution was of infinitely 
greater consequence. In Dorsetshire, for instowye , i 
alcohol was given as a cause in only 6 per cent, of the 
admissions, though the proportion of insane persons to 
the total population was as high as in Edinburgh. The 
neuropathic brain, with its keen delight in art, poetry, 
and the gratification of the emotions, generally appeared j 
to derive the supremest pleasure from the effects of alcohol. i 
The action was really twofold, there being a diminution i 
of inhibitory ^wer and an increase in we more emo-1 
tional or effective qn^ties of the brain. The frequency ^ 


of alcoholism in the neuropathic was, therefore, as much 
a consequence of the mental constitution as a cause of 
it. Experimental peyohologiste, by comparing the power 
of doing definite mental work—e^, arithmetical exer 
rises and the like—before and aftw the ingeetion of 
alcohol, had clearly proved that a lessened mental out¬ 
put was one of its effects. It was further shown that 
this action rarsistf, and renders the effects of the second 
and succeeding doses of alcohol more easy of production. 
The speaker then referred to tire desirability of a scien¬ 
tific commission being appointed to inquire into the 
whole question of aloohol. He also alluded to the very 
general desire on the part of the medical profession that 
the Legislature should assist them (as he believed could 
be done without undue interference with the liberty of 
I the subject) in dealing with a class of patirats who were 
unable to help in their own treatment. 

Dr. Atfleck siwke of the great responsibility which 
rested on the medical man who prescribed alcohol when 
it was not absolutely necessary. He thought it was 
often most difficult, Mpeoially for a young practitioner, 
to take up a definite stand. It was a drug which 
differed from all others, because patients oftw asked 
and expected the doctor to preecribe it. He used 
aloohol constantly in suitable cases, but his experienoe 
was leading him more and more to dispense with the 
very doses formerly used, in pneumonia, for example. 
As to what had been said in reference to its 
action in increasing the susoeptibili^ to infectious 
diseases, one had only to look at pneumonia 
for an illustration of the fact. We all knew how 
gnve was the prognosis in an alcoholic subject, 
llie question was one in which he had always taken the 
very deepest interest, and he thought that it was futile 
to attempt to dissociate its medical and mcial aspects. 

Dr. Jams BrrcHin alluded to insurance statistics as 
pointing to the evil effects of aloohoL From a large 
series of life-tables it was found that among the gene^ 
assured the mortality was only li per cent, below the ex¬ 
pectation of life, while among teetotallers it was no less 
than 26 per cent, lower. Long clinical experienoe bad 
convinced him that alcohol was most deleterious in many 
diseases. la gout he thought that medical men often 
shirked their duties in not enforcing total abstinence, 
and it was the same in some cases of chronic rheumatism. 
He had known many oases in which when aloohol was 
once absolutely stopp^ the gout had not again recurred. 
In heart disease, t^, he thought that alwhol should 
seldom be given. 

Dr. Lxslik Hackxnzib, speaking from the public 
health point of view, said ^at he could not believe that 
alcohol had any effect on the mortality from sperific 
infectious diseases. In Leith there was an enormous 
amount of drunkenness-much more than in most other 
towns—yet it was notorious that its death-rate was 
much lower than that of any of the other large Scotch 
towns. Seeing that the main incidence of the ordinary 
infectious diseases was in children, who are naturally 
abstainers, he could not see that there was the slightort 
evidence that alcohol had any bearing on this question. 
The same applied to such infections diieases as typhus, 
while in cholera we had a disease which occurred chiefly 
among an abstaining population. He then critirised 
adversely Dr. Archd^ Beid’s theory of alcoholism, and 
asserted that there was no evidence of an inborn craving 
for the substance, or that it fills an organic want. 
Alcoholism was as much a consequence as a cause of 
poverty and vice, and formed only one part of the whole 
question which had to be dealt with by the social 
former rather than the sanitarian. 

Dr. Chitbce thought that alcohol was of the very 
greatest value in acute diseases in children, but that it 
should be given with the finger on the pulse. If it re¬ 
duced the pulse-rate and the temperature it was doing 
good, if not, barm. 

Dr. P. A. Yottnq pointed out the enormous difference 
between the mortality and the morbidity of ;tbe two 
gMt friendly societies — the Bechabites snd the 
Foresters—drawn from exactly the same class of the 
community, and differing only in their habits M to 
aloohol. The death-rate among the Foresters corre¬ 
sponded fairly closely with that of the general insnr- 



JctT 10, 1901. 


GERMANY. 


Tn Mxdical Pbsbb <^7 


BBoe tables. He wished to point out that insnranoe 
q^ p i pMiiw did not aooept lives in which there was a sus¬ 
picion of intemperanoe, so that their tables of mortality 
gave the death-rate of moderate drinkers only, excluding 
those who exceed. 

Dr. Wblsh spoke of the diminished ontpnt of mental 
wM-k following small doses of alcohol, and of its great 
valoe in certain forms of insomnia in the i^ed. 

Dr. Eb& (Superintendent of the City Hospital) said 
that he would not like to treat diphtheria without 
alcohol. Hot all typhoid patients, by any means, re¬ 
quired stimulants, but in diphtheria they were ne^ed 
almost as a routine. Whenever he tried to lessen the 
amount of alcohol used in the diphtheria wards the per* 
oenti^ of oases of heart failure at onoe went up. The 
bsi tuee oases of fatal syncope in the homital had been 
in patients who had seemed so slightly ill at the time 
of admission that stimulants were not ordered. If he 
was not to give alcohol, what drug was he to use ? 
While he was waiting for strychnine or digitalis to act, 
the patient would be dead. In scarlet fever, alcohol 
was seldom needed; in typhoid and ^phns he was guided 
byJenner’saxiom, "When in doubt,in typhus, stimu¬ 
late ; in typhoid, do not.” 

Pressor Fraser and Dr. Woodhead shortly replied to 
the disonssion. 


cfranct. 

[tbom oub own oobbbsponuxnt.] 

Pabis, July 7th, 1901. 

PulNOKABT AxTBCTIONS. 

At the Aoad4mie de Medeoine M. Bendn read a paper 
on " Certain Pulmonary Affections Provoked by Lesions 
of the Nose, Ears or Pharynx.” The pus from the above 
lesions created the pulmonary malady of which the patho¬ 
genic microbe was nothing less than that of the nassl or 
urionlar suppuration. Frequently it was possible to 
face from its origin the evolution of the malady; coryza, 
to nsilbti * , pharyngitis, tracheitis, and finally bronchitis. 
The infection assumed varied forms, from 

an irritating cough to symptoms of pulmonary oon- 
gestion, pneumcmia, and bronoho-pnenmonia. Al¬ 
though the clinical phenomena were not exactly 
those of taberculoais, confusion was not difBcult; 
the diagnoeia ropoeed on the presence of two 
tacts; in the first place the existence of suppuration in 
tiie nose, ear, or frontal ainoses was noted, and generally 
when the patient was examined through the mouth a 
purulent etaream was observed running down the 
pharynx. Secondly, the culture of that secretion and 
that of the bronchial expectoration furnished the same 
microbe, which was never that of tuberculosis. The 
lateral decubitus appeared to be favourable to the ex¬ 
tension of the infection as the lung affected corresponded 
frequently to the side on whioh^the patient had the habit 
of lying. 

Death in Ttpboid Fbvbb. 

M. Cb. Fiessinger spoke on the cause of death iu 
typhoid fever, and said that a fatal termination fre¬ 
quently occurred where the patients had not been treated 
by oold water. He employs either baths or the wet 
sheet. The baths are given at 72^ F. every three 
hours as long as the fever attains or exceeds 102» F., 
and last from ten minutes to a quarter of an boor. 
Where the latter is not possible he employs the wet 
sheet. At 102^ he presoribee the wet sheet spread on a 
blanket and wrapped around the patient for five 
minatee. At 103^ the wrapping is repeated once again 
ioimediately, while at 104^ the wet sheet is renewed 
three times. 


The four oomplioationa which frequently cause 
death are intestinal haemorrhage, perforation, cardio¬ 
pulmonary affections, and testhenia. Frequently np to 
the twelfth or fifteenth day the patient is 
well, the treatment of laxatives, quinine, abnndant 
drinks, and acidulated lotions seems to have been suffi¬ 
cient for a happy issue, when suddenly the fever attains 
104^ in the morning, the pulse becomes rapid and weak* 
the abdomen gets enlarged, the longs become congested, 
the intellect obscured, speech difficult and indlstinot, in¬ 
continence or retention of urine appears, death is at 
hand. 

The bmign form of the malady gave reason to hope 
that refrigeration oonld be dispeneed with, and now it is 
almost too late to think of it Let ns try it, however. 
We need not expect anything much from other 
medication: injections of oafeine, camphorated oil, 
artificial semm, retard sometimes the fatal moment, 
but they hardly ever prevent it The physician is 
discounted; morning, noon, and night he injects 
fifteen or sixteen onnoes of serum; twice or three 
times daily oamiffiofated oil or oafeine, but with¬ 
out result; the patient sinks gradually. The only 
rational treatment is that of oold water, which is 
superior to all drugs, as it is the beet it^nt against 
the typhoid p<^n. The wet sheet is more suitable when 
the fever exceeds 104^, and the prostration is g^reat In 
ooQolnding, the speaker said that leaving ont perfora¬ 
tion, for which nothing could be done, the three other 
oompUcatious already mentioned oonld be avoided 
frequently by balneation or the wet sheet In the case 
of haemorrhage, however, the oold bathing shonld be 
suspended three or four days as well as the enemata, and 
the accident treated with ice to the abdomen, injections 
of sranm and the drugs usual in toch oases. 


Sermffits. 

[Fbox Oub Own Cobbxspondxkt.] 


Bbblis, Jnly 6th, 190L 

Thx Deutsih. Med. Zeitung, No. 50, has an article by 
Dr. A. Tausig on 

Tannioxn. 

He has used it for all forms of diarrhcoa, not only in 
children but in adults. It does not diminish the appe¬ 
tite. and even when used for a lengthened period it was 
well home. It was specially useful in the diarrhoea of 
ohildreo, even in those at the breast. In diarrhoea, with 
an alkaline reaction, tannigen especially proved its nse- 
fnlness. 

Tbe best resolts were obtained in snb-aonte and 
chronic diarrhoeas of children. After the third or fourth 
dose even, the mnoua and water in the stools diminished, 
and generallf after three or four days the stools 
appeared normal. 

In chronic intestinal catarrh the coarse was rather 
slower, but the effect of the drug was onmistakeable. 
He recommends tbe continuance of the drag m smaller 
doses, even after the diarrhoea has subsided. The dose 
given was, in children under two, 0‘26 grms.; above 
that age, 0'6 grms., and four or five doses daily. If it 
oonld not be given in the ordinary ways, tabloid, powder, 
Ac., it was g^ven in grueL The stools were often dark 
ooloured from its use. In aonte intestinal catarrh it 
was not so osefnl so long as the aonte stage lasted. 

Digitized b\ 


38 Tus Medical Pusss. 


AUSTRIA 


Jolt 10, 1901. 


Calomel and the other older and tried remedies were 
best then, and later, when the stools took on the 
catarrhal character, tannigen soon brought about an 
improvement 

Simple dTspepeia and isolated stomach affections did 
not appear snitable for tannigen treatment. 

In diarrhcoa from various oanses, in connection with 
a slight chill, measles, excitement in nervously disposed 
persons, in irritable bowel (nervous weakness) it always 
acted favourably. In diarrhcea with vomiting it almcet 
alirays had a good effect In tuberculosis of the intes¬ 
tines, on the other hand, any good result was only 
transient 

At the Society for Innere Medtsin, M. Wolff showed a 
series of preparations of 

Tubxbculous Ahihals aitsb Tbxathbnt bt Hbtol 

AND lOAZOL. 

Both remedies named had been recommended and 
highly lauded as being capable of building a wall of 
connective tissue around tuberculous patches, and 
thereby bringing the disease to a standstill. The 
animals shown were treated simultaneously, or almost 
so, by inoculation of tubercle and one of the substances 
named. The first animal shown was a rabbit that after 
infection with tubercle had twenty-three injections of 
hetol given in the space of three months. There was 
still some caMation at the margin of the cornea, and 
the disease had also spread to the lung. Four animals 
were shown of the first series, and in not one had the dis¬ 
ease been checked in the least, in fact, the animalg 
behaved just as the control Simula did that got no 
hetol. 

Bzperiments on the peritoneum showed a like state 
of things. 

Three guinea pigs inhaled tuberculous dust and 
became infected, two were treated with hetol and the 
other without. One preparation showed the lungs 
thickly strewn with miliary tubercle and large caseous 
patches. Around the patches was a distinct wall of 
connective tissue, but the wall in the aniTintl not treated 
by hetol was quite as distinctly marked. In the third 
animal there was also miliary tuberculosis and extension 
of the disease of the liver. The disease was no worse in 
the control animal. He had also used it in forty-two 
cases of phthisis injecting it into the gluteal regiem. The 
oases were selected as being slight and free from fever. 
The result was very unsatisfactory, no recovery took 
place, the r&les remained unchanged. 

As regarded igazol, which was given as recommended 
by Cervelloof Palermo, by inhalation, the result was no 
better. The control animal lived the longer and showed 
the lees advanced disease than the one treated by 
igasol. In fact, sfil the igasol aTiimaia died before the 
control ones. In three of the animals treated by igazol, 
again, pneumonia was set up. It was given prophy- 
lactically to thirteen men and six women, the inhala¬ 
tion lasting from three to four hours daily. Of the 
men nine remained in the same state, three got worse,and 
one died. The women almost all got worse. The igazol 
instead of having a curative effect had rather its 
opposite. The speakers who took part in the discussion, 
among whom were v. Leyden, A. Fraenkel, and Fur- 
bringer, complimented the speaker on his experiments 
and acknowledged that they tallied with their own 
clinical observations. 

Hr. V. Leyden then showed a 


Cask or Bxcovxbt pbok Tstanus. 

The treatment consisted of serum injections. A 
special epoch dated from the discovery of antitoxin 
serum, but the results were not brilliant. The antitoxin 
was injected subcutaneously to neutralise the poison in 
the blood, but the hoped-for result did not follow, and 
it was then found that animals died even when the 
poison in the blood was neutralised. The toxin was 
therefore present in another part of the body, and that 
could only be the spinal column or the far motor gan¬ 
glion cells. The spinal finid attracted the toxin, and 
fluid withdrawn from a case of tetanus was able to 
infect mice. It was now attempted to bring the 
antitoxin direct into the central nervous system, 
and the serum was introduced below the dura 
of the skull. But the results were again un¬ 
satisfactory. Then Jacob evolved the idea of in¬ 
jecting it into the spinal canal, but experiments on 
animals showed nothing decisive. In a case two yean 
ago such an injection had a good effect. Sinoe then 
there had been nine oases—three recovered and six died. 
In the case shown the result was very satisfactory. The 
patient, a groom, set. 22, was admitted on May 16th with 
distinct rigns of tetanus. On the third day of the disease 
subdural injection was made of 6 com. of antitoxin, after 
10 com. of spinal finid had been drawn off. The injec¬ 
tion was repeated three days later. The dose given now 
was smaller than before, Behring’s original case was 
2 grm. (1 grm. » 20 com.). The result was “ eolatante.” 
The patient’s temperature fell in a few hours from 41 to 
38'6, and the next day to 37*4. This effect could cer¬ 
tainly be looked upon as life saving. Life had never 
before been saved when the temperature had re ached 
41 C. The second injection had soaroely any effect upon 
the temperature. The tetanic symptoms snbmded slowly, 
but the patient was able to swallow. After such an ex¬ 
perience this method of treatment ought to be always 
followed. The other and usual remedies were given 
when special symptoms called tor them. 


JlnBtriA. 

[FBOX OtTB OWN cobbbspondbnt.J 

VixssA, July 6th, 190L 
CtLINDSBUBIA and ALBUmNUBlA. 

Koblbb reported some time ago that he found in the 
urine of patients suffering from constipation the renal 
elements (cylindemria as well as albuminuria), which 
would continue for several days, and rapidly disappear 
on relieving the bowels. 

To test the accuracy of this observation, Wallerstein 
commenced to experiment on dogs and other animals 
producing constipation and closing the anal opmiing 
with similar results. After twenty-four hours' closure, 
in the case of the guinea-pig the examinations were 
carefully commenced, and on the following day distinct 
traces of albumen with casts. In the dogs there were 
no albumen, but the urine was loaded with renal oasts. 

On post-mortem examination of the kidneys, the 
microscope revealed pronounced fatty degeneration of 
the epithdinm in the medullary snbetanoe of the organ. 
Bacilli or Dtsxntxrt and 1>iabbh<sa. 

Kruse has been devoting his attention to the bacilli 
of dysentery and diarrhcea with the result that he has 
never seen any good from serum in oomlating the disense 

Digitized b', OOQ 


JnLT 10, 1901. TBK OPSRA.TI1TGF THEATRES. Thv Mboioal Pbisb 39 


in nuo or animal. Ha confirms the number and oharaotar 
of bacilli present, but the eoTOieign remedy yet was 
hygienic snrfoanding and a heroic endesTeor to reduce 
^ Sow of water into the alimentary There was 

a sort of diarrhcoa to be met with in lunatic asylums 
which was not to be confounded with the true septic 
condition, but which could not be far removed from the 
more rimlent congener. 

Mai. ASIA. 

Coenen has provided ns with a short history of 
malaria as taught in Italy at the present time. In his 
report he commences with Virchow’s discovery of pig¬ 
mentary granules in the red blood corpuscles f om the 
heart of a man who died of intermitting fever m 1848. 
Little was heard of the subject till Laveran discovered | 
his parasites in 1880, which he named Oacillaria 
malarise. This idea was strongly opposed as being cue 
true cause of malaria. In 1885 his observations were 
heqnently confirmed. The observations of Marchiafava, 
Celli and Golgi all supported Laveran’s theory that 
altitough the bodies were differently described by 
different observers it was the same in different stages 
of its life history. 

It was left to Eoch to determine tiiat there were 
three different speciee of these parasites. 1. The quartan 
parasite or plasmodinm malarim, which has a diminutive 
amoeboid appearance, thriving iu the red blood corpuscle 
and destroying the pigment of the cell. After seventy- 
two hours the deposit is broken up into eight or twelve 
segments, or spores. 2. Tertian parasite or plasmodinm 
vivax, reqnires about forty-eight hours for its develop* 
ment, and then it breaks up into fifteen or thirty 
spores, or segments 3. The parasite of the estivo 
autumnal fever. 

Masson’s theory of the mosquito transmitting the 
poison has been confirmed by Bignami, while Battista 
has accused the anoidieles claviger as the true porter. 

Nosocomial GANoasNs. 

A literary fight has arisen between Brabec, In Haydl’s 
clinic, and Hatienaner, of Neumann’s clinic over a few 
particulars in nosocomial gangrene which Brabec claiou 
to bs original, while Matsenauer sets them aside as un¬ 
important. Brabec has gone so far as to classify diph- 
theritic phagedsnic sores on the anal and genital region 
ss closely allied to hospital gangrene, which 
ridicules as nonsense, while Brabec insists on the correct¬ 
ness of his diagnosis from the confirmation rendered by 
bieteriologioal examinations. 

Thb HANAOiMnifT or Consumption Hospitals. 

The following extracts from a letter addressed by 
Professor Moris Benedikt, of the Vienna University, to 
Dr. Professor AUbntt, of Cambridge, and pnbliahed in 
the last number of the Wien, Med. Woeh., will be read 
with interest in Great Britain. He says:— 

“As the subject of tnberonloais will, donbtlese, be 
taken op, after the Congroos, by the English Govem- 
ment, and by Municipalities and philanthropists, on a 
grand scale, it will be very necessary to avoid serions 
blunders. Nowhere is philanthropy so wasteful as in 
E n g l a n d. For Heaven’s sake do not bnild huge preten- 
tioaB palaoes and hospitals, like big barracks, which in 
tiiDe would become strongholds of ftscillt. Every home 
for consumptives should be so planned that it can be 
demolished or burnt down without mooh trouble wbeu 
it csn no longer be kept free from infection. A hat 


system is accordingly to be preferred, and the fittings 
must be so selected, as to material and form, that they 
can be effectively disinfeoted. The mistake generaUy 
made is to spend all the money in hand on building. 
One must not forget bow much pbilmitbropy has to do, 
in regard to tnberonlosis, in looking after the family 
when the [bread-winner is in a borne |for consumptives; 
and, when he leaves it, with reduced power of work and 
resistance, in seeing that he does not take refuge in the 
demon of alcohol, and min both himself and his family. 

“ Small colonies, in localities free from dost and wind, 
are preferable to large sanatoria. Less serions oases 
might, perhaps, be entrusted to families living in 
suitable spots, for payment, and under the anperinten- 
dence of doctors, as the danger of infection from single 
patients is not considerable.’ 

Operating theatres. 

CANCER HOSPITAL. 

Abdominal Htstsbictomt. — Mr. Chas. Stall 
operated on a woman, set. 35, who had been admitted 
for menorrhagia. About six months before, the periods 
first became profuse, and had steadily got more so, now 
lasting ten to fourteen days, with the passage of large 
clots, this having adduced profound ansemia in tbepatient^ 
There was no great pain, no marked loss of fiesh, and 
no interference with micturition, but there was obstinate 
constipation. On examination a tnmonr of the ntems 
was fonnd filling the pelvis and extending about two 
fingers' breadth above the pubes. The os uteri was 
Patulous and the length of the fundus considerably 
increased. A soft myoma of the ntems was diagnosed, 
and as palliative measures had previously been 
tried without any relief hysterectomy was recommended* 
Under ether a medium inoision was made, and by the aid 
of a myoma screw the ntems with the tnmonr was drawn 
ont of the wound; the vessels of the broad ligaments were 
temporarily seonred with forceps, and the ntems was 
amputated about the level of the internal os, the vessels 
of the broad liganent were now permanently seonred with 
silky ligatures, and the peritonenm was sewn over the 
oervioal stomp. The abdominal wallwas closed in three 
layers. Ur. Ryall said that the tnmonr consisted of a 
soft single myoma growing from the posterior wall of the 
ntems, externally it was covered by peritonenm and 
internally by the endometrinm. This type of tnmonrs^ 
be pointed out, was of a mnob more serions nature ritnw 
the hard multiple fibroid, as it usoally tends to gradn. 
ally incrOQso in size and was also associated with profuse 
menorrhagia which, after a time, might even threaten 
the patient's life, therefore he considered it was one of 
those oases where the sn^eon had little hesitation in 
operating. Of all fibroid tumoors be tbonght it was 
the one in whiob snrgical treatment was most 
indicated. He also added that no new method 
was adopted in the technique ot the operation- 
These kind of oases, he said, generaUy do very weU. Oooa- 
sionaUy, however, patients have afterwards a persistent 
vaginal discharge, owing to infection of the ligatures; 
the discharge finding its way through the oervioal 
canal; this disohai^, however, wiU cease when the 
offending ligatnie comes away, or is removed per 
vaginam. This contretempt (the vaginal disoharge), he 
remarked, only oconrred in a very smaU peroentoge of 

Digitized by Google 


^ Thb Midioal Pbbss. 


LEADING ABTICLBS. 


JULT 10, 1801. 


BnisrEBBo roB raAKSicisnoK 

^he JEebtcal ^^zbb attb (Eircnlar. 

Pnbltabed «Ter7 Wedneaday morning, Frio* Sd. Pott free, B)d. 
AOVBETUElCEirTB. 

Pom Ora latnnoa <—Wbole Pace, £fi Ot. Od.; Half Ptc«> 
PS lOt. Od.; Quarter Pafe, PI fie.; Onoeicbtb, ISi. 8d. 

PoB A SiBiaa or iBtiaTioaa t—Whole Page, thirteen inaertiont 
(weekly, fortailghtly, or monthly^ at P8 10a. Od.; twea^-eiz 
inaertiont (weekly or fortnight) at PS 8t. Od.; flfty-two 
Inaertiont (weekly) at PS eaob. Half Page, thirteen inaertioaa 
at SSt. i twen^'tiz at SSt. i flfty>two inaertiont at SOt. eaoh s 
Quarter-page, Inaerttona at ISt. twent^-elz inaerttont 

at Ifla.: flf^-two Inaertiont at ISe each. 

Small annonncementa of Praotloeo, Attittanciet.Vacanoiet, Bookt, 
So.-4eTen llseo or nnder, 4t. per inaertion j Sd. per Unt 
beyond. 


Fboh Amenoft, a country that deals habitually in 
lai^ figures, has recently come the news of a vast 
calamity that has swept the country in the shape of 
a beat ware. New York has been ^vastated by the 
advent of this unwelcome climatic scourge, and for 
a week or more has been paying on that score a 
death-toll to the extent of hundreds of dead and 
disabled in a single day. The official report for July 
4th showed 190 deaths and 3(X) cases of prostration 
from heat, a number which we are assured 
is small when compared with the returns of 
the preceding day. Nor is the immediate 
outlook reassuring, for the Government weather 
expert says that although there has been a slight 
remission there are as yet no signs of perma¬ 
nent improvement. The area involved appears to 
comprise more or less completely the northern 
States east of the Rocky Mountains. Naturally the 
occurrence of so great a disaster in America is calcu¬ 
lated to cause some uneasiness in Transatlantic 
countries, inasmuch as it has long been recog¬ 
nised that some of them, notably the United 
Kingdom, have in many if not most cases an 
unwelcome reversion of the meteorological ex¬ 
tremes experienced in the United States. For a 
long time past British Army surgeons have been 
familial* with the disease among our troops serving 
in tropical and sub-tropical climates. Curiously 
enough, in spite of the great strides of scientific 
medicine, especially in the field of tropical diseases, 
the eetiology of “ sunstroke ” still remains obecure. 
Excluding the apyretic cases, the name of " thermic 
fever,” or “ siriasis,” is usually applied to the far 
commoner form, in which an early symptom is a 
sudden rise of temperature which mounts to 105^ F., 
110^ F., or even higher. The more marked features 
of the attack are headache, loss of conscious¬ 
ness, vomiting, and shock, and ending either 
in death frum asphyxia or heart failure, or 


in recovery with tendency to relapse and many 
sequelsB. The theory of causation hitherto moat 
commonly accepted has been the somewhat 
vague statement that the extreme heat has disturbed 
the temperature-controlling centres in the brain and 
the spinal cord. The pyrexial cases, however, have 
lately been regarded by some observers as due to 
specific invasion, upon such grounds as their sudden¬ 
ness of onset, their marked peculiarities of type, and 
the tolerance or immunity as regards them found 
among natives and old residents. So eminent an 
authority as Dr. Sambon does not hesitate to 
include thermic fever among the infectious fevers. 
He has pointed out that the distribution of the 
malady is practically restricted to low-lying districts, 
and that it is never met with much above an altitude 
of 600 feet. This standpoint boldy places siriasis 
among endemic diseases; and extreme solar heat 
most according to that view be considered as a 
necessary concomitant in its production. In other 
words, while heat is a neceesary contribntory &ctor 
the actual source of the malady must be sought in 
other directions. It will undoubtedly occur to many 
of our readers mth regard to Dr. Sambon’s observa¬ 
tions that New York is built on low-lying, swampy 
ground. Fortunately, while the exact pathology of 
heat apoplexy is still uncertain, a considerable 
advance has, nevertheless, been made in practical 
treatment of the condition. One of the most power¬ 
ful remedies is cold, applied in various forms, 
together with prompt and continued stimulation in 
order to combat the ever present danger of heart 
fmlure. Under the best methods, however, the 
case mortality among British troops in India is 
stated by Dr. Manton to be one in four. By way of 
prevention it is important to adopt light clothing, to 
avoid alcohol, to refrain as far as may be from any 
mental or bodily strain, to live simply, and to keep 
out of the sun as far as possible. Meanwhile, it is 
earnestly to be hoped that the heat wave will not 
reach our shores. 


THE SURGERY OF UTERINE PROLAPSE. 

One of the first problems to attract the attention 
of the new school of gynaecologists was the means 
of affording permanent relief to that distressing 
condition, prolapse of the uterna The etiology of 
this affection is not as clear as one could wish. It 
is ascribed to stretching or relaxation (?) of the 
ligaments supporting the uterus from above and, 
incidentally, to rupture of the perineum, although 
the latter lesion cannot play a very important part in 
its production, seeing that a remedial operation 
for the latter does not necessarily effect a cure 
of the former. It is said to occur in women of lax 
fibre, but this is a vague expi-ession which does not 
convey any very definite idea. Clinically, however, 
prolapse of the uterus is very frequently met with, 
and is productive of considerable discomfort 
even in the mild form in which the oi^i(an 
does not pass beyond the vulva. In its severer 
forme it is an evil not to be bome,Tand it 
Digitized by ' « 0 * I 


^lu anil Ctttnlar. 

"SALUS POPI7U SUPBIMA LEX.” 


WEDNESDAY, JULY 10, 1901. 


THE HEAT WAVE IN NEW YORK. 


Jxtlt 10, ItfOl. 


NOTEb ON 00 RRBNT TOPICS. 


Thb Hsdioal PhB88. 41 


seriooely handicaps women who are dependent upon 
their exertions for a living, or who have household 
duties to perform. It is of course only in the severer 
forms that surreal intervention is likely to com¬ 
mend itself for adoption. The lesser degrees can 
usually be kept within reasonable limits, at any rate 
for a time, by means of a suitable pessary, although 
we have to consider not only the discomfort which 
the wearing of a pessary sufficiently large to keep in 
place but also the fact that sooner or later the 

pressure which it exerts on the walls of the 
v^ina reduces its supporting powers. In devising a 
means of affording efficient support to the uterus, 
we have to bear in mind that we are not dealing with 
an 01 ^^ like the kidney which is always, roughly 
speaking, of the same size. We have to allow for 
pregnancy, and moreover care must be taken not to 
leave the parte in a state which might favour strangu¬ 
lation. Of course all suspensions of the uterus of 
whatever Vind are to some extent mere makeshifts, 
but anchorage of the organ by means of the round 
ligaments is the nearest approach to the ideal, and 
as a choice between evils the round ligament suspen- 
non is superior to all others both from a physiolo¬ 
gical and bom a practical point of view. The opera¬ 
tion devised by Alexander and modified by Kellog 
is perhaps tbe most useful, though it is sharply 
criticised on both sides of the Atlantic. It is a 
somewhat difficult operation requiring, like most of 
the abdominal operations, skill and training for its 
sucoeesfnl execution, bub the principal drawback 
seems to be the difficulty of finding the ligaments. 
The Kelly operation, it is urged, often leads to serious 
embarrassment in pregnancy and may even offer 
insuperable obstacles to parturition, so tiiat it 
is only suitable as a post-climacteric operation, or in 
the case of women who have been rendered sterile by 
removal of the uterine appendages. Atpresentwehave 
rtually no choice between these operations and 
leaving matters much as they are. What suigeons 
must aim at is an operation which will utilise the 
natural supports of the uterus, will ensure a certain 
amount of mobility, will adapt itself to the functions 
of the uterus, will be lasting in its results, and withal 
reasonably easy of execution. Yarious operations 
have been proposed, for which it is claimed that they 
fulfil these desiderata, but the results obtained by 
sugeons who follow the directions of the inventor do 
not tally with those on which the claim is based, so 
that we may take it there is still room for further 
modifications in the technique of this operation 
before it can be confidently recommended for general 
adoption. 


RAILWAY HYGIENE. 

The number of railway passengers has increased 
from 73,000,000 in 1860 to 1,107,000,000 in 1900. Until 
afew years ago the different railway companies seemed 
quite indifferent to the hygienic condition of the 
vehicles they provided for the public. In some few 
instances passengers who suffered from the effects 
of long retention of urine and so forth obtained good 


damages, and it was found to be in the interests of 
the shareholders to provide proper lavatory accom¬ 
modation. Competition was also a factor in producing 
more roomy carriages, better ventilation, an improved 
system of warming the coaches, and seats framed more 
for comfort than torture, which seemed the former rule. 
Thus the more glaring defects were got rid of, and 
it became possible to travel third-class in compara¬ 
tive comfort. But even now railway travelling 
implies many risks from the unhygienic conditions of 
many of the carriages of every class. The loathsome 
and dangerons habit of spitting on the floor of car- 
ru^es is still practised, and in the evening of the 
day many third-class carriages become filthy from 
the habit. There is no systematic cleansing of 
the floor of such carriages on the completion of each 
journey as there should be. If the habit of 
spitting in trains cannot be put down suitable spit¬ 
toons should be provided. We think that in all trains 
a special carriage should be provided for invalids; at 
present the wealthy invalid traveller may experience 
little inconvenience on his journey, but it should be 
possible for the man of limited means to secure a 
coucb, or bed, and some little extra attention on his 
journey. Railwaye are our common means of transit, 
the great powers conferred on the companies have 
practically placed the travelling public at their 
mercy, and oompmiies ought to remember that they 
have their duties as well as their rights. But over and 
above all these details I'eform is required, especially 
in saloon and first-class carri^^es, of which the thick 
carpets, brushed daily, impregnate the cloth-covered 
cushions, the depressions made by the buttons, the 
crevices between the seat cushion and the back 
cushion with all manner of foulness carried on the 
feet of travellers from the streets and platforms. 
A quick, sharp brush, which is all they get 
from the whisk of the railway porter, simply dis¬ 
places a little cloud of dust from one corner to 
another. There should be no fixed cushions or 
nailed-on covers in railway carriages—regard for 
public health forbids it. All the furniture and 
fittings of a railway carriage should be removed at 
the end of each journey and disinfected mid the 
carru^ thoroughly cleansed before being sent on 
another journey. Objection may be taken to 
the cost of such measures for preserving the 
health of the travelling public; but we think that 
they are fully justified by the fact that many 
millions of the public make use of the railway, and 
their lives are quite as precious as those of oxen, 
and we need not remind our readers that after every 
journey a cattle waggon must be cleansed and 
thoroughly disinfected. 


0tt Currmt 

The National Hospital for the Paralysed 
and Epileptic. 

The report of the Committee of Inquiry appointed 
to investigate the affaire of the National Hospital for 
the Paralysed and Epileptic was adopted bw the 

Di-::ized: ‘C 


42 Thb Msdical Psb88. 


NOTBS ON CURRENT TOPICS. 


JULT 1(^ 1901. 


govemora and Bnbsoribers of that institution on 
Saturday last. The effect of this is to put two mem* 
hers of the medical staff on the Board of Manage¬ 
ment, to abolish the office of Secretary-Director, 
and to provide for the revision of the rules- 
During the course of this controversy, we 
have from time to time warned the Board of 
Management what the result must be of treating 
eminent medical men on their staff “ as if they were 
porters,” a term, it will be remembered, actually 
applied to the members of their medical staff by that 
body. The Board have received their just 
punishment in the report of the Committee of 
Inquiry, and to resign appears to be the 
only dignified coarse left to them to pursue. 
In addition to having to listen to some stinging 
remarks from Mr. Melvill Creen, the Board received 
a most severe and just rebuke from the medical staff, 
for which they had only themselves to thank. The 
chairman actually declared that the medical staff 
had never informed the Board of the more serious 
defects dealt with in the report, a particularly foolish 
statement to advance, because the report actually 
blames the Board for intimating to the medical staff 
that they were not to report defects to them, but 
to the Secretary-Director, and to him only. The 
spokesman of the medical staff in this matter 
was Mr. Horsley, and all that the Chairoian 
of the Board could find to say in mitigation, 
after having to submit to the justly severe censure 
administered, wus a meek appeal that he hoped he 
would not be thought to have been disingenuous. A 
strong committee has been formed to reoi^anise the 
hospital, and with a prospect of proper government 
an even larger measure of success than it has already 
secured can be confidently anticipated for this ex¬ 
cellent charity. 


Cseearean Section. 

The advance of medical science has enabled the 
praoritioner of to-day to discuss with no uncertain 
mind the propriety and safety of delivering by 
Ossarean section a woman at term who wishes for a 
living child, but on whom the induction of early 
labour at the proper time has not for some reason 
been practised, and in whom the pelvis is too small 
to allow a living child to pass at term. It is 
certainly a sign of the modem trend of thought 
that Professor Sinclair, of Manchester, should have 
chosen the present time for delivering ” A Plea for 
Csesarean Section’’ at the London Polyclinic, on 
June 26th. Yery notable attention was paid by the 
audience to the lecturer’s description of hie last case 
of Cesarean section, which, he stated, was the first 
operation of the kind that had been done without a 
general anesthetic since the introduction of chloro¬ 
form, local anesthesia being procured by the injec¬ 
tion of solution of cocaine. It took only five 
minutes for the patient to become absolutely 
anestbetised from the waist downwards. She was 
blindfolded and cotton-wool put into her ears so as 
to avoid anything being seen or heard by her to 


cause shook, and a nurse stood by her side to com¬ 
fort her daring the progress of the operation. The 
patient complained of no pain and simply asked for 
a drink. The reason for employing cocaine in 
this case was because the patient had a dilated 
heart, and had been the subject of bronchitiB 
for many winters previously. It is possible 
that the place of chloroform may be taken by this 
method of injecting cocaine to secure local anms- 
thesia, and this particular woman, whose case was 
commented on by Professor Sinclair, did very well 
and made an excellent recovery despite the fact that 
she was a somewhat elderly primipara, aged 39. It 
must be admitted that one of the causes of fatal 
endings in the operation for Csesarean section is the 
injudicious interference previons to the operation, 
and also, to quote Professor Sinclair again, the want 
of a fixed resolution as to a definite and distinct line 
of action and early diagnosis of the condition. After 
this early diagnosis there should be prompt and 
decided action. The most hazardous course that 
can be followed in these cases is to finally resort to 
CsBsarean section after futile delay and objectless 
shilly-shallying, taking up one plan only to give it 
up for another, and generally exhausting the vitality 
of the patient. 


The Midwives Bill. 

By the permission of the Lady Balfour of Bur¬ 
leigh, the Association for Promoting Compulsory 
Registration of Midwives held a meeting in her 
drawing room at 47, Cadogan Square, on June 28th, 
to receive the annual report and to generally help 
forward the Bill that the Association so nearly 
managed to pass through the House of Commons. 
Lord Balfour of Burleigh comforted the members 
for the disappointment in the failure of the Bill to 
get through by assuring them of his warm sympathy 
with their efforts, and this friendly disposition on 
the part of a member of the Government was, as 
Mr. Crombie, MJ*., pointed out, a matter for sincere 
congratulation from the point of view of the mem¬ 
bers of the Association. Members are to be induced 
to ballot for the Bill next Session, and the Govern¬ 
ment is to be shown that legislation must be 
obtained by means of private members and 
their constituents being persuaded to show 
great determination in pushing the Bill Work¬ 
ing-class mothers are to be addressed all over 
the country warning them of the risks they run in 
employing ignorant midwives. The support of the 
mothers is to be enlisted, and especially that of 
their husbands, who can vote, as the people most 
vitally concerned in the movement of the Associa¬ 
tion. The whole country is to be mapped out, and 
societies formed to appeal directly to the people and 
to rouse that public opinion without which Parlia¬ 
ment will not move. A plea not unusual under 
similar circumstances is made for money, and the 
Association trusts that there will be no falling off 
in the donations. Great hopefulness vraa evidently 
I aroused by the statement in the report that in the 
Digiiized; 


JCLT 10. 1901. 


NOTES ON CURRENT TOPICS. Thb Mbdicai Pbibb. 43 


opinion of Dr. Percy Bonlton and Dr. Champnejs 
medical opposition to tlie Midwiyee’ Bill is largely 
d imin ishing. The Association consider that steady 
progress has been made in spreading a knowledge 
for the need of the le^Iation they propose, and that 
every year shows a more wideapreadconviction among 
the pablio that the present state of things cannot be 
allowed to continue. 


Spinal AnaBsthesia by Cataphoresie. 

The risk attendant on opening the dura mater of 
the spinal cord has, perhaps more than anything 
else, done much to make unpopular anaesthesia by 
the ordinary method of injecting the cord with 
cocaine. Injection of the fluid between the arachnoid 
membrane and the dura mater has, as has been noted 
in The Medical Press and Circular, been re¬ 
commended and tried, but it requires great dexterity 
to just penetrate the dura mater only, and there 
is always the doubt as to the success of the operation. 
To avoid the risk of the earlier operation and to 
get rid of all doubts as to the successful performance 
of the second. Dr. Leonard Cot'wing has proposed 
that cataphoresis be utilised to make the ansesthetic 
penetrate the spinal membranes. The method has 
been successfully tested, by its author, on a patient | 
in a New York hospital, who underwent an osteotomy i 
of the foot. The anmsthesia was so long in coming 
on, full half-an-honr, that ether inhalation was 
resorted to, but scarcely were the preliminary steps 
of the operation taken than the house surgeon drew 
attention to the fact that the patient, now 
entirely conscious, for the ether inhalation had 
been discontinued, was sufferii^ no pain. From 
then on there was no giving of ether what¬ 
ever, the patient conversing with those about him 
quite contentedly, and without the least sign of dis¬ 
comfort, although cutting, chiselling, sawing, and 
suturing were indulged in, according to the technical 
demands of the occasion.” (New York Med. Jour.) 
The steps of the operation differ considerably from 
any of those formerly proposed, in that the author 
makes an incision between the spinous processes of 
the fonith and fifth lumluu* vertebra, a little to the 
right of the ligamentnm interspinosnm, thrusting 
the knife down to the Ugamentum subflavum. This 
being done he penetrates the ligament with a fine 
telescopic-like tube, which fits accurately the 
outer tube which rests on the ligamentnm sub- 
flavum. The fine inner tube projects half-a-centi- 
metre beyond the outer tube, and is rounded at its 
extremity, and is deficient in the sharpness necessary 
to penetrate the dura mater. Having pierced the 
ligaments a syringe is attached to the smaller tube 
by means of a socket, and the anmsthetio fluid is 
injected in the dura mater. The syringe and the 
smaller tube are now removed, and the positive pole 
of a galvanic batteiy is secured to the outer tube, 
and the negative sponge of the battery is placed on 
the abdomen; and the current turned on until tiie 
milhampere meter showed three-tenths of a milliam- 
pere. Should any doubt arise as to the perforation 


of the dura mater by the inner tube the piston of the 
hypodermic syringe can be withdrawn, and if no 
spinal fluid is found the membrane is intact. 


Important Legal Decision on the Sale 
of Food. 

The very important issue raised in the case of 
Wallis against Russel, commonly known as the 
” Cork Crab Case,” has been decided, on appeal, in 
the Sing’s Bench Division, by the Lord Chief 
Baron and Mr. Justice Andrews. To the medical 
profession the decision is of much importance, as it 
is distinctly and rightly based on the caveat euiptor 
principle; any other principle would wreck the 
beneficent design of all the recent legislation 
passed for the protection of the buyer of food. 
The plain intent of buyiug food is to prepare it for 
human use, and the essential condition of sale is 
that the food is fit for human use. It was argued 
that crabs were natural products, not manufactured 
ones, and that they were sold as such without war¬ 
ranty. But as the Lord Chief Baron pointed out 
that the Act applied to goods of a description which 
it was in the course of n seller’s business to supply, 
and that liability was to attach to the dealer as such. 
The case is one of great simplicity although it 
raised such important legal issues. The plaintiff 
bought of the defendant, who is a fishmonger, 
some crabs which were dressed and eaten by 
his wife and family. Daring the night marked 
toxic symptoms in all who ate of them were 
found, and their lives were saved with much diffi¬ 
culty, oonvalesoence being long and staggering. 
Toxic effects from shellfish are not unusual; they 
may result from idiosyncracy, from improper feed¬ 
ing of the crustaceans, or from the natural process of 
decay in fiish kept too long. In this case there was, 
however, no question as to the freshness of the 
ombe Idiosyncracy was not considered, so we may 
suppose that there was none; but remains the ques¬ 
tion as to tbe site of the fishing grounds for the crusta¬ 
ceans. If tbe fish fed in a sewage impregnated district 
we might reasonably conclude that others would 
have suffered similarly to the phuntiff and his family; 
but there is no such account. We are told nothing 
of how the fish were cooked, or what, if any, drink was 
taken with them. The case has, however, definitely 
settled an important legal point that affects every 
member of the community, by establishing a principle 
that, though it may at times press hardly on vendors, 
is a protection to the public and a safeguard to 
public health. 

Pl^ue and Small-pox in Glat^ow. 

Ths ftTinniJ Congress of tbe Sanitaiy Inspectors 
of Scotland at Glasgow has naturally given rise to 
retrospects of the plague and pestilence to which the 
ancient town has of late been subjected. Ix>rd 
Provost Chisholm very naturally congratulated his 
townsfolk on the way in which bubonic plague had 
been stamped out of their midst, and the disease 
prevented from extending to other parts of Scotland. 

Di-::zed. OOg C 


NOTES ON CURRENT TOPICS, 


44 Thk M«DioAt. Psisg. 

At the same time he was obliged to admit that there 
were manj unsanitarj areas in the city that formed 
fit nursing places for infectious disease. That 
fact was illustrated by the recent epidemic of 
small-pox that had swept over them, but now, 
happily, had been banished. The experiences 
of that outbreak had left him more than ever a 
firm believer in the virtues of vaccination, but 
the public must not be permitted to imagine that 
universal vaccination would he any excuse for lax 
sanitary administration. With regard to the recent 
critical experiences of Glasgow, it may, perhaps, be 
permitted to remark that a Corporation which has 
sent plague so promptly to the right-about should 
surely be able to deal effectually with the less 
deadly home infections, such as small-pox and 
scarlet fever. But how, above all things, can so 
enlightened and progressive a municipal government 
permit the Clyde to remain the most offensive ink- 
black river of foul pollution known to the civilised 
world P What has the Lord Provost to say upon 
that point ? 


Chorea and Bheumatisin. 

“ Ghosea is rheumatism of the brain, and I feel as 
certain of that as I do of anything in medicine." 
These are the words used by Sir Dyce Duckworth in 
addressing his students at St. Bartholomew's Hos¬ 
pital a short time since, and in support of bis view he 
was able to add that the recent researches of Drs. 
Poyntott and Payne have rendered his conception as 
nearly certain and positive by way of demonstration 
as anything can well be. These two observers have 
succeeded in inducing chorea in the rabbit by the 
inoculation of the diplococci of rheumatism, and they 
have detected these diplococci in the endothelial cells 
and capillaries of the brain. They found them not 
only there, but dipping into the motor centres of 
the rabbit's brain. That is almost as complete 
and perfect a demonstration of the nature of the 
disease as could be wished for, but Sir Dyce 
Duckworth was singularly fortunate in being 
able to quote an extremely interesting cose of fatal 
chorea in the human subject, in which Drs. Poynton 
and Payne discovered theee rheumatic organisms in 
the mitral valve and also in the motor cortex of 
the brain. The very natural conclusion these 
gentlemen have drawn is that chorea is induced by 
the presence of these diplococci or of the toxins 
which they produce in the brain. It would be diffi¬ 
cult to describe the modem view of the morbid 
anatomy of chorea more concisely and clearly than 
Sir Dyce Duckworth, who says that so far as it has 
been studied it shows nothing incompatible with the 
theory that it is an inflammatory process depending 
on microbic invasion, and the symptoms of the dis¬ 
ease appear to indicate that the changes are caused 
by multiple local lesions due to the deposition of a 
particular form of disease rather than to any diffuse 
toxemia. Believing that the determination of this 
process to the brain will only occur in persons parti¬ 
cularly and specifically predisposed to brain weak* 


JOLT 10, 1001. 

ness, we naturally come to regard it as rheumatism 
localised in that organ. 

Foreign Students in Germany. 

No better testimony could be forthcoming of the 
high esteem in which German methods of teaching 
are held by the world at large than the very large 
number of foreigners who avail themselves of the 
facilities provided by the various universities. 
Apart from the Russian students, who, for political 
reasons, prefer German schools to their own, close 
upon two thousand other students of all nationali¬ 
ties rub shoulders with the native students. In 
view of the fact that the foreign students pay for 
their education on the same footing as the native 
contingent, one would have thought that both pro¬ 
fessors and the general body of students would have 
been flattered and pleased at this evidence of popu¬ 
larity. Apparently this is not the case, for a 
movement of protest against the large admix¬ 
ture of foreign students has been inaugurated, 
on the ground that the native students are 
crowded out. This is a very good reason for 
requesting the authorities to provide additional 
accommodation, but certainly not for proposing the 
exclusion of foreigners. We should be sorry to see 
German universities follow the example of the 
French in placing obstacles in the way of foreigners 
desirous of availing themselves of their educational 
institutions. In years gone by it was the boast of 
the French school that it was the favourite resort of 
the studious youths from all parts of the world, a 
proud position which a narrow-minded protectionism 
has mined, although to its popularity with foreigners 
the intellectual pre-eminence which France formerly 
occupied in Europe, and indeed in the world, was 
laigely due. Let our German scholars remember 
that science knows no frontier, and that it is a privi¬ 
lege to be jealously safeguarded to be able to attract 
and retain the affection of the studiously inclined. 

Velocipliilia, 

The disease which a French author has described 
under the name velociphilia is not a new one, 
though it has of late assumed an epidemic form. It 
was a mild and comparatively inoffensive affection 
so long as it could only be indulged in by those who 
were willing to use their legs for the purpose of rapid 
progression. It occasionally assumed an acute form 
in equestrians who risked life and limb in their 
endeavour to outrun the hounds; but it was not 
until the advent of the modem bicycle that it attained 
such dimensions as to constitute a peril for the pubiio 
and a source of evil for the victims. Within the last 
few years the perfection attained by the motor oar has 
been the means of developing the malady in a 
form dangerous at once to the pubiio and to its 
victims. In years to come it may be that our facul¬ 
ties of direction and our agility may adapt them¬ 
selves to new and altered requirements, but at present 
the motor car is an unmitigated terror to those whose 
nerves are ever being agitated by the peremptory 

Digitized t, OOgk 



JuLT 10, 1901. NOTES ON CURRENT TOPICS. Ths Mkdical Prim. 45 


hoot. It is idle to look to repressive penalties to 
stem the course of the epidemic. Under the empire 
of this emotional mania the otherwise sane man 
rushes headlong to his doom, oblivions alike of the 
risks which beset him as he careers along the dnstj 
road at express train speed, and of the dangerswhich 
his rapid passage entails on other travellers. The 
only effeotnal safeguard would be to refuse the 
liberty of the streets and roads to all cars not pro 
vided with a permit of circulation, such permit 
only being accorded on its being shown that the 
mechanism does not admit of a speed greater than 
that allowed by the traffic regulations. We do not 
attach much importance to the proposal to make 
these cars carry numbers. Enveloped in a cloud of 
dust, the outraged pedestrian would not be in a 
favourable position to distinguish tiie number of his 
assailant, which, moreover', it would be easy enough 
to mask at critical moments. 

The Royal Colleg^e of Surseoaa of England. 

Ths ballot for the election of three members of 
the Council of the Royal College of Surgeons of 
England took place on July 4th, with the following 
results:—Mr. Arthur William Mayo Robson, 332 
votes; Mr. William Watson Cheyne, 302; Mr. 
Richard Clement Lucas, 259. Of the unsuccessful 
candidates, Mr. John Hammond Morgan obtained 
236 votes ; Mr. Charles William Mansell MouUin, 235; 
Mr. Henry Hugh Glutton, 145; Mr. John Bland- 
Sutton, 193; and Mr. Jordan Lloyd, 93. Seven 
hundred and fifty Fellows voted by paper and eighteen 
in person. Mr. Mayo Robson and Mr. Watson 
Cheyne were declared to have been duly re-eleoted, 
and Mr. R. C. Lucas duly elected. 

Indian Army Medical Reform. 

Som of the service journals are turning their 
attention to defects in the Indian Medical Depart¬ 
ment. On the principle that coming events oast their 
shadows before them, it is to be hoped that these 
editorial straws point to the setting in of a strong 
reforming current in that direction. From a scien¬ 
tific point of view the preeent system may be 
regarded as absolutely throttUng to all individuality 
and its resulting efficiency. The test of a man's 
opinion appears to be his status in the army, a 
sacrosanct qualification quite apart from such lay 
trivialities as his soientifio attainments. If we 
judse the tree by its fruits then the army medical 
service in India stands self-condemned. After gene¬ 
rations of official administration the death-rate from 
cholera and enteric fever remains very much 
as it was, notwithstanding the vast scientific 
advances that preventive medicine has made 
in dealing with these scourges of mankind. Surely 
anyservioewitb areal grip of the situation would have 
long ago placed its standing camps and barracks on 
a sound sanitary footing. So far from that the 
average view of the Indian Army surgeon upon sani¬ 
tary matters appears to belong to a fossil and pre- 
scientific age. Even now the essentially water-borne 
nature of cholera and enteric fever is not generally 


recognised, or, at any rate, if recognised, is not re¬ 
duced to a practical sanitary basis. The death-roll 
from preventible diseases among British troops in 
India is a standing reproach to our medical adminis¬ 
tration in that Empire. It is a significant fact, 
moreover, that few, if any, of the great advances in 
tropical medicine have hailed from India, in spite of 
the enormously wide field thrown open to scientific 
investigation. 

The Congrees of Taberculosis. 

The arrangements for the approaching Congress, 
which is to be opened by the Duke of Cambridge on 
the 22nd inst, are now virtually complete, mid there 
is every reason to anticipate a successful meeting. 
There is a veritable plethora of contributions, many 
of which will necessarily have to be taken as read ” 
in order to leave time for the discussion on the more 
important. It is hardly to be expected that anything 
strikingly new will issue from the debates. The 
object of these congresses is to educate the profession 
and the public by generalising the knowledge we 
already possess in r^ard to the etiology and spread 
of this fell disease, more particularly from the pre¬ 
ventive aspect. We have as yet only touched the 
fringe of the subject, and as leg^lation cannot use* 
fully go in advance of public opinion, it is all im¬ 
portant to seize every opportunity of fiimiliarising 
the public with the steps that have been taken and 
suggested with this object in view. It will greatly 
facilitate matters if those who intend taking part in 
the Congress will lose no time in inscribing their 
names at the headquarters, 20, Hanover Square. 

The Reform of the Army Medical Depart¬ 
ment. 

The latest information vouchsafed in regard to 
the Committee of Experts renders it more than ever 
necessary to suspend judgment. It appears from a 
reply by Mr. Brodrick, in parliament, that the Com¬ 
mittee will not take evidence, and that its proceedings 
will be private, though it will (of course!) be open to 
any member of the Committee to submit alternative 
proposals. The least reassuring item of the reply 
was that which dealt with the scope of the reference 
which, it seems, is not to be made public. For the 
present, therefore, we must await the result of the 
Committee's deliberations. Meanwhile the competi¬ 
tive examinations have been suspended owing, it is 
asserted, to the lack of candidates. 

An Unregiatered lEtesident Medical Officer. 

At an inquest held last week at the Clayton Hos¬ 
pital, at Wakefield, Mr. George Robert Butler, 
M.R.C.S., who is acting as locum tenens for the 
assistant house surgeon, was a witness, and it trmis- 
pired that his name did not appear on the Medical 
Regieter. The omission was expired on the ground 
that the last issue of the Regitter had been newly 
printed,” which we take to mean that this gentleman 
had omitted to make known his change of address, 
his name having been deleted in consequence. In 
consequence of the more stringent rules which have 
Digitized t ^"^^3 ^ 


46 Th» Mbpioal Pbkbb. _TBA-NSACTCOyS OF SOCIETIES._ Jtot 10, 1901. 


come into force with respect to identification, there 
was, he stated, difficnltj in the waj of his getting 
the omission remedied until such time as he 
could go to London for the purpose. The Coroner 
pointed out that the witness was liable to a penalty, 
which the latter denied. Technically the Coroner 
was probably in the right, and in any event we trust 
this case will impress upon all duly qualified practi¬ 
tioners the propriety of taking care that their regis¬ 
tration does not lapse 

Bathing Fatalities. 

The advent of the summer season has been ushered 
in with even more than the usual list of bathing 
fatalities. Of such accidents there be no doubt 
that a great many are preventable, that is to say, 
they should not occur under conditions of ordinary 
prudence. The number of persons who are drowned 
every year because they cannot swim is simply appall¬ 
ing. With regard to swimming it need hardly be 
remarked that in addition to being a most desirable 
acquirement it is a delightful and health-giving 
exercise, which brings grace and vigour to the body. 
To swim, however, especially in rough water is an 
extremely athletic exercise, and cannot be under¬ 
taken lightly by any person who is not more or less 
in that state of bodily fitness known as “ training.” 
The majority of bathing accidents probably happen to 
those who overtax their muscular resources too sud¬ 
denly and too severely directly they get down to the 
seaside. Another risk arises from too frequent bath¬ 
ing. Only a few days ago an inquest was held on an 
ex-chamnion diver and swimmer who had tempted 
fate by swimming in the Thames several times in a 
single day. The fact is that those who contemplate 
seaside or inland bathing would do well to consult 
their medical attendant beforehand upon the matter. 
Many a man and woman with weak heart and feeble 
circulation, or with flabby muscles would thereby 
be warned against incurring unneoesary dangers. 
This sort of warning cannot be picked up from books, 
but may always be obtained from the ripe treasury 
of sagacity that is gathered by the practitioner 
from the broad harvest fields of medical practice. 

The Spinal Symptoms of Tea Intoxication. 

The injurious effects of excessive indulgence in 
tea on the digestion and on the nervous system are 
familiar to most practitioners in this country, where 
tea inebriety is probably more frequent than else¬ 
where. It is doubtful, indeed, whether practitioners 
generally recognise to the full what a potent agent 
for evQ tea-drinking may prove, especially when, as 
is BO often the case, it is associated with inadequate 
nutrition. At a recent meeting of the Neurological 
Society of Philadelphia, Dr. Alfred Gordon showed 
some patients who presented certain well-defined 
spinal symptoms dependent apparently upon chronic 
tea intoxication, ^om ten to fifteen cups of tea 
daily had determined unsteadiness of gait and easily 
induced motor fatigue. The knee jerks were in¬ 
creased, sensation was impaired in some regions and 
enhanc^ in others. The pupils were unequal and 


there was nystagmua It is open to question whether 
these rpinal symptoms were due exclusively to the 
tea or to the ingestion of minute quantities of lead 
therewith, but the commxmication suggests a useful 
field for future study. 

Degrees for London Diplomatee. 

The diplomates of the London Boyal Colleges are 
still restlessly stating for facilities at the bands of 
the reconstituted University of London in the 
direction of obtaining a medical degree, but 
so far there is no sign that their not unreason¬ 
able demand is likely to meet with a favour* 
able reception at the bands of the authorities. There 
is no obvious reason why special facilities should not 
be offered to diplomates willing to comply with 
reasonable requirements in order to acquire the 
coveted degree. In future, no doubt, most metro¬ 
politan students will take care, when they enter on 
the study of medicine, to keep in touch with the 
University j but this leaves a very deserving category 
of qualified men out in the cold. The best course 
for them to adopt would be to formulate a tangible 
proposal which could be urged on the attention of 
the Senate for approval. It is useless to cry in the 
wilderness, leaving it to others to state exactly what 
they want. 

Buxton Spa. 

The historical virtues of Buxton water are his¬ 
torical. So long ago as the Roman era it was devoted 
to the uses of ^scnlapius. Since then it has always 
been a resort for invalids, and numerous references 
are to be found from time to time in the pages of 
English history. There is no need to refer to the 
fact that the mineral springs which have made 
Buxton famous are chiefly chalybeate and cal¬ 
careous, the latter both hot and cold. In addition to 
the waters, however, visitors have the benefit of a 
glorious mountain and moorland scenery, which of 
its kind is perhaps the most compact and beautiful 
in all England. Indeed, it would be hard to 
imagine a more complete and restful change for 
the jaded town dweller than the clear and 
bracing atmosphere of Buxton. During the last 
two generations great changes have been effected in 
the town, whereby it has become one of the most 
perfectly appointed of spas. The Devonshire family, 
who for centuries past have practically ruled the 
country round, have taken the lead in these improve¬ 
ments. One of their greatest public benefactions 
has been the Devonshire Hc^pital, which for forty- 
two years has fulfilled a career of unbroken useful¬ 
ness and success. During that period no less than 
82,000 gouty and rheumatic patients have passed 
under treatment, and of that number it is reported 
that no less 74,000 have received lasting benefit. 
It would be Buperfinous to comment upon a record 
of that kind, which speaks for Itself with absolute 
emphasis, and bears eloquent testimony to the 
causes that have given Buxton a foremost place 
among English spas. 

Dig;;ized by Google 


Jolt 10. 1901. 


EDINBURGH. 


Ths Mxoioal Pbiss* 47 


The Toxaemia of Bums. 

Ik those cases where death has occurred from the 
effects of severe boms evidence is not nnfreqaentlj 
found, on post-mortem examination, of ulceration of 
the dnodennm. The theorj for some time was that 
this lesion might be due to capillary embolism con¬ 
sequent upon the presence of disintegrated blood in 
the vessels. In connection with this point there was 
read, at the Association of American Physicians, 
a su^festive contribution by Dr. McCrae, of 
Montreal, entitled “ A Study of a Series of Oases 
of Bums,” in which the author puts forward the 
theory that the mischief may be due to a 
tonemia similar to that produced by bacteria. The 
pathological processes at any rate present a striking 
similarity to those met with in diseases characterised 
by the presence of toxins in the blood. The inves¬ 
tigations of Bardeen were suggested by the similarity 
of the lesions found after bums and those accom- 
diphtheria, In fact the changes in bums are 
more proliferative than degenerative. One view, 
probably the least open to objection, is that the toxin 
elaborated in a bum is due to the action of heat on 
the blood in the superficial capillaries. The subject 
is one which, of course, has received the closest 
attention of skilled observers, but so far without 
clearing up the pathology of this very curious and 
interesting lesion. 


PERSONAL. 

Libut.-Colokil R. W. B&bnks, Royal Army Medical 
Corps, retired, has been granted the local rank of 
Colonel whilst in charge of a General Hospital in South 
Africa. _ 

Da. J. W. WasHBOUBK, Assistant Physician to Guy's 
Hospital, who went to South Africa with the Imperial 
Teomaniy Hospital in Pebmary, 1900, has returned to 
London. _ 

Mb, 3, H. LittIiXjohh, who for nearly six years has 
been Medical Officer of Health for Soarboroogh, has 
been appointed to a similar position at Hampstead, 
Middlesex, at a commencing salary of £600 per 

Thx Gold Medal of the Royal Navy Medical Service 
for the year has been awarded to Surgeon A. J. Wemet. 

Thb John Malet Parser Medal has been awarded to Mr. 
B^rinald H. Lee by the Council of Dublin University 
Medical School. 


Ds. J. Lobbain Smith has been appointed a member 
of the Commission “ to inquire into the preeent condition 
of the higher, general, and technical education available 
in Ireland ontside Trinity College, Dnblin, and to report 
as to what reforms, if any, are necessary in order to 
render that ednoation adequate to the needs of the Irish 

people.” - 

Db. Robbbt W. Dotnb, of Connaught Square, W., 
and Oxford, had an unique experienoe a few days sinoe. 
He foond himself in a carriage on the 1.18 express from 
Oxford alone with a man, and on awakening from a 
dose he noticed blood on his fellow traveller’s boots. 
On e xami n i ng him more closely he saw that he had cat 
his throat and was covered with blood, facts to which he 
subsequently testified at the inquest. 


(Edinburgh. 

[PBOM CUB OWN COBBXBPONDXKT.] 

THE LATE PROFESSOR TAIT. 

Pbtxb Guthbib Tait, D.So.. P.R.8 Ed., &a. the cele¬ 
brated exponent of natural philosophy in the University 
of Edinburgh, the one time Senior Wrangler of Cam¬ 
bridge, and prizeman in several other cognate matters at 
or about the same time, the ooUaborator with Lord 
Kelvin in varioos standard works on physios, died last 
week at the residence of his old friend and scientific 
oolleagne. Sir John Murray, in the snbarh of Edinburgh 
known as Trinity, which lies by the sea-shore. A worthy 
snocessor to Hamilton and o^er oelebrated occupants 
of the Edinburgh Chair of Natural Philosophy; ft 
of unusual mathematical talent, to whom intricate 
physical problems, comprehensible by bat few others, 
were a joy, a pleasant amusement: a Tn ^n wholly 
devoted to his life’- work, to the exclusion of almost all 
else; he, nevertheless, possessed the gift of lucid ex¬ 
planation, the rare endowment of perfect adaptation in 
word and line of thought to the capacity of his heaters, 
and, another charaoteristio, by no means common, the 
po cnoo oion of a fond of diy C^edonian humour. 

Disdaining to be the slave of sartorial fsshions, 
seldom seen in other than a grey tweed snit of a very 
personal ont, and a soft hat, he was in private the most 
genial and, at the same time the most rationally unoon- 
ventionai of men; one of the most interesting of oon- 
versationalists, ever disolosing, direotly or indirectly, 
the fact that the working of his mind was chiefly in- 
flnenoed by his predominant obaracteristio—arithmetical 
and propositional. 

Althongh be was not actually a member of the tn ed i ca l 
profession, he was directly associated with medicine in 
connection with the teaching of physios to ^tn- 

dents in their first year. 

The oonjoint works of Professor Tait and Lord Kelvin 
illustrate in a marked manner the extaundinary power 
of invention andtbeory of the latter; the striking faculty 
of the former for praotioal exposition and Incid desorifh 
tion. 

Tait, now mid then, strayed from the strait and narrow 
path of higher matbematios ; he investigated the flight 
of golf-balls, drew up formnlffi to represent the charac- 
teristio course traversed by a child’s indiarubber balloon 
when propelled through the air by a shwrp blow. 

For many years Professor Tait had filled the post of 
Secretary to the Royal Society of Edinburgh, indeed, 
his devotion to this Society was almost Quixotic, as for 
its sake he resolntely declined to seek the hiirher honour 
of P.E.S. 

Professor Taitis illness b^an last year, shortly after 
the death of his son, Lientenant Freddie Tait—as well 
known for his physical aohievemencs in golf as his father 
for his philosophical achievements in physios — 
killed in South Africa; caused him to resign all official 
posts some months ago, and at a time when a greater 
hope that his life, with that power of adding to 
world’s store of knowledge, the perquisite of his brain 
alone, might be prolonged to man’s advantage, the 
suddw onset of heemorrhage—the source of which has 
not as yet been indicated, althongh maybe aneurysmal— 
rapidly dosed a life of unbroken application and of nn- 
questionable benefit to muikind. 




[vbom oub own oobbxspondbnt.] 


Rotal Invibmabt Rbconstbuction Schixs. —This 
subject is exciting (Kmsiderable attention in Glasgow, 
and calling forth mnoh adverse oriticism. Following 
the letter of Dr. R. Anderson, archit^, to) the 
newspapers, complaining of the shabby way he had been 
treats as assessor by the Committee in charge of tiie 
above scheme, in inoring entirely the plana he had 
commended for t^eir consideration or acceptance, a 
farther strong protest has been published in the news-l 

L'.„...zed: I 



48 Tbs Hbdical Psiu. 


LIVERPOOL. 


July 10, 1901. 


papen by the Glasgow Institute of Architects against 
the somewhat arbitrary and apparently tinfaif way 
in which ti)e Committee bM proceeded with the 
important work they have on hand. They state 
that the plans adopted by the Committee, which 
were not in any way rec<^nised by the assessor, 
** are in many vital partionhm inadequate and 
out of date,*' and that if the reoonsbuction is proceeded 
with according to those plans “ the infirmary will not 
conform to the most modem standards of design in this 
olw of building." We understand the planus adopted, 
mthout entoring into any detail with reference to 
internal arrangements, will form a magnificent pile of 
buildings, calculated, unfortunately, from the high alti¬ 
tude of the memorial front (which is likely to prove a 
very late Jubilee memoriu, by the way, of our late 
Queen) with its spire, to dwarf considerably the cathe¬ 
dral which is immediately adjacent. We are informed 
that Br. S. Anderson's reports were somewhat 
meagre, and that while he recommended several plans, 
to^ the entire exclusion of thoee select^ by the Com- 
nuttee, he unfortunately did not enter intodetail, giving 
his reasons for the awai^ he made to the exclusion of 
others. _ The matter has assumed somewhat serious 
dimensions, as the Institute of Architects is not satis¬ 
fied with the explanation given by the managers and 
the Executive in the offiotel statement issued to the 
public. The Institute suggests that the plans should be 
submitted to one or more independent hospital authori¬ 
ties of recognised and outstanding position for considera¬ 
tion and report, and further makes the fair proposal 
that should their contention not be borne out 
by the report received, they would meet the cost 
if the Executive object to the outlay involved, 
while submitting before hand the name or names 
of the experts proposed on obtaining the necessary 
facilities from the Committee. As there is considerable 
diversity of opinion with regard to the plana adopted 
and from the firm attitude of such an influential body 
as the Institute of Architects in the matter, it behoves 
the Executive to give the subject very serious and 
thoughtful consideration. They have charge of an 
undertaking which requires the public to subscribe a 
very large sum of money, notwithstAndiog the .£90,000 
in hand at present. The total coat will exceed a qufuter 
of a million before completion. 

Thb Nkw Pbofzsbob of Mxdicxke in St. Munoo's 
CoLLXQs.—Dr. Thomas E. Monro has bMn appointed to 
the Chiur of Medicine in St. Mungo's College, vacant by 
the resignation of Dr. Alex. Bobertson. Dr. Monro is 
MA. and gr^nated M.B., C.M., at Glasgow in 18S8, with 
commendation, and M.D. with honours in 1895. He was 
strongly recommended in very flattering terms for the 
vacant office by Sir Wm, T. Gairdner, whose house 
physician he was in the Western Infirmary, and also by 
Professor Osier, of John Hopkins University, Baltimore, 
who says in his teetimoni^ " that Dr. Monro is well 
known to ns on this side of the Atlantic as an original 
and careful writer on many medical subjects.” .^ter 
graduating. Dr. Monro studied in Vienna, Berlin, and 
Paris. His contributions to medical literature are very 
numeroxu. St. Mungo’s College is to be congratulate 
on having appointed one to the Chair of Medicine who, 
in the langn^e of Sir W. T. Gairdner, ” will do credit to 
their choice, and will advance the interest of the College 
and its students.” 




[fboh oub owk oobbxspokdbnt.] 


THE rUTUKE OF VICTOEIA UNIVEESITY. 

Thx proposed disintemtion still continues an engros¬ 
sing topiofordisoussion m academic oircles. On June 29th 
an important meeting of the .Court was held, at which 
Earl Spencer, Chancellor of the University, presided, 
and the following resolution was submitted from Uni¬ 
versity College, Liverpool:—"That while gratefully 
acknowledging the advantages which hare accrued to 
University College, Liverpool, by its association with 
Victoria University, this Court is of opinion that a 


university should be established in Liverpool, and will 
welcome a scheme for this object upon an adequate 
basis.” Sir John Hibbert, Chairman of the County 
Council of Lancashire, Professor Euoker, Mr. A. H. D. 
Aoland, Dr. Clifford Allbutt, and others deprecated a 
dissolution of the great federal University of the North, 
and Earl Spencer dearly indicated the dangers which 
might arise from the esteblishment of several local uni¬ 
versities to the cause of higher education. The best 
opinion evidently deplores the impetuosity and ill- 
directed ambition of Livern^l. Strong feeling exists 
among graduates that a dissolution of the Victoria 
University would be an act of injustice to them, and, 
as Earl Spenoer expressed it, is it right or desirable to 
to break up a university which already had a great many 
men dependent upon it. A great many men had felt 
much honour in passing the degrees of that university, 
said Earl Spencer, and he thought they would be exceed¬ 
ingly sorry if the university to which they belonged, and 
whi^ had conferred honour upon them, should no lon^ 
exist, which would be thecaseif the Liverpool resolution 
was carried. The general opinion of we Court was 
finally voiced by the adoption of the following resolu¬ 
tion:—“That in order more fully to deal with the 
resolution of the Court of University CoUfge in refer¬ 
ence to the establishment of a university in Liverpool, 
a Committee of the Court be appointed to consider 
and report, in the event of an application fur a univer¬ 
sity clmrter being made by University CoUege, Liver¬ 
pool, what action, if any, should be taken by the Court 
of the University, and that the authorities of University 
Collie be requested to keep the Committee informed 
any stops which they may propose to take in the 
matter.” The irreconcilable attitude of Liverp^l 
is well indicated by the following resolution, which 
was unanimously attoptod at a meeting of the 
Liverpool City Council on the 8rd inst.:—'‘That 
this Council has observed with much satisfaction 
the growth and progress of the University College, 
and in view of toe fact that the college authorities are 
taking steps to procure the establishment of a separate 
university for Liverpool records its opinion that it is 
desirable, in the interests of higher education in the 
city, that such a university should be founded.” Such 
an eminently parochial point of view may well distress 
those who hope for a raised standard of medical educa¬ 
tion in this country. A serious attempt is apparently to 
be made to Americanise our system of university educa¬ 
tion. Medical educationaliste throughout the country 
will do well to watch the proceedings which are quietly 
taking place with regard to Victoria University, as it 
seems likely that it is premonitory of a phase of thought 
and line of action which will have far-reaching results 
on university training in this country. Meanwhile it 
would be well if m^cal graduates of the Victoria 
University could be associated in a graduates* council 
to watch proceedings and seifeguard their own interests. 




[from OUB own COBBK8PONDBNT.] 

PROPOSED UNIVERSITY FOR LIVEEPOOL. 

Ths proposal of the University College, Liverpool, to 
separate itself from the Victoria University has come 
upon the Manchester portion as somewhat of a cold 
douche. It cannot see any necessity for such a move, 
and it looks upon the proposal as an evidenoe of some 
degree of ingratitude. As regards the attitude and 
sentimente of the University CoUege section, and i ndeed 
of Liverpool generaUy, there can be no ambiguity. The 
proposal of toe College itself—“That while gratefully 
acknowledging the advantages that have accrued to- 
University CoU^, Liverpool, by its association with 
Victoria University, this Court is of opinion that a Uni¬ 
versity should be established in Liverpool, and will 
welcome a scheme for this object upon an adequate 
basis ”—is evidence of this on toe part of the CoUege, 
whilst the resolution of the City]Oounci), passed at a 
meeting on the 8rd inst., is sufficient evidenoe of th» 
feeling of the IJverpool public generaUy.^ 


Jolt 10. 1901. 


CORRESPONDENCE. 


Thi Midical Psaas 49 


No special arguments were employed by the Owens 
Coll^ section against the propel, bat it was qnite 
oatnm that one of Bn<di noTelty and one so revoln- 
tiosary should not meet with immediate acceptance. It 
woald have been too much to expect snob a thing. 
HowereT, the College has done well to bring it forward, 
sod a be^nning has been made. Looked at impartially, 
a good deal may be said in favour of the proj^. The 
LiTerpool University would be a more ^f-contaioed 
instatotioD, a part of its energies would not have to be 
frittered away in seeking the oo*operation of its other 
half, and a stimulus would be given to it to do its very 
beet to keep abreast of other institutfons. 

On the other band, there appears to be only one ob> 
jection to it, and that is that it would interfere with 
Tested interests and damage the prestige of the Vic* 
toria UniTeraity by the formation of still another 
licensing body. This would not be of much moment, 
however; people who are content with the already 
abenrd number of licensing bodies cannot seriously 
object to the addition of one or two others. In Ger* 
many no University is a licensing body; tiiere is but one 
portal for practitioners, and that is the State examine* 
tioD. Why not do here what has been done in Germany, 
and sweep away the power of granting licenses from 
the present licensing bodies and m^e one portal—a 
State examination ? All jealonsiee on the part of 
present licensing bodies would then cease, degrees 
would then become simple academic distinctions, honour* 
able distinctione as much as ever, but the degree would 
be removed out of the sordid atmosphere of licensing 
for money and the commercialism inevitably associated 
with it 


use or the great wounding power of so-called expanding 
bullets of small calibre. 1 believe that a great number 
of the injuries which were attribnted to the employment 
of theM missiles were produced either by ricochet 
regulstion bullets of smiUl calibre, or by large leaden 
bnllete of the Martuii*Henry type.” This opinion is 
of the ntmoet value, coming as it does from a trained 
observer who has avaUed himself of an unusnally 
wide field of observation. From a surgical point of 
view the book is full of interest. A striking instance 
of the absence of initial pain was afforded by a man 
shot throngh the bnttock, the bullet then traversing the 
abdomen ; this patient remaioed unaware that he 
been hit nntil on undressing he found blood in his 
trousers, and exclaimed, “ Why, I have got this bloody 
dysentery ! ” None the lees his internal injuries were 
sufficiently severe to lead to hia death within thirty-six 
hours. A man shot in the pelvis had au attack of 
retention of urine on the voy^e home, and passed a 
Mauser bullet per nrethram. The radiograms are of 
great interest, their technical quality is excellent. The 
illostrations include twenty-five plates and seventy-one 
process pictnres, and add considerably to the valne of 
the book. Regional injuries are dealt with systemati¬ 
cally and minutely, and the anthor may be congratu¬ 
lated on having written a volume that is worthy of the 
beet traditions of British surgery. 


(HjrrrMpoiibmi. 


tW« do not hold oorMlvea responsible for tho opinions of our 
oomspondonts.] 


^eratttre. 

MAKINS’S SOUTH AFRICAN WAE SURGERY, (o) 

This volume is the outcome of the author’s experiences 
as consulting snigeon to the Sooth African Held Force. 
As such it forms part of what will be donbtless a copions 
literature, but it may be questioned whether any indi¬ 
vidual book is likely to be of greater value to the student 
of military surgery than the one now before ns. Mr. 
Makins took to bis task a ripe experience of surgery 
gathered from many years of work as surgeon and 
teacher in St. Thomas’s Hospital and elsewhere. He 
has brought the full extent of his powers to bear 
upon a systematic examination of the immense mass 
of material rendered available to military surgeons 
by the prolonged war that is still draggiog its alow 
langto sJoog in Sonth Africa. The question of trans¬ 
port is intr<Mnced by the statement that its importance 
is felt from the time of the injury till the time of the 
arrival of the patient in the mother country. To the 
surgeon it is of the same vital importance as the carry¬ 
ing of food for the troops is to the combatant general. 
This view bas a little farther on the significant rider 
that a really satisfactory wagon, combining both 
strength and oomfert, still remains to 1^ de¬ 
vised. Hlustrations are given of various wagons, 
hospital traine, hospital tents, and other details 
that enable the reader to form a graphic idea of 
the realities described in the text. The difficulties in 
the way of the surgeon were nameroos. Dust, for in¬ 
stance, was everywhere, and, we are told, “ often when a 
bandage was removed an even layer of dust, moistened 
by perspiration, covered the whole area included with a 
coating of mnd.” Flies were another source of annoy¬ 
ance, and mastered io vast numbers within a few days 
of the pitching of a camp. Indeed, it is not a little le- 
marksble tha^ under the ciroumstuces, eo little septic 
mischief was encountered. Cnriously, the only resdiy 
acute case of joint pysmia heard of by the author 
developed in connection with a blistered toe, followed by 
cellulitis of the foot. From a series of observations the 
author was enabled to arrive at the following definite 
conclnsion as to the alleged nse of expanding ballets 
"Tbe opinion I formed was against either the very free 

(■)“ Balneal Enerieacea in South Africa, 1690—1900.'* Br O. 
E. Makioi, F.B.C.S.. Snrrvon to St. Thomas s Hospital, lats Con- 
■dUng SuriteoD to the Sonth African Field Force. lA>ndon: Smith, 
Elder and Co. 1901 


THE ANDERSON FUND.’ 

2*0 the Editor of Thb Mbdical Pbbss avd Cibculab- 

SiB, —We shall feel much obliged if yon will give tu 
yonr powerful aid in bringing ^fore the medicri pro¬ 
fession and the public the following facte in connection 
with the late Mr. R. B. Anderson, F.R.C.8.. whose widow 
and two orphan sons are now living in Tobago and are 
in the most straitened ciroumstanoes. 

A strong representative committee—with power to 
add to their number—bas been formed with the view 
of appealing for assistance to those members of the 
medical profession and of the public who knew and sym¬ 
pathised with the bard case of Mr. Anderson which 
aroused more interest and sympathy than any other 
professional case of recent years, and raised a most 
vital point in medical etbice. 

Shortly, the history of this case is, that after being for 
some time in attendance on a private patient in Tobago 
Mr. Anderson refused to ooutinne bis attendance, owing 
to her husband’s personal rudeness to himself. On this 
an action was brought against him by the patient and 
her husband, and Chief Jnstioe Gorrie (of Trinidad and 
Tobago) gave damages against Mr. Anderson for neglect 
in retiring from the oaae, although the attendance of 
another medical man bad been immediately secured, and 
no injury to tbe patient was proved. 

Mr. Anderson resisted this judgment, excessive bail 
was demanded from bim, and in default be was im¬ 
prisoned, and in tbe end mined by this and other illegal 
acts of jndicial oppression. Mr. Anderson then came to 
England, a Committee was formed to assist him in 
carrying the West Indian judgments in Appeal to the 
Privy Council, and Mr. Anderson in person brought an 
action before tbe late Chief Justice Coleridge in tbe 
Qneen’s Bench for tbe recovery of damages against tbe 
ColonialJndges. An English special jury gavea general 
verdict in his favour, with ^SSOO against one of the 
Judges—Chief Justice Gorrie having died just prior to 
the trial—bnt Lord Coleridge gave judgment for the 
Judge, opoiset Mr. Anderson, and the verdict in his favour, 
on the gronnd that no civil action for damages wonld 
lie against Judges for acts done in their judicial capa¬ 
city. This judgment was confirmed on appeal, and from 
want of funds a further appeal to the House of 
Lords, and the proposed Colonial Appeal to the 
Privy Conncil, were rendered impossible. Find¬ 
ing his legal remedies nnsuocessful, owing to 
tbe insuffloient snpport be received^ the 


Coog 



&0 TbC HsDICAt PBM8. 


MEDICAL NEWS. 


Jolt 10. 1901. 


corMrBtiottB aod uBoowtioiiB of the profeeaion, Mr. 
Anaerson began an active campaign of medical r^orm, 
by vhioh means alone he sav any hope of proving the 
jnstioe of his case, and seonring for the mtnre the rights 
of the profession, which were involved in his case, 
together with others which, in his opinion, reqnired pro¬ 
tection. 

His life terminated suddenly from heart disease under 
pathetio oircnmstaaoee. on November 8th last, and our 
committee feel that many in the profession, as well as 
others, will be ready—whether or not they were in agree¬ 
ment with Mr. Anderson's views and methods—to re¬ 
spond to this appeal on behalf of his necessitous family. 

Donations " for the late R. B. Anderton Ftn%d “ sent, 
and miwle payable to the Manager, Union Bank of Lon¬ 
don, Chancery Lane, London, will ^ duly acknowledged, 
and tbe amount subeoribed will be dealt with as our com¬ 
mittee, by resolution, may decide. 

We are. Sir, yours truly, 

Stamfobd (Chairman). 

T IXOTHT Holmbs (H< 


Tbe Oxygen Hospital. 

JcDOiNO from the annual report of the Oxygen Hov 

S ital, in Fitzroy Square, this institution continues to 
emonstrate the fart that an atmosphere of oxygen is 
strikingly favourable to the repair rt certain forms of 
uhronio ulceration. The returns show very clearly that 
intractable ulcers of the leg do heal in a very remanable 
way under its influence, and if this method of treatment 
has not come into more general use this is doubtless due 
to the fact that it entails tbe use of sundry appliances 
hardly available outside the walls of a hospital. In all, 
oases were treated during the past year, of 
;^Tml{i(H^tiNBl&a^were discharged as cured, and twenty- 
^ two rema%t^'^qb«treatment. The cost per patient per 
£1 7s., and the average stay in 
three'^hths. 


5Caboratorn fioits. 

ESVACH APERIENT WATER. 

Thi examination of a sample of Esvaoh Water 
and Cross Brand) has shown that it Iim exactly the 
same composition as the sample which we examined 
over two years ago; this being constant gnraatly en¬ 
hances its value. a« persons using it habitually may thus 
rely upon always taking the same amount of the aperient 
salts which this water contains. 

It is undoubtedly efficacious for habitual constipation, 
and tbe skilful manner io which the ingredients are 
combined overcomes the griping effects which are so 
often experienced after the aoministration of some 
aperient waters. Tbe excessively bitter taste which 
frequently leads to the disuse of similar remedies is 
obviated in an ingenious manner in this water, and 
bearing in mind the oomparatively large quantities of 
the sulphates of sodium and magnesium which are in 
solution, this in itself ought to be no omall 
recommendation. 



JftebuRl ^ctos. 

Tbe Bontgen Society- 

At tbe annual meeting held July 4th, the following 
officers and council for ^e ensuing year were elected. 
Those marked with an asterisk have not held, during 
the preceding year, tbe office for which they are now 
elected:—Prudent: Herbert Jackson, F.C.S. Vice- 
Presidents : Lord Blythswood, the Bt. Hon. the Earl of 
Crawford. D. Ferrier, M.D., F.B.S., J. H. Glsdstone, 
B.Sc., F.B.8., F.C.S., A. A. Campbell Swinton, Dawson 
Turner, M.D. Council: Barry Blacker, M.l>., B.8., J. 
Mackensie Davidson, M.B., J. H. Gardiner, F.C.S., A. 
W. Isenthal, F.R.P.8., E. Payne, M.A., *C. E. 8. Phillips, 
♦B. W. H. Shenton, L.R.C.P., M.R.C.S., J. J. Vezey, 
F.B.M.8., H. Snowden Ward, F.R.P.8., J. Wimsburst, 
F.B.8., Hugh Walsham. M.A., M.D.. Chisholm Williams, 
F.B.C.8. Hon. Treasurer: J. J. Vesey, Esq. Hon. 
Secretuy: F. Harrison Low, M.B. 

A Oommlssion on Butter. 

A JOXMT Departmental Committee has been appointed 
to inquire and report as to what regulations, if auy, may 
with advantage Im made under section 4 of the Sale of 
Food and Drugs Act, 1899, for determining what de¬ 
ficiency in any of the normal constituents of butter, m 
what addition of extraneous matter or proportion of 
water in any sample of butter, shall, for the purpose of 
the Sale of Food and Drugs Act, raise a presumption, 
until the contrary is proi^, that the butter is not 
genuine. 

Lady Doctors Not Beqnlrod, 

Fob over six years the medical staff at Claybnry 
Asylum has included two lady doctors, but the Asylums 
Committee now state that as "the arrangement is not 
altogether satisfactory " they have determined to put an 


end to it. Recently only one of the lady doctors has been 
eng^aged, and she sent in her resignation on learning 
that it was proposed to abolish the office. The committee 
propose to make her (Dr. Emily L. Dove), a gratuity of 
£270 as compensation for the abolition of the office. 


under Chloroform. 

.oh Dr. Waldo, the newly-appointed 
of London, bad to exercise his 
( a lad, aged 12, who died under 
St. Bartholemew’e Hospital, after an 
leath was attributed to tbe weak state of tiie 
patient, and tbe usual verdict was retnmed. A aiTniliLr 
catastrophe is reported from Barry, tbe victim being a 
married woman, age 82, who had been anssthetised by 
Dr. O’Donnell prior to the removal of retained membranes 
after miscarriage. As nsnal, no details are forthcoming, 
aod the stereotyped verdict was returned. 

The Westmeath Tragedy- 

At Westmeath Assises last week. Dr. Edward Thonoas 
French was charged with the wilful murder of his wife 
on April 6th last> at their residence at Glasson, near 
Athlone. Dr. French was Medioal Officer of Glasson 
District, Athlone Union. From the evidence it appeared 
that the prisoner, aged about 60, who bad been for mure 
than thirty years attached to the Glasson Dispen¬ 
sary District, and who married the deceased lady 
about twenty-five years ago, was in the habit of drink¬ 
ing to excess, and while under its influence was most 
excitable. During the evening of April 5th tbe servants 
were alarmed by a loud scream, and on rushing to the room 
observed Mrs. French endeavouring to escape from her 
husband, who held in one hand a hammer and the other 
a surgical knife. She said she had been stabbed. The ser¬ 
vants caught the doctor and took the knife. Mrs. French 
ran down some steps to tbe garden and to the front 
door, where she f^, and expired in about twen^ 
minutes. There was a deep wound under the right 
breast, and the liver was pierced and the apex of tbe 
heart wounded. For the defence Dr. Fitsgibbon and 
Mr.Ormaby,F.R.C.8., of Dublin, deposed that the prisoner 
was suffering for years from a chronic inflammatory 
disease of the scalp of his bead, which undoubtedly 
would affect his brain, and they believed he was not 
accountable. Drs. Smart, 8hanley, and Kelly oorrobo- 
mted. In charging the jury Lord Justice Holmes said 
it would be a serious thing to condemn a man who was 
not responsible, but it would also be a most melancholy 
thing if they should come to the conclusion that a man 
was irresponsible when he was actually responsible. The 
prisoner was a drunkard, and in recent times was more 
frequently drunk than sober. It was possible that he 
was a dipsomaniac. His Lordship further said that 
they oonld not come to auy oonclnslon from Dr. French’s 
actions during the day of the crime, but that he was per¬ 
fectly sane. Tbe jury, after a short absence, return^ a 
verdict of guilty of manslaughter. His Lordship said 
tbe manslaughter was the most serious one that could 
be, and sentenced the prisoner to penal servitude for 
life. 

British Pharmaceutical Cooferenoe—The DnhUn ■estlag. 

Thx British Pharmaceutical Conference was esta¬ 
blished in 1868 for theeooouragementof pharmaoeutioiU 
roeoaroh and the promotion of friendly interoomse and 
union among pharaaoists of the United Kingdom, and 



JULT 10, 1901. 


MEDICAL NEWS. 


ThS MxDICAL PbI80, ^1 


now embnoM about 8,000 memben. Meetingn bare 
been bdd yearly in different oentrea, that for 1890 in 
Plymouth, 19U) in London, and titia year ^e oonferenoe 
hare aoo^ted an inritatlon to hold their meeting in 
Dnhlin, it being twenty-two years since a similar visit 
was paid to the Irish metropolis. The oonferenoe oom- 
ni rnimT on Monday, July 29th. Under the presidency 
oi G. 0. Druoe, Esq., M.A., P.L.S. (Mayor of Oxford) 
the tdentifio meetings will be held io the Lecture Theatre 
of B.D.8., when papers dealing wito original investiga¬ 
tion of drugs, tnmr adulteration and impurities, will 
be read disoumd and ooUeotions of rare specimens 
examined. For the enjoyment of the visitors a special 
programme of entertainments and excursions has been 
arranged by the Local Beception Committee. At least 
400 visitots are expected from across the Channel, and 
hotel accommodation has been eecured for these in the 
hotels. By kind permission of the Bight Hon. 
the Lord Mayor, a luncheon will be given in tim Bound 
Boom of the Mansion House on Tnesday and Wed¬ 
nesday. 

St John of Jsmsalem. 

Homdat, June 24th, was the festival of St John 
the Baptist when the members and asso ci ates of the 
Order attended Divine Service at St John's Church, 
cierkenweU, the sermon being preached by the Bishop 
^ Satisbory, one of the chaplains. At the general 
sammbly which took place the same afternoon allo- 
noo was made to the great servioee rendered by the 
Ambulanoe D^nutment and it was mentioned that over 
two men of the Ambulance Brigade had served 

as hospital orderlies in attendance on the sick and 
wound^ in ^nth Africa. 


pass 


Royal Unlvanity of Ireland. 

Tun undermentioned candidates have passed the 
First Examination in M^cine, Summer, 1901:—John 
W. Beime, Cbarlee D. Bell, Samuel Bradbury, Henry 
W. Brennan, Herbert W. Carson, Bohert Chambers, 
LLB., Bobert G. Clements, Bob^ G. G. Croly, Arthur 

G. Cnmmiiis, Jsmes 8. Diokey, James Don- 
BsUy, John Finnigan, Isaac Flack, James Flack, 
Jsmes B. Hackett Adam Hill, William J. UiU, 
Bobert Jameson. Soh., Edward Eavanagh, James 
Eelleher, Bobert I<edlie, Andrew Leitcb, John Lilley, 
Bobert J. Lytle, Denis T. MaoCartby, William MoKee, 
Albert T. M'Ma^er. Samnel M'Morray, James Magill, 
Thomas J. Magill, Timothy Meagher, Charlotte E. Mit* 
ohell, Timothy O'DrisoolI, Michael J. O'Grady, Edward 

H. John J. O'Be^y.William B. Pnrdon, Camp- 
biil G. Bobb, Gabriel V. Bjran, Manrioe P. Scanlon, 
Jsmes Shaw, Michael Shipeey, Pataiok Stem, William 
H. Thomson, Stephen M.wal^, Jsmee Wamock, Harry 
C. Watson, Jemima B. C. White, Wm. B. B. Whitfield. 

The undermentioned candidates have qualified on 
their answering to present themselves for the further 
Examination for Honours:—John W. Beime, Charles D. 
Bdl, Samnel Btadbnry. Bobert Chambers, LL.B., Bobc^ 
G. G. Croly, Arthur G. Cummins. James S. Diokey. 
Jsmes Donnelly, James Flaok, William J. Hill, Bobert 
Jsmeeon, Sob., Andrew Leit^, Albert V. M’Maeter, 
Timothy O'DrisoolI, Campbell G. Bobb, Gabriel V. Byan, 
Manrioe P. Scanlon, Patrick Stem, James Wamock, 
Harry C. Watson. 

lonl Oollflte of Fbirsleiani and Royal OoUete of lucoons, 
Irsland. 

Ths following candidates have passed the first pro- 
femkmal examination A in all rabjeots :—1. Eononrs in 
order of merit: E. L. Sheridan, I. AUaun, W. W. Boyce, 
11 C. E. O'Meara, B. A. Brown, T. W. Brown. 2. 
Fm: AlphabetieaUy; A. C. Adams, J. M. Alcorn, B. 
T. Wbsi^ W. C. CardoD. 8. C. Clark, T. Coffey, 8. 
G. Condon, J. Corboy, F. X. Costello, V. J. Cullen, E. 
f. OT. Dickenson, T. A. Flyno, D. Hampson, B. C. 
HoC. WantiMt, p. K Hayden. J. M. H^ee, B. Hayes, 
J. Leonard, E. P. Haho’, W. P. Mort<», MoCormaok, 
W. J. McCormack, H. V. MoKec^, A. N. Mclmughlin, 
B. A Odium, W. C. T. Bobey, E. Smith, B. H. Smjrthe^ 


P. D. Sullivan, W. Walsh. B. Completed the exami- 
nati<ni: M. Ambrose, L. L. Davys, T. J. Golding, H. 
Eosty, D. McLaughlin, T. J. Sinnott, G. B. Spencer, 
Geo. P. Wright. 

Royal College of Phyridans and Burtieons. IrrianAI 

Thb following candidates have paes^ a special 
examinstioD for the Diploma in Public Health;— 
Hampton Atkinson Gray, M.D., Univ. DabU: Joseph 
Patrick Frengley, F.L.O.S.I .; John Grmit Warren, 
L.&C.F. and S.I. 


Society of Apothecarlos of London. 

Tub following candidates have passed the Primary 
Examination, Part I. 

Biolc^.—G. E. Austin, F. C. M. Gabites, C. A. 
Sampson. 

Chemistry.—G. E. Austin, F. C. M. Gabites. 

Materia Medioa and Pharmacy.—A. Berofeld, A. G. 
Gamble. G. B. Messenger, C. A. Sampson, C. J. Taylor, 
B. B. Westlake. 

The following candidates have passed the Primary 
Examination, Part II. 

Anatomy.—A- J. Ambrose, G. C. M. Davies, B. C. 
Gho^ T. W. S. Hills, H M. Ht^gins, C. Kellgren, G. 
Nxmn, C. H. Osmond, O. P. N. Peam, E. H. Price, B. C. 
Bicbi^s, B. J. 8. Verity, 8. J. Weinberg. 

Physiology.—H. Bacon, G. C. M. Davies, B. 0. Ghosh, 
T. W. S. BiUs, H. M. Huggins, A. C. Jenkins, T. L. A. 
Jones, C. Kellgren, G. Nunn, 0. P. N. Peam, E. H. 
Prioe, G. H. Bauis, B. C. Bicharde, S. H. Sngdcm, 8. J. 
Weinberg. 

Navy Medical Senrloe. 


Thb session of instmotion at the Boyal Naval Hos¬ 
pital, Haslar, terminated on Jane 28th, when the four¬ 
teen surgeons onder instmotion, who had obtained th^ 
commissions after the competitive examination in 
Ixkudon some months previously, received sppomlments 
to His Majeet^s shipe on the determination their 
seniority by me snm-total of the marks obtained in 
London and at Haslar. The following prizee wei» 
awarded, viz.: The Gold Medal to So^eon A. J. Wemet 
and the Microscope and the Silvmr Mcrial and books to 
Surgeon E. Cox. The Director-General of the Medical 
Department of the Navy, Sir Henry Norbury, E.C.B., 
MJ>., in distributing them, complimented all the offloers 
highly on the very favourable report which he had 
reoeivsd from the Inepeotor-Generu the officers of 
the profeesionsl staff as to the great iotereet they h^ 
shown in the subjects which formed oouree, as well 
aa on the general seal and ability they had evinced 
during the time they had been nndw inetmction. 
Surgeons in order of seniority:— 


1. E.Cox, BA, M.B. 6,669 

2. J. hlaoDonald, M.D 6,168 
8. A La P. Darley... 6,656 

4. A. J. Wemet ...6,631 

5. C. E. C. Stanford, 

MB.6,208 

6. A. B. Thomas ... 4,966 

7. W.E. Buttledge... 4,826 


8 . T. F. O'Keeffe, 

M.B.4,681 

9. E. F. Ellis ... 4,472^ 

10. D. y. Lowndee ... 4,260 

11. G.C.C.Bo68,B.A, 

M.B.4,246 

12. P. F. Alderson ... 4,032 
18. H.C.Woodyatt... 3,865 
14. J. Thornhill, M.B. 8348 


Tbs Indian Medlosl Servlos. 


Thb following is a list of the surgeons on probation for 
the Indian Memcal Seivioe who have been sooceesful at 
both the London and Netley examinations. Combined 
London and NetW marks 


Charles, G. E... 

... 6,168 

M'Eendriok, A G. 

... 6,969 

Mosee, 0. 84 J. 

... 6,872 

Little, J. W. ... 

... 6,418 

Snmner, F. W. 

... 6,286 

Nntt,H.B. ... 

... 6334 

BaroM, J. A.... 

... 6,078 

Bitchie, W. D. 

... 6,014 

Soott,N.E. H. 

... 4,914 

Fleming, J. K. S. 

... 4878 

Hofmer, E. C. 

... 4,819 

Sontnon, C. E. 

... 4603 

Fowler, G. ... 

... 4,686 

Husbai^, J.... 

... 4,680 


Foster, H.B. ...4,630 

Batt,G. B.4,644 

Kerans, G. C. L. ... 4,607 
M'CoDMhw, C. B.... 4488 

Illins, H. W. 4 396 

Browne, E. W. ... 4390' 
Christian, J. B. ... 43I6 

Mnrphy, A.4,161 

Thompson, F. T. ... 4.124 
Braasey, L. P. ...8,881 

Harr, C. F. 8,848- 

Box, 8.8,761 

O'Neill. P. L. ... 834V 

D i by Google 




52 Thi Mbdioal Pbxss. NOTIGBS TO GOHRGSPONOCiNTS. 


JPLT 10, 1901. 


4 intice 0 to 

CoTrc0)>oitlient0, ;$ltort ^Cetttro, &c. 

GoMBiPOVDim raqairin; » repl^-in this oolomn are par- 
tienlarlf reqneated to make nae of a dittinetivt $itmatmr4 or 
MtUtU, aad aroid the practice of signinx themsetToe “ Baader,” 
"finbaoriber,” “Old Sabaoriber,'* Ac. tfoob oonfnaion wilt be 
•pared bjr attention to tbia mle. 

Kb. 'Wu. Tebb.—T onr letter hariBR already appeared in the 
la^ preas it ia onneoeBaa^ to ^re apace to it in our oolumna. 

TatrTB.—Tlte extraordiscur mortality to which you refer in 
Galcntl a was for the week endii^ March 23rd of preeent year, when 
it reached ]43'6 per 1,000 of the population, but these are 

Taluelees for comrariaon in the other case. 

JuMiOB Asbistabt will find racanciea adrertlaed In our preeent 
nnmber under the London County Council, the Metropolis 
atyluma Board, Cheater General Infinnaryi Ac., each aa he seeks. 

MODEBK METHODS I 

Eldeklt Practitioner: The ohildappeara to be teething. 

Ifew Graduate: Impoeaible! The bacteriological diagnoais dia- 
clocee no trace wbaterer of the characteristic taathing bacUlni.— 
/IrilifAcnd Coienial Druggist. 

Dx. JoHB N. Sheb.—T he question it a natural one in riew of the 
attitude taken up by tbia journal on the subject. In reply, it may 
be atated that the annonncement got in by an oreraigbt, and when 
diacorered it waa unfortunately too late to withdraw, 

OKOBBua.—The nse of the tetanus antitoxin has not proved 
luccesafnl in all easM of tetanus. But the value of it la shown by 
the faot that it has reduced the mortality in the diacuae from 90 to 
is per cent. 

A GOOD HOSPITAL STOBT. 

I> a recent number of the St. Mary’s Hospital GasetU we find the 
following story told a propos the resignation of Mr. Critchett: A 
man bavug been jambed In a traction engine waa brought to the 
boepital OLd admitted. Aa he wae suffering frum diplopia. Mr. 
Critobett'sadvice waa sought. Discovering a paralysisof one of 
the ocular muscles, he gave him large doses of iodide of potassium. 
The house surgeon wuhedtotrr galvanism. Afterafew weeks the 
ptraljsiB wtecnivd, and the diplopia had vanished. Ths house 
surgeon asked Mr. Critchett whi^ treatment he thought bad 
cured the diplopia. Mr. Critchett said, “ I think we might cry, 
* honours easy,’ fori took him by assault aad you by batte^.*, 

D1M. (Belfast).—B Napthltol is a somewhat irritating substance 
if allow^ to come into contact with the walls of the stemaoh, but 
it is practically non-tonic, owing to its eatreme insoinbility in 
aqueous fluids. 


gtarg for Ihr SEcek. 

ENGLAND. 

'WBunssAT, Jolt 10th. 

DxBMAiOLOOiCAL SociKTT OT IiOVDOB (20, HsnoverSquste, W.}.— 
b.lSp.m. Consultation on cases of clinical interest, i 
TauasnAT, Jult 11th. 

BaiTiSH GwacoLOOiCAL Bocibtt( 20, Hanover Square, London, 
'W.).—at 8 p.m. Dr. H P. Nob^e, of Philadelphia, on “.Degenera- 
tiona and CompUcatlone of Uterine Fibromyomata.” 

FaiDAT, JULT 12rK. 

BnmsB Lartkgolooical, Bbiholooical, ann Otolooical Abso- 
ciATiOK (11, CbandCB Streep W.).—Special discussion on “Tumoure 
of the Pharynx,“ to be opened br Dr. Bobert Woods, Dublin, 
all 0 cases and spedmens the Prudent, Mr. Mayo Collier, Dr. 
Barclay Baron, Mr. lannox Browne, Dr. Dundas (Jrant, Ac. 

IBELAND. 

WanwESDAT, Jolt IOth. 

PHAaMACEOTiCAL SoctETT.—11 a.m. Examination. 

Tbobbdat, Jolt 11th. 

DoBLiH Sahitabt AssociatiOB (42, Dame Street).—4.30 p.m. 
Council Meeting, 

Mokdat, Jolt Utb. 

let, 2nd, and ifrd Professional Examination, Apothecaries Wall 
Fii^ Profeedonal Examination, Boyal CoUe^ Physicians and 
Surgeons, 

GoBDON-SatTB, H.,M.A., B.C.Cantab., Besident Medical Officer to 
t he W est iKindon Ho^taL 

Collar, A. Qobdov, H.D.Lond., F.B.C.8.Eng., L.B.C.P.Lond., 
Physician to the Stanley Honital, Liverpool. 

Heatbeb, Liwis Dabixl, L.RC.P.Lond., H.B.C.S.. Medioal 
Officer of Httlth for the Hay (Brecknockshire) Urban and 
Buial Dis'rict Councilr. 

HiRCKB, Thomas, M.B., C.M.EdIn., Medical Officer of Health by 
the Faincastle (Brecknockshire) Buial District Council. 

JORBS. OwER Clattor, M.B.Oxon., M.B.C.S.hng., L.S.A.. Medical 
Officer for the Ilfracombe District of the Barnstaple Union. 
Littlejohr, Tbomas H..M.B.,C M.Edin., F.B.G.S.Edln.,D.P,H., 
Medical Officer of Health, Hampstead. 

Mabbh, Johr Hsolxt, M.B.C.S.Eng., L.B,C.P.Lond., Honorary 
Surgeon to the Macclesfield General Inflrmara. 

McCall, Eva, M.B.. Cb.B.ulasg., Asaistant Besident Medical 
Officer at the Birkenhead Union Infirmary. 

McKbrsix, J., M.A., M B., Ch.B.Aberd., House Surgeon to the 
West lAmdon Hospital. 


HooBE, S. G., M.B.. Ch.B.Vict., D.P.H.Lond., Medioal Officer of 
Health to the County Borough of Huddersfield. 

PsRDLEBOBT, Hbkbbbt S., F.B.C.S.Env., Snrgeon to the Boyel 
Hoenital for Women and Children, Waterloo Bridre, London. 
Scott. D. Wolselbt, L.B.C.P., L.B.C.S.Edia., Li.F.P. A S.Glasg., 
Medioal Officer to the Hendre Morgem and Henllls Tale 
Collieries. 

Sexild, a. Mabhadukb, F.B.C.8.. Consulting Surgeon to the 
Boyal Hospital for Woman and Children, Waterloo Bridge. 
London. 


Iac«ncu 0 . 

Chester General Infirmary.-HonsePhysician. Salary commencing 
at £90 per annum, mth board, residence, Ac. Also a House 
Surgeon. Salary commencing at £100, with board, reeidenoe, 
Ac. Applications to the Ch^rman of the Board of Manage* 
ment, SMretary a Office, 29. Eaetgato ^w, Chester. (See advt) 

Croydon Union Infirmary, Maryday Boad. Croydon.—Besident 
Aesutant Medical Superintendent ami Dispeneer. Salary £120 
per annum, in«reaeing to £190, with fnrniihed ap^ments, 
rations, and washing. Applications to the Clerk of the 
Guardians. 

Cnmberlandand Weetmoreland Asylum, (Hrlands, Carlisle.—Senior 
Assistant Medical Officer, uomarrfed. Salary £190 a year, 
risiu to £180, with board, lodging. Ac. 

Devon County Asylum, Exminster, near Exeter.—Third Assistsnt 
Medical Officer. Salary £125, rising to £150, with board, 
lodging. Ac. 

King’s CoU^e, London.—Pnrfeesor of General Pathology and 
Bacteriology. Also Assistant Physician (or Surgeon) for Dia- 
eeses of the Throat. Conditions and othn parucnlara will be 
supplied by the Secretary. 

Liverpool Port Sanitary Anebority.—Assistant Medleal Offioer of 
Health. Salary £300 per annum. Further particulars of the 
Town Clerk, Muniolpal Buildings, Liverpool. 

London Ckmnty Asylnm, (Tlaybary, Woodlord Bridge, Essex.— 
Junior Asnstant Medical Offioer, unmarried. SMry£I50pec 
annum, with board,furnished apartmentsand washing. 

London (^nnty Asylnm, Baustead.—Medical Snpeiutendant. 
Salary £1,000 per annum with bouse, rates, taxes, and water 
supply tree. Forms of application to be bid of the Clerk to 
the Asylums Board, London County CounclL (SM^vt.) 

Metropolitan Asylums Board.-Assistant Medicm Offiosrs (on- 
married) at the Fever and Small-pox Hospitals. Sslaiy £160 per 
annum, rising to £200, with board, lodging, attenunoe, and 
washing. 

Newcastle-upon.Tyne City Lnnatio Asylum. — Second Assistant 
Medical Offioer, unmarried. Salara £140 a yenr risiog to £100. 

Nottingham General Dispensary.—Senior Besident Surgeon. 
Sali^ £200 p«g annum, increasing by £15 every year. Aiao two 
Assistant Besident Snrgeons. Balarira £100 per annum each, 
increasing by £10 every year, furnished apartments, attendance, 
light, and fuel Unmarried. 

Owens College, Manchester.—Senior and Junior Demonstrator in 
Physiology. Stipends £150, lisug to £200, and £100 rising to 
£150 respeotively. AppUoations to the Begistnr. 

Plymouth Borough Asylum.—Assistant Medical Offioer, onmarried. 
Salat 7 £150 per annum, rising to £200 per annum, with fur¬ 
nished apartments and board and washing. AppUcations to 
the Medical Superintendent at the Asylum. 

West Biding Asylnm, Wadsley, near Sheffield.—Third Assistant 
Medioal Offioer. Salary £190. with board, Ao., rising to £200. 
Ai*o Fifth Assistant Medical Offioer. Sala^ £140 per annum, 
with board, Ac., rising to £100. 

WUlesden Urban District Conneil Isolation HoepitaL—Ifodioal 
Superintendent atid Assistant Medical Officer of Health. 
SaUry £350 per annum with allowance of £50 per annum tor 
residence. 


girths. 

BxRKaTTS.—On Ju^ Is^ at Boseat, Northants, the wife of F. 

Bennetts, M.B.Cr.B., L.B.C.P., of a daughter. 

Gboss.— On July 3rd, at 100, Commercial Botd, London, E., the 
wife of FhineHS Gross, L.B.C.P.Lond., M.B.0.S.Eag.. of a son 


ARPasws— Hobreb.— On July 4th, at the Parish (Tbnrch, Ton- 
bridge, Henry Arthur AmUows, M.B.C.8.. of Tonbridge, fourth 
son of the late Martindale Andiows, of London, to Amy Dlau 
Fianoes, only daughter of the late A. C. Homer. M.B.C.S., of 
Lyons, Tonbridge. 

Bull Cbook. —On July 3rd, at the Church of St. Peter and St. 
Paul, Weoblay, Herefordshire, Hsrry Ashworth Bull, M.B.C.8. 
Eng., L.B O.P.LondU, second son of James Bull, J.P., of Birch 
Hall, Ingestre, Staffs., to Edith Marian, second daughter of the 
Bev. James Crook, vicar of Weobley. 

Eierrbrder Masor.—O n July 2nd, at Framfleld Parish Church, 
Sussex, Willie Evan Melfort, only surviving son of H. B Eier- 
nender, L.B C.P- and L.B.C.8., Sydney, Australia, to Charlotte 
Gordon, only aurviving daughter of the late Lieut -CoL B. O. 
S. Mason, Belfast, Ireland. 


^£ath0. 

Bell—O n July 5th, at Bedford, after a very short illness, Zebee 
Steward widow of William Bell, M.D., Inspector General of 
Army Hospitals, aged 74. 

HuRTEB.—On July 3rd, at the Poplsrs, Pontypridd, Bobert Charles 
Hunter, M. 


B.O.S.,L.B.C.P.,J.P.,aged6e. )Q 




JEhf and ffiimtlat 


•&AXU8 POPULl SUPPEMA LEX.’ 


Vou CXXlll. WEDNESDAY, JULY 17, 1901. No. 3. 


Original Cnirnmuticationfi. 


NiEVI AWD THEi^i TREATMENT, {a) 

Bj THOMAS H. KELLOCK, M.A., F.R.OS., 

Affistuit Sorgeoa to the Ulddlesez Hoepital, and to the Great 
OmOBd Street Hoepital for Sick Children, London. 

It U sometimefi profitable and interesting to con¬ 
sider minor subjects which acquire importance from 
the frequencj of their occurrence, and, as in neevi, 
from the good that can so often be done in relieving 
a patient of what is always unsightly, and, it may be, 
a cause of considerable inconvenience, for, situate as 
mevi BO often are on exposed parts of the body, it is 
a matter of no little importance to those who have to 
earn their livelihood, as well as for appearance sake, 
that these disfigurements should be as far as possible, 
and as soon as possible, remedied. 

Of the paihology of nsvi there is comparatively 
little to sa^; structurally they are composed of an 
agglomeration of slender blood-vessels, with very little 
muscular tisane in their walls, lined with the 
usual endothelium, separated from each other, 
and at the same time bound together, by a small 
amount of fibrous tissue. The size of tlie^ vessels 
differs in the several varieties; in the snperficial ones 
they are very small, little more than capillaries, 
whilst in the deeper so-called subcutaneous variety 
they are often found of considerable size, and in the 
latter the whole tumour is lobulated and enclosed 
within a thin capsule of connective tissue, which is 
not found in those more superficially situated. The 
circulation of the blood is a little peculiar, arteries 
lead up to them, and veins carry the blood away, and 
yetin excising them the vascularity of the surround¬ 
ing parts is not very great. In the bright red super¬ 
ficial nsevi the circulation is rapid, as shown by the 
way in which the colour returns after they have been 
pressed upon; and if cnt into, or penetrated by an 
ulcer thev bleed readily, but owing to the thinness of 
the Tsesel walls the haemorrhage is easily controlled 
by pressure. In the deeper ones tne circula¬ 
tion is not BO rapid, as shown by their much 
darker colour; if cut into, dark blood issires in a 
feeble stream and the haemorrhage will often 
cease spontaneou*ly when the vessels of which they 
are composed have been emptied. That part of the 
skin which covers a superficial nsevus is always badly 
tourished, in spite of the free circulation underneath, 
and if ulceration takes place in it from any cause 
it spreads rapidly and is healed slowly and with 
difficulty. 

Excluding cases of so-called nsevus of the skin of 
the legs and other parts which arise in elderly people 
—women espeoially—and which are really dilatation 
of pre-existing veins and capillaries—varicose veins 
they might more properly be called—and those cases 

(a) Abktzket of % Lectaro delirored at tb« Hospital for Sick Chil- 
u«n, Great Ormond Street. 


of angioma of the liver which are said to commence 
in adult life, but which cannot probably be classed 
with nsevi, it may be said that neevi are Mmost with¬ 
out exception congenital; they increase in size, it is 
true, after birth, rapidly and extensively sometimes, 
bat there is always a something, however small, pre¬ 
sent at the time of birth. Of their causation little 
or nothing is known; whether they are hereditary is 
doubtful, but it is, without doubt, common to mid 
several children in the same fami y affected. It is a 
curious fact how many more girls than boys are 
affected by nsvi. Of eigbty-tbree cases, fifty seven 
were girls, and of ten cases which were so extensive 
as to necessitate tbeir admission to the ho spital for 
opeiation during the year 1900, only one was a male 
child. 


Nsevi are essentially an affection of the epib’astio . 
layer of the embryo. They are found on almost 
every part of the skin, and on mucous membranes 
at the orifices where the epiblast turns in to join the 
hypoblast, as at the month and anus. If they occur 
in the mucous membrane of the alimentary; respira¬ 
tory or urinary tracts, they do not seem ever to be 
discovered or to give rise to any symptoms. The 
following is the order in frequency of the parts of 
the body affected:—Trunk, face, sca'p, upper extre¬ 
mity, lowerextremity. The fema'e external genitals 
are often affected ; not so the penis and scrotum, but 
this may possibly be accounted for by the relative- 
infrequency of neevi in mate children. 

Nsevi are generally divided into three classes: 

The superficial cutaneous, or capillary; the deep, 
subcutaneous, cavernous, or venous; and the mixed, 
which are a combination of the other two varieties. 
There are, however, two varieties of the first class 
which are often seen, the diffuse and the circumscribed. 

The first of these, the diffuse—perhaps bettei' termed 
a nsvoid condition of the skin—is extremely common 
in very young children, situate in the upper eyelids, 
on the forehead in the shape of a Y, the apex at the 
root of the nose, and the base at the junction of the 
forehead and sc^p, and also among the hair imme¬ 
diately under the occiput. Of the circumscribed 
superficial nsevi there are again two kinds, some— 
the majority—are^aL hardly rising above the level 
of the surrounding skin ; in passing the finger over 
them except for the sensation of a slight increase in 
the temperature, hardly any abnormality is recog¬ 
nised. The edges of these are often very irreguU^, 
and at times their limitation is not very marked. 

The others are raUed, almost pedunculated at times, 
looking like velvet plush cushions; they are always 
sharply marked off from the surrounding healthy 
skin, and are very satisfactorily treated by excision. 

The deep, snbentaneous, or venous nsavi generally 
form darkish coloured tumours which project but 
slightly on the surface of the body; certain situations, 
however, modify this, and they may form projecting 
, or even pedunculated masses. I 

Digitized by VjOO^lC 




54 Tm Mdical Pbisb. ORIGINAL COMMtJNTCATiUNS. Jclt 17, 1901. 

There is a form of deep csvus which is sometimes takes place. A superficial userus, which at birth is 
associated with tumours and new growths. They hardly visible may attain a very considerable size in 
are generally termed neevi, but can hardly be classed a few months, or even weeks, and a crop of 
pathologicaUy with those found in the skin; they similar g^wths sometimes springs up around the 
are^ composed of a collection of thin>walled vessels original one—a good argument! in favour of early 
which are separated from each other by much more, removal There seems, nowever, a limit to their 
and much looser, connective issue than is foimd in growth, which does not go on indefinitely, but 
the cutweouB variety, and these vessels are, so to ceases ^ter a time and the tumour becomes station* 
speak, in the direct circulation, not forming a cul ary. The cause of this cessation of growth is just 
da sac, M in the case of ordinary nevi; in fact, they as obscure as that of its occurrence. The deep 
are reminiscent of the condition found in a varicocele, nsevi very often increase in size after birth, but not 
and probably the two conditions have a good deal in nearly to the extent the superficial ones do. These, 
common. Of such is the collection of vessels found then, are the risks that are run by leaving a naevns 
In those rare cases of congenital unilocular cyst of untreated; on the other hand, some of them may 
the axilla, forming a pedicle to this, passing up under spontaneously disappear partially or entirely as the 
the clavicle, and connected with the deeper structures cnild grows. The nsevoid condition about the eye- 
in the lower part of the neck. lids, forehead, and occiput always does so, and that 

A superficial nevus may be associated with a too in a relativelv short time; if looked for when the 
tumour of a more impo^nt kind. It is quite child is a year old probably no trace will be found, 
common to find the base of a spinal meningocele or The deep cavernous nevi rarely, if ever, disappear 
myelocele surrounded by a superficial nevus, and it without treatment, but the diffuse superficial ones 
is necessary to be careful in dealing with a tumour sometimes do, and it is not uncommon to watch 
of the back situated in or near the middle line on them getting less bright in colour, although their 
whose summit there is a nssvuB; it may, of course, size may not diminiM, and eventually they may 
be only a nevus of the mixed variety, but the super- become hardly noticeable. 

fictal nevus may also be a very useful danger signal, Treatment—‘There are so many ways of dealing 

for the tumour beneath it may be connected with with nevi that perhaps the best plan w^l be to con* 
the spinal meninges or with the spinal cord itself. sider the meth^s $eriaiim, and under each heading 
Nevi are found, too, in association with other con- the advantages and disadvantages of the method and 
^^ital tumours; it is not uncommon to find them the cases for which it is suitable. For, consisting as 
in the skin covering hygromata, or in ^e skin of a nevi do of several varieties, and situate as they are 
limb affected by lymphatic hypertrophy. on so many parts of the body, no one plan can be 

Nevo'lipoma is a term usm sometimes, but it is a a^ptod for them all, and it is necessair to consider 
condition rarely seen. The congenital lipomata have for each which of the various methods should be 
peculiarly few blood-vessels, and it is uncommon to chosen. Excuion. —This has the advantage of 
find more than the ordinary subcutaneous fat about a thoroughly removing the growth at one operation, 
deep nsBvuB. Union by first intention can be obtained { the scar 

PrognoM .—Parents will ask what will happen to the left is the least possible, and becomes practic^y 
nsBvuB if it be leftaloneP This question will probably impereepUble as the child grows, and there is no 
be asked, not about one on the face or other visible danger of recurrence if the excision has been properly 
part—these they are always natnrally anxious to earned out It cannot, of coarse, be practised in 
nave removed—but about those on the tranks or those situations where the neoessary drawing to- 
limbs where they are not likely to be seen. Even gether of the skin would cause disfigurement. An 
these, as a rule, mothers are anxious to have removed, ansssthetic is necessary, and the heemorrhage, even 
for in the first place they seem to have an idea that where the greatest care is taken to cut wide of the 
any disfiguring mark or deformity in their child is a growth, is often considerable, and not to be too 
sort of disgrace to themselves; and secondly, they lightly considered in the case of a young baby, 
think that, should a nevus ^ cut or knocked, the The incisions should be planned so as to m corn- 
child will bleed to death. The bright red colour has pletelr clear of the superficial part of the growth, 
probably something to do with the latter idea, which and yet to remove the least possible amount of 
alarms them unnecessarily, for, although it is true healthy skin. For the deep ones it is generally 
that if cut, bleeding and rather free Ineeding does possible, by turning back skin flaps, to avoid sacri- 
occur, yet the hemorrhage can be easily stopped by ncing any skin at all Sometimes two carved 
the mildest pressure; at the same time it must be incisions, one on either side, sometimes a triangular 
borne in mind in this, as in every other condition, that wound, where the edges are united afterwards in a 
loss of blood to any extent is always serious in a triradiate fashion, or, again, a quadrlLiteral wound, 
young body. A more real danger m nsvi of any united afterwards in “ envelope * shape, will answer 
size is ulceration with sloughing and possibly best. An infant’s skin is wonderfully elastic, audit 
hsmorrha^ as a complication. An injury or con- is remarkable how large a growth may be excised in 
tinned imtation may start this, and once started this way and the edges brought together without 
there is little tendency for it to cease until idmott undue tension, possimy with the help of a little 
the whole tumour has been destroyed. The ulcera- undercutting of the surrounding parts; even if the 
tion often stops near the edge, leaving a ring of edgescannotbe broughtquitetogether, theremaining 
nsevus near the healthy skin, and this ring, instead of surtace can be graft^ immediately, and a very good 
being destroyed by the ulceration, is apt to be, as it result be obtained; but if this has to be done it is 
were, stimulated in growth, and to spread outwards advisable not to be too free with the suturing, it is 
into previously unaffected skin, if the nsevus be better to graft rather more than appears neces- 

large, ulceration taking place in this way may be sary so that the small amount of contraction 

serious. On the other hand, if the growth be small that takes place under the grafted surface may 
and the ulceration extend to its edge, it may result not cause disfigurement by dragging on an 
in a cure, but while this is going on there is the already tightly sutured part. Horsehair sutures 
dan^r of sepsis and bsemorrhage, and the cure, after are very unirritating, and leave less mark than 

ail, 18 not a very scientific one. It is possible to any others; they should be removed at the earliest 

imagine malignant disease, sarcoma, or epithelioma possible date, or the little white marks they leave by 
arising in a nesvas. In addition to these dangers the side of the soar make the latter more noticeable; 
there is always the chance of a neevus spreading, and a collodion dressing can often with advantage be 
it is rather remarkable how rapidly this sometimes substituted for the sutures after two or three days 

C 



Jolt 17, 1901- 

This refers, of ooiirBe, to operations on risible parte 
of the ; in other parts the marks do not matter 
macb. There are a few sitoations where excision 
cannot rei 7 well be carried out, where a nsems 
invades the whole thickness of the lips, cheeks, 
auricle, or e^lids, in the tongue, on the nms, or 
where it inrolres important st^ctures, such as the 
parotid gland; or in a female child where a nsrns 
inrolres the breast and excision would mean the 
.sacrifice of the gland, which should not be done 
uolesa erery other form of treatment is oontra-indi- 
cated. A common situation for a mixed meros is in 
the scalp orer the anterior fontanelle. Here excision 
is quite suitable; the dangers of interfering with one 
in that situation hare been much exaggera^. They 
polsate, it is true, but the pulsation is only com¬ 
municated, and between tnem and the superior 
longitndinal sinus and membranes of the brain there 
is toe thick fibrous membrane closing the fontanelle. 

Subcutaneous tumours at either of the fontanelles, 
at the root of the nose, or at the inner angle of the 
orbits, may be meningoceles or dermoid cysts, both 
of which communicate generally with the interior of 
the skull; these tumours are not so often accom¬ 
panied br nseri as the similar ones in the back, but 
the combination might be met with and lead to 
great difficulty in ti-eatment if their nature had been 
orerlooked. 

Sleeirolynt is another method of treating nsri. It 
is a rather tedious performance, painfm, and so 
needing an anesthetic, probably on many occasions. 
If, as sometimes happens, sloughing occurs about 
the spots where the needles were inserted, rather 
ussigntly marks are apt to be left. A large mass 
of fibrous tissue is oftm left in the situation of a 
deep nsevus treated in this way, which is in itself a 
disngnrement, but which can sometimes be subee- 
quently removed by excision. Electrolysis has the 
Mvantage t^t it is bloodless and can m employed 
in certmn parte of the bod^ where other methods of 
destruction are contra-indicated, where, for example, 
a niBTus involves important structures, such as the 
deep muscles of the face, cheeks, lips, tongue, eye¬ 
lids, female breast, Ac. For superficial nsvi it is 
rarely needed ; if it destroys them it often does so by 
caasmg ulceration, and this can be brought about 
more thoroughly and quickly by other methods if 
excision is out of the question. 

In employing electrolysis there is no need for a 
very strong current; that from eight to twelve cells 
is generally sufficient, and the current should be 
allowed to pass through the growth for from five to 
ten minutes at a sitting. The needles should be 
insulated to within half an inch of their points, and 
passed into the growth far enough to prevent any 
DOD-insulated part being in contact with the surface, 
or ulceration is almost sure to occur at the points of 
insertion. 

Cauterinng Agtnit.—The actual cautery, galvano- 
caute^, and strong acids are useful in destroying 
superficial nsevi which for some reason cannot be 
excised. 

An anesthetic is hardly necessary when cauter¬ 
ising a nevus, especially if it be small. The pain 
appears to subside very rapidly on the application of 
a httle ointment, or better, dry powder. Whichever 
of the cauterising agents is employed, it must be 
done thoroughly, or uter a few days the scab that 
has resulted wiU come off, and the nsevus be found 
as vigorous as ever underneath it For this reason 
the acids, nitric or sulphuric, are perhaps better than 
the cautery, as their effect is more penetrating; but 
they require more care in their application. It is a 

C 'ful teing to see a child’s face ucamd by acid that 
been applied carelessly to a nesvus in infancy; 
to avoid this, when using any kind of caustic, the 
surrounding skin should be protected by vaseline or 


Thi MxDioAt Pbms. 55 

some simple ointment, and, of course, great care 
taken that only a very small quantity of the acid is 
carried by the glass rod or other instrument used. 
It is hardly necessaiw to add that especial care in 
this respect should be taken when operating near 
the eye. A few of the deep n»vi which cannot be 
excised, and which do not respond to treatment 
by electrolysis, may be dealt with by turning 
back a flap of skin or mucous membrane and insert¬ 
ing the actual or galvano-cautery in different direc¬ 
tions, and then the skin flap replaced. A slough 
will very likely come away if it has been thoroughly 
done, but the result is sometimes most satisfactory, 
and the subsequent scarring much less than would 
have been expected. 

Cnahing a nsevus is a plan that has not much to 
recommend it. 

Ligaturt was once a recognised mode of 
writh deep nsvi, especially those on the scalp, and in 
the older text-books on surgery rather eteborate 
directions are given as to the art of tying the ligatures 
subcutaneously. 

There is also the practice of injecting nsvi to cause 
the coagulation of the blo^ they contain. Various 
substances have been us^ for this purpose, such as 
perchloride of iron, carbolic acid, It is possible 
it might be done successfully in a part where it would 
be feasible to put a clamp or temporary ligature 
round the growth to prevent the clotting spreading 
too far, or the clot separating, as in the lips or tongue. 
The danger of subsequent soughing must, however, 
be greati and there are other methods of treatment 
more scientific and of more proved value. 

It is said that small nsri may be cured by the re¬ 
peated application of ethyl chloride or collodion, 
which act oy causing contraction of the growth in 
much the same w^ as elastic pressure. It would be 
a tedious way of dealing with them at the brat, and 
it is not much to be wondered at that the method is 
not much employed. 

Neither these substances nor those which ordi¬ 
narily cause muscular contraction of the walls of 
the blood-vessels can have much effect on a mevus in 
this way, on account of the very small amount of 
muscular tissue which exists in them. 

Of the treatment by elastic preeeure it can only be 
said that if it be sufficient to cause effect, that 
effect would probably be a slough, and if the pres¬ 
sure were not sufficient to produce this, the mevus 
would probably be unaffect^. To attempt to regu¬ 
late the pressure of a bandage nicely enough to 
strike the mean between these, and so cure the 
nsevus by keeping it empty of bood, is an undertaking 
that would hardly commend itself. 

In conclusion, there is a method of treatment 
which probably exists more as a popular delusion 
than as a surgical proceeding, that by vaccination. 
Owing to the thinness of the walls of the blood¬ 
vessels vaccination on a nsevus would be almost sure 
to cause a little bleeding, which would very likely pre¬ 
vent its success as far as vaccination was concerned, 
and even if it took it could only cure the nsevus by 
causing inflammation and sloughing. This might 
be only partially successful, and might even cause 
the rest of the growth to spread or multiply, there¬ 
fore it is much wiser to treat the nsevus b^ excision or 
cauterising, and to perform the vaccination on some 
unaffected part of the body. 


Bojral Appointments. 

lixssas. Bramd akd Co. ask lu to announce that 
they have been honoured by the Boyal Warrant of 
Appointment as Purveyors of Concentrated Beef Tea to 
His Majesty Eing Edward VII. The honour of being 
purveyo'S to H.B.lI.the Prince of Wales was held by 
them for many years. t 

Cooglc 


ORIGINAL COMMUNICATIONS. 


56 Tn Midioal pBUi. OSIG'INAIj COMMUNICATIONS. Jult 17, 1001. 


THE DIAGNOSIS 

OP 

DIAPHRAGMATIC HERNIA, (a) 

Bj E. FLETCHER INGALS, M.D„ 

Of Chica^. 

The diagnosis of diapbragmatio hernia presents 
many difficulties in the living subject; so great, 
indeed, are these, that the condition is seldom 
recognised until operation or death has yielded an 
oculu demonstration. The affection is found in 
rare cases at autopsies, and it is occasionally dis¬ 
covered in the dissecting room in bodies dead of 
other affections, hut, all told, only a little over 300 
cases have been reported. H. I. I^wditch reported 
a case in 1847, and at that time collected reports of 
eigbtj-eight cases. Leichtenstem (b) reported a 
case in 1874, and at that time colle^d reports of 
250, but only five of these were diagnosed 
before death. Tboma (c) collected 290 cases in 1882 
and many more have since been reporied, but still 
the obstacles to diagnosis r4mmn. although as shown 
by Leichtenstem, and by Abel (d) in 1894, there are 
some cases in which a reasonably positive diagnosis 
may be made without great difficulty. As I 
have elsewhere stated (e); “ This affection possesses 
miany symptoms and signs in common with pneumo¬ 
thorax, like which it causes disteusion of one side, 
displacement of the heart, diminished motion, tym¬ 
panitic resonance and feeble or suppi'essed respira¬ 
tion with metallic tinkling." The history will often 
be of the greatest aid in reaching an accurate con¬ 
clusion. In the cases collected by Bowditcb, twenty- 
six were congenital and the rest traumatic. The 
principal symptoms noted were dyspncea on exertion 
and sometimes on lying down: pain in the bowels, 
especially after a full meal, in those where the open¬ 
ing through the diaphragm was small, and vomiting 
in several cases where the stomach was wholly or in 
part within the chest. In most of the casei the 
pulse was disturbed and in a few it was weak and 
rapid. In 27 Mr cent, of these cases the patients 
were in good h^th and engaged in active business. 

In AmI’s case the symptoms, which came on sud¬ 
denly. were those of obstruction of the bowel, with 
vomiting, profound collapse, retraction of tbe 
abdomen and distension of the left side. He based 
his diagnosis upon the retraction of the abdomen, 
distension of the left side with tympanitic resonance 
and displacement of the heart to the right, with the 
collapse, and absence of ai^ passages either of gas 
or fmces from the bowels. In his case it was impos¬ 
sible to introduce a stomach tube through the 
cardiac orifice; therefore this organ could not be 
irrigated. In Leichtenstem’s case be was able to 
demonstrate the presence of stomach and intestines 
in the pleural cavity and to note changM in them 
from the introduction of water and air. This patient 
complained of dyspncea on exercise, but worse during 
eating. There was slight cyanosis of lips, increased 
respiraioiw frequency, and almost an absence of 
heart dufness. Percussion and auscultation over 
front of thorax yielded normal sians. Heart sounds 
muffled and loudest at lower end of sternum. 
Abdomen flattened. Posterior part of thorax: 
slight loss of motion and prominence below 
the left shoulder blade. Percussion and auscul- 
tation normal to lower angle of left scapula. 
Below this a hollow, deep, tympanitic note. In 
this region absence of vesicular breathing; instead 
of this.^igh-pitched metallic inspiration and expira- 

(a) B«ad before the ChiomfO Lerriirolo^ael aod Cliatatologieal 
AMoelatloa, May Ssd, 1901. 

S Leiobtesetem: Berlin. Klin. ITor^ 1874, p. 487. 

Tkoma: Virehow't ArcJiiv, toL Imvin., p. 515. 

(d) Abel: Kcrlin. Klin. WoeKtu., 1884, p. M 

(() “ Sis. of Chest, Throat, and Nose, ’ 1900,4th Kd., p. 88. 


tion, transmitted from the bronchial tubes, the. 
inspiration loudest. Metallic tinkling and snccns- 
sion sounds part of the time. The exact extent of 
area of me^lic resonance and breath sounds was 
determined by auscultatory percussion. The bor¬ 
ders where the metallic not^ ceased abruptly varied 
considerably at different examinations. At times 
over the lower part of the chest the metallic 
breathing and quality of the percussion note would 
disappear entirely, and the resonance would merely 
appear exaggerated; at other times it would 
occupy a mrger area and invade the axillary 
region and even send a tongue.like projection 
to the left border of tbe sternum. Duriug per¬ 
cussion the pitch would run up and down the 
scale from deep to high notes, or the reverse. He 
believed this the result of peristalsis and emptying 
of the stomacher colon or mling of same witn gas. 
At times percussion produced notes of varying pitch 
at different parts of the affected area indi¬ 
cating more than one cavity. At tbe lower part 
of the left and back of tbe thorax dulness would 
be noted at times. The border of this would 
change with changes in position of patient. (Con¬ 
tents of stomach.) He based hie diagnosis on 
tbe following points: Percussion showed in tbe 
lower left side of thorax behind a hollow cavity 
that applied itself to the chest wall in a change¬ 
able area. It changes its position, shape, and 
volume in a very short time. The circum¬ 
stance that at times metallic resonance was absent 
in tbe affected area while there was also absence of 
fremitus and vesicular breathing at all times over 
the area, showed that tbe cavity persisted, but the 
metallic resonance was lost because of filling of the 
cavity with contents or because of its coutraction. 
When this contraction occurred tbe lung tissue and 
vesicular breathing encroached on the area of tbe 
cavity, tbe lung expanding and following it up. Tbe 
shifting of tbe upper border of the area of dulness 
showed that the cavity contained at times movable 
contents, and tbe size of this area indicated the pre¬ 
sence of tbe stomach. Tbe different pitch of certain 
areas of metallic percussion that at times were sepa¬ 
rated from each other by areas of dulness was ex- 
plamed by tbe presence of more than one cavity. 
(Small intestine, colon, stomach.) The breath 
sounds over tbe area were either metallic or often 
absent. Tbe respiratory sounds be thought were 
changed in quality and acquired a metallic character 
by transmission through smootb-walled cavities. 
Tbe pitch of tbe metallic breathing was decidedly 
less intense than that beard in the pneumo¬ 
thorax, because the sound was not transmitted, 
through the pleural cavity alone, but also through 
the gastric and intestinal walls. At times the 
metallio breathing was heard only with inspiration^ 
whereas, in pneumothorax, on account of greater 
compression of tbe lung, tbe expiratory sound is tbe 
loudest. In addition, gurgling, either simple or 
metallic in quality was heard, also the metallic tink¬ 
ling and splashing sounds, with bursting bubbles, 
trickling and pouring sounds, such as are beard in 
diairbceas or ecstasis of the stomach. These souoda 
were at times very frequent, at other times absent. 
Leichtenstem argued that where similar sounds are 
heard in the normal thorax in the axillary and infra- 
scapular regions if tbe stethoscope is applied to the 
stomach or intestines, it can be readily shown that 
these sounds are far more intense in the normal 
situation of these organs, whereas in diaphragmatic 
hernia the dislocation of tbe intestines or stomach 
enoourages the formation of peristaltiobounds through 
tbe place of communication of thorax and abdomen, 
and these sounds are louder by far in tbe thorax than 
they are when listened for over the abdomen. Afte 
old plemisy with high location of tbe diaphragm the 

C 


OBIGHTAL COMMTOIOATIONS. Thi Medical Pbm8. 57 


JPLT 17, 1901. 

stomaoli and inteetineB can occnpy a high sitnation, 
bat here we have a letraoted and not distended 
thorax, with scoliosiB. Ac. SnccuBsion soonde in this 
case showed the variable character belonging to all 
the other signs. When they were present they were 
deep, showing a lai^ cavity. (Stomach.) 

Almost all reported cases of diaphragmatic hernia 
show great variability in the signs. 

Pneumothorax, the affection with which dia* 
phragmatic hernia is likely to be confounded, results 
from polmonary tuberculosis in 90 per cent, of all 
cases and in probably all of these is speedily fol¬ 
lowed by effusion of serum or pus into the pleural 
sac. The affection develops without the history of 
an injury. In toe remaining 10 per cent, nearly 
all result from traumatism, and in most of these 
inflamma ion of the pleura speedily follows with 
effusion of fluid, though in a very few there may be 
no infection and the air may be absorbed without 
causing any effusion. In pneumothorax dyspncsa 
may come on suddenly or gradually, and we may 
often hear amphoric respiration, especially in expira¬ 
tion, which may be either intense or feeble, and 
which disappears when fluid rises high enough to 
cover the opening into the air pass^es. When fluid 
and air are present in the pleural cavity we may 
often hear metallic tinkling during the respiratory 
acts, and we may obtain distinct splashing sounds 
by shaking the patient’s body while tne ear is applied 
to the chest. The heart is constantly crowded to the 
opposite side, where it remains without variation. 
Diaphr^^atic hernia is congenital or occurs through 
congenitol defects in about 38 per cent, of the 
casco that have been recorded and in many of these 
it does not cause marked symptoms unless the hernia 
becomes strangulated. In about 60 per cent, of oases 
the affection is traumatic and therefore the history 
is quite different from that of pneumothorax. The 
dyspncna in hernia may come on suddenly, and as 
suddenly subside, whereas, that of pneumothorax is 
more continuous. I have elsewhere stated that there 
is no amphoric respiration in diaphragmatic hernia, 
but the reverse of this is maintained by others. I 
cannot understand how typical amphoric respiration 
could be produced in diaphragmatic hernia, although 
I know that similar though more distant sounds, 
especially on inspiration, are sometimes heard. 
These, I believe, are caused by the transmission of 
the bronchial Bonods through the intestines or 
stomach, some parts of which are distended by gas. 
The meet important factors in the differentiation of 
non*Btrangulated oases are the following;— 

1. The metallic tinkling in pneumo-hydrothorax 
and a similar sound, though different in (Quality, 
may be beard at times in diaphragmatic hernia. The j 
quality of the sounds product in the bowels and in 
the pleural cavity wouldoften besofficientto differen¬ 
tiate between them, but this quality cannot be accu¬ 
rately described; therefore the principal value of 
the sign depends upon the fact that in pneumo- 
hydrotoorax it is heard only with respiratory move¬ 
ments or upon shaking the body, while with the 
hernia it occurs independently of these movements 
and is associated with rumbling or gurgling of gas 
in the stomach or bowels which have escaped into 
the pleura. 

2. The displacement of the heart, which in pneumo¬ 
thorax remains practically constant, in diaphrag¬ 
matic hernia may vary with the varying contents of 
the stomach or liowels, as when the patient is fasting 
or soon ^tereatiog or drinking freely. The retrac¬ 
tion of the aMomen may prove of some value as a 
sign, and the symptoms of obstruction will be of the 
utmost im^rt^ce if strangulation occurs. In a 
case saved by operation that was recently reported 
by E. W. Wi^er, tiiere was the history of a severe 
injury, with symptoms of intestinal obstruction and 


“ diminished expansion of the left side of the chest, 
tympanitic resonance at the base of the left lung, 
amphoric breathing, succussion sound on shaking 
the patient and the apex of the heart was displaced 
two inches to the right.*' In this case there had been 
a fracture of two ribs and the patient had some pain 
in the left side, which leads one to suspect a rupture 
of the lung with pneumothorax, in addition to the 
knuckle of bowel (involving eight inches of the gut) 
which was firmly held in the rent in the diaphragm. 
Walker cites numerous authors and stated that among 
the symptoms named, dyspnoea, intense pain, and 
cough are the most prominent, and that tympanitic 
resonance over the prolapsed gut, amphoric t.fnkling 
and sometimes succussion sounds are present. 

The symptoms and signs must necessarily vary 
greatly according to the cause, the nature of the 
injury, when traumatic, and the condition of the 
organs protruding from the abdominal cavity. 
Larcher found that in about 91 per cent, of 275 
cases no hernial sac existed. The signs would 
doubtless vary considerably in the cases in which 
the^ intestines protruded freely into the pleural 
cavity and in those where they were held down by 
the overlying pleura. 


THB 

CAUSE OF DIFFUSE PERITONITIS 
COMPLICATING APPENDICITIS 
AND ITS PREVENTION, (a) 

By A. J. OCHSNEB, M.D., 

Of Cbiea^. 

Evbrt surgeon who treats patients suffering from 
acute appendicitis must be impressed with the fact 
that an unfavourable outcome in any given case 
means that the infection which was ori^nally con¬ 
fined to the small space occupied by the vermiform 
appendix itself has first invaded the tissues imme¬ 
diately surrounding this organ apd has been distri¬ 
buted over the entire peritoneal cavity. In other 
words, in fatal cases the patient practically always 
dies as the result of a diffuse peritonitis. 

Other conditions may arise which may result in a 
fatal issue. There may be a septic thrombosis of the 
vessels in the vicinity of the appendix or an em- 
pysema, or even pymmia, but by far the greatest 
number of deaths occurs from diffuse peritonitis, 
and if it is possibleto prevent this, the mortality from 
appendicitis must at once fall enormously. In order 
to plan a means for the prevention of this condition, 
it is well to study the progress of the disease 
from its onset. 

There is danger of the occurrence of diffuse peri¬ 
tonitis in the following classes of cases(1) In 
gangrenous appendicitis; (2) in perforative appen¬ 
dicitis ; (3) in cases in which the cecal end of the 
lumen of the appendix is closed and the distal por¬ 
tion so thoroughly distended with septic materim as 
to make its walu permeable to micro-organisms; 
(4) in the very rare cases in which there are small 
absoesses in the walls of the appendix not directly 
connected with its lumen, and (5) in cases in which 
there is a septic thrombosis of some of the yessels, 
but not sufficient to cause gangrene. 

The first, second, and thito conditions are so 
common that every surgeon who operates frequently 
during the acute attack has seen them many times. 

Were it possible to keep the septic material in 
these cases within the circumscribed area in which it 

(a) AddxaM delivered before the SeetioB on Surgery end 
Automy, at the FUty-eeooad Annoel Meeting of the A.M.A., at 
St. Faol. Minn., June 4th to 7th, 1901. . 


Oo Thj UiDioAL Pbcbs. ORIGIN A.1j OOMMUNTCATIONS. Jult 17,1901. 


occoTS primarily, it is plain that the condition would 
remain comparatiTely oarmless. 

The appendix is virtually surrounded on all 
sides excepting in the direction of the median 
line by relatively fixed tissues. Above we find 
the lower end of the caecum and the csecal end 
of the ileum; to the right and in front is the 
parietal peritoneum; behind the peritoneum covering 
the iliacus muscle, and towards the median line it 
is surrounded by loops of small intestines. More¬ 
over, the omentum extends far bevond its lower end. 
It is true that the appendix may ue displaced down¬ 
wards, but in this case it will again be surrounded by 
fixed tissues which seem especially adapted to dis¬ 
pose of septic material. Again in this case there is 
an enteroptosis affecting the ciecum, and always with 
this a marked lowering of the transverse colon and 
stomach and with these the omentum. Thus we see 
that the natural anatomical arrangement for the 
protection of the general peritoneal cavity is ex¬ 
tremely efficient. There is but one weak point in 
the anatomical provision for this protection, namely, 
in the direction of the median line, because the great 
mobility of the small intestines naturally favours 
the distribution of septic material to all parte of the 
peritoneal cavity. If we can prevent the small 
mtestines from doing harm in this direction we will 
have accomplished our end, theoretically at least. 

At this point 1 wish to direct jonr attention to 
another important anatomical conmtion. The blood 

3 1 y of the omentum is so enormous that it will 
iy dispose of a very severe infection by walling 
off the surrounding stractures if it is permitted to 
^ve ite physiological attention to a single area. It 
IS a weU'koown lact which eveir one who frequently 
operates during the acute attack: of appendicitis has 
had many opportunities to observe, that the omentum 
crowds itself about any inflammatory or traumatic 
lesion within the peritoneal cavity the moment the 
latter occurs, and if left undisturbed, a few hours will 
suffice to cause efficient protective adhesiens. These 
adhesions become stronger every hour and the blood 
supply in the omentum becomes greater, so that if 
no dirturbance arises one can reasonably expect 
efficient protection to the general peritonem cavity 
from the omentum. 

Another important fact must not be lost sight of 
in this connection. The fact that the surrounding 
structures are relatively fixed in position favours 
the condition of rest of the inflamed part and per¬ 
mits the omentum to act after the manner of a 
splint applied to an inflamed joint. The value of 
rest as a preventive to the extension of an infection 
in any p^ of the body cannot be over-estimated. 
Gona^uently, if it is possible for us to secure this 
condition of rest we have gmned another important 
point in the right direction, 

In case the appendix is displaced upwards its posi¬ 
tion is even more favourable, because the avaimble 
amount of omentum is thus increased. Again, if the 
appendix is retro-csecal in its position, which is very 
fROuently the case, the infection of the general 
peritoneal cavity is more easily prevented than 
when in its normal location. If anteriorly misplaced, 
it is likelv to be fastened to the anterior abdominal 
wall by the adherent omentum. 

It is plain, then, that the infection of the general 
peritoneal cavity must occur from a disturbwee on 
the part of the small intestines, and must be due to 
their peristaltic motion. It is significant that in 
almost all cases of severe acute appendicitis the ob¬ 
struction to the passage of gas and intestinal con¬ 
tents through the ileo-cecal valve is one of the early 
^mptoms. Nature is trying to prevent this very 
dangerous disturbance by closure of the ileo-csec^ 
valve. We have a condition corresponding to the 
contraction of the muscles surrounding an inflamed 


;]oint, to the closure of the eyelids in conjunctivitis. 
&c. Moi'eover, the muscles overlying the appendix 
become tense. Eveiything tends toward the estab¬ 
lishment of conditions of rest in the vicinity of the 
inflamed organ. 

It is a fact which has been demonstrated a great 
number of times that peristalsis does not occur 
unless food or cathartics are introduced into the 
stomach. If the attack occurs shortly after a meal 
and before all of the food has passM through the 
ileo-cmcal valve, its presence may cause peristaltic 
motion in the small intestines. Upon reaching the 
ileo-ceeoal valve the latter may prevent its pass^e 
into the csoum, causing return peristalsis, and the 
intestinal contents are forced back into the stomach, 
whence it may be expelled by vomiting or be agun 
forced into the small intestine, giving rise to further 
peristaltic motion. Moreover, it will give rise tu the 
formation of gas, which must cause disturbance and 
pain in its attempt to pass the ileo-cscal valve. 

This motion, it is plain, will be harmful primarily 
from the fact that it »ves rise to pain by disturbing 
the sensitive inflamed tissues; and secondarily from 
its likelihood of carrying infectious material with 
which it has come in contact in the vicinity of the 
inflamed appendix to other parts of the peritoneal 
cavity. 

Besides this the physiological attention of the 
omentum can now no longer be directed to the 
single area of infection, because other parte of the 
peiitoneal cavity require ite protection, and such 
portions of the omentum as are not yet thorougly 
adherent about the inflamed appendix are likely to 
be diverted from this point. 

Theoretically, then, the disturbance which is to be 
feared to so great an extent is caused by the pres¬ 
ence of food or cathartics in the stomach, and its 
logical remedy would be to absolutely prevent the 
introduction of any form of food or cat^rtics into 
the stomach and the removal by gastric lavam of any 
portion of food which may ^ retainea in the 
stomach at the beginning of the attack. It may be 
necessary to perform gastric lavage tvrice or at most 
three times in order to entirely remove remnants of 
food which may have regurritated into the stomach 
from the small intestines by reason of return peri¬ 
stalsis. That this is not only true theoretically, but 
also in practice, I have demonstrated in a large 
number of cases ;*and many other snigeons who have 
followed the same plan of treatment have informed 
me of the fact that their experience has agreed with 
mine. 

It is true that a few surgeons have reported 
failures with this method, but an investigation of 
their treatment in each instance has shown that 
they disregarded one of the three cardinal points in 
the treatment. They either gave just a little liquid 
food by the moutl^ or they gave some form of 
cathartics, or disturb^ the rest of the intestines by 
giving large enemata, or they neglected removing the 
stomach contents by gastric lavage. Of course, the 
slightest amount of food is sufficient to start 
peristaltic motion of the small intestines, and the 
same is true of cathartics, and consequently if either 
of these features in the treatment is omitted one can¬ 
not hope for the same results. It does not matter 
what form of appendicitis may be present in any 
given case, it seems clear that this form of treatment 
must be useful, because in the milder cases it will 
result in rest of the affected part, and consequent 
rapid resolution; while in the severe cases it will 
guard against mechanical distribution of infectious 
material, and in all cases it reduces the tendency to 
meteorism and stopp the pain. 

There is, however, one class of patients in which I 
have found this treatment of the greatest value. I 
refer to the class in which the appendix is gangrenous 

oogic 



July 17, 1901. OfilGINAIj COMMUNICATIONS, Tn Mmiwaat. Pjans. 59 


or perforated, and in which there ia already a 
beginnint; general peritonitis. These patients ^re 
the impression of being extremely ill. There is 
oomplete obstmction to the passage of gas or fseces. 
There is naosea or Tomiting and markea meteorism; 
the pnlse is small and qnick; nsnally there is high 
fever, but the temperatore may be suraormal; respi* 
ration is rapid, and the abdominal muscles overlying 
the appendix ai*etenBe. The patient is in a condition 
in wmch I formerly operated at once, day or night, as 
a last resort, only to find that it was too late in more 
than one*third of the number of cases, the mortality 
increasing with the time that had elapsed since the 
beginning of the attack. In this class of cases there 
is still a recovery of over 90 per cent, if the prin¬ 
ciples laid down above are thorousbly applied. 

If peristalsis is absolutely inhibited, as it can be, 
the infection will soon be^me circumscribed and 
the pus can be evacuated with safety. Moreover, 
the condition I have just described is in itself the 
result of the administration of food and cathartics. 
Had these patients received neither food nor cathar¬ 
tics from the beginning of their attack, the condition 
would never have advanced to this dangerous point. 
This refers particularly to a class of cases which 
Bichardson W so well described as ** too late for an 
early and too early for a late operation.” 

If the plan I have outlined above is carried out, 
the following changes are likely to occur;—^The 
nausea and vomiting will cease a^r one or two, or 
at the most three, ga^ric irrigations. The meteorism 
and the pmn will decrease greatly during the first 
twelve hours, and will almost completely disappear 
in twenty-four hours. The pulse beiromee slower and 
firmer and more regular, the breathing deeper, and 
the patient’s general appearance improves to an 
astonishing extent. If tne temperature was high, it 
will go below 100^ F. the first-twenty-four hours, and 
in three days it will be practically normal The ab¬ 
dominal muscles will become soft as soon as the 
stomach contents have bemi removed by ^fastrio 
iava^. Usually the improvement is so rapid that 
one u tempted to spoil everything by giving nourish¬ 
ment by mouth, because the patient’s conation does 
not seem serious enough to warrant such severe 
measures. 

That this form of treatment, which I have employed 
einoe 1892, at first only in selected cases, and 
later more and more generally, is really of great 
value is shown b^ clinical results. My mortality in 
cases of perforative or gangrenous appendicitis with 
beginning diffuse peritonitis is less tuan one-fourth 
as nigh as it was in the oases operated at once upon 
making the diagnosis, and even in advanced oases of 
diffuse peritonitis there has been a marked decrease 
in the mortality in my experience. It might be said 
that these cases were not due to perforated or gan¬ 
grenous appendicitis, but that they were simply 
severe catarrhal cases, which are known to result 
favourably under any form of treatment. To this I 
would respond, that 1 have later removed the appen- 
^ces in many of these cases, and have almost in¬ 
variably demonstrated the correctness of the 
diagnosis. 

In my statistics I utilise only the cases which I 
have operated in the Augustana Hospital, because 
of these I have full and aocurate records, while of 
those operated in other hospitals and in private homes 
my records are not accurate,because there tbepatients 
and assistants are not so completely under my con- 
troL From Jan. Ist, 1898, to May 1st, 1901, I have 
operated in this hospital upon 565 appendicitis cases, 
which I have divided into three groups: 1, those who 
entered the hospital suffering from diffuse peri¬ 
tonitis ; 2, those who entered toe hospital suffering ' 
from gangrenons or perforative appendicitis, and 3, 
those who entered the hospital snffering from recur¬ 


rent appendicitis in the interval between attacks or 
at the beginning of a recurrent attack when the 
infectious material was still confined to tbe appendix. 
Of tbe first class I treated 18 oases, with 10 deaths, 
55'5 per cent, mortality; of the second class I 
operated 179 cases, with 9 deaths, 5 per cent, mor¬ 
tality ; of tbe third class 1 operated 868 cases, with 
one death, 1-3 per cent, mortuity. Total, 565 oases, 
with 20 deaths, 3*5 per cent, moriality. Tbe statistics 
contain all patients who entered tbe hospital suffering 
from appendicitis ; even those who died a few honrs 
after admission. 

Of Classes 2 and 8, all were operated, so there can 
be no doubt concerning their diagnosis. Of Glass 1 
all but 4 were operate^ and these were in an abso¬ 
lutely hopeless condition when they entered tbe 
hospital. I will state also that during this time no 
patient suffering from appendicitis was refused 
admission into the hospital. 

Judging from the authorities upon this subject, 
our mortuity of 55'5 per cent, in diffuse peritonitis is 
as low as that recorded by any of the authors whose 
statistics contmn a considerable number of these 
cases, while some authors with less than half this 
numl^r report as low as 20 per cent, mortality. 
Xrogius bM compiled tbe statistics of fifty-eight 
authors whose combined mortality is a little over 70 
per cent. 

As compared with my own experienoe in former 
years, when all of these cases were treated surgically 
at once, my experience in this series of cases of 
diffuse peritoni^ following appendicitis is quite 
encoim^ing. 

It is in the second class, however, in which the 
greatest benefit from the tr^tment is found. In this 
class, according to most modern sutborities, Muiphy, 
Mynter, Porter, Lennander, Bull, and many others, 
there is a mort^ty of at least 20 per cent. This in 
my cases has been reduced to 5 per cent.; and had 
the treatment been instituted at the beginning of 
tbe attack, I am oertain that the mort^ty could 
easily have been reduced to one-half of tnis. In 
Class 3 there should have been no death. Many 
of these cases had been treated through their acute 
attack by the method I have describe^ before being 
sent to the hospital. But as not all of the cases I 
treated outside of the hospital came later to opera¬ 
tion, it is not fair to utilise these in demonstrating 
the value of the method. 

Again, I have treated a large number of cases 
through tbe acute attack of appendicitis with this 
meth<^ which have never been operated, and which 
I have not included in my statistics, because tbe cor¬ 
rectness of toe diagnosis could not be establisbed by 
actually demonstrating tbe condition present in the 
appendix. 

However, the fact that there was a mortality of 
less than one-third per cent, in so laige a number 
of cases is significant. It shows the value of a 
method by which oases of acute appendicitis in whom 
an operation is bound to give a high mortality at best, 
can M changed to chronic appenmcitis in which tbe 
mortality following operation is almost nothing. 
It is, of course, not possible to come to any definite 
conclusions from a collection of statistics, because 
there are so many differences which can not be 
balanced. 

Amon^ these cases one is especially instructive 
because it illustrates the danger of operating too 
early. The patient entered tbe hospital five days 
after the beginning of the attack. His condition 
was exceedingly grave, as indicated in the history. 
With an immediate operation I should have expected 
his death within thirty-six hours. The diagnosis was 
made of gangrenous appendicitis. He was placed 
on exclusive rectal feeding. Within twenty-four 
hours his pain had entirely disappeared, his general 




60 Tn Mbdioal P&bss. 


ORTGIITA.L COirfMUiaOlTION. 


JULT 17, 1901 


appearanoe improyedgreatlj.the meteorism subsided, 
histemperature fell three degrees,his pulse came down 
forty beats per minute, bis abdominal wall became 
soft, and twenty-four hours later I began to doubt 
my diagnosis. At the end of the fourth day hie con¬ 
dition bad impruved so much that, upon his request, 
I concluded to operate, because he was normal in every 
respect with the exception of a slight induration in 
the region of the appendix and pain upon deep 
pressure. It seemed h> me as though the process 
must have stopped just short of a perforation. Had 
he been left without an operation there could be no 
doubt but what he would recover temporarily from 
his attack. It seemed perfectly safe to operate. 
Upon opening the abdomeu 1 found a perforated 
gangrenous appendix surrounded by a small abscess 
completely walled off by the omentum. I removed 
the appendix and the surrounding pus with great 
care, and drained the cavity, expecting the patient to 
recover, but a diffuse peritonitis develop^, from 
which he died five days mter. This case impresses 
the lesson that it is not wise to operate until the 
patient has fully recovered from the acute attack. 
Of course, be should be cautioned as regards his 
diet in order to prevent a recurrence, but I am con¬ 
fident that the mortality in my practice will be still 
smaller in the future, especially because I shall wait 
longer after the acute attack before removing the 
appendix. 

The danger of rupture of a circumscribed abscess 
into the general peritoneal cavity has been the cause 
of great anxiety. experience has led me to con¬ 
clude that this practically never happens unless food 
or cathartics are nvea by the mouth. In my entire 
experience it happened but once, in a child, set. 7, 
which was brought to the hospital on the hfth day 
after the beginning of an attack of gangrenous 
appendicitis with loginning diffuse peritonitis. It 
had received foodandcathartics constantly since the 
beginning of the attaclr, and although its condition 
seemed hopeless either with or without an operation, 
it improved slightly from day to day under exclusive 
rectal feeding, but never became well enough to 
make drainage of rather an extensive infection of the 
entire area between the umbilicus and pubis and 
right anterior superior spine of the ilium safe, and 
still, had I anticipated the likelihood of a rupture 
into the remaining portion of the peritoneal cavity, 
I should certainly have made the attempt with the 
hope of bringing about a recovery. On the fifth day 
the abscess suddenlv ruptured. I anmsthetised the 
boy within half-an-bour, made a free incision, washed 
out the peritoneal cavity, drained freely, but the 
child diea in six hours. In this case ^tric lavage 
had not been employed because the child was very 
nervous and we leared the effects of the fright. I 
have frequently seen oases in which fo(^ and 
cathartios were given in whom this accident occurred. 

Aside from the benefit to the patient of increased 
safety there are other advant^es to be derived from 
this plan of treatment, which are well worth con- 
sidermg. ^ing able to operate during the quiescent 
state, draina^ is not inmcated, and consequently 
there is no likelihood of the occurrence of post¬ 
operative ventral hernia. With the reduction of the 
area of infection the amount of peritoneal adhesions 
must necessarily be reduced. As a matter of ex¬ 
perience I can say that fscal fistulm almost never 
occur in cases treated by this method. 

Of course, all these advantages, as well as the pre¬ 
vention of diffuse peritonitis, can be accomplish^ if 
the appendix is removed during the very l^^inning 
of the attack, before the infectious material has 
passed beyond the walls of the appendix, but unfor¬ 
tunately it is but very seldom that a parient enters 
(he hands of a surgeon at so early a st^e. 

I am positive tlmt the mortality would have been 


at least four times as great had all patients been 
operated at once, upon admission. Inhere are three 
cases which do not pro|>erly belong in this group, 
because perforation had not actually taken place, but 
I am confident that this was only prevented by the- 
treatment. Moreover, each one of these cases bad 
quite advanced peritonitis at the time of admission,, 
which would undoubtedly have progressed rapidly 
had not peristalsis been inhibited. In each of these 
cases the attack was exceedingly violent until this 
form of treatment was instituted, but subsided very 
promptly after commencement of this treatment. 

Conclusions. —As a result of my clinical observa¬ 
tions I am prepared to formulate uie following con¬ 
clusions :— 

1. Peristaltic motion of the small intestines is the- 
chief means of carrying the infection from the per¬ 
forated or gangrenous appendix to the other portiona 
of the i)eritoneum, changing a circumscribed into a, 
general peritonitis. 

2. This can be prevented by prohibiting the use 
of every kind of food and cathamcs by mouth, and 
byemjHOjing gastric lavage in every case in which 
there are remnants of food in the stomach or in 
the intestines above the ileo-cscal valve, as indi¬ 
cated by the presence of nausea, or vomiting, or 
meteorism. 

3. The patient can be supported by tbe use of con¬ 
centrated predigested food administered as enemata- 
not oftener than once in four hours, and not in larger 
quantities than four ounces at a time. 

4. This form of treatment, when instituted early,, 
will change the most violent and dangerous form of 
acute periorative or gangrenous appendicitis into a 
comparatively mild and harmless form. 

5. Cases of perforative or gangrenous appendicitis, 
with beginning general peritonitis, can usually be- 
carried throu^ the acute attack safely with tbia 
method. 

6. In all cases of this class gastric lavage should' 
be practised in order to prevent the absorption of 
decomposing material from the alimentary canal. 

7. In cases of doubtful diagnosis this form of 
treatment should always be employed. 

8. This treatment will prevent a lai^ proportion 
of tbe most troublesome complications and sequelae 
of appendicitis, such as ventral hernia, f cecal fistulm,. 
extensive adhesions, &c. 

9. The patient should be permitted to recov‘«r fully 
from his acute attack before an operatlonis performed, 
except in cases encoimtered within the nrst thirty- 
six hours after the beginning of an attack or in case 
of the formation of a superficial circumscribed 
abscess. 

10. It often requires but a small amount of any 
kind of food to change a harmless circumscribed inte 
a dangerous diffuse peritonitis. 

11. The treatment does not protect the patient 
against a subsequent attack. 

12. It does not contraindicate the removal of a dis¬ 
eased appendix^fore the septic material has extended 
beyond this organ. 

13. It is indicated in all intra-abdominal conditions 
in which it is desirable to prevent the distribution of 
septic material by means of peristaltic motion. 

14. Tbe laity should be taught to stop feeding and 
giving cathartics to patients suffering from intra¬ 
abdominal diseases. 


A FATAL case of small-pox is reported in Dundee-, 
luring the recent outbreak cases were for the most 
>art of a mild type, and when the epidemic was at 
ts height the city enjoyed a complete immunity 
rom (^ths. Tbe first having now occurred, the 
»ther inmates of the dwelling have been removed to 
he reception house for observation, I 

oogk 


JuLT 17, 1901. 


TBAKSAOIIONS OF SOCIETIES. Tri Mxdio^ I'bwb. 61 


FEMORAL CYSTOCELE. 

Bj Dr. KACOVIOBAKO, 

Bttohaiwt. 

In 1898 I had the honour to druw jour attention 
to three oaaes of inguinal cjstocele which I then 
presented to the Society. At the same time hi. Aurin 
presented his paper on the subject, citing five cases 
which had occurred in one praotioe. 1 hare said that 
in the records of medicine two cases of pare cjsto- 
•oele (a) are not to be found, the majority being cases 
of cysto-enterocele. 

Tnis complication of hernia is serious. To point 
oat any characteristic sins of the bladder is diffi* 
oalt, owing to its physiosd state being so changed 
from the normal, anC in some cases, the vesical walls 
are tom during the earlier steps of the operation. 
Within my personal knowledge I can speak of two 
cases where the vesical walls were so thin as to tear, 
and were incapable of holding sutnres, any attempt to 
secure which caused them to come throa|fh. This 
breakdown of the tissues was accompanied by a 
bleeding, which terminated fatally. 

A case is published by 1£. Boux, and another by 
M. Flaqnemment, in which a divertionlam of the 
bladder was mistaken for a hernial sac and resected. 
Hr. Feriger, of ChiciM^, cites seven cases in which 
be produced vesical nstulas, all of which did well 
He ccmsiders the accident very common, not serious, 
one from which he has never seen a death. In my 
£rBt case in 1894 I recollect a diverticulum of the 
bladder, which I mistook for a hernial sac, the 
viscas extracted, the linture fell off, urine 
escaped into the fundus of the belly, and the patient 
died. 

To-day I wish to bring under your notice a case of 
femoral cystocele complicating an irreducible entero- 
cele. The patient, a servant, mi. 45, has been suffer¬ 
ing for some Ume from an irr^ucible femoral 
bemia. He never complained of any bladder 
trouble, he passes his water in a full stream, and bis 
prostate is out alightly increased in size. Durinz 
the operation there appeared a second pouch which 
eansed me to suspect the possibility of the bladder 
beinu eng^ed. To test this I now injected the 
bladder with fluid and passed in a sound, but with¬ 
out effect. I now enlarged the opening, re¬ 
placed the suspected pouch in the belly, 
and again used the metallic sound which I 
now could readily feel with my finger through the 
vesical wall. By this manoeuvre I satisfied myself 
that the second pouch was the urinary bladder. 
These cases are rare. Jaboulais in Delbet's Patbo- 
tot^ quotes the theses of De Legmud, which gives 
thirteen oases, and gives in detail two cases, one by 
himself and one by M. Aue,published in the Central- 
hUUfur Chirurgie, which with our own makes six¬ 
teen cases in aU. I do not know how many of these 
were women. 

I consider this case important, and I think it right 
to report such complications as occur in hernias, in¬ 
guinal and femoi'al, so that the risk of injury to 
the bladder by cutting or tearing may be avoided; 
for, as I have showu, such injuries are sometimes 
mortal. And, lastly, I may add that I have had the 
opinion that such a complication in inguinal hernia 
in women most be very unusual—indeed, I was 
sceptical as to its existence in woman, when on June 
^th, 1899, operating on the woman, M.H., for an 
inguinsl enterooele, I came on an inguinal cystocele. 
bulletins et Hemoire de la Society de Cbiruigie de 
Bucharest TomelY., 2)o. 1.) 


(a) In this, U. Bscoriceano ia not scouate; there are more than 
two oa record, the majority of which escaped notice durlny life, 
tieeanse pore eyatoeele is, u « role, not nsinfnl.—E d. 


^raiuia£ti0n0 of 


SOCIETY POE THE STUDY OP DISEASE IN 
OHILDBEN. 

Thx provincial meeting of this society was held on 
June 29th at the Uedioal Institution, Liverpool, 

Mr. EoBsax Jonbs, F.B.C.S., in the chair. 

Clinical oases were demonstrated by tbe Chairman, 
Dr. Logan, Hr. E. W. Monsarrat, Dr. Maoalister, Dr. 
Lloyd Eoberts, Mr. W. Thelwall Thomas. Dr. James 
Barr, Dr. Stopford Taylor, Dr. Nathan Eaw, and Mr. 
G. P. Newbolt. 

Dr. Hzkbt Ashbt (Manoheeter) related a case of so- 
called fostal rickets. The mother was forty-six years of 
age, and the infant was her fourteenth, bom at 
term, and well nourished. When seen »t two weeks 
there was oranio-tabee, deformed chest walls, and five 
fraotnres, inclnding both hnmeri, left radios, right 
ninft, and left femur. Three weeks later the right 
femur fractured. The infant eventually mads a com¬ 
plete recovery. Dr. Ashby donb^ if snoh oases were 
examples uf tme rickets, but rather resembled the osteo¬ 
porosis produced by feeding puppies on food defiotent in 
salts of lime. 

Dr. Eichabd Caton (Liverpool) reada paper on 

THl XaXATMBirr aw BHDOOABDrriS, 

based upon about 600 cases of that disease ooonrring in 
acute rhenmatUm and chorea. He advocated (a) abeo- 
lute rest in bed for several weeks (6) the application 
of a seriee of small blisters in the r^on at the first 
four dorsal nerves in front, followed by ponltioing; and 
(e) the internal administration of sodium io^(to. To 
be of eervioe this treatment must be commenced within 
the first fortnight or so. 

Dr. William Cabtib bore testimony to the great 
ntility of the method. 

Dr. A Ebnbst Saksoh thonght blisters a little lees 
than worthless in endocarditis. 

Dr. C. I. Macalibtxb advocated blistering and rest 
both in endocarditis and in pericarditis. Instead of a 
blister an ointment of the rM iodide of mercury (1 in 
8) might he employed. 

Dr. Jambs Babb spoke of the good effects obtained 
from blisters in the treatment of acute rhenmatism. 

Dr. H. B. Hutton testified to the rapid disappearance 
of pericarditis under blistering. 

Dr. Catom, in reply, said that in acute rheumatism he 
used the salicylates along with small blisters to the 
joints. 

Dr. Gxobob Cabfbnteb and Mr. Stdnbt Stephen¬ 
son read a paper upon 

TUBKaCULOSlB OF THB OHOBOID, 
based umn the examination of forty-nine oases of the 
kind, llie lesions were fonnd ophthalmoscopically in 
twenty-one oat of forty-two oases of acute tubwoulosis 
and tuberoalons meningitis, or in exactly SO per cent. 
In 119 cases of chronic tnbercaloais, choroidal changes 
were discovered in no less than 9‘2 per cent. In quies¬ 
cent tubercle they were also found. The author 
described the characters of the choroidal tubercles, and 
pointed out tbe great diagnostic value of the growths. 
Tbe communication was illustrated by miorosoopioal 
preparations and by numerons paintings of disCMwed 
eyes. 

Dr. A. Ebnbst Sanbom and Dr. Hbnbt Ashbt dis¬ 
cussed the paper. 

Dr. Wabeinoton asked whether tubercles in the 
choroid were observed except in the last stage of illnees. 

Dr. Qbobox Cabpxntbb, in reply, said that in the 
acute cases mentioned in the paper tubercles were fonnd 
in the choroid from one day to six weeks before death. 
Tubercle in the choroid did not necessarily warrant a 
grave prognosis, since some of the cases became 
obsolescent. 

Dr. D. M. Hutton (Soutbport) read a note on a 
case of 

STFHILIB TBANSHITTBD TO TBB THIRD QINBBATION. 

The grandfather produced a certificate before his mar¬ 
riage certifying that havii^ bad syphilis he was cored. 

Google 


I 




Thb Hidical Paxes. 


TB4NSA.CT[0K8 of SOCIETIES. 


July 17, 1901. 


The motiier solfered from speoiflo psoriasia. The child Mr. J. B- Lawiokd reported s case of 

died of oongenital syphilis at the age of five weeka. hxlanotio sabcoma of thx cohjokctita. 

Dr. Hbmbt Abmbt thought the infant might have ano- patient, a wonum, was shown at the Society in 

combed notto syphilis butto a paendo-BjphilitioproceBS 1806. In July following two piwkiidi nodnles 


of septic origin. 


appeared on the conjunctiva. A month later the cornea 


Dr. Emund Oautlst enquired whether there was haay, and the intraocular tenuon raised. In 

any post-mortem evidence of syphilia in the infant. October, 1896, the eyeball and oonjanotiva were re- 

Dr. Gxo. A. SuTHXBLAUD could not accept the pso- and examined by Mr. Deverenx Marshall, 


riasiB present in the mother as pathognomonic of who refuted the growth to be a pigmented sarooma. 

, , .. , , The pinkish nodules consist^ of oonnective tissue. 

Dr. Huttok, in repiv, said the whole question resolved ceUs and blood-vessels. Therewasnogroirthwhat- 
itself into one of possibilities and probabilities. Trans- ever within the eyeball. In May, 1897, the patient had 
ission in this case could not be demonstrated, but was ^ serious with brain symptoms, and it was 

,, , , thooght that an intracranial growth was present. 

Mr. B. W. Monbabbat (Liverpool) road a note on two However, she got better. In October, 1897, some new 


icaeii into one of possibilities anc 
mission in this case could not be 
highly probable. 


cases of 


MXNINOITIS TBXATXD 8UBOICALLT BY DBAINAOX. 


growth was seen in the orbit, and the 
was not good. On October 2l8t, 1807, 


eneral health 
e growth wae 


The resnlts were fairly satisfactory. The choice of a removed, and was examined and found to be a saroo^ 


route for drainage wae discussed. In August, IbWi, anotner recurrence w» bw»u. v/« 

Dr. EdkUNO Cautlxt dwelt upon the initial difficulty September let, 1898, ^be i^w^ wm removed an 
of distinguishing between simple basic and tuberculous examined by Dr. Jenner and foimd to be a sarooma. in 
meningitis. In his own oases the result of surgical April, 1899, another pigment^ s^t was seen, Md m 
interference had been uniformly unfavourable. the following September another hM appearMin 

Dr. J. B. Looah mentioned a case of chronic hydro- upper lid. On September 14th, 1899 , the wMie ooi^ 
oephalus where the lateral ventricle had been drained, trats of the orbit were removed. On M«oh lyw, 
but the chUd died some months later. the patient was ve^ iU and ied on Apnl Wtb, but 

Mr. Dambb Habbisboh bad passed ohromioised gut necropsy was obtained. Owmg to the {mnentrs very 
into the lateral ventricles for the purpose of dnuuing irregulctf attendance and also to hw refiwing oporatioo 
fluid into the base, but he was not inclined to proceed in the early ^ stage of the disease her chances of cure- 
with the operation. were much diminished. 

Mr. Monbabbat, in reply, thought no operation satis- Major H. Hsbbbbt,I.M.B. (Bombay), described" Co^ 
factory that did not combine ventricular drainage with janotival Bridges and Pouches,” due to union m 
dtain^te of the subarachnoid space. retrotarsal folds, a condition found in nine upper lids cu 

Dr. John H. Bbtant read notes of a case of pnenmo- seven patients of ^1 ages. One or more retrotarsal 
coccal peritonitis, which be had observed in a girl, set, folds had contracted permanent adhesions with th» 
4t years. The abdomen was opened, general acute peri- tarsal oonjanotiva evidently whUe displaced downwar^ 
tonitis was found, and pneumococci were demonstrated through swelling in some previous inflammatory attack, 
in the effusion. At the autopsy there was no pneu- xhe adhesions were sometimes multiple along the sum- 
monia or pericarditis, but ftlenrisy and peritonitis were of the one fold; in other cases smaller adheuons of 
present. Dr. Bryant was inclinM to think that so- nnderlying folds were found beneath the prineipm 
called idiopathic peritonitis was of pneumococcal origin, ones. The folds had retracted, except when held 


In August, 1898, another recurrenoe was seen. 


Dr. Jahxb Babb disoassed general infection with the by the adhesions, thus leaving the permanently 
pneumooooons as shown by pneumonia, pleurisy, peri- displaced portions as broad or narrow ban^, or 
tonitis, and meningitia bridges of conjunctiva connecting tarsus and fornix and 

The following communications were taken as read:— freely admitting the passage of a probe beneath ^enu 

(1) Mr. B. Clement Lucas: Bemoval of a Hail from There was no history of injury in any case, but in the- 

the Second Portion of the Duodenum.” majority there was or had been trachoma. Two cues 

(2) Dr. John M‘Caw (Belfast): “ Notes of a Case of ^rere also mentioned in which small bridges of union bad 

Infantile Scurvy.” formed between folds in the lower fornix. ^ In another 

(8) Dr. C. J. Macalister (Liverpool): ” Observations patient recovering from acute conjunctivitis (mem- 
on Cirrhopis of the Liver and Endocarditis in Children.” braoousor pseudo-membranoi^ the actual formation 

(4) Dr. James Carmichael: “ Bimanual Examination of the se adhesions was seen. Tne union was primarily 


the actual formation 
e union was primarily 


in the Diagnosis of Abdominal Disease in Children.” by means of fibrinous exudation, which apparently 
■ .1 ■ ■ - became organised. Finally, another upper lid wae men- 

OPHTHALMO LOGICAL SOCIETY OF THE “ "J*®!* * 

UNITED KINGDOM bad adhesions not only at its sumnut but also over 

UNllLD KINGDOM. greater part of its surface, leaving only a shallow 

Mbxtino held jdlt 6th, 1901. \ under each curved lateral margin. 

^ Mr. Stdkxt Stbphbnbon communicated notes of a- 

The President, Mr. G. Andxbson Cbitohbtt, F.E.C.8., 
in the Chair. 

_ MILD sympathetic IBIDO-CTCLITIS 

Mb. Simbon Snell (Sheffield) related a case of ^ fifty-four days after removal of an injured 

BLINDNESS BE8ULT1NO FBOM SODIUM SALICYLATE. gyg. The interval between ^e original injury and the 

The patient, a girl, suffered from acute articular enucleation of the eye wae twenty days. The injured 
rheumatism, for which so^um ealioylate was prescribed, eye was affected with puro-plaatio cj^tis, rot micro- 
She woke from sleep at 7.80 a.m. and said that every- organisms could not be reoo^ised. The patient *hro 
thing wae dark in front of her. On the medical atten- seen 16i months ^tor the accident had made a oompletfr 
dant’s visit between 11 and 12 he found her unable to recovery. . 

distinguish between light and dark. The next day Mr. The Pbesidbnt referred to an obsei^tmn of Liebnrou 
Snell saw her and found her perfectly blind. The that pressure on the nerve stump in the vacant orbit 
ophthalmoscope disoloeed nothing abnormal in either was painful in these oases. 

fundus. The following day be ^ain saw her, when she Mr. Devebeux Mabshall asked Mr. Stephenson ix 
was snccumbiog to pericwditis with endocarditis, this was a record case. He himself had seen a mild 
Again nothing abnormal in either fundus was detected, case develop between two and three wMks after an eye 
There was no return of vision, and she died that same bad been removed for injury, but he hro never eero K 
evening. It was calculated that the total quantity of case develop eo long as fifty-four days wter enudrotiro. 
sodioiD ttUoylfttB tftkon niist bAve b66Q At loAst 140 Mr* Simaon Skill DarrAtAd A cbm of woov^y of botiw 


grains in sixty hours. Mr. Snell said he thought that j eyes under similar circnmstanoes. Enucleation eom^ 
there could be very little question that the sodinm j times sacrificed the better eye of the two. _ ^ 

salioylate was the cause of blindness in this instance. Mr. Stephenson, in reply, said that he wae not oeitaiik 


OOg[( 


JPLT 17, 1901. 


G B B H A N T. 


Ths Msdical Pew8 63 


what was the longest interval observed, bat he did not 
think that his was the longest on reoord. 

The following cases and card epeoimenswere shown.— 

Mr. C. Wray: Oomma of the Orbit which ooonrred 
forty years aftw Primary SyphUitio Infection. 

Dr. W. C. Bookliffe: Cystic Growth of the Betina 
(probably Carcinoma) Se^ndary to a Primary Scir* 
rhos of the Breast. There was evidence of both eyes 
being affected. 

Mr. Marons Chum : Exceptional Appeaianoe of a 
Choroidal Lesion, probably tnberonloas. 

Mr. Inglis T^jlor: Peculiar form of Vitreons 
Opacity. 

Mr. flarman: H<de in the Maonla. 


(frmtce. 

CraoK OUB own ooBBSSPOKnmrr.] 

Paub, Jnlj ISth, IMl. 

PUBBPKBAL IirrX<7riOK. 

At the Acad^mie de M^deoine M. Bodin spoke on the 
treatment of pnerperal infection as praotioed by him for 
the last ten years. If fever set in, in a woman recently 
delivered, and that at the same time clots, foetid or not, 
were fuond in the ntems, interference might be limited 
to removal of the clots and washing ont of the aterine 
cavity. Bat if the mnoons membrane were found to be 
diseased, especially at the point of insertion of the 
placenta, the physician should not hesitate to praotioe 
ooretti^ of the organ. Bapid improvement followed, 
provided that the operation was not retarded; but when 
the infection had lasted already several days a cure was 
effected more slowly, as the toxic germs had penetrated 
into the economy. 

On the other hand, where the woman was delivered 
or had aborted several days after the rapture of the 
membtanei, if the amniotio liquid were fcetid, the same 
treatment applied. 

THX THKBAFBTTTlOe Ot IiBCITHINB. 

M. iMoereaux treated the question of the emidoy* 
ment of ledthine in therapeutice. Beoent researches 
have proved that leoithine plays an important rile in 
the nutrition of the organism in general, and the 
nervous system in particular. Several experiments 
have confirmed this fact, and have demonstrated, more* 
over, an increase of weight of the animal or of man 
under the iwflnAnfiA of the agent. Professor Lanoereanx 
instanced the oases of two patients in his wards who 
were soffering from pancreatic diabetes arrived at an 
advanced stage, and who wasted away in spite of every 
effort to prevent the emaciation. Under the infiuenoe 
of leoithine not only did the wasting cease bat the 
patients gained rapidly in weight and at the same 
time their general condition was improved. 

These reeolts prove the great value of leoithine as a 
atimnlant of nutrition. Not only does it arrest the 
rapid denntrition of diabetic patients which generally 
nothing arreeta and leads to phthisis, but it increases 
their weight, reetoring to them their strength, and, to 
a certain d^ree, their buoyant spirits. 

He also employed leoithine in several other oases, in 
pers<x>B suffering from different affections accompanied 
by deantritioD, and the results were always the same, 
an increase in the weight and a rapid progression of 
strength. A young man suffering from osseous tuber* 
culosis with amyloid kidneys and abundant albumin* 
aria, was given six grains daily of leoithine for fifteen 
days; his weight increased by six pounds. A child. 


et. extremely hin and ilUnonrished, with coughing 
and hectic fever every evening, was ordered four grains of 
leoithine duly; at end of a month he had gained 
fonr pounds in weight, while the general condition was 
notably improved. A litle girl, eat. 8, ill with broncho* 
pneumonia and in a very wasted condition was given the 
same dose of leoithine for a month with similar resnlts. 
Other examples might be cited, but these are sufficient 
to establish the excellent effects of leoithine in all 
oasee of rapid denntrition. 

Germans. 

[Fbok Oub Own Cobbxspomdbkt.] 

BBELn, Jolr IStb, 190L 

At the Society fur Innere Meduin, among those who 
took part in the discussion on 

TOBKBCUnOSlB 

were A. Fraenkel and v. Leyden. The former tud that 
he had made extensive investigation into the presence 
of bacteria in the blood, and it was indnbitable that the 
presence of baoteri/i in living blood was not incom¬ 
patible with maintenance of life for lengthened periods. 
The pnenmococous had been observed in blood for six 
months. The speaker wonld not deny mixed infection, but 
he would not ascribe every possible thing to this origin, 
and especially failures in treatment. The fever was not 
always dne to it; tabercolin inooulatioo showed that. In 
a recent investigation in the last stageof the in a 

patient no bacteria were fonnd in the blood. How 
oonld they attribute the hectic fever to this vanishing 
quantity of germs ? It was andoubtedly the prodaot of 
the toxins formed in the cavities. The signifleanoe of 
germs in the blood depended on their nnmbers. In 
fibrinous pneamonia the pnenmococoas only was con¬ 
stantly found. If present in large quantities it might 
be taken that death would result from sepsis or that 
metastases wonld form, but with a small number of germs 
their presence was of no importance. The majority of 
these patients got well, whilst experiments on AnimAl« 
proved that the bacteria were virulent. 

Hr. V. Leyden said that Hr. Hamtner had brought for¬ 
ward an important practical question, one, moreover, that 
could not be solved at once. He had long been interested 
in the subject of the artifidBl interruption of pregnancy. 
In 1891 he had disoassed the question of pregnancy and 
heart disease, as to whether artificially induced abortion 
should be performed. Oynseoologists had esponsed 
different views as to his proposals. Gussserov had at 
first opposed them, but later on had conceded that in 
bad cases of cardiac disease the pregnancy should be 
interrupted. In connection with his work he had sag- 
gested artificial abortion in renal disease and phthisis. 
In his view the question shonld be decided on its merits 
in respect of each case, and not on general lines. The old 
belief that tuberculosis came to a standstill during preg¬ 
nancy, and got rapidly worse after delivery, oonld not be 
retained, one could not see how pregnancy oonld be a 
protection Skgainst tuberculosis. Formerly it was a 
custom to starve lying-in women for a week after 
delivery, and this perhaps oontribnted to the more rapid 
decline, muoli wonld depend on the state of the woman, 
and if she was living in great misery she ehoold be freed 
from her burden. In any case the physician had the right 
of intermpting a pr^naacy, a right which formerly, in 
view of the destmotion of infant life, had not been con- 
Digitized by ^ 



64 Tub Midical Pbbss. 


AUSTRIA. 


JULT 17, 1901, 


ceded. Another qneation wee, ehonld the physician dis- | 
enade taberonlooe people from marrying. Here also no ! 
distinot principle oonld be laid down, as the transferenoe ! 
of the disease to the embryo not having been decisively i 
proved. 

At the Berlin Medical Society Hr. Herzfeld showed a 

Casb or Bbcovbbt avtbb Abscbss in tub Lift 
Fbontal Lobb 

in a yonng man, at. 20. The patient came to the 
Klinik on May 16th; he had nasal catarrh first on the 
Rght and then for three weeks on the left side, then he 
had severe left ft'ontal headache of a malarial type. 
Examination showed swelling of the mncons covering 
of the tnrbinated bones, copious purulent discharge, 
high temperature (40 C.), and slow pulse, 86 at first, 
later 60. The speaker, from the character of the pulse, 
concluded that intracranial disease was present On 
May 22nd he trepanned the left frontal sinus, this 
oontained much pus and granulations. The posterior 
wall of the sinus was carious, and could be penetrated 
with a probe. This was removed when the dura mater 
projected. No pns appeared at first Then a piece of 
frontal bone was opened, the dura mater split, when a 
large quantity of pus escaped from the sub^dural 
space. A small fistula led into the absoess cavity 
proper. This was enlarged until the finger could be 
passed in. The result was favourable. The rather 
lai^ intra-dnral and intra>oerebzal abscess had caused 
absolutely no other symptoms than those named. The 
intelligence had in no way suffered except for slight 
weakness of thought. 

Hr. Gluck showed four children with 

BbCUBBINO TuBBBCULOUS PxBITONITlB, 

in which puncture, laparotomy, Ac., had been performed 
without snooess. Becovery was brought about by 
leaving the abdomen open, on several occasions in two 
sittings he bad opened it widely, with a transverse in- 
ouion added, and haul removed the tuberculous mass 
partly with the blunt spoon, had resected the omentum, 
and packed the abdominal cavity. The duration of the 
recovery after the operation haul been from four to one 
and a^half years. During the after treatment one could 
watch the caseous masses gradually disappeariug, to be 
first followed by fungous granulations and cicatrisation. 

The Deut. Med. Zeii., 63/01, relates a case of 

Tbiplbt Abobtiom IK Two Staobb. 

A woman, let. 80, after two months suppression, had 
haemorrhage, and was delivered of a two months’ fcetus. 
Three months later she again complained of pain, and 
stated that the abdomen haul continued to enlarge after 
the last abortion, and that the menses had not re¬ 
turned. On examination a pregnancy of four or five 
months was diagnosed, Soon after this, on lifting a 
heavy weight, bleeding came on f^ain, and two living 
foetus, both males, were expelled, one being 24 ctm. in 
length, the second 21 ctm. They bad a common 
placenta. 


JlttBtrta. 

[FEOM OtJB OWN cobbbspondbnt.J 

ViS5XA, Julr IStt, 1901. 
CCCatSCH CONGBXSS. 

This is the third Congress held under the auspices of 


this body, although it has been in existence for the last 
twenty years. Its object is the furtherance of medicine 
and allied physios among the Ceohs and Slavs whose 
language is official. It is now nineteen years since the 
last Congress was held, which is a very unusual interval. 
On that occasion the inauguration took place of 
a Cechisch University at Prague, which is now a 
flourishing rival to tiie German seat of learning in 
the same city. The numbers present at the Prague 
meeting are computed at 1.000, while the XIT. sections 
had 360 papers read of a national interest. It was sug¬ 
gested as an explanation that the last time they met. it 
was to obtain a charter fora University; on the present 
occasion a second University is proposed on account of 
the rapid increase of students at the first. The second 
University will be for Moravia, with the native language, 
which they consider is more conducive to education and 
scientiflo investigation, the promoters pointing to 
Holland and Sweden far examples. 

Prof. Thomayer opened the proceedings with an ex¬ 
haustive paper on The Influence of Civilisation on the 
Nerve System." He treated the subject in a manner 
that proved that civilisation was not injnrions to the 
nerve system, but rather favoured its preservation. On 
the last day Prof. Bayman gave a very inteiasting 
address on the advance of chemistry and its influence on 
physios. 

The next Congress is fixed for 1906 in the same city. 

Mtblitib Chbonica. 

At the Bohemian Society of Medicine Prochazka 
exhibited two cases of a neurotic order. The first was 
that of a young man. sst. 29, a porcelain painter, who 
complained of geneial weaknetsin the lower extremities 
which had commenced about five years ago, otherwise 
he was fairly well. On examination the objective sym¬ 
ptoms were distinctly marked paresis of the lower 
extremities, pyretic movement, and distinctly spas¬ 
tic symptoms. There were well-marked muscn- 
lar tonus, forcible resistance to passive movements, 
increased patellar reflex, shortening of the Achillis 
and pee eqninus of the feet. Sensibility was 
normal, bowels regular, but the fuuotion of the bladder 
was disturbed as the feeling of micturition brought 
about instant attention, the patient having no power to 
retain his urine. The upper extremiUes had the triceps re¬ 
flex increased. There was no history of syphilis, chronic 
hydrocephalus, or cerebral dipl^ia, as no cerebral sym¬ 
ptoms were present. The bladder disturbance seemed to bo 
the only differential point between multiple sderoeis 
and ohronio myelitis, which is common in the latter. 

The second case was that of a man, let 80, who for 
twelve years past had suffered from a distinct weakness 
in the lower extremities, which he observed in springing 
01 jumping. A similar sensation was also present in 
the The leg weakness had increased within the 

last four years more rapidly, be having to assist himself 
with a stick in locomotion. The flr»t symptom of pain 
appeared two years ago in the form of cramp while 
shooting or undressing. For the last ten years the 
hands bad got thinner and the muscular tissue wasted. 
The object of examination pointed to hydrooe- 
pbalos nysbactiform contractions, atrophy of botli 
optic nerves, atrophy of the muscles of the hands 
of the Aran-Duchenne type, atrophy of the muscles of 
the lower limbs, analgesia over the whole trunk. 

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JULT 17, 1901. 


THE OPERATING THEATRES. 


Thb Mbdioal Pbb88 65 


'thenoo-bypersMtheeia in the eztieroitieB, although the 
patient ie able to tell the difference between hot and 
4 M>ld water, he is unable to distingnuh smaller 
differences of temperature. There were aleo spastic 
symptoms present, with exalted mnscnlar tonne, 
cramping in the qnadxiceps omris when active move¬ 
ment was produced, as well as fibrillary contractions 
in the npper limbs. 

Piocbazica di^nosed disseminated sclerosis in this 
case. Syringo • myelitis was negatived by the long 
duration (sixteen to eighteen years) of the disease, the 
temperature sensation, and tiie absence of trophic dis- 
tnrbances. Amyotrophic lateral sclerosis was also 
negatived by the protracted dnratiod of the disease. 

Blood Pbkssoab im Fkvbks. 

Fedemread an exhanstive paper on blood pressure to 
tile *'Oesellsohaft,** which has mnch interest for the 
medical practitioner in tiie application of drags. Scar¬ 
latina, cholera, and malaria, as he has told ns before, 
^ve always a high blood pressure, and in scarlatina the 
higher the pressure the more severe the attack, probably 
owing to the early cardiac hypertrophy not being 
maintained. 

On the other hand, inflnensa can be diagnosed by the 
low blood pressure being 60 to 60 mm, of mercury, or 
1*9 to 2*36 inches. Eight years ago he pointed tbi« out 
from the intestinal symptom which seemed to point to 
dilatation of the vessels of the bowel. The only other 
■disoaso tiiat might be confounded with this low pressure 
is iotmus, which may be differentiated by the colour 
of the skin, oonjnnctiva, Ac. 

In the recent epidemics of influensa, antipyrin, phena- 
oetin, salipyrin, Ac., were used as specifics, which looks 
rather anomalous when we consider that it relieves the 
pain in febrile or non-febrile conditions, and that these 
drugs are supposed to act throngh their depression of 
tiie arterial system. The curative action of these drugs 
in influenta rests on the physiological fact that they 
dilate the small arterial vessels, which are greatly con¬ 
stricted by the inflaensal toxin, and thus diminish the 
resistance to the cardiac efforts, which are also weakened 
by the toxin. The first effect of the influenzal poison 
is expended on the heart and vascular circnlation, 
^ving rise to a multiplicity of symptoms such as fatigue, 
headache, Ac., and according to the severity or other¬ 
wise of the fafematio symptom some patients suffer from 
a variety of symptoms not met with in other*, sneh as 
brain affections, others from mnsoular troubles, while a 
tiiird may have only a bowel lesion. 

The primary cause is the toxin, as the simple inter¬ 
ference with the cardial movement would not so affect 
the muscles, white the slow recovery from the brady- 
oardia, often lasting a year, confirms this opinion. 

The prognosis in disease c».n also be gauged by the 
blood pressure with approximate aocnrscy. In diseases 
of high pressure the danger is greatestin elderly people, 
and when not fatal may so irritate the vasomotor centres 
as to produce arterio-solerosis. It has been affirmed that 
the opposite condition prodnees calcification of the 
vessels, bnt this is incorrect, although normal blood 
pressure not infrequently produces arterio-soleroeis. 

The treatment of influenza ie correctly carried out with 
antinenralgics and antipyretics in order to relieve the 
blood pressure. Pn^;ativee also relieve the atony of the 
bowel. 

Eisensohnitz thonght the infinenza poison damaged 


more than the heart, and opined to show that it 
was a case of general intoxication. 

Teleky objected to antinenralgics as specifios in 
influenza, and doubted very much the action ascribed to 
the heart. 

Wintemitz asked if the blood pressure remained low 
throughout the disease, or was it altered in the event of 
oronpouB pneumonia appearing. As to arterio-soleroeis, 
he always understood this to be associated with high 
pressure, which so paralysed the vascular system as to 
to induce the sclerosis. 


<Dptratht5 ^kmtrea. 

MIDDLESEX HOSPITAL. 

LaPABOTOMT fob PlBITONTTIB OF DoUBTFUL ObIOIN. 
—Mr. JoHH Mubbat operated on a man. st. 33, a cab 
driver, who had been admitted for abdominal p«" 
The man had bad good health all his life, bnt he stated 
he had snffered from indigestion. A fortnight before 
admission he began to complain of pain scross the lower 
part of tiie abdomen. The pain was of a griping 
character, and he was unable to account for it in any way. 
It got worse, and he was obliged to take to bed. He 
felt very weak, bad no appetite, and during the attacks 
of pain he oonld feel a lump in the left iliac region 
about the size of a walnut; the abdomen was very 
tender and deep inspiration caused pain. His bowels 
were confined, and he had great difficulty in p n s M ng 
very scanty motions. He was ordered an enema, which 
produced a good evacuation, and he passed a large 
quantity of flatus. The day before admission he 
vomited once, the vomited matter being white in 
colonr and frothy. The pain commenced always on the left 
side of the abdomen. On admission at 10 p.m. be 
was a well-nourished man with a great deal of tender¬ 
ness in the abdomen. He lay on his back, the face was 
pale, he was not collapsed, the skin was moist; the 
abdomen was slightly distended, the abdominal wall 
rigid, and respiratory movements were limited to the 
upper part. The abdomen was resonant except in the 
left Uiac region, where there was marked dulness ex¬ 
tending into the left Sank; liver dulness was normal; 
there was resonance in the right iliac region, and 
nothing abnormal conld be felt on deep palpation. 
There was marked tenderness over the whole of the 
abdomen, especially in the left iliac region, where an 
increased sense of resistance was distinctly felt The 
temperature was normal, pulse 98, the tongue was moist 
and thickly coated with white fur. Examination per 
rectum the bowel was found to contain some hard fsecal 
matter, but nothing abnormal oonld be felt either 
in the rectum or in the pelvis. On the following 
day the patient’s condition was worse, the pain 
and tenderness were more marked, the rigidity 
of the abdominal wall more pronounced, the 
man bad vomited once, the vomited matter being 
greenish in colonr. The bowels had not acted satisfao- 
torily, though he had been ordered an enema only a few 
scybalous masses came away; pulse was 112, tempera¬ 
ture 101^. It was decided to open the abdomen, the 
patient’s condition being obviously serious. An incision 
was made in the middle line below the nmbilicns. On 
opening tiie peritoneum a quantity of stinking, puru¬ 
lent fluid escaped; the intestines ware everywhere 

Di2:;:zed by ^ 



36 Thz Hidioal Pb>s8. 1j£AD1ITG' ARTIGLjES. 


adherent and covered with nomerone flakes of thick 
yellow lymph. The abominal cavity was flushed out 
with sterilieed water at temperature of 110°, and an 
attempt was made to And the eonroe of infection. The 
oseonm and appendix were found to be normal; in the 
left lumbar and iliac redone there was a large, hard 
mass consisting of matted coils of intestine, and on 
separating some of these adherent coils a large 
collection of exceedingly foetid pus was evacu¬ 
ated from the left iliac fossa. At this stage of the opera* 
tion the patient stopped breathing, but soon recovered on 
artificial respiration being performed. As it was not con¬ 
sidered desirable to farther inveetigate the cause of the 
trouble, the abdomen was mopped out, a glass drainage 
tube inserted into the pelvis, and the wound closed with 
silk-worm gut sutures passed through the whole thick¬ 
ness of the abdominal wall. Mr. Murray said that the in- > 
terest of the case lay in the diagnosis, which was ren¬ 
dered difficult on account of the impossibility of obtain¬ 
ing anything like a complete history from the patient. 
When seen shortly after admission, he (Mr. Murray) was 
of opinion that the esse was not one of peritonitis, 
and was rather inclined to regard the symptoms as due 
to chronic intestinal obstmotion; the general appear¬ 
ance of the patient and the normal temperature 
rather strengthened this view. The pain was of 
distinctly colicky character, and daring attacks the 
patient was seen to raise himself in bed on his hands 
and kneee, which was thought not likely to occur in 
peritonitis. The case had none of the features of an 
ordinary one of appendicitis; if the patient’s statemente 
were to be relied on his ^mptoms commenced and for 
some time were limited to the left side of the abdomen, 
and the tenderness was less marked on the right side, 
and there was nothing to be felt in the region of the 
Cfecum. There was no history of injury such as might 
point to a rupture of the intestine, and although the 
man complained of attacks of indigestion, there was 
nothing to indicate perforation of a gastric or duodenal 
ulcer. Operation was therefore postponed, the patient 
being ordered an enema and a hypodermic injection of 
morphia. On the following day there could be no doubt 
that the patient had general peritonitis, though there 
was nothing to indicate the cause of the condition; 
therefore it was decided to operate at once. The abdo¬ 
men was opened in the middle line, as it afforded the best 
position for exploring all parts. All that could be deter¬ 
mined at the operation was that the origin of the infection 
lay in the matted coils of intestine on the left side 
the exact nature of which was purely speculative, 
though Mr. Murray thought that it might be aooounted 
for by some slight injury which had produced rupture of 
the intestine, which had escaped the patient’s recollec¬ 
tion, or that it was secondary to ulceration of the intestine 
with perforation. He pointed out that from the condition 
found at tiie operation it obviously would have been 
better to have opened the abdomen the night before, 
though it would not have made any difference to the 
ultimate result, as the extensive adhesions present 
showed that the peritonitis was at all events of some 
days’ duration, if not dating bac^ from the commence¬ 
ment of the illwftM a fortnight before, and such a 
condition he considered absolutely hopeless. 

The patient died twenty-four hours after the opera¬ 
tion. At the post-mortem an annular growth of the 


JuLT 17, 19U1 

upper part of the rectum was found giving rise 
to considerable stricture, with ulceration and perfora¬ 
tion at seat of growth; there was general peritonitis. 
The glands of the mesentery in the region of the growth 
were infiltrated, otherwise there were no secondary 
deposits. 


BaOISTEESO rOB nUKSMISSlOX ABSOXD. 

jpttsjB anb Circnlat. 

Pabllshed tmrj Wednssd^ mornins, Pnoe M. Pott free, Std. 

ADTSBTISEICEMTS. 

foa On IxBUTios t—Wbola Pose, £5 Ot. Od.; Half P>cs> 
a lOs. Od.; Quarter Page, £1 fit. ; One-elglith, ISt. 6d. 

Foa A Ssams or IvsianoasWbole Page, thirteen Inaertiooa 
(weeklj, fortnightlr, or monthly), at £8 10s. Od.; tweatr-six 
insertlona (weekly or fortnightly) at £3 8a. Od.; fifty-two 
insertiona (weekly) at £8 eaoh. Half Page, thirteen ineerttoae 
at 8&e, i twenty-alx at 82a. t fifty-two ineertio&e at 80n. eaoht 
Quarter-page, thirteen insertioiia at 18a. twenty-eix inaertione 
at 16 b. : fifty-two inaartiona at 15a each. 

Snail annonneements of Praotloas, Assistanoies,VBoancias, Books, 
fto.—4aTen or under, 4a. per inaartlon; Sd. par line 

beyond. 


JfUbtcal fvesB $nb Circuisr. 


“BALU8 POP0LI SUPBIMA LBX.*' 


WBDNESDAT, JULY 17, 1901. 


LORD ROSEBERY ON A NOBLE PROFES¬ 
SION. 

It would be hard to find a more fitting orator than 
Lord Rosebery for any festival requiring cheery itit 
and a philosophic knowledge of men and tilings. 
Last week he occupied the chair at the twenty-eighth 
I festival of the Royal Medical Benevolent College at 
Epsom, of which institution he is President. The 
college is one of the few organisations in existence 
for the benefit of the families of deceased medical 
men. Its present position was tersely described 
by Lord Rosebery when he stated that 
there were fifty foundation scholars, chiefly 
necessitovm orphans of medical men, and the 
fixed income of the institution was not more than 
one-third of the £6,000 which had to be raised for its 
maintenance. It is gratifying to be able to announce 
that the result of the appeal made by the noble 
chairman resulted in subscriptions and donations to 
the extent of £4,127. The mere fact (rf the necessity 
of such a step implies that the members of the 
medical profession have not extended to Epsom Col¬ 
lege that measure of support which it deserves at 
their bands. The well-to-do medical men in 
the United Kingdom could readily support the 
Epsom foundation in affluence by an individually 
smaL contribution. It is a melancholy fact 
that the conditions of practice in this country 
are such that in many cases the medical practitioner 
is unable to make any provision for his wife and 
family. Should he die before the children are grown 
up and equipped to take their part in the battle of 

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July 17, 1901. LEAdHTC ArtTIOLGS. Th> Medical Fbbss. 67 


life their lot is often of the hardest. The Chairman 
summed np the position in a few terse and eloquent 
sentences when he remarked that it was easy in an 
assembly like that he was addressing to fancy that 
the medical profession was nothing but a brilliant 
and a lucrative one, bnt when one came to think that 
thereweresomethousands of medical graduates turned 
out every year— that there were some 30,000 in the 
United Kingdom—^ne could not feel but that the 
number of blanks in that profession must be out of 
all proportion to the prizes. The princes and the 
prizemen formed only a small proportion of the great 
number in the country, and of the small practitioners 
in the towns who are at the beck and call of disease 
and suffering by day and by nij;ht, in every weather 
and at every hour. It was a noble profession, but 
in mmiy cases it was a profession of forlorn hopes. 
The truth of that presentment must be at once 
endorsed by all who know the inner life of the medical^ 
world. The interests of the medical profession are 
at the mercy of unfair competition on all sides. 
Perhaps when Lord Bosebery returns to Office in 
the Grovemment, es one day he assuredly will, he 
may remember the sad case of the medical profes* 
sion and help forward some saving legislation on 
its behalf. An amended Medical Act is wanted as 
an iwitiftl step whereby quack practice might be 
readily and efficiently repressed; the patent medi* 
cine stamp should be abolished; but, above all 
things, a General Medical Council should be consti¬ 
tuted upon a basis really representative of 
tile rank and file of the medical profession, and 
its powers should be extended so as to include 
the power of protecting the public as well 
as the profession from illegal practice. In that way 
Lord Rosebery might do much to relieve the folom 
hopes of what he has kindly sx>oken of as “ one of 
the noblest, if not the noblest, of all the professions.” 
It is to be hoped that the hurry and rush of political 
Kfe, especially for those who are weighted by the 
responsibility of office, will not obliterate or over¬ 
whelm the convictions that were stated by him with 
BO much eloquence at the recent festival. As every¬ 
one knows, it is one thing to give utterance 
at a public dinner to abstract and general 
admismons of the existence of an undesirable state of 
affurs, but quite another thing to undertake the 
task of practical reform. It seems hardly possible 
to imagine that the Medical Acts will remain 
untouched when Parliament finds time to turn to 
the many social matters that demand earnest atten¬ 
tion. Meantime it is the duty of the medical pro¬ 
fession to proclaim its wants with clearness and 
steady insistauce, and to urge that the public 
speeches of statesmen may be backed up with legis¬ 
lative performance. 

THE CASH VALUE OF A FINGER. 

A PROVISION merchant by ill-chance happened to 
scratch the second finger of his right hand on a nail 
projecting from some part of a haddock box. On 
April 14tb, 1900, he consulted his private medical 


attendmit, in Leith, five days after the accident 
The physician j>resm7>ed (according to reports of the 
case) for him. On May 18th the di^t had to be 
amputated; t.e., thirty-nine days after the scratch. 
The merchant then claimed £500 damages from his 
physician for professional negligence. The judge 
who first heard the case in the Lower Court dis¬ 
missed the action, but on appeal the Higher Court 
decided that there were grounds for it going to 
triaL Before this, however, the defendant settled 
the case by payment of £100 and expenses. As 
reported the important facts in the case non tunt. 
The doctor explained that his work after his first 
interview with the pursuer had had to be 
delegated to another physician, owing to hia 
own ill-health. No note is given of how the 
pursuer acted up to instructions, if he com¬ 
mitted indiscretions, &o. An instance of personal 
application might well be noticed here. The writer 
was summoned to a club official, the greater part of 
the top of whose left index finger hung by only a 
narrow band of skin to the proximal portion of the 
digit; the nail crushed and crumpled, but the ter¬ 
minal phalangeal bone only bruised, not broken. 
These injuries were due to a crush between a door and 
its jamb. The detached portion was pulseless, in¬ 
sensible, bloodless; the terminal phalanx devoid of 
periosteum over a part of its surface. The method 
of treatment followed consisted in trusting to nature. 
The various bits brought together after their sur¬ 
faces had been “dabbed” only with 1‘40 icarbolic,. 
covered with protective, protected with dry antiseptic 
cotton wool in excess, and the hand and arm sup¬ 
ported by a sling. The questions at issue were 
mainly: " Is it possible to preserve the vitality 
of the bruised and tom fragments P Which ia 
of greater importance: Rendering the wound asep¬ 
tic, or endangering the vitality of the half-separated 
portions by the use of antiseptic agents P 
Now, if this incomplete and theoretically inefficient 
cleansing of the wotind had been followed by septic 
conditions, the judgment of the exponents of legal 
empiricism would probably go against the adviser of 
such a plan of treatment. If successful, as was the 
case just mentioned, no fault would be found 
although the measures adopted in each event 
were the same. It is most common to meet with^ 
instances among doctors in which a finger, or part 
thereof, has had to be amputated owing to 
their too faithful adherence to antiseptic rules^ 
to the death of tissue caused by too forcible 
bactericidal measures, and ignorance of the fact 
that antiseptic agents employed in even slightly too 
concentrated a form may kill more than bacteria, and 
result in more barm than benefit. Each case of 
crushed or poisoned fingers or toes differs in charac¬ 
ter and detail. The result in such oases physicians 
or surgeons must needs strive for, consists in the 
attempt to save tissue. If vitality be so low that 
the action of antiseptics will possibly destroy 
the diseased or injured part, trusting to nature 
may be quite successful. Should this fail, the 

Di^:;ized byCjOO^Ic 


68 Thi Mbdioal Pbbbb. 


LEADING ARTICLES. 


July 17. 1901. 


is one and the same—the knife. How, then, 
can anjone judge, especially in the absence of 
emergency, the motives which may lead to the 
adoption of one of two courses, when it is 
Apparent that either of them may fail, either may 
-succeed, either seem to he unsuitable, or either to be 
warranted P Gases belonging to this category usually 
impose most unmerited hardships upon medical men. 
How can they explain that they prefer expectant 
methods, and have obtained good results from them, 
to the more official, up-to-date measures, in dealing 
with certain cases P This argument is logical, full of 
•common sense; the chances of continuance of vitality 
in severely affected tissues, when reliance is chiefly 
plaoed upon the recuperative powers of nature, are 
often better than after a routine application of anti¬ 
septics from a too conscientious regard for the 
iashionable usages of the day. 


NEW DEPARTURE IN PENALISING THE 
PROFESSION. 

Sis Fostescub Fla.nnbby, has the repu- 
'tation of being a level-headed and capable man of 
business. What Nemesis, then, can have driven him 
to bring forward the fresh clause of which he has 
given notice as an amendment to the Factory and 
Workshop Acts Amendment Bill, now being die- 
•cussed by the Standing Committee on Trade of the 
House of Commons P We cannot persuade ourselves 
that Sir Fortescue Flannery could have drafted the 
olause himself. For not only is it utterly 
objectionable in principle and design, but it 
betrays such crass ignorance in every line, and 
is withal so entirely unworkable, that we can 
only imagine the clause was drafted by some 
illiterate and ignorant persons, and that they in 
An evil hour have been able to exercise pressure 
to induce Sir Fortescue to adopt it without his 
having even read it. The clause in question is 
Another of those unjust inroads on the personal 
liberty of medical men whereby government by 
special penal legislation exacts the fruits of their 
scientific knowledge and experience. Such forced 
labour is indistinguishable from slavery, and whether 
paid for or not is utterly objectionable and unjusti- 
ffable. In this case Sir F. Flannery does not even 
propose to gild the chains of the forced labourers, 
and he praposes not even the noble half-crown for the 
important services which, in his ignorance of the sub¬ 
ject, he hopes to compel medical men to render 
to the public. It may not be inopportune 
to ask whether he allows the Government to compel 
him to give information on special engineering sub¬ 
jects to the public, and if he is content to do such 
work for nothing p By his proposed new clause he 
would compel medical men, attending a case of 

anthrax (suspected),” to take some of “ the serum ’’ 
from the patient, whether the latter or his friends 
are willing or not, and to send it to “ a bacteriological 
expert ” for microscopical examination; and in case of 
the death of the patient some person or other, for 


no one is specified, is to take “ the serum ” from the 
dead body and forward it to the same destination. 
It is somewhat amiuing to note that what “the 
serum ” means is not indicated. It is well to 
be outspoken on such a matter. To us the pro¬ 
posal is nothing short of an outrage on the patient 
and bis friends, to say nothing of the medical 
attendant who may consider the proceeding would 
seriously affect a prostrate sufferer from anthrax, for 
we know well the alarm with which moat persons, 
especially the poor and ignorant, regard anything 
which their imagination suggests is in the nature of 
what they all term *' an operation.” Is the doctor to 
be compelled to waste the flickering energy of his 
prostrate and dying patient by arguments directed 
to prove the painlessness and harmlessness of 
the proceeding, and the benefit to science, and 
the evidence which it may afford in legal pro¬ 
ceedings against an employer P Even if the doctor 
thought the agitation of this proceeding might injore 
or kill his patient, under Sir F. Flannery's clause he 
must persist in drawing the serum. The idea is repul¬ 
sive in the extreme. It is more cruel than 
the most reckless experiment in vivisection, and it is 
not certain that the medical attendant would not be 
liable for cruelty were he to carry out such a heart¬ 
less and unjustifiable experiment, and the offensive 
proposal has not even the recommendation that it is 
intended for the relief of the sufferer. He would 
receive no benefit from it whatever. When we add 
that even if the medical attendant succeeded in over¬ 
coming the objections of the friends and the patient, 
the whole heartless proceeding would in most cases 
be utterly useless, we shall have completed the in¬ 
dictment against this most unjustifiable proposal. 
Now, it is well known to all persons acquainted with 
the subject, but obviously not to Sir F. Flannery, 
U.P., though he represents a district where anthrax 
is familiar, that the bacilli are very rarely indeed 
to be found in the blood in the early stage of 
anthrax, by microscopical examination, even when 
the presence of the virus can be demonstrated by 
inoculation. The negative result would tend to 
seriously confuse the diagnosis in the opinion 
of many persons. The action of Sir F. Flannery, 
M.P., in persisting in putting forward this propos^ 
is greatly aggravated by the fact that the Home 
Office refused to act on the suggestion to insert the 
clause in the Bill, on the irresistible ground that 
existing powers are quite sufficient to enable all 
necessary information about such cases to be ob¬ 
tained. We trust the whole profession, and all 
reasonable men will rise agmnst this indefensible 
proposal to impose fresh penal legislation on medical 
men, and to compel them to inflict unjustifiable 
hardship, pain, and cruelty on their patients. The 
following is the text of the proposed clause, and 
never did so few words construct such a monument 
of ignorance and folly. 

Sir Fortetcue Flannery $ Proposed New Clauee tn the 
Factory and Worhehop Acta Amendment BiU. 

“ With every notification by a doctor (*; or other 


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JULT 17. 1901. _NOTES OK CTTBREfTT TOPICS. Tas M.dical Pe.8». 69 


mterested person of a case of anthrax (suspected) (•) 
poiMnin)?, the medical practitioner attending (”) the 
patient shall immediately forward a specimen of the 
serum (*) to a bacteriological expert appointed by 
the Secretary of State for microscopical examina¬ 
tion (*), and in each fatal case of anthrax a specimen 
of the serum taken (*) as soon as possible after death, 
shall also be forward^ to such expert by the doctor 
who certifies the death.” (^) 

The following points are deserving of attention:— 

(*) Doctor of what ? Music, laws P 

(•) Merely “suspected” cases are not notified. 

(*) If some “other interHsted person” has sent 
away the notification without informing the doctor, 
bow can the latter be compelled to send the serum 
along with it P 

(♦) What serum? Who is to take “ the serum P ” 
There must be no blood with “ the serum”! 

(”) Such microscopical examination in early stages 
usually gives a negative result, and this may lead to 
a denial of the case being anthrax. 

(*) Taken by whom P Who has authority to 
forcibly make such a post-mortem examination P 

What is to happen when the bacteriological 
expert has made his microscopical examination P To 
whom is he to report bis results P 
(*) Inquests are usually held on fatal cases of 
anthrax. Interference with the body before the in¬ 
quest would cause serious difficulties with the coroner. 


on ®nrrntt ^opiro. 


Cocaisisation of the Spinal Cord. 

Ax the meeting of the “ Soci6t4 de Biologie,” on 
the 2obh ultimo, asvery interesting discussion on the 
action of cocaine as anansesthetic and the best method 
of cocainisation of the spinal] cord took place. To 
exhibit the constricting power of the drug M. 
lisborde exhibited a rabbit, the sympathetic nerves 
of whose ears he had cut. The vessels of the ears 
became enormously engorged, and then he hypo¬ 
dermically injected five milligrammes of cocaine into 
the base of the ear. which quickly became ex¬ 
sanguine. This effect M. Laborde considers is not 
wholly due to the effect of the coc^e on the 
muscle tissue, but is due is great part to its 
effect on the nervous tiseue. And he considers that 
the direct action of the drug on nervous tissue is a 
great source of danger, and quotes the case of a 
woman in whom a carelessly-given interspinal injec¬ 
tion produced dangerous effects from coming in con¬ 
tact with the nerve tissue. For the intra-medullary 
injection he proposes an extra-doral one, where ab- 
scRption is very rapid. Indeed, he found that inter¬ 
muscular injection was in many cases equally useful. 
He gave hypodermic iujections to dogs of from 
five millierammes to one centigramme to animals 
of from four to five kilogrammes in weight, and 
found that complete ansssthesia of the posterior 
fimbs down to the very footpads followed. M. 
Brooard, who adopted the extra-dural method, found 
that in sixteen cases a ha.lf per cent, solution pro¬ 
duced relief from pain in sixteen cases of sciatica, 
one of herpes zoster, one of lumbago, and one 
of “lightning puns” in the limbs. Ko un¬ 
pleasant effects followed, with the exception of 


one case, a neurasthenic patient, who com¬ 
plained of headache after the anesthetic effects 
had passed away. The pain in every case was 
relieved within two or three minutes after the- 
injection, and in the cases of sciatica the freedom- 
from pain continued for four days, in some cases,, 
and for two days, at least, in all. The members 
appear to be agreed that the tolerance of the epi¬ 
dural cavity of the spinal canal is under esti¬ 
mated. M. Brocard injected with impunity 1,000- 
grammes of serum into tha epidural cavity of a 
dog seven kilogi-ammes in weight without producing 
any symptoms of compression. But a profuse poly¬ 
uria, lasting for some hours, followed. By inject¬ 
ing a dark-coloured liquid into the space, he demon¬ 
strated clearly at the autopsy of the animal 
the rapidity with which absorption takes place- 
in the part. Any modification of the interspinal 
operation of cocainisation that diminishes its risk 
will be welcomed by every branch of the medical 
profession. Cocainisation of the cord, if robbed of 
its risks, offers to displace all the other methods of 
ansesthetisation in minor surgery. M. Laborde’a 
proposal for extra-dural injection seems a step in 
the right*direction, but it will require considerable 
skill and practice to acquire the necessary dexterity 
of manipulation to avoid piercing the membrane and 
yet inject the canal. 


The Assumption of Folse Designations. 

Within the past few days two persons arrested 
by the police described themselves as members of 
the medical profession, and a third, who was found to 
have beaten a poor woman savagely over the bead 
with a stick, without provocation, declared be was 
a medical student. He may possibly have com¬ 
menced qualifying studies and his name be enrolled 
on the 8tud«nU‘ Register. For the honour of medi¬ 
cine we hope it is not, but if it should he we hope it 
will be struck off. The leaven of such men must be 
kept out of the profession if it is to retain the 
honoured place in public esteem it has so 
long enjoyed. But are the men who so often 
figure in police reports as doctors and medical 
students really what they pretend to be P In nine 
cases out of ten we have failed to verify the names 
on searching the official Register. The statement is 
apparently made to excite sympathy from a public 
that naturally esteems medical men as their beet 
friends in sickness. The impostor trades on this. 
He shelters himself under the cloak of medicine,, 
and would pass off his blackguardism and brutality 
as the innocent jocularity or frivolity of the 
medical student. The constable takes the descrip¬ 
tion and carefully enters it in the station-book and 
the chaige-sheet. The lie is again repeated before 
the police magistrate, and thus finds its way into the 
daily papers until many respectable members of 
society come to think that a large number 
of medical men and students are to be found 
as hab%txMe of the police cells. This dirt¬ 
throwing on the medical profession should be- 

Di^:::zed bi ^ 


70 Tsx Hidioal Pbbb8' 


NOTES ON OUERENT TOPICa 


stopped. Our raake are 
** oomer-boys,” and no profession calls for i^reater 
sobriety cf conduct from its members. It is intoler* 
able that every ruffian found in a drunken row 
should bring discredit on the profession by a lie easy 
of detection—a lie told deliberately to excite a 
friendly feeling in the audience and take off some¬ 
what from hie riohly-deserTed punishment. In every 
police-court there should be a copy of the Medical 
BegisteraxiA of theAfedieoZ Stvdenf$‘ Regieter, and any 
person claiming to belong to the profession should be 
compelled to prove it; and this not in palliation, but 
rather as an i^gravation of his crime. If it should 
so happen that a medical man or student be found 
to hare committed a brutal offence, his name should 
be reported to the General Medical Council. It is 
imperative that medicine be kept free from all un- 
cleanness ; the man coming within her portals must 
have clean hands. 

The Hospital Scandal" at Stockport. 

The Town Council of Stockport appears to be 
unable to dispose of the charges of misconduct in 
the management of the Isolation Hospital. The 
matron of that institution has addressed a latter 
through her solicitors to the Council, pointing out 
that suggestions have been publicly made that she 
had starved the patients and staff for the sake of 
personal gain. Under these circumstances an inde¬ 
pendent public investigation was asked for, but 
declined by the Sanitary Committee on the ground 
that no useful purpose would be served by acceding to 
the request. The questionwas raised laterintheTown 
Council and gave rise to an acrimonious and heated 
debate. It was stated that the stock of linen, 
utensils and other things was defective, and that one 
patient had to have vegetables and podding on the 
same plate, whilst another had to wait until a plate 
was finished with by the occupant of the next bed. | 
The Mayor of Stockport and other members of the 
Council appear tu have objected strongly to any 
discussion of the matter, because of “holding up 
the town to notoriety" and to bring the place to 
disrepute. That standpoint certainly is not likely 
to commend itself to those who entertain a high 
ideal of the duties and responsibilities of local 
governing bodies. The Town Council may decline a 
public inquiry when demanded by a late official, but 
they surely can hardly hope to escape the much 
moie public and searching ordeal of an inquiry by 
the Local Government Board. If the state of affairs 
at the Isolation Hospital has been anything like as 
bad as presented by rumour it is a wonder how the 
matter could have escaped the notice of the Board 
inspectors. 

Plastic Operations on the Ureter. 

Fboh time to time there have been put forward 
fascinating proposals for the treatment of those cases 
where loss of substance has occurred in the ureter to 
such an extent that vesical grafting is not possible. 
Under these circumatances many methods have been 
advocated, butin the majority of them experience of 


JULT 17, 1901. 

theresultshas been gained by experimentson animals. 
Nussbaum, in 1887, suggested joining the divided 
ends of the ureter by a connective tissue tube, but It 
must be urged against this su ggestion that'contrac- 
tion would almost certainly follow. Rydygier, in 
1892, improved on this idea and favoured the plan 
of constructing the splicing of the ureter from the 
skin of the abdomin^ wall. Van Hook has pub¬ 
lished an ingenious plan for replacing a lost 
portion of the ureter by means of a diverti¬ 
culum when it is not possible to implant the duct 
directly into the bladder. A few years ago a 
very interesting report was published on the 
substitution of the upper portion of the ureter in a 
calf by a decalcified turkey’s wing bone, the back¬ 
flow due to intra-vesical pressure caused the f^ure 
of the investigation, but a perfect tube of connective 
tissue was reported to have formed round the 
bone. Dt. J. B. Bacon, of Chicago, recom¬ 
mended the substitution of the ureter, where 
it was wanting, by an isolated piece of bowel, 
and D’Urso and Favii, of Borne, suggested the 
Fallopian tube as a substitute in woman. Mr. Henry 
Morris has now given it as his opinion that it is 
more than improbable that these suggestions will be 
accepted by the surgeons of to-day, and he also con¬ 
siders that the condition of the patient under the 
circumstances in which plastic operation on the 
ureter is likely to be called for would not be such as 
to justify a trial of these procedures. Though the 
surgery of the ureter is young in years it has lately 
come prominently into notice, for since 1894 about 
100 papers on the subject have appeared, whilst 
from 1890 to 1894 scarcely a dozen articles were pub¬ 
lished. 

Police Station Medical Certiflcatee. 

Some points of general interest to the profession 
have lately arisen at Newcastle in connection with 
the medical examination of persons charged with 
being drunk and incapable. Two cabmen in that un¬ 
desirable position asked to see their own medical 
men, but in each case the police called in Dr. Baum¬ 
gartner, who is presumably their official sui^eon. The 
magistrate, Sir Charles Hamond, appears to have 
adopted the view that a request of the kind men¬ 
tioned should have been granted. The police, 
he remarked, should always be very careful in agree¬ 
ing to the demand of any person who wanted a 
doctor under such circumstances, because there 
were peculiarities in the life of every man, 
and he might readily believe he would be better 
examined by his own medical man than by a stranger. 
There is much sound reason in that view of the 
case, but the police are hardly likely to abandon 
their somewhat autocratic attitude in dealing with 
persons taken into custody upon a charge of 
drunkenness. There is much to be said in favour of 
a routine medical examination of every prisoner 
lodged in a police station on suspicion of intoxica¬ 
tion. Another of the magistrate's suggestions may 
be accepted with little hesitation. He has firmly stated 

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JuLT 17, 1901. NOTBB OIT OU ABENT TOPICS. Tbb Midioal Pans. VI 


that the opinion of the medical man called to the 
police station should be reduced to writing, in place 
of the Terbal report at present often tendered to the 
police. The door to possible abuse thrown open by 
the slipshod method of statement by word of mouth 
is so obvious that it is a wonder any responsible 
magistracy could accept evidence of the kind. 

Pathology at the London Hospital. 

Ths Hon. Sydney Holland struck a tree note 
when be said that the new Pathological Institute at 
the London Hospital was a recognition of the 
responsibility which rests on the management of 
the largest hospital in England with its vast power 
of doing good and lessening misery and suffer¬ 
ing, and with its equal power of doing mischief 
if it refuse to advance. Mr. Holland and his 
Ho us e Committee have realised that it was their 
duty to provide accommodation for men whose life 
is spent in the specialised work of in'<reetigating the 
exact canse of death by the scientific methods which 
the great advances in bacteriology, chemistry, and 
microscopy have placed at the disposal of modem 
observers. The number of post-mortems at the 
London Hospital is from 900jto 1,000 in a year, and 
in the new Pathological Institute such studies of 
the causes of disease can now be made under 
conditions which will secure success and make 
advance i>oesible and probable. The inauguration 
of work was well graced by the presence of 
Sir Henry Boscoe, Lord Lister, and other eminent 
men. 

What Lid Mr. Chamberlain Beally Mean? 

Ik the course of a recent great public speech, Mr. 
Chamberlain made use of a simile not quite in tune ; 
with his nenal brilliancy. Speaking of the internal 
dissensions of the Liberal party, he likened them to 
organisms of a low type called by naturalists fissipa- 
rous organisms, which fall to pieces at the slightest 
touch. Any schoolboy who has studied natural history 
for a term or two knows that fissiparous division is 
a peculiar method of reproduction and is independent 
of outside physical violence. If the Liberals are in 
an active state of fissiparons division they are on 
the high road to become a huge numerical aimy, 
for that particular method of reproduction proceeds 
at a phenomenal rate. Mr. Chamberlain certainly 
did not convey that impression. The risk of 
ai in flaw is proverbial, especially when taken from 
fields with the topography of which the author is 
not altogether familiar. 

Suggested Alteration of Title, Royal Medical 
Benevolent College. 

Loan Hosbbbbt, the President of the Epsom 
College, objects very much to the fall name and 
title of this institution. His idea is that to call 
Epeom College the Royal Medical Benevolent Col¬ 
lege is to ose a superabondance of adjectives. Even 
the boys at Epsom College, according to Lord 
Bosebe^, dislike the full name with its many 
spithets, and certainly the suggestion that the insti¬ 


tution shonld be called Epsom College, with the 
words Boyal Medical Foundation in brackets below, 
is worthy of all consideration. The Treasurer, Dr. 
C. Holman, who undoubtedly has considerable in¬ 
fluence in the matter, will not consent to shortemng 
the name because it may affect the amount of sub¬ 
scriptions. This, of course, is a perfectly reasonable 
opinion, and few men are in a better position to judge 
of the correctness of the conclusion than Dr. Holman. 

Cough. 

A 8IMPIK faith in the efficacy of cough mixtures 
is apt to be rudely shaken by the study of the 
namerons reflexes through which the exciting im¬ 
pulse may travel, independently of pnlmonary 
bronchial irritation. We are told that there are 
fourteen recognisable varieties of useless cough, 
that is to say, cough which has not for object to rid 
the respiratory apparatus of irritating secretions. It 
is a matter of cliitical experience that quite a num¬ 
ber of cooghs are caused by some abnormality in 
the nose, ear, and throat, while others are, with 
equal plansibiliiy, ascribed to disordered states of 
the stomach or some other distant organ. This 
fact adds singularly to the diffioulties with which the 
physician has to contend in his endeavour to ascer¬ 
tain the source of, and to relieve, tbe cough. One 
I of the most fruitful sources of reflex oough 
is the presence In the nose or pharynx of 
varicose veins or some form of local hypertrophy, 
consequently the examination should commence in 
these regions. The root of the tongue is a common 
site of varicosities, but the epiglottis is often 
involved, and if success is to attend oar efforts to 
relieve local treatment is indispensable. Apart from 
obvious structnral changes, the existence of hyper- 
sasthetio areas on the nasal mneons membrane and 
on that of the vaolt of the pharynx may and do 
determine a dry, irritating cough, exceedingly diffi¬ 
cult to subdue, except by the discovery and treat¬ 
ment of such areas. The probability of a oough 
being of reflex origin may he inferred when it is 
spasmodic, practically constant, and accompanied by 
little or no expectoration, especially when signs of 
pulmonary disease are absent and when the sym¬ 
ptoms persistently resist all medication for per¬ 
manent relief. The presumption is strengthened if 
the general health is not thereby obviously affected, 
and the diagnosis will be] absolutely confirmed when 
upon removal of the assumed cause, it promptly dis¬ 
appears. 

An Overlooked Factor in Ear Disease. 

The remedial treatment of ear culminating 

in deafness is, on the whole, so nnsatisfaotory that 
every su^estion as to causation is worthy of pass¬ 
ing consideration. That the field of investigation 
is as yet far from closed is evident from the com¬ 
parative inefficacy of the means employed for the 
relief cf such conditions. In a recent number of 
the Journal ofihe American Medical Aaaeeicdion Dr 
Jackson calls attention to the influence of hjrper- 
trophic thickenings on both sides of the vomer near 


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NOTES ON CURRENT TOPICS. 


72 Ths Mbdioai. PsEsa. 


JULT 17, 1901. 


the posterior free margin. The effect of these hyper* 
trophies is to deflect the incoming blast of dust* 
laden, cold, dry air, and to cause it to impinge on 
the Eustachian eminencies, thus setting up a chronic 
state of irritation of the mucous membrane in the 
vicinity of the tube mouths. This action, he points 
ont, is independent of any harm such hypertrophies 
may do in increasing pre*exi8ting stenosis. 
These growths are usually soft, though but slightly 
erectile, and, like the anterior spurs, which how* 
ever are soft only at first, they are produced by the 
vascular stasis resulting from pressure against the 
membrane covering the vomer by the hypertrophied 
or swollen turbinals, usually the inferior. Noi'mally 
the inspired air deposits suspended particles in three 
places before it reaches the larynx. First, on enter* 
ing the nose the current passes upwards and strikes 
against the anterior inferior portion of the septum 
and the anterior end of the middle turbinal. Thence 
the current is deflected and strikes the posterior 
pharyngeal walk In the normal nose the Eustachian 
eminence is well out of the way of the blast of air, 
but the presence of abnormal thickenings of the 
kind described directs it on to the Eustachian areas, 
and in this way may ultimately determine the form 
of deafness dependent upon obstruction of this 
nbawTiftl of aerial communication with the middle ear. 


Fade in Medicine. 

A FAD in medicine may be defined to be a trivial 
fancy adopted and pursued for a time with irrational 
zeal, or a matter, whether important or unimportant, 
imperfectly understood and taken up and urged with 
more zeal than sense. Fads of this kind are cer¬ 
tainly more common in medical matters than in any 
other department. Although the tenacity and fre¬ 
quency of such fads are usually in dii'ect proportion 
to ^lie ignorance of the faddist, we are fain to admit 
that a tendency to fads is occasionally met with even 
among the followers of .dGsculapius themselves. 
Every new remedy, introduced with a flare of 
trumpets into therapeutics, becomes for a time the 
subject of the faddist, but this, perhaps, is more or 
less inevitable, because those who have hitherto 
failed to obtain the relief for which they crave 
from existing remedies are certain to give a 
trial to every new claimant to their confidence. The 
worst form of fad, however, is that which leads its 
victim voluntarily to restrict his diet, either in quan¬ 
tity or by the elimination of many useful articles of 
food. Another is that in which the faddist pins his 
faith to some nostrum of xmknown composition, and 
administers it to all and sundry with touching in¬ 
difference to their special symptoms. It is especially 
on the borderland of medicine that the fad flourishes 
most freely. Osteopathy, Christian Science, are 
modem examples of the " fad gone mad,” but hypno¬ 
tism and electricity for long years defrayed the 
craving of the ignorant for a universal panacea. 
Human nature forbids the hope that the fad will 
ever be exterminated, but it is all-important that 
medical men should jealously guard their independ¬ 


ence of mind and steer clear of unjustifiable faith 
in any particular measure or group of measures 
for the cure of disease. To yield to such a 
tendency is to degrade the practice of medicine 
and to abandon all the advantages associated with 
the progress of science. 

Higher ” Dental Degrees. 

If there be any one thing that has done more than 
another to bar the unity and the progress of the 
medical profession as a whole, that accursed thing 
is the multi-portal system of entrance into the inner 
precincts of qualification. That fact stands out aa 
a kind of rock which the medical reformer selects as 
the base of his operations. For generations past 
those who have been crying in the wilderness for 
changes that are still to come have inscribed upon 
their banner the watchword of a one-portal system. 
It certainly savours of the backward path, therefore, 
when the dentists begin to create distinctions and varia¬ 
tions of examination standard in their special qualifi¬ 
cations. Something of the kind, however, appears to be 
in the mind of those responsible for the regulations 
of the University of Birmingham. They do not pro¬ 
pose to grant any qualifying licence to practice 
dental surgery, a position that is understandable 
enough. What they have done is to invent a new 
deg^ree in the shape of a Bachelorship of Dental 
Surgery, which is open to those who have obtained 
a registrable license elsewhere at least a year pre¬ 
viously. The curriculum involves several extra 
subjects and extra courses, and the examination in 
the case of anatomy and physiology will be identical 
with those passed by ordinary medical students. 
Why a young and enterprising University should 
revert to the exploded multi portal system at this time 
of day is an inexplicable mystery. 

Instrumental Imperfections. 

In no department of surgery, perbaps, is it more 
necessary for the operator to pass his instruments in 
review before using them than in laryngological and 
nasal work. Several instances are on record in which 
the nozzles of insufflators or sprays have become 
detached and have actually fallen into the larynx or 
even beyond, with, in some instances, very untoward 
and even fatal results. One such incident occurred 
in the practised hands of the late Sir Uorell 
Mackenzie, and although his distinguished patient, 
ultimately coughed up the foreign body it was not 
until after a period of intense anxiety to all oon- 
cemed. More recentiy two cases have been re¬ 
ported in which the curette used for the 
removal of adenoids broke off at the junction of 
the sharpened spoon with the shaft. In one case 
the piece was removed without incident. In the other 
it was swallowed, and the piece was p as sed in the 
stools three days later. Similar accidents have 
occurred in the hands of dentists, and have given rise 
to actions for damages, happily unsuccessful, because 
it is hardly fair to hold the dentist responsible tor 
defects which he could hardly be expected to be oog’ 


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'X^i Msdioaii Pbsm. 73 


JCLT 17. 1901. NOTES ON CURBByT TOPICS. 


nieant. Tbe moral is that care should be taken as a 
matter of routine to inspect an instrument before 
using it The consequences of the entrance of a 
foreign bodj into the trachea are such as to make the 
boldest shudder, in view of the extreme difficulty of 
remoTing the intruder. 

The Beeolts of Four Years* Inoculation 
against the Plague. 

Iv a recent number of the Indian Medical Gateiie 
Major Bannerman, I.M.S., gives the results of four 
years’ experience of preventive inoculation in re¬ 
stricting the spread of plague. Up to tbe end of last 
year no less than 1.628,696 doses of anti-plague vac¬ 
cine had been issued from the Pli^ue Research 
Laboratory at Bombay, and in all cases in which 
accurate returns were obtainable. Major Bannerman 
is enabled to state that without exception there has 
been a striking reduction in plague mortality, and a 
markedly favourable effect on the case incidence has 
been produced.” The returns which he gives from 
tbe various plague centres appear to justify this 
encoimaging statement, and they are well worthy of 
attention by those who are interested in forming a 
trustworthy opinion on the value of Professor 
Haffkioe’s method. We agree with our contem¬ 
porary in the view that no one who studies this 
report can do other than believe in tbe efficacy of 
inoculation as a protective measure agmnst plague. 
Major Bannermann concludes bis report with the 
assurance, based on experience, that, to be^n with, 
inoculation is harmless, that when given in the in¬ 
cubation stage it appears in most cases to abort tbe 
disease; further, that inoculation confers a high 
degree of immunity against an attack, and thus re¬ 
duces the number of cases, and that when an inocu¬ 
lated person is attacked his chances of recovery are 
greatly enhanced. 

Can Anseetheeia be Induced During Sleep ? 

Ih the course of a recent trial it was stated by an 
expert medical witness that it was not possible to 
produce anesthesia in the case of a sleeping indivi- 
dual, and it does not appear that this state¬ 
ment was challenged in cross-examination. It 
might easily have been pointed out to the 
Court that no less an authority than Dolbeau 
found that only three persons awakened out 
of a series of nine to whom be administered chloro¬ 
form while sleeping. Dr. Leonard Guthrie is smd 
to have frequently attempted to have chloroformed 
children in their sleep, but without success; but on 
tbe other hand. Dr. Dudley Buxton has no doubt that 
chloroform may in some cases be so administered, 
though be is less sure about ether. These views have 
an important medico-legal bearing, because anes¬ 
thetics are sometimes administered with a criminal 
purpose. It is difficult to understand how ether can be 
used for successfully placing a sleeping person under 
anesthesia, but it is asserted by Dr. Turnbull that 
either chloroform or ether may be administered during 
sleep without awakening tbe subject of tbe experi¬ 
ment. Dr. P. O. Faugh has reported three cases, 


all boys between tbe ages of four and nine, in which 
be succeeded in accomplishing such anesthesia. 
Chloroform was used in each case, and no great diffi¬ 
culty seems to have been encountered, the probability 
being that the patients in these cases were excep¬ 
tionally heavy sleepers, in which case it is quite 
conceivable that an expert anaesthetist would not 
experience any insurmountable difficulty. 

Camphor in the Treatment of Varicose 
Ulcers. 

CxMPHOS is a drug which for many years was 
held in great esteem, especially in extra-professional 
circles, indeed the late M. Raspail founded a school 
of therapeutics which still rejoices in great popu¬ 
larity in France, based on the use of camphor 
internally and externally as a curative agent. Its 
anti-spasmodic properties, though well authenticated, 
have of late fallen into disrepute, or at any rate into 
disuse, and externally it is only employed in this 
country in the form of a liniment of which it is but 
a subsidiary constituent. Two German physicians 
have recently cal'ed attention to the value of 
camphor dressings in promoting tbe cicatrisation 
of varicose ulcers of the lege which are noto¬ 
riously refractory to treatment. They make use 
of an ointment containing 2 per cent, of camphor 
with from fifteen to twenty parts of oxide 
of zinc, or, if this be found too irritating, they pre¬ 
scribe a mixture of two parte of camphor with forty 
parts of zinc oxide, and fifty parts of olive oil. An 
alternative application is a solution of the drug in 
spirit, but this must only be applied after tbe ulcer¬ 
ated surface has been thoroughly cleaned of scabs 
and crusts by poultices. It is asserted that under 
this treatment tbe most obstinate ulcer will cicatrise 
within three weeks, which is more than is claimed 
for the much lauded oxygen treatment, over which, 
moreover, it has the advanti^e of being more 
generally applicable at a vastly smaller cost. 


The Toxic Effects of Cantharides. 

It might be said that it was unnecessary to draw 
attention to the toxic properties of cantharides when 
externally applied; but we think that tbe younger 
members of the profession hardly realise tbe fact thati 
not alone in the extremes of life, but that in young 
vigorous adults also this toxic effect is produced. 
Even in the lower animals tbe tendency to pro¬ 
duce nephritis is well known. We must, however, 
make an exception in favour of tbe common hedgehog, 
M. Ehorvat {Vrach, 1897) having failed to produce 
toxic symptoms in the animal by a free use of tbe 
drug. The difficulty the prefcriber is placed in is 
that there is no means of knowing what class of 
patient the drug disagrees with. It is a safe rule 
never to apply a cantbaridine blister to an infant; 
but all ages are liable to the toxin, and Signor 
Muratori {Gas. Oeped.) has just published a case of 
severe nephritis follo^ring on the application to the 
back of tbe thigh of a cantharidine blister in an 
adult eighteen years old and in robust health. I 
Digitized b, 




74 Thi Medical Peebs. CORRESPONDBKCE. _ July 17, 1001. 

PERSONAL. 


Oalcium Carbide in Inoperable Utenne 
Cancer. 

The emploTmeni of carbide of calcium as an 
application in cases of inoperable uterine carcinoma 
dates from 1896, and it seems to hare come into 
favour in the United States, though its use is not 
unknown in France and Germany. In contact with 
the secretions the carbide liberates acetylene gas, 
which is stated to have a distinctly escharotic 
action on carcinomatous tissue, in addition to 
its antiseptic action, which inhibits the bacteria 
of putrefaction, and, pro tanto, reduces the 
fcetidity. It transforms the necrotic area into 
a clean, contracting, granulating wound, and 
the tendency to haemorrhage is greatly diminished. 
Its use is said to be unattended by any painful or in. 
juriouB collateral effect, and it greatly adds to the 
comfort of the patient, whose death may thereby be 
indefinitely postponed. We are unable to detect in 
the claims that have been advanced in favour of 
this treatment any element of therapeutical novelty. 
Its effects, such as they are, can be obtained by less 
offensive agents, and the suggestion that it may in 
some cases produce a complete cure must be dis* 
missed as absurd. 


Probable Origin of the Heat Wave. 

Bepobts of the meteorological offices in America 
have appeared regarding the amount and extent of 
the atmospheric heat there and its results, but they 
have not yet, it seems, vouchsafed even a plausible 
explanation of the origin and maintenance of the pbe 
nomenaof the heat wave. There may, however, here' 
be hazarded a suggestion to satisfy the cariosity of . 
the general inquirer that this abnormal air heat is 
probably local and not cosmic, and that there need be ! 
no fear of its spreading outside the States. The heat is 
not reported extending over the sea or the coasts, or 
in the great lakes, so that it is probably purely terres* 
trial and dependent on the condition of the soil or 
country surface. In the |>opulated States the progress 
of colonisation has brought the deforestation of the 
valleys and hills, for the purposes of cultivation, til¬ 
lage, and pasturage, roads, railways, and towns, with 
log huts, and firewood, and this clearage has extended 
into the plmns and prairies, which also contribute a 
quorum by theirfires. It is probably bringing slowly 
on a condition of the earth’s surface there as appears 
in an exaggerated form in the deserts of Sahara, 
Persia, Australia, Mongolia, &c., where no vegetation 
exists for sheltering the bare earth from the hot sun, 
or attracting moisture from the clouds. The conse¬ 
quence of this would be aridity of the air over the 
country, and no moisture to take up the sun’s rays 
by clouds, and this state of matters in the climate 
tends to repeat itself, and to prolong itself, till some 
atmospheric storm cyclone sweeps down from the 
tropic, or blizzard comes from the polar regions to 
disturb the heat bank formed over the States. 


Dr. B. K. Brown hss been appointed Medical 
Officer of Health for the borough of Bermondsey. 


Mb. Hxnbt Obbbkwat Howsb, |F.B.C.8.Eng., H.S. 
and M.B.l^d., Senior Surgeon, Guy’s Hospital, has been 
elected IPresident of the Royal College of Sui^^eons of 
England. 

Mr. Thomas Bichard Jxssop, F.B.C.8.Eng., J.F., Con¬ 
sulting Surgeon, Leeds General Infirmary, and Mr. F. 
Howard Marsh, F.B.C.8.Eag., Snrseon to St. Bartholo¬ 
mew’s Hospital, have been elected Vice-Presidents of the 
Boyal College of Surgeons of England for the »Mning 
collegiate year. 

Dr. Anderson, who for about ten years has been 
the BlatApool Medical Officer of Health, has been 
appointed to a Mtniifci- position at Capetown. The 
salary is Al,600 a year. 

Miss Malcom, sister of Sir James Malcolm, Bart., of 
Balbedie, has bequeathed a l^aoy of £4,000 to St. 
Andrews University for the purpose of establishing 
medical bnrsariee or sobolarshipe. 

Db. a E. Porter, Asdstant Medical Officer of Health 
for the county of Essex, has been selected out of nin^ 
teen candidates for the poet of Assistant Health Officer 
for Leeds, at a salary of £800 per annnm. 

We regret to learn that Dr. Gillee de la Tonrette, a 
distinguished pupil the late Professor Charoot, has 
fallen a victim to one of thoee mental maladies, in the 
cure of which he displayed each soientifio zeal. 

We regret to record the fact that the death of Dr. 
James A. Myrtle, the popular Mayor of Harrogate, has 
been qoicUy followed by the sudden death of the Mayor 
of Bolton, Dr. J. E. Soowcrof t. Both were in the prime 
of life and were performing their offidal and profes¬ 
sional duties when stricken. 

The important post of Medical Officer of the Port of 
London, rendered vacant by the promotion of Dr. Col- 
lingridge, has been bestowed on Dr. Herbert Williams, 
who has been in the service of the Corporation since 
1892 as Medical Officer at the Port Hospittl, Gravesend, 
and who therefore has an intimate knowledge of the 
work and requirements of the Port. The salary 
attached is £660 per annnm. 


CorrfiBptmiiena. 

[We do not hold oonelveezeeponeiblo for the opiniona of our 
oorreepondentt.} 

THE ATTITUDE OF PHARMACISTS TO PATENT 
MEDICINES. 

To the Editor of The Medical Press and Circvlab. 

Sir, —We were mooh interested iby some editorials and 
correspondence which appeared recently in your columns 
regarding the attitude of pharmacists to the sale of 
semret nostrnms. We feel sore that any pharmaoists 
who have had the matter brought under their notioe 
must feel noder au obligation to yon for ventilating a 
subject of such importance to them; and we are glad to 
learn that several of the leading boosee in Dublin are 
ser'ously oonsidering the adoption of the label suggested 
by Mr. ^mard, with the object of disassociating in the 
misds of the pnroha«er8 of secret remedies the fact that 
the sale of wem by a pbarmsoist implies any reoem- 
mendation by him. Acting upon Mr. Bernard's idea we 
had a label printed about twelve months ago as 

Dig,;,zed by Google 


Jolt 17. 1901. 


LITERATURE 


Thk Medical Pbcss. 75 


follows: — Tbe oomposition of the contents of 
'Uiis package teing unknown to ns, we in no 
wa 7 snarantee its effeota.” We hare not used 
this iMwl rety extensirely, as we feared we might lay 
-onnelres open to a libel action, and we find that the 
Chemist and Draggitt, in a leading article in its issne of 
June 22nd, inclines to this idea. If it could be shown 
'that tbe suggested label mignt be used with impunity, 
then we ha^e no doubt but that it would become adopts 
by pharmacists generally, who do not at all lore the sale 
of patent medicinea, but are forced by tbe present atti- 
tuae of tbe public towards them to bratow npon them an 
amount of attention entirely out of proportion to the 
remuneration gained. The pharmacists of Dublin hare 
tbm thoughts at present centred on tbe British Pharma* 
oeutical Conference which meets here tbe end of this 
month, and so are not able to discuss at the present 
moment this important subject; bnt we trust that 
during the coining winter something practical may be 
'done. 

We are. Sir, yours truly, 

J. OSAHAK AND Co. 

[Our correspondents’fear that the use of a label such 
aa they hare had printed may inrolre them in a libel 
action, are, in our opinion, groundless. We are not in 
a position to gire a legal opinion on this matter, bnt it 
appears to us 

1 . lliat the label in question is merely a statement 
of fact. 

2. That it is affixed with the object af protecting the 
wendor. 

8 . That no jury taking into consideration 1 and 2 
would decide that it was libellous. It is a matter on 
which the Connml of the Pharmaoentioal Society might 
with great adrantage obtain a legal opinion.— Ed ] 

VIBCHOW’8 EIGHTIETH BIRTHDAY. 

To the Editor of Thb Mxdical Psbss and Cibculab. 

Sib,—I learn from Professor Waldeyer that Virchow’s 
mghtieth birthday will be celebrated in Berlin on Satnr- 
day, October 12th, when he will personally reoeire 
del^ates with congratulatory addrMses from rarions 
•dentifio bodies, foreign as well as German. 

A preliminary notice of tbe intended celebration was 
giien by Sir William Turner at the meeting of the 
General Medical Council last November to the represen- 
tativee of the universities and medical corporations on 
that body ; and if such of them as desire to be repr^ 
aented on the occasion mill kindlr send to me as soon 
as ooDvenient the names of tbe delegates appointed I 
will communicate them to Professor Waldeyer, who is 
the president of tbe Executive Committee. Further 
particulars as to arrangements will be furnished later. 
The insertion o( this letter in your columns would oblige. 

I am. Sir, yours truly, 

Listkb. 

12, Park Crescent, Portland Place, W., 

July 6^, 1901. 

THE SCIENTIFIC EDUCATION OP MEDICAL 
STUDENTS. 

To th« Editor of Thx Mbdical Pbxss and Cibculab. 

Sib, —It appears to me that in endeavouring to estab¬ 
lish a sort of pTotecticm in favour of the medi<^ schools, 
so far as tbe scientific education of tbe student is con¬ 
cerned, the General Medical Council has committed a 
tactical error which may be fraught with grave con- 
sequenoss. Whatever may be the case with tbe fore- 
meet metropolitan medi<^ schools, it is a matter 
of common knowledge tl^t tbe equipment, both In 
apparatus and in the teaching st^, in the smaller 
eehools leaves much to be desired; indeed, I question 
whether tbe majority of them could adequately prepare 
a student in all branchee of science for tbe preliminary 
•cientifio examination of tbe l<ondon University, for 
example. 

But, after all, tl'is is not tbe cmx of the question. 


There is no obvious reason why any restriction should 
be placed on stndents in this matter. All that the 
Council is concerned to know is that they have attained 
a proper standard of knowledge in these snbjeota, and 
if examinations cannot be trusted to elicit this fact 
they must be regarded as useless. Tbe Council loudly 
proclaims its desire to insist upon five years of mediciu 
study, but elementary science is not medical study any 
more than arithmetic or geography. By all means let 
ns have five years of bona fid« medical study, to date 
from the time when these preliminary stndies ^ve been 
completed. I say it with relnotanoe, bnt 1 am fain to 
admit that the Council’s attitude in this matter 
savours of a desire to increase the revenue of the medi¬ 
cal schools, which is not exactly the purpose for which 
tbe Council was created. Tbe cost of mescal ednostion 
is already exorbitant enough judged by that of other" 
countries where the teaching is not one whit inferior to 
that in our own country,withont artificially inflating the 
total. 

I am. Sir, youn truly, 

Post-Gbaduatb. 

THE SUNDAY TIMES AND “SIR JOSEPH 
LISTER." 

To the Editor of Thb Mbdical Pbbss and Cibcudab. 

Sib,—T he Sunday Time* is a bitter opponent of vivi¬ 
section. The opening of the new pathological depart¬ 
ment at the London Hospital gave it abundant 
opportnnity for caustic comment. Unfortunately, the 
sub-editor has allowed tbe name of Lord Lister to 
appear more than once as ’* Sir J. Lister ’’! 'This seems 
not a little curious in an np-to-dute censor of the 
morals of the medical profession. 

I am. Sir, yours truly, 

Scbutatob. 


CHLOROFORM DEATH. 

To the Editor of Thb Mbdical Pbbss and Cibculab. 

Sib, —With regard to your remark as to tbe death of 
a rbild at Guy’s Hespitid, a week or two ago. that ^era 
was no evidence as to how the chloroform was sdminis- 
tered, I may say that being present at the inqnest I can 
supply the informatxjn. TTie chloroform was given by 
tbe " open ’’ method. The operation was for empyema 
of the long, and death rented from suppression of 
breathing in a puny child, the subject of chronic tuber¬ 
culous disease. The case shows how difficult it is to 
expect exact evidence from newspaper reports. 

1 am. Sir, yours truly, 

Pbactitionbb. 




CABOT’S PHYSICAL DIAGNOSIS OF DISEASES 
OP THE CHEST, (o) 

This book, we are told in the preface, is intended for 
students, and a very useful* guide it will be. The 
deecriptiona are faithful and good, and the abundant 
illustrations aidmnoh in making that which is described 
plain and clear. We cannot agree with tbe statement 
that “Nothing is less like a barrel than the "barrel 
eheet." As depicted in the figure, page 15, a g(x^ 
type is given of one form of asthmatic thorax, but tills 
is quite unlike tbe true *' barrel chest ’’ of chrouic large 
luDged emphysema, of which an excellent drawing will 
be found on p^e 16. 

The instructions as to percussion, specially as to light 
percussion, are to be commended to the notice of all 
stadenta. 

The anthor is all in favour of binaural stethoscopes, 
provided they be not jointed, and numerous illnstra- 
tiozu are given of ordinary binanrals and also 
of the rvoentiy invented Bowles stethoscope. This 


ia) “ Physical DUsitosU of Dtoeaaeg of tbe Cheat.' By Bichard 
C. Cabot, U.D., Phyaician to Out-patiente, Hacaaohoaetu Qvoeral 
Hoapital: Awletaot in Clinical Hedioine, Harvard Medical 
School. With 142 illaBtrat'.ons. London: Baillidre, Tindall, and 


Cex. 190L 


Diglized by 


Google 




76 Tbk Mcdioal Pkiss, 


MEDICAL NEWS. 


JULT 17, 1901. 


fltethoMope in its ordinary and mnltiple forms 
is folly described. Its valne in recognising super¬ 
ficial and fine r&les we bare prored. The old 
wooden instrument fails to obtain a notice in this very 
modem work, though Broadbent and other English 
observers believe that the slight iar communicate to 
the ear by the rigid instrument helps to distinguish the 
first from the second cardiac sound. The remarks on 
the relative intensity of the pulmonic second sound as 
compared with the aortic, basM on the observations of 
Dr. tUrab A. Creighton, are interesting as showing the 
effect of ^e on this sign. In almost every individual 
over sixty years of age the aortic second sound is 
louder than the corresponding sound in the pulmonary 
area. 

The diagrams which are shaded where the murmurs 
are best heard ought to be very helpful to the student. 

At the and of the book some well executed radio¬ 
graphs and fluoroscopic pictures will be found. Those 
of phthisis in various sta^s at page 301 (after Walsham) 
show how far this art baa hitherto progressed. 

The instructions to guide the observer in cases of early 
phthisis are given with accuracy i so too are those 
regaling large lunged emphysema. Atrophons, small 
lunged emphysema, receives but scanty notice. 

A useful addition to the next edition of this book 
would be a chapter on tnterole bacilli, though this 
is a matter which does not strictly fall nuder the 
bead of physical diagnosis. 


SCHAPEE’S “TEXT-BOOK OP.PHT8IOLOOT.” (o) 

This huge volume oonoludes the magnificent encyclo¬ 
pedia of physiological knowledge which does honour 
alike to ito editor and to the various members of the 
staff of oo-workere. The preceding volume having been 
issued about three years previously, the only feeling of 
regret which we experienced on examining that now 
before us was that a portion or portions of its contents 
bad not been doled out to us long ago. It would relieve 
the growing feeling of scientific hunger which the good 
thinn of its predecessor had made ns feel, and from 
which we suffered in direct proportion to the unpre¬ 
cedented value of its contents. It would also have 
made the first stage of the mental digestion of the 
present more enjoyable. Magendie’s now too frequently ' 
Ignored stage of “ prehension “ loomed up before ns in all 
toe grandeur of its gloomy responsibility when we 
greemly laid bold of this voluminous octavo, and 
became for the first time conscious of its weight! 

The subjects are numerous, and, as the following list 
will show, have been judiciously distributed. That of 
the Mechanism of the Circulation of the Blood has been 
dealt with by Leonard Hill; Contraction of Cardiac 
Muscles by W. H. GaskeU : Animal Mecbanios by J. B. 
Haycraft; Muscular and Kervous Mechanisms of the 
Respiratory Organs, of the Digestive Tract,' of the 
Urinary Tract, and of the Generative Apparatus, by 

E. H. Starling; Mechaoical, Thermal, and Electrical 
PrO|iertiee of Striped Mnicles, by J. Bnrdon Sanderson; 
Nerve, and the Physiology of Electrical Organs, by 
Francis (^toh} The Nerve Cell, by E. A. Schafer; The 
Sympathetic and other Related Systems of Nerves, by 
J. N. Langley; The Cerebral Cortex, by E A. Schafer; 
The Spinal Cord and the Parts of toe Brain below the 
Cerebral Cortex, by C. S. Sherrington ; Vision, by W. H. 
R. Rivers; The Ear and Vocal Sonnds, by John Gray 
MoEendrick and Albert A Gray; The Sense of Taste 
and Smell, by J. B. Haycraft. 

With such a list of subjects of surpassing importance, 
and such a staff of anthoritiee to supply information, it 
may well be expected that the volume under notice should 
form a necessary part of the mental equipment of every 
living physiologist and practical physician. Even the 
most aooomplitoed of the former cannot have already 
been a master of all the scientific facte and theories 
which are here to be found, and it is toe imperative 
duty of the latter to the public, to endeavour to make 
himself master of them aa rapidly as he can. There is no 

(a) •'Text-Book of Physiology.’' Edited by E.A.Schafer.LL.D., 

F. B.S. Vol. II. Pp. 1,365. E linborgh and London: Toung J. 
Pentlsnd. 1000. 


longer any excase ae the material has been pla oed 
witoin easy roach, and this monnmental work pene¬ 
trates the onset of a new era in the history of 
of physiolt^ in Englisb-speaking countries. It need no 
longer be said, as it often hae been in our hearing, that 
toe first necessary step in becoming even a mode¬ 
rately-skilled physiologist is the acquiaition of & 
sound knowledge of the German langn^ie. We 
now boldly say that we have as good teachers and aa 
sound toeoriate at home, and prnut to the text-book 
now completed under the editorship of Prof. Soh&fer 
as inoontrovertible proof of the truth of our assertion. 
We need not repeat the old formula of wishing toia 
work all the suooess it deserves. We feel sure that it 
MMsf have it. We look forward for an early isiue of a 
second edition—and this, we hope, divided into a much 
greater number of parts. 


©bituarg. 


DEPUTY-INSPECTOR-GENERAL RICHARD 
DOMENIJHETTI. MJ). 

Ths death is anuonnoed, at Wocdhall Spa, on Friday 
last, of this gentleman, at the age of 76. He was the 
eldest son of the late W. L. Domeniobetti, 95to Regi¬ 
ment and graduated at Edinborgb iu medicine io 
serving afterwards in the 8to King’s Regiment and let 
Gordon Highlanders (75tta Foot). Dr. Domenichetti 
was preeeut as senior medical officer in the aotions pre- 
oe^ng the capture of Cawnpore and the relief of Luck¬ 
now, and received the thanks of the President of the 
Council of India for his services before Lncknow in 
1667, with the medal and clasp. Dr. Domeniobetti, 
after retiring from the service, reoeived the honorary 
title of Deputy-Inspector-Oeneral, Army Medical De¬ 
partment, sabsequently acted for 25 years as medical 
officer of health at Loath, Lincolnshire. Iq 1893 be was 
appointed Honorary Physician to Queen Victoria, and in. 
1897 reoeived the Queen’s Jubilee Medal. 


JEcbtral 


Society for Belief of Widows and Orphans of Medical Men. 

A Quabtkblt Court of the directors of toe Socie^ 
was held on July 10th, the President, Mr. Christopher 
Heath, being in the ohair. Seven new members were 
elected, and tbe deaths of four members were reported, 
and toe election of a member declared void. Two fresh 
applications for grants were read from widows and 
grants at the rate of X60 a-year made. It was resolved 
that a sum of j 21,284 be distributed among the fifty-two 
widows, fourteen orphans, and six recipients from the 
Copeland Fund. The expenses of toe quarter amounted 
to 138. Od. 

The Bleotrloal Oxons and Light Treatment. 

A XAOKiFicxNT installation for the applioation of the 
combined electrical, ozone, and light treatment, intro- 
duoed from America, was opened by a musioal soiree 
at 14. Hanover Square, W., on Tuesday of last week, 
when Mr. Puroell Jones, Mr. Hanrice Farkoa, Mrs. 
Max Langetnann, and last, bnt not least. Signor 
Anoona, delighted a select andienoe. Tbe visitors, 
among whom were many well-known metropolitan, 
medical men, were then shown the various appliances 
for the utilisation of actinic rays produced by a large 
number of incaudescent lamps iu a suitable iuipaotr, 
the atmosphere whereof is largely composed of nascent 
ozone generated by very powerful Tesler ooila. High ten¬ 
sion currents traverse the body without the production 
of any disagreeable sensations, and these currents are 
appli^ locally by means of specially constructed 
I vacuum electrodes. Apart from a slight bitch due to 
I too melting of the main fuse the demonstration was 
I very successful and excited great interest. It is hoped 
that medical men will inspect the very complete and 
oostly installation, and we are plMsed to note that in 
order to secure aa far ae possible the scieutifio appUca. 
tiott of the method, patients will only be admitted 

s 



JVLT 17,1901. 


MEDICAL NEWS. 


Ikx Mxdical Pbcss. 77 


to treatment on the recommendation of their medical 
nen. 

Death firom Chlorofrom. 

Am inquest was held at Nottingham on the 6th inst., 
on the b^y of a little girl, tet. 7, who had suoomnbed to 
chloroform administered for the purpose of removing 
enlarged tonsils. It was pointed out that ether would 
not have been suitable for so young a patient, and the 
aisual verdict was returned. 

Aunnal Temperance Breakfast of ttis British Hedical 
association. 

Wb are asked to announce that the usual breakfast 
iriven hy the National Temperance League in oonnec* 
tion with the British Hedi^ Association annual meet¬ 
ing, will be held on Thursday morning, Augnst Ist, 
at eight o'clock, in the Parish ItMm, St. James’s Square, 
Cheltenham. The secretary (Mr. Bae, 34, Paternoster 
Sow, Xiondon,) will be glad to send ca^s of invitation 
to any of our readers desirous of attending. 

Health of Belfast. 

Thb report of the Medical Officer of Health for the 
year 1900 has jnst been isened. In the conrse of it Dr. 
Whittaker states that although the population of the 
city has increased during the past year, yet the deaths 
were less numerous than in either of the two preceding 
years, numbering 7,642 from all oanses. whilst the i 
nomlwrs in the \ ears 1896 and 1899 were 7,768 and 7,933 | 
respectively. The number of deaths from zymotic 
causes were 50 per cent, less than in the four preceding 
years, although this decrease does not apply to typhoid 
fever, the deaths from which still keep abnormally high. 
Of the number of deaths roistered daring 1900, 2,899 
were attributed to chest affections, and 737 to zymotic 
disesses—making a total of 3,636, or nearly one half 
of those registered as having died from all oanses. 
Dr. Whittaker oomplaios that there is no city in the 
three kingdoms of any importance in which the hospital 
aooommodatioo for those suffering from infections 
diseases is so limited as Belfast. Practically there is 
but one hospital—the Union—available for the pur¬ 
pose The total accommodation thereiu is 250 iMds. 
There were treated in it during the past year 1,261 
cases. Although the neoessity for an infectious 
diseases hospit^ for the city has been long acknow¬ 
ledged, yet but little has been done towards the erec¬ 
tion of one. Plans, however, have been prepared and 
adopted by the Public Health Committee, and he hopes 
that during the year active measures will be taken to 
see to the completion of the building. 

Hedical Sickness and Accident Society. 

Thb usual monthly meeting of the Executive Com¬ 
mittee of the Medi<^ Sickness, Aunuity, and Life 
Aissnranoe Society, was held at 429, Strand, London 
W.C., on 28th ult. There were present Dr. de Havil- 
land Hall, in the chair; Dr. J. B. Ball, Dr. Fredk. S. 
Palmer. Mr. J. Brindley James, Mr. F. A Edwards. Dr. 
M. Greenwood, Dr. St. C. 6. Sbadwell, and Mr. Horatio 
P. Symonds (Oxford). The aooonnts presented showed 
that the bosineas was satisfactorily progressing. For 
the time of the year, the mckness claim aocount was 
moderate, and a larger number of new members than 
usual indicates that the advantages of the Society are 
becoming more recognised by the profession. Few 
claims were being received for accidents, and a very 
moderate number of influenza cases had bssn recorded 
this year; while the list of members receiving permanent 
provision of the Society was growing very slowly, as the 
additions to it were about counterbalanced by losses 
through death. Prospectuses and all particulars on 
application to Mr. F. Addiscott, Secretary, Medical Sick¬ 
ness and Accident Society, 33, Chancery Lane, London, 
W.C. 

Boyal HsdlcsJ Benevolent Collage. Epsom. 

Om Joly 9th the Earl of Rosebery, K.G., President of 
the College, presided at the twenty-eighth festival 
dinner in aid of its funds at the Hotel Cecil. After 
the loyal toasts had been honoured, Lord Rosebery pro¬ 
posed the toast of the evening, “Success to Epsom 
College.” As President of the College he suggested that 
he would like to see the title changed and the institution 
called simply Epsom College, with the words “Royal 


Medical Foundation ” ns a sub-title; he did not see why 
Epsom College should not rise to the level of Eton. 
Present statistics showed that there were fifty foundation 
scholars in Epsom College for whom exhibitions had to 
be found from some fund or other, and then there was a 
difference which had to be met from public funds for 
those who were sons cf medical men and those who were 
not sons of medical meo, besides a considerable nnmber 
of pensicners. That represented a sum of some ^,000 
a year. The fixed income of the establishment was not 
one-third of that, and considerable reinforoements were 
required from outside. We have elsewhere referred to 
the salient points of Lord Rosebery's brilliant speech, 
which he closed with a strong appeal to the very large 
company present with the assnraoce that everything 
they gave would be well and worthily expended, and that 
they would have done no better deed in their lives than 
by assisting to maintain that noble institution. Dr. 
Holman, the treasurer, followed with ao eloquent and at 
the same time a very practical reply. Personally, he did 
not object to the change of name proposed by Lord 
Rosebery, and if those present and their friends would 
only make the position of the pensioners and foundation 
scholars secure the adjectives might go; but the diffi¬ 
culty which he had each year to meet expenditure con¬ 
vinced him that unless people bad a gwd pro quo they 
would not give the money, and the omission of the words 
“ Medical Benevolent ’’ might result in a considerable 
loss of subscriptions. That was painful for him to say, 
but it was true. If the Council were provided with 
£50,000 they would wipe the whole thing out as regards 
benevolence altogether; but he did nut feel jnstifi^ iu 
doing BO without that security. Epsom College was 
mainly built by John Propert and members of the 
medit^ profession, and Propert could scarcely do less 
then call a college “medical” which was built by the 
funds of medical men. With regard to the benevolent 
part, he had seen in his long life the enormous amount 
of misery among his professional brethren, by sickness, 
death, and other misfortunes necessarily connected with 
an extensive and at timee dangerons calling, to relieve 
which in a very bumble way Propert institute the two 
classes of pensioners and foundation scholars. The needs 
of the school amounted to about £ 6 , 000 a year, though the 
numbers varied considerably. Since he (Dr. Holman) bad 
been treasnrer some £17,000 or £16.000 hud been appor¬ 
tioned to foundation scholarships and pensionersbips. 
To dimmish in any way the amount of r^ief which had 
hitherto been afforded would result in incalculable 
misery. The toast of “ The Chairman ” was proposed by 
Dr. J. L. Propert, a son of the founder of Epsom College, 
in felicitous terms. Subscriptions to the amount of 
£4,127 were announced during the evening, including 
100 guineas from the Chairman and a donation of 1,000 
guineas from an anonymous friend who had been moved 
to generosity by Lord Rosebery’s speech. Lord Rosebery 
having briefly replied, the proceedings terminated. 
Thanks to the dinner committee, the arrangements were 
of the most perfect kind, and a most pleasant evsning 
was the result. 

The Mortality of Foreign Cities. 

Thb following are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several of 
the populations:—C^entta 144, Bombay 41, Madras 
43, Paris 17, Brussels 13, Amsterdam 14, Copenhagen 14, 
Christiania 10, St. Petersburg 24, Moscow 46, Berlin 17, 
Hamburg 14, Breslau 23. Munich 21. Vienna 17, 
Prague 23, Buda^Pesth 16. *^6316 23, Rome 16, Venice 
17, Cairo 34, Alexandria 32, New York (including 
Brooklyn) 17, Philadelphia 15. 

Boyal CoUefOB of Physicians and Snrgsons of Edinburgh 
and Faoul^ of Physicians and Surgeons of Glasgow. 

A SPECIAL examination for the Diploma in Public 
Health was held in Edinburgh in June, and the fol¬ 
lowing candidates having passed the First and Second 
Examinations, received the Diploma in Public Health:— 
Mrs. Euphemia Stoker, L.R.C.P. and S.E., Sheffield; 
Major Robert C^dwell, F.B.C.S., Eng., R.AM.C.; 
George Melville, M.B., C. M., Penicuik, and James Sin- 
claur Tait, F.B.C.S.E., St Jo^’s, Newfoundland. 



78 t™ M.moAL Pe..., NOnCBB TO CORRESPONDENTS. 


Jolt 17, 1901. 


iloticeg t 0 

(!Dorre0tr0nbent0, jShort 'Cetlere, &c. 

9* CosBvarowDBVT* nqnlrlnf » nplr io thii oolnmn are par- 
firaUrl7 raqoMtod to mako bm of a dUtinetivt ripiMtwr* or 
and avoid tka pnotlee of atriiiay themselvea "Baader,” 

"Sobaerlbar,” “Old Sabaorfbar,*' Ac. kfooh oonfnalon will ba 
■parad by attantloa to thia rnla. 

BaPBima.—Baprinta of artielaa appaariair is this Journal can be 
had at aredueel rate, providing anthora ffire notice to the pub* 
liahar or printer before the type baa bean distributed. Thla ahonld 
be done when retnmlnar corrected proofa. 

Oeioimal Articlib or LnTXRa intended for publication ahonld 
ba written on one aide of the paper only, and mnatbeantbenticated 
with the name and addreaa of the writer, not neoaaaarily for pnblioa' 
tion bnt aa evidence of Idantitv. 

Bradiito CAaiB.— <noth board caaea, gilt lettered, eontalnln^f 
twenty*aix atrinita for holding the numbera of Tns Ubdical PbbbS 
AMP CiBCULAR, may now be had at the office of thia Journal, 
price Sa. 6d. Theaa caaea will be found very naefnl to keep each 
weekly nnmberlntaet, clean, and flat after it haa paaaed tbron^b 
the poat. 

PB0P08ED EXAMINATION QUESTIONB POE POUBTH 
YBAB STUDENTS. 

Am irrepreaaible correspondent haa inflicted the following npon 
na: - 

What is the most suitaUr treatment for chimney awerpa’ cancer P 
Hov wonidyou proceed to diaanwae mitral regurgitation in the 
fatna third month of pregnancy ? 

When performing the operation of ovariotomy would yon pocket 
the fee or the pedicle first ? 

The extirpation of the ntema and the complete occlnsion of the 
vagina has been recommended aa the radical cure for “leacorrhaei.’’ 
Can yon auggeat a milder form of treatment, and one equally sue* 
ceasful? 

la the reduction of hernia always accompanied by a gnttniat 
sonnd? 

What is the largest dose of iren yon would shrink from taking 
(ironically speaking) ? 

Stale bread baa bean hithly spoken of aa a cure of Juvenile oon- 
snmption. Explain the rationaie and giro the author’s name. 

Why is ‘‘openinr medicine” prohibited in cases of swallowing 
penknife or scissors ? 

How wonld vou proceed to treat a case of chronic vomiting in 
which the patient *' threw up ” his employment P 

A. D. 

Mb. J. M. M.—We cannot trace the article to which von refer. 
Onr French correspondent drew attention to the "injection of 
quinine in the treatment of cancer “ in one of the March isenes. 

8. £. B. will find his commnnioation has been utilised editorially 
in onr present number. 

THE ANTI-MICBOBIC MANIA. 

To tkt Editor of Tmb Mbdical Paxaa amd Gibculab. 

Sib,—I n these days of sterlliaed milk, Ac., Ac., when war is waged 
against the microbe, I waa much interested in observing four 
begrimed dustmen, frsah from their work, sitting on their baskets 
bv the roadside eating their breakfasts. Their hands were simply 
black, and yet the gusto with which they enjoyed their thick slices 
of bread and butter (or more probably “ marsarine ”) eatm from 
their dirty hands dirMt, would, I fancy, be an eye-opener for tbe 
bacteriolorlst, who would protebly (like the barbarians, Acta, 
chap. xxviiL, verse 6) look “when they should have swollen or 
fal'en down dead suddenly.*' Surely extremes meet, and it wonld 
be most instructive to discover the average mort^ty among dust¬ 
men, who must, in London alone, number a small army. 
Go to the dustman, thou bacteriologist, consider AtJ ways, and be 
wise. 

I am, Sir, yours tmlv, 

Cheltenham. Albxamdkb Dpxb. 

Bos IM Ubbs.—W e agree with yon that the Finsen light treat¬ 
ment has not yet been placed nMn a sufficiently sound scientific 
basis to warrant the claims made on its behalf. The physicians 
whose names are connected with the method would do better to 
disoourage newspaper notoriety, at any rate in the tentative stage 
of tbe treatment. 

W. E. Q.—We fear that the drug in question has not fulfilled 
its earlier claims to confidence. At the best it could only act aa a 
wUliatlve to some of the minor symptomsof tbe disease in ques¬ 
tion. Aa a matter of fact, the eondllioii may be relieved if not 
cured by the prolonged administration of thyroid gland. 

LONDON SALT EATEBS. 

Thb Revxit InttmalionaU Hf TherapU Phytu/ue is responsible for 
tbe following, which will certainly be netoi for Londoners “ Since 
tbe English nave learnt from the American newspapers that salt is 
a panacea—a kind of veritable elixir of life—its consumption has 
considerably increased in all the Lc-ndon restaurants. An TtngHsii 
Journalist has ‘ interviewed ’ the principal restannuit Beepers in 
the City and tbe West-End, who everywhere declare that ue aalt- 
oellan are emptied In tbe twinkle of an eye. They have now to 
fill salt-oellart many times a day which formerly still oonfoined 
salt at the end of a week. Indeed, a restaurant keeper in Leicester 
Square declared that, on Saturday last, he completely ran out of 
amt in the evening, and in oonseqnence was put to a great deal of 


trouble. HabUuts of l«rge restanranta oontinually atk for very- 
salt dishes to be served eeveral times a weak, such aa ’ pickled 
pork' and ’ bloaters.' ‘ Cat ene mpe, un« fHrie.‘ In i.oiidon 
everything at the proeent moment is salt. Salt haa become the 
king of oomestiblet. And still, nnmerona Londoners complain 
bitterly that during the Exhibition of IMO the Parisian restanrant 
keepers salted them too heavily.” Cum prano soiia 


BanroBD, T., M.B.C.S.Eng., L.B.C.P.Lond., Medical Officer of 
Health the Uttoxeter (Siailordshlre) Urban Sanitary Dia- 
triot. 

Bablow, T. W. N,. M.B.C.8.£nM.. L.B.C.P.Lond , D P.H.Camb., 
Medical Officer of Health for the Borongh of Bootle, and 
Visiting Medical Officer of the Linacre H'>spital. 

Bbowm, B C , M.B., B.C.Camh., Medical Officer of Hesdth of Disa- 
(Norfolk) Urban Sanitary District. 

Coopsa. Lodpobd. L B.C.P.Lond., M.B.C S.Eog., Assistant Oph¬ 
thalmic Surgeon to St. Bartholomew's Hospital. Boebeater. 

Dumb, P. EL, L B.C.F.Lond., M.B.C.6.. Medical Ofilcer of Health 
of Stevenage (Hertfordshire) Urban Swtary District. 

Edwards, B. J. LL, M.B.., C.M.ulaag., Medical Officer for No. 1 
District and for the Workhouse of Swansea Union. 

Faoam, p. j.. F.B.C.8., Lecturer on Elementary Physics at th» 
^thoUo University Medical School, Dublin. 

Obvpim, W. Watsom, M.B., F.B.C.S.Eng., Oohthalmic Surg eon to- 
the Snsees County Hospital. Brighton. _ 

HnoHss. Jambs BaixaLET, M.B.C.8.Eng., L.S.A., Consulting 
Medical ufficer of tiie Macclesfield General lafirmary. 

Huosxs, Jobs B., M.B., B C.Cantab., M.B.C.S.. member of the 
Honorary Medical Staff of the Moccleefield General Inflrmery. 

Mbixlb, B. M.B., C.M.Olasg,, MedicAl Officer of Health of the 
Darlington Bnral District. 

Pbobtm-Williamb, B. J.. H.D.Dnrh., I<ectnrer and InatmctoriiA 
Anesthetics at the London Hospital. 

Wabe, Ckablbs, L.B.C.P.Lond., M.B.C.S.Eng., Medical Officer for 
the BoeoasUe District of the Camelford Union. 

1Bac$ndt0. 

Biabop Auckland.—Medical Officer of Health for the Bural District, 
dal^ £350 per annum. Whole time t > be devoted to the 
offlea Applications to the Clerk of the Oonncil, Bishop Auck¬ 
land. 

Oldham Infirmary.—Senior Honse Snrgeon. Si^y £100 per 
aimnm, with board, washing, and restdeuoe; also Junior, £7& 
per annnm, with board, reeidenoe. and washing. 

Boyal Cornwall Infirmary.-House Surgeon, unmarried. Salary 
£100, increasing by £10 a year, with boa^ (exclnding atimu- 
lonta) and apartments. 

University of Sydney, New South Wales.—Profeeaor of Pathology. 
Salarv £S0u per annum. Pension £400 per annum after twenty 
years’ service. £100 allowed for paaaaga. Farther particulars 
of the igent-Genaial for New South wales, 9, Victoria Street,. 
London, S.W, 


#irth0. 


Wbitelocex.— On July 8th and 9th (midnight) at Banbury Boad' 
Oxford, the wife of Biobard Henry Anglin Whitelooke, H.B., 
M.Ch., F.B.C.8.£ug., of twin daughters. 




Cearlbs—Hodosom.— On July Bth, at the Parish Chnteh, Hands- 
worth, Btaflordshlre, John Boger Charles, M.D., to Alice Mary 
Oartrude, daughter of the Venble. Mobert Hodgson, rector m 
the parish and Atch'ieaoon of Stafford. 

CaoPTS— Hbkdbrboh.— Ou July lOtb. at St. Peter's Chnrch, 
Leicester, George Harry Crofts, M.B.C.8., L.B.C.F., son of 
John E. Crofts, of Leicester, to Margaret Mary, eldest danghter 
of Duncan Henderson, of Leicester. 

Hambob—Wallis.-Ob JuW 10th, at St. Saviour's Church, East¬ 
bourne, Basil Francis Hansou. youngest son of H. J. Hanson, 
Esq., of liilecotes, Marlow, Bucks, to Maud Bath, youngest 
daughter of the late Q. A. Wallis, Esq., M.I.C.K., J.P., of 
Eastbourne, 

HuMMABo—P ools.- On JuW 9tb. at Llanbeblig Chnrch, Carnarvon, 
by the Her. J. W. Wynn Jones, Arthur Hunnard, M.B., 
b.S.Lond., to a. K. Cicely Poole. 

Emox-Bocbs.— On July 9Lb at the Parish Church, Weaton-suMr- 
Mare, bv the Bev. E. Moma, Bobert George Enox, M.K.C.S., 

L. B.C.P., to Annette, danghter of tbe late Mr. Francis Boche. 
Stokes—Obbt.— On July 9tb, at tbe Church of Bt. Michael and All 

Angels, Bedford Park, London, John Wilfred Stokes, 

M. &C.S., L.B.C.P.EDg., to Doris Louisa, daughter of Mr. 
and Mrs. Gray. 




Baoot.— On July 7th, at Leinster Square, Dublin, Edward Bagot, 
F jLC.S.I.Tmte of Ennirklllen. 

Dx’AtH.—On Jniy 7th, at Buckingham, George Ebtnby De'ath, 
L.B.C.P.Lon<L, H.ii.C.8.£ng., aged 39 years. 

Hallidat.— On July 8tb, at Nottingham Street, Marylebone, kCd- 
dletott Wood Hailiday, L.D.8., B.C.8.Eng., sged oO vetra. 

Moses.— On June Srd, at Amoy, China, of typhoid lever, John 
Moees, M.B.C.8., L B.C.P., aged 31 vsan. 

NiCBOLS. —Un July 8tb, at Chanmont-Vexin, France, Thos. Low 
Nichols, M.D., sg^ 86 veara. 

Wabbepobd.- On July lOu, of pnetunonla, at Paignton, Devon, 
Cbas. F. Wameford, M.D., late Snrgeon H.M. Indian AxmT 
aged 79. 


D.i^,.,zed by 


Google 


andi Cittnilat 



♦•8ALU8 POPtJU 8UPBKMA LEX.” 


VoL. CXXIII. 


WEDNESDAY, JULY 2 4, 1901. 


No. 4. 


(DriQinal Commmtications. 

THE COMPLICATIONS AND DEGENEBAT10N8 

OT 

FIBROID TUMOURS OF THE 
UTERUS 

AS BEAEIKG UPON THE TREATMENT OF THESE 
GROWTHS, (a) 

By CHAELES P. NOBLE, M-D., 

8af g6on-in-Chie<, Eenciiigton EtMpital for Women, PfaUadelpUa. 

Thb tnditioaal teaching concerning flbromyomata of 
the ntems ia, tiint these tnmonn are of frequent oocnr- 
xenoe ; that only exceptionally do they prMnoe grare 
symptoms; that after the menopause they tend to 
imdergo a spontaneous cure; and that omy in the 
rareet do they cause death. This teiching, 

while traditional, has nerer been nnirersally aooepteA 
Tt has been combated from time to time by wose 
having to deal with nave conditions arising from 
the presence of fibroid tnmonrs. As early as 1868 
the olassioal essay of Washington L. Atlee on "The 
Surgical Treatment of Certain Fibrous Tnmonrs of the 
Uterus heretofore considered beyond the Resonroee of 
Art ” appeared, (i) This essay largely consists of a 
deeoription of the seiions conditions resulting from 
fibroid tnmonrs, together with an earnest plea for their 
radicstl removal. Until recently basmorrhage has been 
considered the chief, if not the only danger arising 
from them. It is now appreciated that patients suffering 
from fibroid tnmonrs are subjected to many other risks 
that arise from the degenerations and complications of 
these growths. Necrosis, myxomatous and cystic de¬ 
generation of the tumour, calcareous infiltration, asso¬ 
ciated malignant disease of the body of the uterus or of 
the cervix, and complicating diseases of the uterine 
^>pendages, such as ovarian tnmonrs, pyosalpinx, stl- 
pingitis, Ac, not to mention the more remote effects 
upon the alimentary tract, the oardio-vascnlar, urinary, 
and nervous systems, may cause death or oontinu^ 
invalidism of such patients, independent of the natural 
history of the tumour itself. 

In estimating the risks of patients suffering from 
fibroid tumours the profession has been too prone to be 
guided by the teachings of the past, rather than by the 
results of the more careful observatioiu of the present. 
The chief purpose of this paper is to present in detail 
the nature and complications of fibroid tumours as they 
are met with in acriial practice. It is well known t^t 
fiinoid tumours of the uterus are frequently compli¬ 
cated by other conditions, but accurate tables of 
considerable numbers of cases with their compli- 
catioiu are conspionoos by tiieir absence. As a oontri- 
buti<ai to the study of fibroid tumours I wish to report 
218 oases, in which various operations have been per¬ 
formed. This report includes all oases of operation for 
fibroid tnmonrs in my practice. An analysis of this 

(s) Papw reed before the Britieb O/UMOlociosl Society, 
Jsly 11th, 1901. 

(6) *'Trus." Amer. Med. Amoe., 1853, t<^ tI., p. 547. 


group of cases, showing the degeneratione in the tumours 
and the various complications encountered, should give 
a moro satisfactory picture of the condition of patients 
suffering from fibromyomata of the uterus than any 
merely theoretical consideration of the snl^eot. 

It will at once be apparent, from the accompanying 
analysis that fibroid tumours do not occur in actum 
practice as an isolated, uncomplicated, morbid condi¬ 
tion. On the oontiary, patients suffering from these 
tnmonrs, as we meet th^ in the consulting-room and 
hospital, are found very frequently to have in addition 
serious complicating diseases, not only of the utems and 
of its appendaM, but also various morbid conditions 
in the body at Wge. 

In the 218 patients operated upon for fibromyoma 
uteri to May 24th, 1901, the following complications 
were encountered:— 

Appendicitis. 4 

Bilateral hydroealpiu .8 

Unilateral hydrosalpinx .6 

Hsmato-salpinx .1 

Calcareous infiltration .6 

Cystic d^^eration of ovaries .2 

Ovarian cyst vrith twisted pedicle . 1 

Ovarian cyst, bilatmral .2 

Ovarian oyst^ unilateral . 19 

Ovarian cyst, suppurating . ... 1 

Bilater^ devoid ^st; umbilical hernia ... 1 
Dermoid o]^ suppurating, sinus through abdo¬ 
minal wi^ .1 

Dermoid cyst with twisted pedicle . 1 

Intraligamentous development of fibroid ... 10 

Retroversion of utems .8 

Procidentia of utems .3 

Parovarian cyst .2 

Ectopic pregnancy. 3 

Papillary caroinoma of both ovaries . 1 

Abscess of ovary .1 

Pyosalpinx, bilateral .6 

Pyosalpinx, unilateral .8 

S^pingitis, bilateral .2 

Salpingitis, unilateral .6 

Myxomatous degeneration of tumour . 6 

Cystic degeneration of tumour.6 

Necrosis of tumour.12 

Adeno-caroinoma of body of the uterus. 8 

Epithelioma of cervix uteri .4 

Sarcoma ... 2 

Synoytioma.1 

In estimating the risks encountered by patients 
suffering from fibroid tumour we shall consider first 
those growing out of the complications themselves, 
which we shall ria^ify in three groups. Firtt, those 
wUoh would lead to a fatal result; second, those which 
would threaten the life of the patient; and, third, those 
which would involve more or lees invalidism. 

1. Of oomplicatione which would lead to the death of 
the patient are tire following 

Ovarian cyst with twisted pedicle. 1 

Ovarian ^rst, bilateral .2 

Ovarian cyst, unilateral .19 


Carried forward 

BO 0 . 


•oog' 






80 Tkb Mxdical Fbbss. 


ORIGINAL OOMMTJNIOATIONS. 


JuLT 24, 1901. 


Brought forward . 

Orarian cyst, suppurating. 

Bilateral dermoid cysts umbilical hernia 
Dermoid cyst suppura^g, sinus through abdo* 

tninal wall . 

Dermoid cyst with twisted pedicle 

JB^pio pregnancy. 

Papillary oaroinoma of both ovaries 

Abscess of ovary . 

Pyoealpinx, bilateral . 

I^osalpinz, unilateral . 

Cystic degeneration of tumour ... 

Necrosis of tumour. 

Adeno-oarcinoma of body of the uterus 
Epithelioma of oervix uteri 

Sarcoma . 

Synoytioma. 


22 
1 
1 

1 
1 
3 
1 
1 
6 
3 
6 
12 

3 

4 
2 
1 

66 

To these must be added three oases of cancer of the 
oervix complicating fibroids, in which hysterectomy was 
not petformeA reported in 1897. (a) 

Also one case of epithelioma of the cervix compU* 
eating a fibroid tumour of the uterus, seen in consulta¬ 
tion with Dr. W. Wayne Babcock in 1899, in which the 
patient's general condition forbade operation. Also a 
mth case from my hospital service, reported by Dr. 
Babcock. (&) 

This is Case 2 of Dr. Babcock’s report, in which a 
fibroid tumour of the uterus was complicated by epi¬ 
thelioma of the cervix, making altogether twelve oases 
of cancer complicating fibroid tumour which have been 
encountered. Of these fatal degenerations and oompU- 
cations of uterine fibroids, making a total of seventy-one, 
thirty-two are of the uterus or tumour, and thirty-nine 
are of tbe appendages. 

2. Of complications threateniog the life of the patient 
are the following:— 

Appendicitis. 4 

Bilateral hydrosalpiox .8 

Unilateral hydroe^pinx .6 

Hematosalpinx .1 

Parovarian cyst .3 

Myxomatous d^^eration of the tumour ... 2 

23 

3. Of conditions leading to more or less permanent 
invalidism of the patient are the following:— 

Calcareous infliction .. ... 6 

Cystic degeneration of ovaries .2 

Intraligamentous development of fibroid ... 10 

Betroversion of uterus .3 

Procidentia of uterus . 3 

Salpingitis, bilateral .2 

Salpingitis, unilateral .6 

80 

It is probably a moderate estimate that seventy-eight 
of these patients would have died of the eomplicationt 
of the fibroid tumour had they not been operated upon. 

It is difficult to estimate the number of deaths 
which would have resulted fromtiie symptoms produced 
by tbe tumours themselres—deaths due to hsemorrhage ; 
to chronic anemia, leading to degeneration of the heart 
and kidneys; to pressure of the tumour upon the 
ureters and bowels; to malnutrition induced by tbe 
hemorrhages and by the increase of intra-abdominal 
pressure iuterfering witii the functions of the alimen¬ 
tary canal; to tbe lowered vitality of the patients, 
increasing their liabili^ to contract interonirent dis¬ 
eases ; to septicemia from necrosis of the tumours; and 
to thrombosis and embolism through associated phlebitis. 
To these mn»t be added the risks of pregnancy and par¬ 
turition wh< n complicated by fibroid tumour. It can 
hai^y be considered as other than moderate if we 
estimate that fifteen of these patients woi^d have died 
eventually as a result of the presence of ^e tumours, 
independent of the above complications. This would 


( 0 ) Noble, Charles F., “ The DeTelor^ent and Preaeat Status ol 
%y a r ec toa »y for Pibroiojroaiata.'’ "Trans.'' Amer. Oroee. Soa. 
1SV7, !>. 38: SrMah Otfnae. Jour., 1897, vol. ziit., p. 48. 

(b) Amor. Cyn. and Obs. Jount,, toI. zilL, p. 403. 


make a total of ninety-three deaths in the 218 cases as a 
result of the tumours themselves or their complications, 
a mortality of 42 per cent. 

In estimacmg tbe numl^ of deaths which would occur 
from the various complications encountered there may 
be a difference of pinion as to the probable history of 
the special complications. It should be pointed out, 
however, that t hi s would merely take away a small 
number from tbe list of deaths to add it to the list of 
invalids.! 

It is impossible to know whether my own experience 
with the complications of fibroids has been an average 
one, or whether the oases of fibroid tumour coming 
under my care have been more or less complicated 
ust^. I am not familiar with similar tables of compli¬ 
cations of fibroid tumour based upon a definite number 
of cues which would afford a basis of comparison. 
Martin (a) reports the following complications and 
degenerations:— 

Complications o/ I’ibroid Tunufurs mel unth in 206 Caus. 


Fatty degeneration of tumour . 7 

Calcification of tumour . ... 3 

Suppuration of tumour .10 

(Edema of tiunour.11 

Cystic degeneration of tumour . 1 

Teleangiectuis of tumour ... 3 

Sarcoma of tumour.6 

Carcinoma of cervix uteri . 2 

Carcinoma of corpus uteri .7 


50 

It will be noted that he makes no reference to the 
condition of tbe appendages, and that thus his table 
, can be compared only in part with my own. 

It may be urged with reason that some of the cases 
included in this table might have been otherwise 
olusified. The cases of cancer and sarcoma of the 
uterus complicatins fibroids and the cases of large 
ovarian tumours might perfectly well have had a 
different claesification, and in this way the list of com¬ 
plications having a fatiti termination would have been 
decreased. But even allowing for such a difference in 
clauifioation there can be no doubt that at least a 
third of the patients would have died as a result of the 
tumour or their complications. 

Some of the more striking complications which have 
' been encountered will next be considered, in order to 
illustrate more clearly the nature of fibromyomata of 
the uterus. 

One undoubted case of sarcoma of the uterus had the 
following history: Mrs. O., set 51, childless, had been in 
failing health for more than a year. She had had a 
fibroid tumour of the uterus for years, which b^d 
recently taken on renewed growth. 

The tumour was the size of a foetal head. Abdominal 
8eotion.Feb. 2nd, 1893, revealed a very soft tumour of the 
uterus, with secondary growths in tbe left broad liga¬ 
ment. Upon subsequent microscopical examination, 
the tumour was pronounced a sarcoma. Tbe uterus and 
its appendages were removed by hysterectomy. The 
patient died after a few months from tbe rapid develop¬ 
ment of tbe secondary sarcoma in the bro^ ligament 
and aMomen. (5) 

A case of syncytioma had the following history 
Mrs. £., »t. 31, hM had two ohilren and one miscarriage, 
which occurred between the two labours at term, llie 


(а) Martin, A., " Patbol^nr and Thenpenticaof the Diieaaoa of 
Women,*' Boston, 1880, p, 2W-272, 

(б) I have seen a second case of undoubted sarcoma of the nterns. 
This was a case of recurrent spindle-celled sarcoma of the cervix. 
The first tumour was removed at the Women's Hospital of Phila¬ 
delphia. and the second at tbe Eensinxton Hospit^ for Women. 
Each time when the patient came under observation the tumour 
was neorotio. making hrsterectomr inadvisable and eaoh time the 
patient refused radical operation after reoovennx from removal of 
tbe sloughing tumour. Tbissarcoma waspedioulatod, and wasnot 
associatM with a fibroid tumour. 

A somewhat doubtful case is that of Mrs. W., operated upon 
September 19th, 16B5. A fibroid tumour undenroiog regenerative 
ohangee was removed, and a elinioat diagnoeia of saroomatous 
degeneration was made. The pathologist reported that this wae 

S bable, but that the tumour was too neorutio for a poaitiTa 
rnools. The Mtient died anbeeqnently of disease of the liver, 
believed to hare been a secondarj development of the taxnonr. 





OBieiNAL OOMMUSICATIOm Th. m.dioai, 81 


JPLT 24, 1901. 

yoongeBt ohild wu thirfy moaths old when she conaalted 
vw, Joae 20. 1893. Meutmation waa normal until wtaA 
months before she came under obeerration. since wfaiob 
time she has been bleeding almost constantly. She 
enffered from pronounced anemia, corresponding with 
the history of the hemorrhage. On examination, the 
uterus was found enlarged by a tumour in the fundus. 
A diagnosis of fibroid tumour with probable cancer of 
the endometrium was made. A combined T^inal and 
abdominal hysterectomy was performed on June 29tb, 
1898. A fairly normal convalescence followed. She 
died early in the December following, about five months 
after the operation. Death was due to secondary involve¬ 
ment of the left lung, and there were numerous small 
tumours undertfaeskinscatteredoverthebody. When the 
specimen was examined after operation, a clinical 
di^noeis of fibroid tumour of the uterus undergoing 
mrcomatous change was made. The final report of the 
pathologist is that the case was one of synoytioma. (a) 

The two cases following were operated upon duirng 
pregnancy : — 

1. Mrs. A., tet. 38, nullipara, was pregnant two 
months. Shortly after becoming pregnant she dis¬ 
covered an abdominal tumour, which on examination 
prored to be freely movable and pedunculated, very eoft 
to the touch, and was believed to be an ovarian cyst. 
Abdominal section was performed, December 8rd, 1894. 
On delivering the tumour it was found to be a soft 
fibroid with a slender pedicle, which was injured in the 
delivery of the tumour. This made the removal of the 
fibroid preferable to its return, in spite of the complica¬ 
tion of pregnancy. The pedicle was ligated and divided. 
The patient made a good recovery from the operation, 
but unfortunately aborted. Subsequently she gave 
birth to a living child. 

2. Hr. P., ffit., 37, mother of four children, suffered 
markedly from pressure symptoms, due to a large 
rapidly-growing fibromyoma. Pregnancy was suspect^. 
This was believed to add to the indication for hysterec¬ 
tomy because of the sise of the tumour. Hysterectomy 
was performed June 20th, 1898. Beoovery was unin¬ 
terrupted. Examination of the specimen showed the 
existence of a twin pr^nancy of six weeks. 

Of the twelve cases of necrosis of the tumour six 
ooenrred in submucous fibroids or fibroid polypi, the 
necrosis being due to interference with the circulation 
by the efforts of tiie uterus to throw off the tumour. In 
these cases the tumours were removed by operation per 
voyiaaM. Two died: one from embolism resulting from 
a septic inflammation antedating operation and persist¬ 
ing after it; the other from advanoM endocarditis. 

Of the six cases of necrosis of the tnmour operated 
upon by abdominal section all were in bad condition 
fi^ septic absorption. All would promptly have died 
from septicemia without operation. Three suooumbed 
to septicemia. One died of embolism of the brain. Of 
the twelve cases of necrosis six died and six recovered, 
showing the extreme gravity of this condition. 

A striking illustration of the fact that the menopause 
need not bring relief to a patient suffering from a 
fibroid tumour is the case of Mrs. C., »t. 67, &e mother 
of one child, mt. 40, who consulted me for the relief of 
intolerable bladder symptoms. She suffered ooustantly 
from tenesmus of the bladder, which had resisted long- 
continued treatment in the hands of others. She 
suffered from hemorrhage of the uterus from the age 
cd thirty-five until the menopause was' establish^ 
at fifty-two. Examination showed a multinodular 
fibroid tnmour, the pelvic portion of which had become 
■calcareous. The subsequent investigation of the case 
proved that, by pressure on the right ureter, the oalca- 
Tsous portion of the fibroid had Ofuised degeneration of 
the right kidney, (^ration was performed, March 6th, 
1805, at the argent request of the patient, in spite of a 
bad prognosis, in the hope that the removal of the 
tumour might afford an (^portunity to relieve tiie 
bladder symptoms. She died four days later of sup- 
p to ai i on of orine. 

In this oonneotion and as bearing upon the behaviour 


(a) KoFidand, Joaopb, " A. Cue of Dsoldnoina ICallfnam,” 
'“noe.," Fatbslogical Soo. of Pliila., UOO, vol. Iv., p. 8S. 


of fibroid tumours after the menopause, reference wi 
be made to the case of a physiciau's wife, seen in con* 
saltation some years ago, who had suffered from the age 
of thirty-five to fifty-three from uterine hemorrhages 
before the menopause was established. Subsequently 
her health improved, but she was never a vigorous 
woman. When about seventy years of age, after a drive 
on a rough country road, the tumonr became necrotic. 
An abscess developed, which mptnred into the bowel. A 
drainage operation was performed, but the patient ^ed 
septic. 

The disappearance of fibroid tumours after the meno- 
pame and after labour is a part of the classical teaching 
concerning tbe life history of these growths. My own 
experience adds little in support of this teaching. Ho 
instance of a fibroid tumour having disappeared after 
the menopause has come under my notice. lu one case, 
seen fifteen years i^o, a fibroid tumour was said to have 
greatly lessened in size after labour, as compart with 
its size before pregnancy. Ho other similar case has 
come under my observation since. That one having 
large opportunities for observatiou could ^ve had this 
experience indicates that the disappearance of fibroid 
tumours as a result of the menopause or as a result of 
pregnancy is not to be expected. This occurrence is 
merely one of the curiosities in the history of ^ese 
growths. 

The ^es of the patients operated upon, grouped in 
deosnnial periods, were as follows :— 


Under ^ . 1 

Between 20 and 30.6 

Fetween 30 and 40.77 

Between 40 and 50.76 

Between 60 and 60.20 

Between 60 and 70.7 


The remaining thirty-one cases were operated upon 
per vapinam. In these cases' the histories are not com¬ 
plete. One of them was between fifty and sixty, and a 
number between forty and fifty. 

From the standpoint of the youth of the patient the 
following are of decided interert: One, at. 17; one, 22; 
one, 24; and one, 26. 

The history of the youngest patient is as follows: 
Miss T., ffit. 17, began to menstruate at 13. Menstrua¬ 
tion was regular ror five months. It then ceased for 
two years, with the exception of two periods. She then 
menstroated every two or three weeks, and from July, 
1890. until December, 1890, when she cousnlted me, she 
had been bleeding constantiy. The patient oomplained 
of extreme debility from loss of blood. Upon examina¬ 
tion a fibroid tumour was found chokiDg the pelvis and, 
extending half-way to the umbilicus. Operation, March 
23rd, 1892. 

l''rom the standpoint of the age of the patient it is 
of great interest that twenty-one patients, including 
one operated on per vaginam, were between 60 and 
60 years of age, and seven patients between 60 and 
70 years of age. The oldest patient was aged 67. 
It will be observed that over 12 per oent. of tbe 
patients were above 60 years of ^e when their 
symptoms caused them to seek relief in operation, at 
which time, according to the classical teaching oonoem- 
ing the life history of fibroid tumours, most of the 
patients should have regained their health as the result 
of the influence of the menopause. Tbe teaching that 
the menopause ensures the symptomatic cure of tbe 
atient does not receive much support from these 
gnres. 

It is not feasible to give the exact ^e at which 
menstruation ceased in patients operated upon after the 
forty-fifth year. A large peroent^e of them menstru¬ 
ated until they were put fifty, and one as late as the 
fifty-fifth year. Ho fact in connection with the history 
of fibroid tumours is more evident than that the meno¬ 
pause is delayed for from three to ten years. 

The relation of fibromyomata to sterility u indicated 
by the fact that of the 218 patients operated upon, only 
ninety-ooe had been pregnant. Of the 127 who had not 
been pregnant, a oertam percentage were unmarried. 
This experience is in accord with tbe accepted belief 
that fibromyomata are a cause of sterility.. . t 

C > gl 







82 Thx Midioil PBRsa. 


ORIGINAL COMMUNICATIONS. 


JPLT 24 , 1901. 


In the list of compliontions no mention was made of 
the qneation of adhesions. In nnmeroos oases adhesions 
were a mark^ featnre—intestinal, appendionlar and 
vesiosl. This was more espeoiall; troe when the tumour 
WM complicated by sidpingitis in its Tarious forms. 
Adhesitms are often the cause of pain, constipation, and 
diwrdm of digestion, and a source of added ri^ at 
the operation. ExtensiTe adhesions add definitely to 
the risks of operation, by increasing the mechanical 
difficulties encountered. 

The relation of fibroid tumours to phlebitis and em¬ 
bolism l^th before and after operation is well reoog- 
nis^. In 1889, before hysterectomy for fibroids wu 
well established, I saw a well-marked case of phlebitis 
consequent upon infiammatory changes in a fibroid 
tumour. In 1900 a very striking case of phlebitis and 
eml^lism, with deatii, came under my observation. 
Mrs. D., mt. 46, multipara, when standing upon a ladder 
working with the arms extended, was suddenly seized 
with violent pain in the abdomen, followed by collapse 
and grave peritonitis. After several weeks the pm- 
tonitis improved, but was followed by phlebitis involving 
the veins on the left side of the neck and left axilla 
She apparently made a good recovery from this condi¬ 
tion, but some weeks later died of embolism of the 
brain. The peritonitis was due to torsion of a pedxm- 
C^ted fibroid, resulting in necrosis of the tumour. 

Another death from embolism was that of a patient 
operated upon when septic, as a result of sloughing of a 
fibroid polypus. She died from embolism tweve days 
after operation, her temperature never having become 
normaL 

Phlebitis following operations for fibroids is quite 
oommon. The exact pathology of phlebitis is imper¬ 
fectly understood. It is the tendency of surgeons to 
attribute all accidents following operation to infection, 
but in many cases phlebitis following hysterectomy 
and myomectomy, the rols of infection is difficult to 
prove or to believe. The most prominent characteristic 
of a series of of post-operative phlebitis is that the 
patients almost, if not without exception, are anremic 
and prostrated. . . 

The most characteristic symptom of patients sunermg 
from fibromyomata of the uterus is anemia. It is not 
feasible to give the exact percentage of patients suffering 
from marked anemia in this group of cases, as many of 
them wore operated upon before the present methods 
for the study of the blo^ were in um. A large percentage 
were anemic, and some of them in the highest degree. 
The following case illustratee the degree to which 
anemia may develop as a result of hemorrh^e:— _ 
Miss E., et. 46, was admitted to the hospital,: 
January 16th, 1901. She was markedly anemic, the 
skin having a waxen appearance, and her hands, ears, 
Ac., being characteristically translucent. She hM been 
bleeding almost constantly for m<mths. Examination 
showed a number of fibroid nodules, and also a small 
tumour of the right ovary. It was evident that the TOn- 
dition of the patient forbade a radical operation. The 
Qtonis wsB curetted on tb© 19tby with tb© hope of con* 
trolling the uterine bleeding, so that with proper feeding 
and treatment her blood state could be improved to the 
point rendering a radical operation feasible. On the 
23rd examination of the blood, gave the following result: 
Erythrocytes, 2,326.000; bemaglobin, 10 per cent.; 
poikilocytosis marked; leucocyte^ marked, of the usual 

Upe. On February 6th, the following: Etythr<»y^, 

2 760,000 ; hemaglobin, 36 per cent. On March 4th, the fol¬ 
lowing : Erythrocytes, 3,640,000; hemaglobin, 46 pwMnt. 
MissE. was discharged March 6,1901,with the advice ttot 
the should return for a radical operation so soon as her 
blood condition bad somewhat improved. She was again 
admitted April 2nd, and on the 4th hysterectomy by 
supravaginal amputation was performed, removing the 
fibroid tumours and the ovarian cyst. The blood exa¬ 
mination on the 3rd showed: Erythrocytes, 3,770,000; 
bsemoglobin, 66 per cent. The examinations of January 
28rd and April 8rd were made with Gower's heou^lo- 
binometer, that of March 4th with Fleischel’s instru¬ 
ment, and that of the 6th with the instruments of both 
Gower and Fleischel. The pathol<^iet'B notes oonoem- 
ing the examination of January 28id state that the 


estimation of tiie bssmagloUn was very difficult beoaosw 
of the exoeesive hemi^lobinemia. The blood was a 
slightly turbid straw-coloured liquid. 

After the curettage Miss E. was extremely ilL Her 
pulse was very feeble and prostration was extieme. 
After the hystMectomy she made a good recovery. 

It seems hardly credible that a patient could live with 
such a hieh giade of anaemia—only 10 per cent, of 
hemaglobin. Had the blood-count been made before 
the curettage was done it is doubtful whether it would 
have been undertaken, as the danger of administering 
etiier under such conditions is well recognised. 

In others of the graver cases of anaemia the result was 
not so fortunate. The risks of shock, of oedema of the 
lungs and of septio infection, after operation, sire all 
increased in anaemic patients. 

The attitude of those advocating what they call the- 
oonservative plan of treatment of fibroid tumours, but 
which would more properly be called the expectant mode 
of treatment, with reference to haemorthage from fibroids,, 
is difficult to appreciate. They agree that when a patient 
has become profoundly anaemic from haemorrhagee,. 
operation is indicated, but oppose operation before tiiat 
>tate has 'oeen reached. It would seem much more- 
li^oal to operate early, thus preventing the develoiK 
ment of a profound degree of saving the 

patient montiis or years of invalidism, lessening the- 
immediate risks of the operation Itself, and very greatly 
shortmiing the period of convalescence after opera¬ 
tion. IVhen anaemia has become profound and of 
long duration, at times it is incurable, and usually 
appropriate treatment must be continued many months 
to bring about a cure. The secondary effects of 
chronic anaemia aire also difficult to cure, and should 
therefore, be avoided. This is especially true of the 
effect upon the nervous system. 

The progressive anaemia often engendered by fibro- 
myomata of the uterus baa a distinct bearing upon the 
operative mortality. In certain oases in whiob a pallia¬ 
tive line of treatment has been followed, it may become 
imperative to operate, despite the transgression of 
Mikulicz’s rule: Kever to operate in any case when the 
haemoglobin is below 30 per cent. 

A certain proportion of deaths also results from 
thrombi formed in the vessels of the tumour, which, 
becoming detached, produce emboli and infection in the 
lungs and other viscera. Besides these alterations in 
the blood, degenerative changes in the form of fatty 
degeneration, brown atrophy, hyal.ne d^eneration, and 
atheroma, have been found in the walls of the heart 
and blood vessels in numerous cases. Over fifteen years 
ago, Hofmeier (o) collected seven cases of uterine fibro- 
myoma, in one of which sudden death resulted from 
pidonazy embolism, in two from a high grade fatty de¬ 
generation, and in four from brown atrophy of tbebeart 
muscle. 

In a number of my own fatal cases the immediate 
cause of death was the rapid onset of pulmonary oedema. 
Whether in those oases the pulmonary oedema was an 
extension of an embolic process in the lungs, or from 
myocardial degeneration, I am unable to say, as it was 
difficult to secure thorough post-mortem examinations. 

Carcinoma and fibroma being such common diseases, 
it would be expected that they should frequently co¬ 
exist in the uterus. In proportion to its relative fre¬ 
quency, the adeno-carcinoma of the uterine body is 
more often in this association than is the more oommon 
squamous epithelioma of the cervix. That the irritative 
action of a fibroma should predispose to the development 
of the adeno-carcinoma would seem slightly lees plausi¬ 
ble that laceration of the cervix should predispose 
to that, of epithelioma of the cervix. Clinical experience 
and embryologioal studies both refute the idea, how¬ 
ever, that the benign tumour may undergo careino- 
matons transformation. Indeed, even the penetration 
of the capsule of the fibroid by an adjacent oaroiooma is 
extremely rare. In two of my cases the carcinoma had 
reached the capsule, but there was no tendency to 


(a) Hofmeiar, M.. Zor Lehre vom Shock (ITeber Erkzsolra^t 
der CipcuUtiOM-Orgaaa bei UnterleibSfMcliwnlBtcn), Z«ti /. Ocow. 
« Gm., Uffi, Band xi., p. 366. -1 


JlTLT 24, 1901. 


ORIGINAL COMMUNICATIONS. 


Thi Mxdioal Puss. 83 


pMielratd tbe snbBtaooe of the flbromyoma. Von Beck* 
lini^henaen observed several cases of adeno^myomata in 
which the glandntar tiesne present seemed to have 
acquired maSig^ant properties. 

Saroomatons degeneration of fibroids would eeem to 
be possible, yet^e close histologioal similarity between 
fibre- and spindle - celled sarcoma and fibromyoma 
renders it difficnlt for the pathologist to determine 
whether a given growth has been malignant from its 
inception or has been the result of a sarcomatous 
degeneration in a fibroid. It is generally accepted, 
however, that the benign tumour may undergo this 
transformation. 

Of the cases of epithelioma of the cervix complicating 
fibroid tumour of the uterus, one is of special interest, as 
it occurred in a virgin. Miss H., set 54, was admitted 
to the hospital, March 26tb, 1901. She bad been in 
failing beall^ for a year, the prominent symptoms being 
increased menstmal fiow, dyspeptic symptoms, in¬ 
creasing debility, inability to retain urine, and neuras¬ 
thenia. On examination there was found an epithelioma 
of the cervix complicating multiple fibroid tnmonrs of 
the ntems. The epithelioma was first onretted and 
homed away. Total hysterectomy was performed on 
28th. An enlarged gland was found over the iliac 
vssaels. This was removed, and under miorosoopioal 
examination proved to be a secondary squamous oell 
epithelioma. A go^ recovery follow^, with the dis- 
^ipeatanoe of all symptoms. 

According to the classical teaching concerning the 
history of fibroid tumours, a fatal tennination is very 
rare. At the present time it is not difficnlt to under¬ 
stand why this is trae, because when the condition of 
petients Buffeting firom fibroid tnmours becomes grave, 
whether from hemorrhage, repeated attacks of peri¬ 
tonitis, distnrbances of the digestive organs, of the 
vssonlar system, or the urinary organs, they are sub¬ 
mitted to operation. Patients operated upon when in 
bad rendition swell the mortality of operations, and also 
greatly increase the list of those making poor recoveries 
after operation. Doubtless in the future the number of 
casee dying directly as a result of fibroid tumours or 
their complications will be less than in the past, becaose 
in a larger percentage an early operation will be per¬ 
formed. Nevertheless, nnmerons cases of death from 
fibroid tumours can be found in the literature. Bishop 
(a) reports 37 fatal cases which be has collected. 

If the cases of fibroid tumour of the uterus which 
have oome under my observation can be taken as repre> 
senting these growths as a class, it is a fair conclnrion 
that death will result in more than on»'third of the 
cases. In more than one-fourth of the cases the result 
will be chronic invalidism. This percentage of invalids 
would be increased by the psroentage of cases nltimately 
ending in death, so that from on^half to two-tbirds of 
the patients having fibroid tumours, which have come 
under my oheervation, have been confirmed invalids. 
Of the remainder, about on^tbird, bnt few have not 
been incommoded to a considerable degree as a result of 
the presence of the tnmonrs. The percentage of cases 
in which tnmonrs have been found more or less aooi- 
dentaliy is quite small. This estimate of the gravity of 
fibroid tumours is radically opposed to the classical 
teaching upon this point. 

It is gratifying to contrast the resolte which can be 
secured through the resources of modem gynmoology 
with those which follow an expectant plan of treatment. 
The mortality of hysterectomy and myomectomy is 
variously estimated et from 2 to 10 per cent. In a 
Series of 346 cases published by myself in 1897 (5), the 
moitali-y of hysterectomy by supravaginal amputation 
in the hands of five American gynsBOologists was 4‘9 
per cent.; in a series of 100 total hysterectomies, the 
mortality was 10 per cent. In a ooUectioa by Ols^ns- 
sen (c) of 806 cases of supravaginal amputation the 
mortality was 6'6 per oent., oontrasted with a mortality 

la) Bisbop, E S., “ Fibromyomata," 1901, pp. 97-31. 

(b) MobI*. CbarlM P.. ’* The Developwent and the Present 
Status of Eysterectomr for Pibromyomata,” Trane. Amer. Oyn, 
1897, roL xzlL, p. 69 

(e) Olahanseo, B,. ''Comparison of Remits in SnpTangioal 
Ampatation and in Total Extirpation of the Utsms,” Keif« Hand. I 
i. 1897, p. 713. 


of 0’6 per cent in a collection of 620 cases of total ex¬ 
tirpation. According to Bishop (Z. e) Mr. Christopher 
Martin reports thirty-five cases of total extirpation, wi^ 
a mortality of 2'8 per cent.; Doyen, sixty esses, with a 
mortality of 2’6 per oent.; A. Maitin, eigbty-one oases, 
with a mortality of 7'4 per cent. The advocates of 
vagina] hysterectomy for fibroid tumours report equally 
as good, if not bettor resulto. The reenlto of myomec¬ 
tomy indicate that enucleation is a more dangerous 
operation than hysterectomy, although, in the bands of 
tmoed men, the results are excellent. Kelly (a) reports 
ninety-seven myomectomies, with four deaths. This is 
to be contrasted with 307 hystero-myomectomiee, with 
fifteen deaths, or a mortality of 4*8 per oent. reported in 
1900. MaoMonagle (6) reports sixty-five oases of myo¬ 
mectomy, with no death. 

From these reports toe estimate that the mortality of 
hysterectomy asd myomectomy varies from 2 to 10 per 
cent., depending upon toe gravity of the oases, upon the 
operator, and upon the environment in which the opera¬ 
tions are done, is quite jostifled. 

We are now able to contrast the mortality of fibroid 
tnmonrs, including that of their degenerations and com- 
plicutiooB, with the mortality uf operation—upwards of 
83 3 per cent, with lees than 10 per cent.; alio the 
morbidity incident to the history of fibroid tnmonrs as 
compared with that which follows operation, in which 
the comparison is very mntii in favonr of operation. 
From all the facts presented, the oonclusion is inevitable 
that the proper treatment of fibroid tnmonrs of the 
utoms is their early removsL Early operation not 
only gfreatly lessens the mortality, but what is of more 
importance, it saves the long period of invalidism, 
which is otherwise unavoidabie- 

Believiog that the best treatment of fibroid tomonrs 
in general is tbeir early removal, the question remains 
whether there are no exceptions to this rule. The beet 
answer to this is that eaob esse must be decided upon 
its merits. It is my individual experience that small 
multinodular snbperitoneal fibroids in women of foity 
yetfs of age or more are the least apt to grow aud to 
cause serious symptoms. Conversely, sabmuoous and 
intramural fibroids in younger women are the most apt 
to develop and to cause serious trouble. It has been 
my experience to meet with but few fibroids which were 
not producing symptoms, and it is, ther-fore, my belief 
that toe percentage of oases is small in which operation 
is not more advisable than expectancy. 


jpatiB dinical jDectuns. 


MEDICAL TREATMENT 

OP 

CANCER OF THE STOMACH. 

By CHARLES ROBIN, M.D., 

Professor of Clinicsl Medicine, nnirenitr of Paris. 
[aXPOBTSD BT OOB PARIS OOBBBSPOMDBHT.] 

It appears strange to make this question the sub¬ 
ject of a lecture when it is known that gastric car¬ 
cinoma is an incurable lesion. But I want to show 
you bow you can and ought to improve the condition 
of these unfortunate patients. When I was a student 
I was painfully struck by the lamentable state of 
abandon in wh'ch these cancerous patients were left. 
I have seen the best professors manifest complete 
indifference towards them. Milk diet, injections 
of morphine when pain was intolerable, iron 
where there was hfematemesis, and that was the end 
of the therapeutic treatment. It was naturally in¬ 
sufficient; by reason of the apathy of the pnysi- 
cian, surgeons claimed the treatment of cancer, so 
much so that at present 75 per cent, of the patients 
who enter the hospital submit to a curative or pallia¬ 
tive operation—pylorectomy and gastrectomy on 

• a) Kelly. H. A., "Abdominal Myomectomy.’' “Trsns.’' Amer. 
OytL Soc., 1898, voL xzHi., p. 223: end ibid., 1900, rol. zxv., p. 213. 

(b) MeoMonegle, Beverly, Private Communication, Deoembe 
2Bth,lB8a 


84 Tmt Mkdioal Pbkss. 


OBIGINA.L OOMMUNICA.TrON8. 


JuLT 24. 1901. 


one band, gastro^nteroBtomy on the other. I think 
it neceasarj, consequently, to react and to warn you 
against this tendency, which appears to me to be 
excessive. For this reason I wish to speak to you 
to-^yon the medical treatment, of cancer; we will 
study later on under whac conditions an opera* ion 
would bejus'ified. 

The treatment of gastric cancer aims at a double 
end: attenuate the sufferings of the patient, nourish 
them and prolong their existence as long as possible. 

The hope of an ultimate cure must beencouraged, 
and tbe treatment should be to that end. as there 
exist other curable affections of tbe stomach that 
might be confounded with cancer. 

Some years ago I observed in this sense a typical 
oase: a man who presented the classical signs of 
epithelioma of the stomach—dark vomiting, tumour, 
emaciation, cachectic condition, Slc. In conformity 
to the rule which I have just indicated, 1 reserved 
my diagnosis, and treated the case on its merits; 
two months later the patient left the hospital cured. 
It was a false cancer. It is evident that the milk 
diet alone would have given tbe worst result. The 
medical treatment of cancer is consequently more 
complicated than would first appear. We are going 
to see what it.is. 

First of all, yoii most not fall into tbe error that 
we have at our disposition a specific medication for 
cancer, and yet some distinguished confrere» have 
thought at one time to have discovered a curative 
therapeutic agent. It is thus that Cabazes thirty 
years ago proposed tbe employment of condurango 
for the cure of cancer. Rives related that out of 
fifty-one patients that agent gave him four cures. 
These results required confirmation. But condurango 
is none tbe less a useful remedy as a stimulant to the 
appetite and tbe digestive functions. It is given under 
the form of decoction, extract or tincture. The decoc¬ 
tion is made with two drachms and a half of tbe bark 
in eight ounces of water boiled down to five ounces 
and fifteen drops of hydrochloric acid added after 
the secretion is filtered. The patient takes three or 
four tablespoousful daily. The extract is given at tbe 
dose of two to ten grains daily, and the dose of tbe 
tincture is from ten to fifty drops daily. 

A second therapeutic agent enjoys great favour 
since the interesting communication made by 
my friend and colleague, M. Brissand; I allude to 
chlorate of soda. 

For a long time chlorate of potash was employed 
in epitheliomata of the tongue and the skin. H. 
Brissand did not adopt this agent because it is a 
poison of the blood transforming the oxy-hsemoglo- 
bine into methemoglobiue. The author in his com¬ 
munication cited five patients absorbing from two 
to four drachms daily of chlorate of soda, a dose 
impossible in tbe case of chlorate of potash. Under 
the influence of this treatment tbe patients were 
much improved, the cachexia disappeared, and in one 
case in six weeks the melena and nsematemesis had 
ceased. 

Our own experience, and that of several authors, 
brought me to conclude that if chlorate or soda had 
not a specific action on gastric epithelioma, it at least 
acts as a tonic, increases the strength of the patients, 
and stimulates the appetite. I must not forget, how¬ 
ever, to mention one counter indication to the employ¬ 
ment of chlorate of soda, and that is the presence of 
albumen in the urine. 

A host of other remedies have been proposed as 
specifics; I will only mention the principal sub¬ 
stances. 

Bichromate of potash was recommended by Yul- 
plan at the dose of one grain daily; it irritates the 
stomach; it should not m employed. 

Tincture of thuya occidentalis, which had its day. 


was I'ecommended at the dose of four dropm at each 
meal, and increased gradually to 100 drops daily. It 
increases the weight of the patient, and might be 
ordered. 

The extract of chelidoioe was proposed by 6re- 
sensko to cure cancer in general, either as a local 
application on external cancers such as that of the 
breast, or used internally against tbe cancerous 
diathesis. I have not obtained any good results 
from it, and cannot advise you to try it. I pass 
rapidly over other substances such as calago, em* 
ployed by the doctors of Paragui^, sulphate of 
aniline, pyoctanine, chloride of gold and sodium, 
bromide of gold associated with araeniate of soda; all 
these products have a more or less hurtful effect on 
the gastric membrane. There remains the important 
questions of serum and beer yeast, but they belong 
as yet to the experimental period, and nothing posi¬ 
tive can be said of them, although it is possible that 
useful results may be reached. 

To sum up, all the drugs proposed as specifics of 
cancer should be regarded simply as stimulants of 
the appetite. The curative treatment does not exist 
practically by medical means. We will see in another 
lecture what must be thought of surgical inter¬ 
ference. 

THE DETECTIOfi OFLOCULATED 
FLUIDS IN THE ABDOMEN. 

By GEO. M. FOT, M.D., F.R.O.S., 

Surgeon to tha Whitworth Hospital, Drumcondra. 

Sir Thoma.8 Watson, in his classic lectures, 
writes ; “ The parietes of the fore part of the belly 
being soft and flexible you might naturally suppose 
that the physical morbid conditions they cover 
would submit tbemeelves to an easy diagnosis. Bat 
tbe truth is . . . the diseases of the abdomen are 
more hard to discriminate than the diseases of the 
thorax.” Bright taught his class to note “ the form 
and appearance presented to the eye, the form still 
further discovered to touch, the resistance ascer¬ 
tained by pressure, the sounds elicited bv percus¬ 
sion, and, in a few instances, tbe sounds perceptible 
to the ear, either alone or by aid of the stethoscope.” 

M. Louis Rostan (Trait/ /l/men. de diag.) illos- 
trates the neceassity for tbe exercise of caution in 
snch cases' by tbe following: An old woman, a 
patient in bis hospital, complained of a severe pain 
in the abdomen, towards the left iliac, region. Her 
face was flushed, her skin hot. her pulse strong and 
frequent, her tongue dry, and she was very thirsty. 
The abdominal pain was aggravated by pressure, 
and by tbe movements of tbe patient. Upon these 
data M. Rostan diagnosed abdominal inflamma¬ 
tion, and he prescriMd accordingly. One of his 
pupils, however, lingered behind, and having 
removed the patient’s chemise saw that the 
trouble proceeded from an attack of shingles. 
To-day the physician, when tbe ordinary methods of 
diagnosis fail him, calls the surgeon to his assist¬ 
ance, and a laparotomy for purposes of diagnosis is 
a justifiable and recognised proceeding, but such 
a step cannot be rightly taken until tbe less serious 
methods have been triM, and as a valuable addition 
to these we wish to bring forward the bimanual 
method of percussion for toe detection of cystic or 
loculated fluids in tbe abdomen, as recommended by 
Dr. John Clark, of Philadelphia. 

On bimanual examination of a pelvic mass of 
questionable consistence, tbe intestines intervening 
Mtween tbe anterior abdominal wall and tbe 
tumour may dissipate the percussion impulse of 
the abdominal band, and although fluid may be pre¬ 
sent, a wave of sufficient intensity to be feu by the 

o'e 



July 24, 190]. 


ORIGINAL COMMUNICATIONS. 


Thx Mxdical Pbiss. 85 


Tafrinal tonoh is not induced. To overcome this 
difficulty Dr Clark confines the tumour as closely 
as possible between the two examining bands, while 
tbe percussion is made by an assistant. “With 
light, quick taps, even small collections of fluid may 
be det^ted by the quick, reeponsiTe, pulsatile wave 
passing from the abdominal to tbe pelvic hand.” 

In tumours other than pelvic the method has been 
modified. By pressing one hand deeply in over the 
bypoohondrium, while with the other deep counter 
pressure is made just below the fixed ribs, the author 
was able to detect an appendical abscess situated 
beneath the csecum and the lower lobe of a down¬ 
ward displaced liver. 

Such cases and such tactile methods of diagnosis 
require from tbe physician the tactm eruditus which 
comes of long practioe and careful observation; but 
which is almost a lost art since scientific instruments 
have become so generally adopted. To those who 
possess the gift the bimanual method of percussion 
cannot fail to be helpful, and it is worthy of a trial 
from all. 

CARDIAC DRUGS AND THE VASO¬ 
MOTOR TREATMENT. 

By Peof. GOTTLIEB. 

Of Heidelbsrs. 

[specially teanblated for the medical press 

AND CIRCULAB.] 

Seeing that circulatory disturbances have for 
result to determine an unequal distribution of blood 
in the organism, the object of cardiac and vasomotor 
treatment must be to restore the equilibrium thus 
destroyed. 

Parmysis of the blood vessels, due to the in- 
anfficient central innervation of the vasomotor 
centres, causes the bloodto flowinto theabdominal ves- 
seb, while the peripheral vessels and those of the skin 
and brain are depleted; the pulse is feeble and the 
heart only receives an inadequate supply of blood 
during diastole. This variety of circulatory inade¬ 
quacy occurs in cases of intoxication resulting 
from the use of narcotics and during attacks 
of infectious disease. In such cases the 
exhibition of cardiac drugs would generally be 
without effect, since it is not the strength of 
tbe heart that is lacking, but that the quan¬ 
tity of blood which it receives is insufficient. 
But tbe blood, withdrawn from tbe action of 
tbe heart and accumulated in the dilated v^sels 
of the abdomen, can be brought back into tbe 
general circulation by the use of drugs acting upon 
tbe vasomotor system, through which they give rise 
to contraction of the vessels in the splanchnic area. 
To obtain this result, strychnine, camphor, and 
caffeine are prescribed. Much the same result may 
be obtained % irritating the skin, or by making cold 
applications. 

Cardiac drugs are used for the purpose of restoring 
the energy of the heart. They increase tbe volume 
of systole, and in this manner tend to remedy the 
defective distribution of tbe blood in the organism, 
which is tbe usual consequence of most complaints of 
the heart, accompanied by a diminution in the energy 
of this organ, an accumulation of blood in the venous 
system and azuemia of the arteries being tbe inevit¬ 
able result of incomplete systole and of insufficient 
ventricular diastolic aspiration. 

Digitalis acts chiefly by strengthening the energy 
of the heart; its vasomotor effect is of secondary im¬ 
portance. Prom experiments made on the heart of a 
fiog,it was long since observed that the cardiac systole 
increases, and that tbe eneigy of tbe ventricular con¬ 
traction is strengthened under the influence of 
digitalis. Recently we have succeeded in making 
the same experiment on warm-blooded animals in 


whom the heart was protected from the variable 
resistance of the general circulation. We are, there¬ 
fore, no longer compelled to base our conclusions 
on experiments made upon frogs. By isolating the 
cardio-pnlmonary circulation, following the example 
of Frangois-Pranck and of E. Henng and Bock, 
we are enabled to study tbe action of digitalis 
on the heart, independently of its effect on the 
vessels; we can also make use of a separated heart, 
in which the functions are maintained by an artificial 
circulation through the coronary vessels. I have 
been able to afford direct proof by this latter method 
that an increase in the volume of tbe systole takes 
place, and by the aid of a special arrangement I 
satisfied myself that after a dose of digitoxiu tbe 
energy of the ventricle is trebled or quadrupled. 

The increase in tbe volume of the systole is caused 
more particularly by a more complete contraction of 
the cardiac muscle; the ventricle emptying itself 
with greater facility. This action is tbe more 
important in connection with an luling heart since a 
failing ventncle becomes less and less capable of get¬ 
ting rid of its contents. Moreover, the slight diminu¬ 
tion in tbe frequency of tbe pulse, due to the stimula¬ 
tion of tbe pneumogastric, which occurs in addition 
to the more strictly cardiac effect under the 
influence of digital, has a beneficial iTifiiiftinvn 
on the cardiac function. Tbe diastolic aspira¬ 
tion of the blood of the veins into the cardiac 
cavity is also favourably influenced by this slowing 
of tbe pulse. Consequently the efficacy of digitalis 
becomes very evident, in proportion as this slowing 
effect is ma^ested. The maximum effect of this 
treatment corresponds to complete expansion of the 
ventricles during diastole, plus a maximum contrac¬ 
tion during systole. Tbe heart in this way pumps a 
greater quantity of the blood which is contained in 
tbe over-filled veins, and propels it into tbe bloodless 
arteries. 

All drugs acting in a manner analogous to digitalis 
have, in addition to the action on the heart, a vaso- 
constricting effect, as I was able to demonstrate anew 
in my recent experiments. But this vasomotor 
action is accessory, from a therapeutical point of 
view; the important factor in combatting venous 
stasis is an improvement in tbe cardiac function. 
The vascular contraction may be of some utility in 
the sense that tbe blood is thereby driven out of the 
congested portal system into other parts of tbe 
vascular system, for, in tbe first instance, it is princi¬ 
pally on the portal vein that the vascular action of 
digitalis is produced; but, if this contraction exceeds 
certain limits, its beneficial effect is transformed 
into one very inimical to the organism, since, in 
consequence of tbe rise of arteri^ resistance the 
work of the heart is needlessly increased. 

Camphor does not only act on the heart indirectly 
through the vasomotors, italso directly increases the 
irritability of tbe cardiac muscle. Its action on the 
normal heart is little marked; on the other hand I 
was able to convince myself in the case of the rabbit, 
that under certain pathological conditions, when tbe 
heart ceases to beat, it is possible by the application 
of camphor to combat this momentoneous stoppage 
and to save the rabbit’s life. 

Caffeine has a direct effect on tbe heart, but one 
quite different from that of digitalis nor can it be 
considered as a substitute for the latter. As a 
matter of fact it does not increase tbe fimctional 
energy of the healthy heart in casee where the blood 
tension is normal, but it strengthens tbe action of the 
cardiac muscle in the presence of a pathologically 
high arterial resistance; it may also be nsmul in 
cardiac complaints accompanied by a high aortic 
tension. 

Alcohol has not a direct influence over tbe heart; 
it acts indirectly on this organ by diminishing the 


C 


86 Th» Mbdicix Pb»88. _ ORIGIN AJj COAMTTlfIOA.TION. _Jult 24, 1901 


pdripkeral resietance, when in consequence of an 
exaggerated aortic tension, the left ventricle can no 
longer completelj emptj Itself. In this' case it 
causes the vessels to dilate, and the resistance to 
diminish, and ss a result whereof the heart carries 
on its work under more favourable conditions, and 
is enabled to furnish a greater amount of work. 

The various cardiac drun, it will be seen, act on 
the circulation in quite a different manner to those 
which act in the vasomotor system. In spite of the 
difficulties that present themselves in the study of so 
complicated a mechanism we may hope that bv asso* 
ciating clinical observation with experimental phar¬ 
macology we may succeed, little by little, in gaming 
a deeper insight into the natoi’e of the circulatory 
troubles which present themselves to our notice, and 
to choose with more discernment the treatments 
capable of combatting these troubles and of 
restoring the equilibrium. 


of gffcictica. 

BRITISH LARYNGOLOaiCAL, BHINOLOQICAL, 
AND OTOLOGICAL ASSOCIATION. 
OnNXBXL Mbstino bild July 12th, 1901. 

Mr. Mato Collibb, F.R.C.8., President, in the Chair. 


Mb. Mato Collibb showed a case of Double Optic 
Neuritis with Paralysis of both External Recti following 
Right Tympanic Disease. The interesting point was 
the cause of the neuritis. Dr. Hawthobnb suggested 
cavernous sinus thrombosis; Dr. Dundas Gbant t^ 
possibility of tubercle. Dr. Woods also spoke, and the 
PRBsiDBNT.in hie reply, objected on anatomical grounds 
to implication of the cavernous sinus. 

Mr. Mato Collibb also related a case of Deafness 
dne to Chronic Sclerosis of the Middle Ear, which had 
bet n greatly improved after relief of nasal obstruction and 
showed a case of Epithelioma of the Maxillary Antrum 
nine months after operation, in which there had been, so 
far, no return. 

Dr. Babclat Babon showed a case of Complete 
Aphonia with Close Approximation of the Cords. It had 
resisted all treatment, and was brought forward for 
diagnosis and suggestions for treatment. There was 
general agreement that the case was functional. Chloro¬ 
form naroosia, hypnotism, and cautery to the enlarged 
veins at the base of thetongus being variously proposed. 

Mr. Lbknox Bbownb showed a specimen of a Fibro- 
Hyxomatons Polypus, removed from behind the palate, 
and found to have proceeded from the maxillary antrum 
through the opening in the inferior meatus, made during 
the course of operation performed some months pre¬ 
viously for relief of maxillary empyema. 

Mr. Lennox Bbownb exhibited a case of Pretubercu- 
lons Condition of the Larynx in a patient who bad been 
treated by him twenty years previously for Traumatic 
Perichondritis due to the impaction of a chicken-bone in 
the larynx. The patient bad since developed symptoms 
which pointed to tubercle, but both pulmonary and 
laryngeal evidences had been—to say the least—incon¬ 
clusive, The main feature was recurrent aphonia, but 
with phonetic cough. 

Mr. Lennox Bbownb also showed a patient with 
Sarcoma of the Pharynx, who had been exhibited twice 

S reviously, first in March before removal, seoon^y in 
[ay after removal, and now ^^in, to demonstrate, first 
that a certain amount of infiltration suggestive of a 
possible recurrence had entirely subsided, and secondly 
in regard to the epiglottis which formerly compressed 
by the growth had now entirely recovered its form aud 
positiim. 

Mr. Lbnnox Bbownb showed a patient, st. 66, ! 
with an enormous tonsil and glandular infiltration | 
which had existed for three months, but up to 


now, though causing comparatively little difficulty 
in sw^owing, had been the occasion of severe pain. 
The microscopical examination revealed that the growtii 
was a sarcoma, and it was suggested that, although 
quite inoperable, the case was one suitable for treatment 
by Coley’s finid, of which the exhibitor had had more- 
than one favourable experience. 

The Pbesident, commenting on the iotereet of the 
case, expressed the opinion that the majority of malig¬ 
nant tumours of the tonsil are Mrcomata. 

Dr. McColl showed a patient suffering from Laryn¬ 
geal Tuberculosis iu an aidvanc^ stage, which bad been 
treated by insufflations of resorcin and orthoform. Both 
deglutition and voice bad been greatly improved, and 
the laryngoscope showed several cicatrices of healing. 
The general treatment bad been that of ’'open air ” and- 
the patient had gained a stone in weight. The Presi¬ 
dent Mr. Lennox Browne, and Dr. Dundas Grant spoke 
in congratulatory terms on the result. 

Dr. Lodob showed a patient with Lupus of the Nose 
cured by Excision according to the method of Anderson, 
with an artificial nose of aluminium madi by the patient 
himself, who, a ooechbuUder by trade, bad achieved a 
success far exoeediogthat of one of ordinary manufacture 
which was exhibited for comparison. 

Dr. Dvndas Gbaht showed (1) a case of Post- 
Diphtherial Paralysis; (2) Ulceration of the Tongue^ 
probably malignant; (3) Thrombceis of the Jugular 
Vein. 

Dr. Woods (Dublin) opened a special di<oix8sion on 

TCHOUBS OP THE PBABTNX FBOM THEIR CLINICAL 
ASPECT. 

He related eeveral cases in his own practice both in 
the naso-pbarynx and in the lower pharynx and his 
methods of operating. The chief interMt t^ned on the 
advisability of operation. 

Mr. Lennox Bbowke SDoke in favour of removal at 
the earliest postible moment after di^nosis and related 
several cases, and the Pbesident discussed the question 
from the point of view of aorgioal anatomy, giving 
several fatal instances which, from the experience of 
others, might have been successful had they been 
attacked with courage in their early history. 

Dr. Dundas Gbant confessed himself at a loss to 
account for the undoubted hesitancy of even bold 
surgeons to interfere with these casee, considering tho 
great advances that had been made in radical operations 
generally. 

Dr. Lodge related a case, and showed photographs of 
a successful operation for removal of a sarcoma of the 
naso-phnrynx and of involved cervical glands. 

Dr. Vinbace drew attention to the success of the 
case of Mr. Lennox Browne, which, when first exhibited, 
was almost unanimously pronounced by the Fellows pre¬ 
sent to be inoperable. 


^ermsttp. 

[Fbom Odb Own Cobbebpondent.] 

Bbblib, July SOth, 190L 
Pathoobnbtic Studies on Phthisis, Cancer, and 

SOME OTHEB DISEASES. 

This is the title of an interesting work by Professor 
Riffel Carlsmhe, in which he endeavours to ghow the 
origin of various diseases. The onset of various 
epidemics observed in four places poeseesing different 
kinds of geographical position, drinking water, subsoil, 
Ac., confirmed an idea already in his mind that 
the prime causes of diseases are to be sought in the 
individual himself, and in the peculiar character of his 
organs and tissues, wnioh become changed from one 
moment to another, and not alone by the chemical and 
bacteriolc^cal examination of external things, nor by 
experiments on animals or infection of wounds. The 
author gives tables of family trees of about fifty 

oogfc 



AUSTRIA 


Thi Medical i’sEAS 87 


Jolt 24. 1901. 

4ifferMit families, and draws from this material his 
ocmolnsion that tnbercnlosis is a distinot disease from 
phthisis, which is a neorotio process of the lungs depon¬ 
ent on congenital disposition or tendeno 7 . The pro¬ 
phylaxis of phthisis lies, therefore, in the avoidance of 
constitstional weakness. As medicinal means of 
improving the constitution are not always at hand, 
residence in mountain ourative resorts is necessary, and 
the furtherance of tiiese institutions is one of the most 
important hygienic objects. 

By far the greater part of the cases of cancer ob¬ 
served by the author occurred in families in which 
phthisis also had occurred. The presence of the tubercle 
tiaciUnsin broken down cancer masses is for him a proof 
of their saprophytic nature. 

Begarding puerperal fever the author comes to the 
oottolosion that women who belong to phthisical families 
are susceptible to septic diseases. With any suspicion of 
phthisis about them pregnant women in lying-in hos¬ 
pitals should be isolated. 

He {oophesies that the results of bacteriolc^cal 
achievements in regard to phthisis will eventually 
prove to be as small as that obtained from the Hambui^ 
obolera epidemic in respect of that disease. In spite of 
a good deal that must now be considered heterodox in 
Professor Siffers teaching, the factors of tiie individual 
himself, hia o^ans, and his tissues has of late years been 
somewhat overlooked, and all disease has too generally 
been put down to '‘outside things.*' 

At the Society fur Innere Medizin Hr. Litten related 
a case of 

Ekbolisk op the Pulkonabt AaTauT. 

A woman of 70 was brought into hospital a few days 
ago with symptoms of myocarditis, extensive dyspnoea, 
irregular pulse, and albuminuria. Death took place 
suddenly through iucreased dyspnoea. Section showed 
the following conditionsIn the lungs firm large 
Bodnlee, of which four or five appeared as prominences 
on the surface. They were haemorrhagic in parts, as 
shown by cutting into them. The arteries leading to 
the nodules were blocked even up to the finest branches. 
On the hilus of the lungs was a large fleshy mass that 
came from the pulmonary autery of the left Inng, which 
was completely blocked by an embolism the thickness 
of the thumb, so that not a single drop of blood could 
paws through it. Here was the oause of the sudden 
death. When the question came up: whence does this 
embolic material arise, there were two possible sooroee, 
either clotting in the veins or thrombi in the heart. 
In this oaeethe latter were present ; the left ventricle, 
which was exceedingly dilated, was filled with 
atdherent thrombi; the left auricle with haemorrhagic 
iatarots and tiirombi in the right heart, especially in the 
auricle. - The emboli had at first passed through the 
arteriee of the lungs and set up the infarcts, and later 
blocking of the arteries themselves took plaoe. 

He remembered a case seen when he was assistant in 
Prerioh’s Klinik. A man, act. 29, was taken in with 
severe dyspnoea, systolic and diastolic murmurs in the 
r^on of the pulmonary artery, and soon died. Section 
showed the followingThe trunk of the pulmonary 
artery and the two branches given off were filled with 
nofflberless echinocoocus cysts, which filled up the 
Inmmi of veeeels np to thcwe of the third order. The 
systolic and diastolic murmurs were caused by the 


emboli, which prevented complete closure of the valves. 
There; was a question how long the man might have 
lived with this blocking of his arteriee. A little blood 
might possibly have passed, and the section showed 
evidences of this in small blood clots at the peripheral 
ends of the embolus. Whence the eohinooooous cysts 
originated was not ascertained. 

The MuHch ifed. WocAervtch., 19/1901, contains the 
relation of a case of 

Gdnssot Wodnd of the Bladdbe 
by Dr. Bayerl. A little boy, sb. 8, was accidentally 
shot by his brother by a small pistol. Examination re¬ 
vealed a small roundish opening just above the os pubis, 
the borders being braised and blackened. The opening 
led to a small canal passing to the right, which could 
be followed a distance of 5 otm. The ballet could not 
be found. From the opening trickled a small quantity 
of watery fluid (urine), slightly mixed with blood. The 
boy complained of strong desire to micturate. The next 
day matters had improved so much that clear urine was 
passed spontaneously from the urethra, but the next 
day they became worse again. There was great restless¬ 
ness and excitement, violent pain in the scrotum with 
swelling, swelling at the fundus of the bladder, vesicnlar 
swelling at the root of the penis, and fever. No urine 
came throngh the wound. There was, therefore, infil¬ 
tration of nrine. A number of incisions were 
now made in the scrotnm, penis, Ac., and a 
good deal of urine escaped throngh the wounds. 
The pain ceased, however, and the swelling and fever 
subsided. Three days later the ballet was found in the 
dressings. Recovery witii healing of the wounds now 
speedily followed, without any necessity for farther 
sulcal procedures. 

The Deuit. M»d. Z»it., July 8th, reports a case of 
supposed 

Syphilitic Fabaltbib after Chlobofobm Nascosis. 

A patient, et. 84, was operated on for hernia. The 
stage of excitement was so extreme that the man's arms 
had to be tied together. Afterwards the patient noticed 
that the left arm was quite powerless, and that the right 
arm could only be moved with difficulty. Twenty-three 
days after the operation the reporter of the case 
diagnosed bilateral paralysis of the btaohial plexus. It 
was ascotained anamnestically that the man was an 
alcoholic, and that five weeks before be had contracted 
a syphilitic infection. On treatment by inunction im¬ 
provement took place, and in a few weeks complete 
recovery. The reporter atcribotes the paralysis to the 
syphilis, bat paralysis onder similar oonditions is not 
unknown where syphilis is out of the queation. 


JluHtrift. 

[fboh oub own COBBBSPONDBNT.J 

VnasA. Jolp 90th, 1901. 

Lichen and Lupus. 

SiBOFBiBD Janovbkt at the Pragne meeting showed 
two oases of lichen and several of Inpos. 

(a) Suber planus in the case of a female, st. 67, 
scattered over the body and extremitiee aa brown, flat, 
waxy lesions, with glancing, homy, shield-like appear¬ 
ance. Arsenio was administered with tar and hydro¬ 
pathy to relieve the itohing. The 
slowly, leaving a brown sepia ooloor. 


> disease improved 

by Google 



88 I'HS Medical Pbbso. 


CONTINENTAL STATIONS. 


Jdlt 24, 1901. 


(i) Svhtr vermeota in ayoatb, eet. 19, localuedonthe 
lower extremities. The effioresoenoe appeared to be doe 
to an excessire proliferation of the papilla. The feeble 
oonstitntion and imperfect assimilation of food was in 
favoar of Bobinson’s theory of the oaone of the disease, 
Tiz., a great enfeebling of the individual and diminished 
resistance of the body. 

Lnpas erythematosus in a typical facial form.— 
Patient a female, married, tet. 36. Various remedies 
were applied till erysipelas commenced on the healthy 
side and extended to the affected side. On recovering 
from the erysipelas the lupus disappeared also. 

The next case was that of a male, set. 49, which was 
peculiar from the hyperkeratosis developed on the 
affected side. 

Janovsky related a number of similar cases to the 
first which were cured with Koch’s tuberculin contrary 
to the opinions of French authors. In seems that the 
toxin from the tuberculous bacilli has some beneficial 
effect on lupus erythematosus by awakening some 
centre not reached by external applications. 

The beet therapeutic for lupus vulgaris was scarifica¬ 
tion after Brook’s method. He cannot speak favourably 
of Holl&nder's hot air treatment, and thought UUmann’s 
apparatus for treating epididymitis with warm air was 
certainly more curious than clinically useful. 

He slso showed a patient from whom he had removed 
a keloid by means ef electrolysis, according to Ehrman, 
with very happy results. On the first occasion he ex¬ 
cised it under the impression of extirpating the disease, 
but, unhappily, it soon recurred. 

PoTSNCT ov Acid F&xb Alkaloids. 

Velioh, at the same meeting gave the result of his 
experience with non-acid alkaloids, such as nicotine, 
coniine, and piperidin, which were more active in 
raising the blood-pressure than any of the others* 
this he attributed to their more energetic action on 
the vasomotor centres, while the other substances act 
more on the periphery. To demonstrate this fact is no 
easy task, as the whole central nerve system must first 
be eliminated, whi<di means destroying the life of the 

afilwitLl 

If 100 or 200 cubic centimetres of a physiological 
solution of sodium chloride be injected into the vessels 
on the right side of the heart immediately after 
removing the medulla the be made to survive 

two hours after the operation, which was demonstrated 
long ago by Spina. By the help of Spina’s foots Velioh 
found that Iniootine, coniine and piperidin raised the 
blood pressure by their peripheral action. 

If any of those poisons are injected several times in 
rapid succession this elevated pressure is not observed, 
but if at this point the extract of the suprarenal body 
be injected the vessels are rapidly contracted, as if only 
one dose of poison had been injected. 

Nicotine seems to act more through the vessels, while 
conine and piperidin act more on the peripheral vaso¬ 
motor ganglia. 

The vessels of the brain, lungs, and retina were 
exceptions to these drugs, as some of them were con¬ 
tracted by the acid free alkaloids, but on the contrary 
the vessels of the brain were dilated. Velioh cannot 
say he has yet discovered a drug that causes real con¬ 
traction of the vessels in the lung. 

Whether tiiese drugs have another action on the 


medulla oblongata and spinal cord, when i» titu he 
will not venture to predict as his experiments were con¬ 
fined to the peripheral organs. In tying the carotid 
artery close to the subclavian we cannot depend upon 
the half of the medulla being acted on as the arterial 
anastomosis is too great to make the experiment 
of any value. 

Facial Pbssbmtation. 

Ostreil gave an analysis of 11,613 cases delivered at 
the Hebammen ” Clinic of Prague, of which fifty-nine, 
or 0‘5 per cent., were face presentations. Of these 
fifty-nine one-third were primiparae, and two-thirds 
multiparse. This position was no more dangerous for 
the mother than the vertical pole, except that labour 
was more protracted. Infant mortality is high, being 
41'8 per cent. In six cases, or 10 per cent., instru¬ 
ments were used, with two fcetal deaths. In one case 
perforation was performed $ twice turned; while nine 
were improved by Thom’s manual correction. 

Ostreil recommends the earliest possible interference 
to correct the position according to that recommended 
by Schatz, which may be easily performed if sufficiently 
early diagnosed and no complications present. 

Wheu the head haa descended well into the pelvis, 
and the os fully dilated, chloroform should be given, and 
Schatz’s method tried; failing this, Thom’s method 
may be undertaken, ».e., pass the hand into the utema 
till the occiput is firmly grasped, which is then drawn 
forward while the face recedes. This operation is assisted 
by the second hand manipulatingthe external surface of 
the abdomen. 

The cause of this position is often attributed to the 
doUohocepbalic condition of the foetus, but Ostreil thinks 
this a result and not a cause. The primary cause he 
assigns to the great else of the foetus ; in all his eases 
only eleven of them were under 8.000 grammes. This 
state shows the chin to fail low and catch on the pelvis. 

(Eontincntal (Elimatic Stations 

[raOH ona own ooaaxspONDBNT.] 
MUBBEN. 

Where Alps o» Alps arise.” 

Mubbbn claims pre-eminence among the health resorts 
of the Bemer-Oberland for beauty of position, and for 
unique mildness of temperature at so great an eleva¬ 
tion. The village occupies a broad sheltered terrace 
6,300 ft. above the sea-level, and face to face with the 
great peaks of the Jungfrau range, commanding a very 
near view of an incomparable Alpine panorama. On 
the left, across the deep valley of the White Lutschine 
river, the prospect is over the verdant Wengen and the 
stony Soheideck plateaus, with the snowy summits of the 
Wetterhoms behind; to the tight of these is the precipi¬ 
tous pyramid of the Eiger and the broad snowy outline 
of the Monch. Yet nearer is the dark mass of the Black 
Monch, on which can frequently be seen chamois 
grazing, and above which towers the superb Jung¬ 
frau, and by its side the dazzling loveliness of the Silbar- 
hom. Yet more to the right come, one after the other, 
the Gletscherhom, Ebnefluh, Mittaghom, Grosshora, 
Breithorn, Tschingelgrat, Gespaltenhom, Buttlasseo, 
each great enough in its grandeur to make any other 
spot notable. 

The village has a mixed aspect; old-world oh&lets 


Ji^T 24, 1901 THC 0P£!B)&.THfG' TB£ATjEtE!S. Ths Mxdical Pbbbs. 


%)xt (S))reratm9 ^heAtrts. 


iatecrningle with Jin de tiirle hotels, of which the 
premier for position and comfort is tiie Grand Hotel 
dee Alpes. Mnrren is an all-year>roand reeidenoe. In 
July and August its hotels and pensions are gay and 
crowded, giving an attractive, lively spectacle of 
Continental summer life. To many its quieter months 
of May and June are more attractive, for as soon and 
aa rapidly as the snows recede, its meadows, hillsides, 
and woodlands are richly decked with flowers; white 
croons, violet bells, gentians, anemones, auriculus, and 
primulas abounding all around, and making the 
numerous walks “things of beauty." for here Nature 
has placed the grand and the lovely side by side. One 
of these walks is to the Blumenthal, a hollow surrounded 
by mountains and remarkable for its wealth of Alpine 
flora. For the athletic the heights near Mnrren afford 
sunple exercise, especially in September, when the very 
clear atmosphere is most favourable for mountain views. 

Among the climatic advanti^es of Mnrren may be 
mentioned:— 

1st. Its complete protection at all seasons, although 
&t so high an altitude, by the AUmendhnbel and hills 
further ba(^ to the north and west, from bleak and 
violent winds and against sudden changes of tempera¬ 
ture. 

2nd. Its very desirable southern exposure. 

3rd. Its separation by a ravine-like valley, 1,600 feet 
in depth, horn the immense glaciers and snow covered 
mountains immediately vw-a-vt« to the village. This 
deep valley has a peculiar beneficial effect upon the 
evening temperature. During the day the radiation 
from sun's beams on the precipitous wall of rock upon 
which the village is built warms the air in the valley. 
'When the air on the heights opposite Mnrren after 
sunset becomes cool and heavy, this cooler and heavier 
air sinks gradually into the intervening valley, forcing 
up on the Mnrren side the lighter and warmer air which 
flows as a warm current over the Mnrren plateau j an 
agreeable prooess often noticeable in the village until 
midnight. 

A sojourn at Mnrren can be recommended in oases of 
debility, especially for variations in the composition of 
blood arising from anaemia, defective assimilation,' 
haemorrhages, suppurations, fevers, excessive mental 
exertions and perturbations. It has been very success¬ 
ful for cachexia, malaria, and disorders caused by 
tropical climates ; also in convalescence aifter pleurisy 
and pneumonia, in chronic asthma, dyspepsia, insomnia, 
and early stipes of consumption when unaccompanied 
by hectic symptoms. 

Murren is accessible from Interlaken and Grindelwald 
by railroad to Lanterbrunnen ; thence by Funicular to 
Gmtaohalp ; and thence by electric railway through 
pleasant fields and woods to Mnrren village. The water- 
worked Funicular from Lauterbrnnnen will be changed 
the coming autumn into an electric line, giving greater 
facility of access, and enabling the Murren hotels to 
have an excellent winter season. Its southern expo¬ 
sure, equable temperature, and peculiar position will 
speedily make it a popular home when the change of 
Funicular has been completed. 


His Kajbbtt Kiko Edwabd VII. has consented to 
become the Patron of the Boyal Medical Benevolent 
Fond Society of Ireland. 


ST. MART’S HOSPITAL. 

Casb of Middlb Mbkimoeai. H^hobuhaos. —Mr. H. 
Stansfibd Collixb operated on a man, st 40, who 
had been admitted after having fallen from his 
bicycle on to his head. He been picked up in an 
unconscions condition, but when brought to hospital he 
had r^^ned consciousness. He was bleeding con¬ 
siderably from the right ear, and his left hand grasp 
was a little weak. He expressed himself as not being 
much hurt, and Mr. Hunt, the House Surgeon, had some 
difficulty in persuading him to stayin. Three hours later 
the patient showed a definite left hemiplegia, and very 
rapidly became unconscious, and had a very slow pulse. 
The oircumstances being very urgent, three hours and a 
half after admission he was taken to thetheatre, and Mr. 
Collier turned down a large flap of scalp from the side of 
the head, and founds linear fracture crossing the base o^ 
the mastoid prooess from behindforward. A disc of bone 
was removed from the parieto-mastoid junction, and an 
enormous extra-dural clot was discovered, but no tear 
of the dura mater. A second disc of bone was now 
removed at the anterior inferior angle of the parietal 
bone: it was then ascertained that the dura mater was 
separated over nearly the whole of the right half of the 
vault. By the aid of a suitably curved Volkmann’s spoon 
some oxmoes of firm clot were removed. While this was 
being done sharp bleeding continued, and this was 
with difficulty arrested by plugging with strips of 
cyanide ganse which were passed down through the 
anterior trephine hole towards the foramen spinosnm. 
At the completion of the operation the cavity from 
which the clot had been removed was still present, 
and there seemed to be no expansion of the cranial con¬ 
tents. Mr. Collier remarked that this case was an 
excellent example of middle meningeal htemorrhage, and 
that the sequence of transient nnoonscionsnees, recovery 
of consciousness, and hemiplegia, followed by a relapse 
into an unconscions state, was particularly well illus¬ 
trated ; the pouring of venous blood from the ear bad 
made him at first a little uncertmn as to the di^nosis, 
because he had seen a similar group of symptoms lesnlt- 
ing from intra-dural hemorrhage from the lateral 
sinus; it was on this account that he had made the 
posterior trephine hole. In this case, he pointed out, 
it was clear that a fracture of the base ran through 
the petrous bone into the greater wing of the sphenoid 
and the middle meningeal artery was ruptured very close 
to the foramen spinosum. Failure on the part of the 
cranial contents to expand was probably in part due to 
the condition of shook, the cardiac failure being very 
obvious; in addition perhaps the brain was actually 
buckled in towardstheventricle. To stop the heemorrh^e 
it mi ght appear to be better, he said, in such a case to tie 
the external carotid, but the collateral circulation is so 
free that this procedure might not stop the bleeding 
altogether, and one would have the disadvantages of 
operating on a neck which was unprepared by antiseptics. 
He pointed out that tiie plug as he had iuserted it 
would not be large enough to cause any serious compres¬ 
sion, it would be removed the next morning, and in 
spite of the shocked condition of the patient he would 
hope tiiat he would do well. 

The Tnan rallied well, and was conscions three or four 


90 The Midical Pbesb. _ LEADiyC 

honn after the operation. Five grains of calomel were 
given, and some bromide of potassinm to combat the 
leetlessnees. Next day the paralysis had disappeared, 
and the man was discharged cared in a fortnight. 


Begistebed for Feamshissiok ABROxn. 

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PnbUsbed emy Wednesdsj morning. Price 5d. Post free, 6id> 
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(weeklj, fortni^htlj, or monihly), at £S lOs. Od. { twenty-six 
insertioiis (weekly or fortnightly) at £S Ss. Od. | fifty-two 
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at 18s. i fifty-two insertions at IRx each. 

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beyond. 


^kt (jEebical ^vtss anb (Eircnlar, 


BALU8 POPULI SDPBIlfA LIX.” 


WEDNESDAY, JULY 24, 1901. 


THE “LIGHT” AND OTHER TREATMENTS. 

Recently a sab-committee of the British Medical 
Association has passed in solemn conclave a resolu¬ 
tion that it is a breach of professional ethics for any 
medical man to allow his photograph to be pub¬ 
lished. As an abstract resolution the standard of 
that decision stands high, but when reduced to 
practice it will, in all likelihood, sink at once to the 
futile level of a pious opinion. The truth of the 
matter seems to be that veiled advertisement finds 
its folleat and most skilled expression among the 
higberranksof the profession. Any candid reoderwho 
thinks for a moment of the scores of photographs of 
professional brethren that have come to his notice 
in lay journals will be able to form a decided opinion 
not only as to the extent of the practice, but also as 
to the status of these victims of editorial pushful- 
ness. But if it be wrong in principle to obtain pub¬ 
lic newspaper notice in the form of portraiture, it 
is clearly no less culpable for a physician or surgeon 
to have bis name lauded in the lay journals iu con¬ 
nection with this or that treatment. Yet this kind 
of thing has been going on for a year or more in 
connection with one of the largest of our 
Loudon hospitals. We allude to the systematic 
press notices of the Finsen light treatment of lupus 
and certain other skin condiiiona that have appeared 
in the public press, together with specific and 
repeated, mention of the names of certain medical 
men. To some extent the gentlemen thus in¬ 
vidiously selected for journalistic attention most 
command our sympathy in their somewhat painful 
position. If this sort of thing is to be permitted in 
high places, however, there is no reason, at any 


ARTIOLEb . ___ Jolt 24, 1901. 

rate on the surface, why a similar means of 
getting in touch with the public should not 
be wilfully and knowingly adopted by enterprising 
general practitionei's. Tbe ethical offence is the 
same whether committed in tbe West End square or 
the East End slum. In tbe case of the Finsen 
light treatment the facts of tbe case are such as to 
demand serious attention on the part of the medical 
profession and of the public. The success of tbe 
method in curing lupus is undeniable, but there is 
no scientific evidence either that the cure is per¬ 
manent or that the results of that particular plan 
are better than those yielded by ordinary surgical 
tiuatment. On tbe other hand, the cost of tbe 
apparatus and of its administration are relatively 
enormous, to say nothing of tbe tedious nature of tbe 
process. On tbe whole it may pretty safely be pro¬ 
phesied that in a few yeaiv' time the Finsen method 
of the treatment of lupus will be a curiosity of medi¬ 
cine, just as many a therapeutic fashion has come 
and gone. Meanwhile the lay journalist finds 
material for much interesting “ copy ” from tbe com¬ 
plicated measures introduced by Finsen. At the 
same time, a matter that more nearly concerns our 
readers, the names of a certain number of physicians 
and surgeons are being noised abroad in connection 
with that treatment. Something of the same kind 
is being done in the tberapentio action of 
the X • rays, or rather of the focus tube 
from which the X • rays are emitted. There 
can be no doubt that the focus tube exercises 
a healing action upon lupus, certain forms of ulcer, 
and other affections of the skin. Here again, how¬ 
ever, we are faced by the general consideration that 
similar beneficial results can be obtained equally 
well from ordinary treatment. That view of the 
position is confirmed by tbe attitude of tbe leading 
dermatologists, none of whom have seriously advo¬ 
cated the use of tbe X-ray tube in skin practice. 
On tbe other hand, we find a few medical 
men receiving wide newspaper notice on the 
score of their wonderful results with the 
X-rajs in that class of case. Now and then, it may 
be well to add, some of these attempts, guided by 
more zeal than balanced knowledge, have resulted 
in serious injury to tbe patients. To sum up the 
position of the profession with regard to the light 
ray and so-called X-ray cures, it may be said that, for 
the time beinir, professional judgment is suspended 
as to their exact value, and that in tbe meuitime it 
is derogatory to the medical profession as a whole, 
and to those medical men in particular whose names 
are publicly asssciated with those methods, that the 
therapeutic measures iu question should receive 
notices in the public Press. 

THE PROPOSED NATIONAL JOURNAL OF 
OBSTETRICS AND GYNAECOLOGY. 

The adjourned meeting, to elsct a committee with 
a view to the foundation of a national journal 
devoted to midwifery and the diseases of women, 
and representative of Great Britain and Ireland, 



JuLT 24 , 1901 


L 1 EA.DTNG ARTICLES. 


Thk Midical Pbiss. 91 


tofcether with the Colonies and Dependencies which 
complete the British Empire, will be held to-day 
Tuider the presidency of Sir John Williams. Accord¬ 
ingly. it b of interest to ask ourselves what position 
will such a journal occupy, if it be founded ? Ques- 
ticms of many kinds must occur to the minds of 
obstetricians and gynscolofirists with I'egard to 
ite future. Is it required ? Will it injuri¬ 
ously affect the interest of tbe various societies 
which already publish journals or transactions ? 
What will be its scope ? That a national journal 
devoted to obstetrics and gynsscology is required, 
there is little room for doubt. Indeed it b curious 
that such a journal was not sooner started. But it 
most be a national, or rather an imperial, journal, 
carried out on tbe widest lines, well illustrated, and 
of large sbe. In fact, to take a phrase from our 
Transatlantic brethren, it must be a “big thing.” 
If it is stunted in its youth, assuredly it will never 
get the necessary pabulum of subscriptions which it 
requires. A journal of gynecology and obstetrics 
which limits itself to tbe United Kingdom will have 
but a short life. A few years ago, such a journal 
might have been successful, when the newness of 
gynecology, and the consequent opportunities 
which this subject furnished for individual work 
were such as would have provided abundant 
materiaL Now, the newness has somewhat 
worn off, and tbe consequent yield of journal¬ 
istic matter is diminbbed. But perhaps this 
in itself b an advantage. We do not want a journal 
in which the opinions of British gynecologists are 
repeated ad nauseam—opinions which in many cases 
can be readily foretold before they are uttered ; but 
we do want a leavening up or down—as the case may 
be—of home opinions and doctrines by tbe introduc¬ 
tion of the knowledge and opinions of our Colonial 
brethren. But will not such a journal interfere 
prejudicially with the interests of our British 
obetetrical and gynscological societies? There are 
two sodeties which publbb Transactions, and there 
ia one which publishes a quarterly journaL Do not 
these publications adequately meet the needs of the 
British gynecological and obstetrical world, and will 
not tbe proposed journal sap the strength of the 
societies by depriving them of their members? We 
do not think so for one moment. The proposed 
journal must, in our opinion, be an imperial one in 
order to succeed. Tbe journal of tbe British 
Gynecological Society is devoted to the work of tbe 
fellows of that Society, and ite circulation b—save for 
a few copies—limited to the Fellows. It is a 
part of tbe Society, and Fellows and prospective 
fellows will be no more drawn away from their 
actual or prospective allegbnce by the fact that an 
Imperbl journal of gymecology has been started, 
than are the Fellows of any medical or surgical 
society drawn away because there are great medical 
and surgical journals published. Men join a society 
in order to belong to that society and to take part 
in its debates, and not merely to obtain the pub- 
Ibhed report of its proceedings, even if such a report 


assumes the form of a journal. The interests of the 
other societies to which we have alluded—the 
London and tbe Edinburgh Obstetrical Societies— 
will be even less affected by the bsue of the pro¬ 
posed journal than is the Gynmcological Society, 
inasmuch as they publbh their proceedings in 
the form of transactions. Consequently, we trust 
that all our British gynecological and obstetrical 
societies will join in furthering tbe establishment* 
and in ensuring tbe success of the proposed journal. 
No individual society can prevent the foundation of 
such a journal, but by withdrawing its aid and so 
depriving tbe journal of that universal support 
which is so necessary, it can make ultimate failure 
take the place of success. If the new journal goes 
abroad as the representative of only a section of 
British gynscologists and obstetricians, what hope 
has it of becoming truly Imperial? And upon 
this we lay specbl stress, the more truly imperial the 
new journal is, the less it will affect the interests of 
individual British societies ; the more it is crippled 
by tbe lack of universal support, the more it will 
interfere with tbe interests of tbe societies. Space 
forbids us from writing more. One point we would 
strongly urge—that the promoters of the journal 
should take every step, as we believe they will take, 
to ensure that their journal shall be representative 
of tbe entire obstetrical and gynssoolog^cal world of 
Great Britain and Ireland, and of our colonies and 
dependencies, and that if they find insuperable diffi¬ 
culties in the way of creating so universal a 3 oarnaI 
they will spare themselves the pain of originating a 
failure. 

HERNIA OF THE URINARY BLADDER. 

One of the commonest operations which the 
surgeon is called on to perform is that for the relief 
of inguinal hernia. As a rule no difficulty is 
experienced, and if tbe patient is in hospital the usual 
course is to supplement tbe primary operation by 
performing tbe radical cure. The operation, how¬ 
ever, is not always one of election; it is not 
unfrequently one of urgency, to be performed 
under the most unfavourable conditions, and in a 
state of extreme physical prostration of the patient. 
To add to the difficulty it has, at times, to be done 
by a poor, artificial light, which is very unsuitable 
for making the necessary examination of the con¬ 
tents of the tumour. In such hernial tumours tbe 
surgeon must be prepared to meet any of the abdo¬ 
minal or pelvic viscera, or, indeed, almost all of 
them, as in tbe case of the distinguished patient of 
Cline and Cooper. One of the least frequently found 
of the viscera is tbe bladder, which is present in 
about one per cent, of such cases, according to 
Sjovall, and at all ages, from twelve months to 
eighty years. It is not easy to recognise the 
viscuseven in daylight and in artificial light the recog- 



operator needs not to be told that the walls of tbe 
urinary bladder as seen in such a tumour may vary 
in thickness from that of the wall of the ileus to 



92 Th» Medicai. Pb*88. notes ON CURRENT TOPICS. 


that of the cardiac ventricle. A fold of peritonenm 
may completely or partially envelope the protruding 
part, or it may be wholly nncovered by peritoneum, 
bat found adherent to a lipoma. A golden rule 
in such cases is to cut nothing until yon know .what 
it is. And although circumstances may require 
that the urinary bladder be incised —* as it 
has been for a calculus—it is very seldom 
necessary to do so, and the neatest closure 
of an incised wound is not equal to tbe un- 
wounded viscus. In all doubtful cases the diagnosis 
may be made by passing a catheter, and,if necessary, 
so raising and gently pressing the protruding part 
as to drive its contents into the bladder, and again 
passing the catheter, as recommended by <Percivall 
Pott; there still remains the hypodermic syringe, by 
which fluid may be drawn off and tested, ^fore 
operation it is well to get the history of the case—in 
some of the recorded cases the patient found even 
when be had emptied his bladder a further flow of 
urine was caused by pressing on and raising tbe 
rupture. In Brodie’s case urination was effected 
by lying down and raising the lower limbs and press¬ 
ing on the sac, which extended almost to tbe knee. 
Petit’s patient adopted a similar manoeuvre to empty 
his bladder. Sometimes these cysts became very 
large, in Clements’ case pressure on tbe swelling 
produced two quarts of urine. In Percivall Pott’s 
case and in Mr. £. S. O’Orady’s the hernia was 
suddenly produced by violence. But this is excep¬ 
tionable, in the great majority of cases the 
piotrueion of the viscus is gradually brought 
about, and not unfrequently the protruding 
part assumes an elongated form like to tbe appendix, 
for which it has been mistaken. This gradual 
formation of the cyst allows of tbe function of tbe < 
viscus being carried on without any serious incon¬ 
venience to the patient, unless tbe cyst becomes very 
large, so much so that in many cases tbe condition 
has not been recognised until after death, as in tbe 
case reported in 1520 by Dom J. Sala, in which 
tbe patient had all the symptoms of stone in 
the bladder. Tbe stone could never be felt by 
tbe sound, but was found after death in the bladder, 
which had formed a cystocele in the groin. 
Similar cases have been reported by Bertholiui 
Platean, Bonetur, Petit, Heny, Vardier, and others 
tbe majority of whom are quoted by Morgagni and by 
Vardier. Some few cases have recently been added 
which show the difficulty of recognising the urinary 
bladder when present. Dr. Cheesman's case (Med- 
Itec.), in which the conditions were such that he did 
not recognise that he had incised the bladder until 
he examined the sac after removal, and was dis¬ 
turbed to find attached firmly to it a disc of mucous 
membrane about as large as a silver dollar, and easily 
recognisable as bladder mucous membrane. In our last 
issue we published M. Bacoviceano's two cases, one 
a case of femoral hernia, in which he avoided open’ 
ing the viscus by confirming his diagnosis by a 
skilful use of the sound; and the other a case of 
inguinal hernia in a female. Both sexes are liable 


JULT 24, 19 01. 

to the condition, and it occura at all ages. It is one 
of those complications of hernia which the operative 
surgeon must ever bear in mind. And in all doubtful 
cases it is advisable to utilise the hypodermic 
syringe for diagnosis. Where the invaginated por¬ 
tion of tbe bladder has become greatly elongated 
and is, if returned, likely to form a pouch in which 
urine msy become stagnant and decompose, or form 
a calculus, it is good surgery to excise it. 

J(0tc0 on Current 

Army Medioal Service Committee. 

Sib Thobnley Stoker contributed an able 
letter to The Timee last week on tbe scandalous 
manner in which tbe Irish medical schools have 
been denied representation on the Special Committee 
appointed to inquire into tbe working of tbe Army 
Medical Service. “Of eight gentlemen,’’ says Sir 
Thomley Stoker, “ who, exclusive of the President 
and Secretary, compose the Committee, five repre¬ 
sent schools or licensing bodies in London, one in 
Scotland, and one in Ireland, tbe eighth being 
Surgeon-General Hooper, who presumably represents 
the Indian Medical Service.’’ Tbe member of the 
Committee wbois named by Mr. Brodriok, specifically, 
as representing Ireland does so in virtue of as small 
a pretext as could be denoted by such a term 
He 18 an Irish graduate, who attended the Galway 
Hospital in addition to Gny's Hospital, and who 
presnmably has been in tbe Army Medical Service 
since he was qualified. His early connections seem 
to have been entirely about London. “ While,” 
says Sir Thomley Stoker iu another part of his 
letter, “ I have no doubt that he is a thoroughly capa¬ 
ble officer, who will ably represent tbe Army Medical 
Department on this Committee, to speak of him as 
representing Irish schools with which he can have no 
connection save as a student, and not much then, is 
palpably absurd.” What have the Irish schools 
done to deserve this slight ? They have done what 
in aU things Irish is a fatal bar to the receipt of jus¬ 
tice in Qoverment matters. They have been loyal to 
the Government, and have supplied them with 
candidates, and, wbat is more, with competent 
candidates, entirely out of proportion to the number 
of tbeir students. It is a sad thing to have to write, 
but loyalty in Ireland does not pay—at least, if 
the Government can help it. The latter are so 
accustomed to tbe man and the Body in Ireland 
which is “ agin the Government,” that they have 
come to regard tbe man or the Body which is not in 
this blissful condition as lacking something morally 
or mentally, and, therefore, not to be tbe kind of 
person or thing to be encouraged. “In 1893”—we 
again quote from Sir Thomley Stoker’s letter—“ out 
of 891 officers 429 had Irish qualifications.” “ In 
1896 the bulk of tbe Ai*my Medical Department was 
composed of Irish graduates.’’ At tbe present 
time 37 per cent, of the personel of the Army 
Medical Department are Irish graduates. And the 
return which has been made to tbe Irish schools for 

D . . OOg 


NOTEtJ ON OOiiaBNT TOPICS. 


Thb Mxsioaii Pbm8. 93 


Jci.T 34. 1901. 


farmsbiniir these graduates is—that after many 
years one Irish examiner is elected, and that when a 
committee is appointed to inTestigate the causes 
which'haTeled to, and the remedies for, the depopula¬ 
tion of the Service, one Irish representatire is nomi¬ 
nated, and he has no conoection with any branch of 
the medical profession in Ireland—an Irish bull, as 
perpetrated by an Englishman, and one of the dis¬ 
tinctly sterile genus. In addition to Sir Thomley 
Stoker’s letter in TAe Time«, we understand that the 
Irish Kedical Schools have made strong representa¬ 
tions to the Secretary of State for War, pointing to 
the importance of nominating a representative of 
these schools on the Committee. We hear that Hr. 
6rodrick has expressed his willingness to do so, if a 
representative can be suggested who will imdertake 
to attend the meetings of the Committee regularly' 
and that such a representative will be found 
in the person of Sir William Thomson. We 
do not know that there is any necessity to thank 
Mr. Brodrick for his o^ncession, as it is one which 
will benefit the War Office more than it will benefit 
the Irish schoola Why the determination should 
require to be reached by the devious route of letters 
to the public Press, questions in Parliament, and 
letters from the Colleges to the Secretary of State 
would puzzle anyone outside the world of officialdom. 


Diphtheria Antitoxin in Scarlet Fever. 

Daa Washkousn and Gloodall, in their work on 
infectious diseases, published in 1896, gave it as their 
opinion that there are no known drugs that will either 
cat short an attack of scarlet fever, or, as has been 
alleged by some writers, prevent susceptible persons 
from being attacked. Referring to septic complica¬ 
tions of this disease they mention that it is possible 
that the anti-streptococcal serum may be found 
to be beneficial. We now learn from the Medical 
Record of New Tork that Dr. G. H. Dalton, 
about two years ago accidentally discovered that 
diphtheria antitoxin is an excellent remedy in the 
treatment of scarlet fever, and it is further stated 
that later investigation proves that it is equally as 
efficacious in the prevention of this disease. Dr. 
Dalton seems to have been particularly impressed 
with the fact that after using antitoxin in a 
number of cases which were running a very 
severe course the malady assumed a mild form. 
Progress in therapeutics has advanced with such 
rapid strides that it is by no means safe to definitely 
deny the possibility of the usefulness of new 
measures. In this particular instance the difficulty 
of avoiding the contagion of scarlet fever is so widely 
recognised, and the liability to confuse the faucial 
affection in true diphtheria with the undoubted 
membranous formation that may be found in 
scarlet fever at once raises the question whether 
Dr. Dalton’s .cases might have been examples 
of patients suffering from the two infec¬ 
tions. To arrive at a safe conclusion in this 
matter one would like to have the data recorded 
upon which Dr. Dalton founded his diagnosis. 


because the ** strawberry” tongue, for instance, met 
with in scarlet fever is also occasionally noticed in 
cases of diphtheria. Before the diphtheritic anti¬ 
toxin, therefore, can be credited with this new virtue 
every care must be taken to eliminate all doubt as to 
whether the oases were really scarlet fever, and we 
would suggest that this can be done by the simple 
expedient of determining the nature of the infection 
by bacteriological examination. 


Transfusion of Lambs Blood. 

The treatment of severe anmmia by transfusion is 
by no meaos a new idea, but the method has been 
recently improved upon by injecting the blood of 
lambs, which appears to be the least toxic for human 
beings, and certainly Jias the merit of being readily 
available. Improvement was obtmned even in some 
cases of pulmonary tuberculosis, the patients gain¬ 
ing considerably in weight. According to Bier, in 
the Munckener Med. Wochen , the theory on which 
the treatment was founded is that the animal 
organism can accustom itself to very varied condi¬ 
tions, A man suffering from severe tuberculosis of 
bcth sacro-iliao syncbcndroses which had suppurated 
and broken through the skin in numerous places was 
given ascending doses of lamb’s blood until 10 c.cm. 
had been injected. Smaller and smaller doses 
were then used, until it was found that only 
1‘5 c.cm. could be employed with safety. The 
general condition of this patient improved remark¬ 
ably, and the suppuration almost entirely ceased. 
In four cases of lupus, all of which had been pre¬ 
viously subjected to treatment without obvious 
benefit, remarkable improvement followed, but it is 
not possible as yet to say whether this gratifying 
result is permanent or only temporary. From the 
description of the cases it seems that the first effect 
of the injection was a general flushing of the face, 
and in the majority of the patients there was a 
desire to deftecate, and a large stool was usually ex¬ 
pelled some time after the injection. Urticaria was 
sometimes noticed. In a large number an abnormal 
appetite was developed, and fever and chill, without 
any subjective signs of discomfort, accompanied the 
treatment. Most of the cases complained of a feel¬ 
ing of dryness in the mouth and exhibited severe 
thirst, symptoms which testify to some change in 
the physical character of the blood. The indications 
afforded by these experiments of Bier are certainly 
suggestive, and fuller details may stimulate other 
observers to confirm and extend the utility of his 
work. 


The Executive Ability of Medical Men. 

The Governors of the National Hospital for the 
Paralysed and Epileptic have only lately announced 
that in future two of the medical staff shall have 
seats on the Board of Management of that institu¬ 
tion, and this should to some extent be an answer to 
the narrow-minded outburst of prejudice in connec¬ 
tion with the appointment of a phjsician'lbn the 



94 Thi Hidical Press. 


NOTES ON CURRENT TOPICS. 


JvLT 24, 1901. 


Board of the Lunacy CommUslon of the State 
of New York. There are some men in New 
York who apparently entertain the same opinion in 
regard to the executive capacity of medical men as 
that held and expieesed by certain members of the 
Board of Management of the National Hospital for 
the Paralysed and Epileptic, for we find the old 
familiar nonsense brought forward in New York that 
the education of physicians is such as not to fit them 
for the discharge of the executive duties inci¬ 
dental to memberahip of the Lunacy Commission, 
and they are alleged to be mentally contracted 
rather than expanded by their speoial education. 
It is almost absurd to have to argue this matter 
seriously, but a vei^ good answer can be found in 
the disorganised condition of Bellevue Hospital 
which can be shown to be due to the want of mescal 
control in the choice of the attendante. With proper 
medical control it would have been impossible for 
any such terrible state of affairs to have existed in 
the detention wards for the custody of insane 
persons or alcoholics picked up in the streets of New 
York. No medical man would have permitted un¬ 
skilled persons without adequate instruction or 
proper supervision to have had the care of this most 
difficult and trying class of patients. It cannot be 
too clearly understood that no medical institution 
can permanently prosper whose Board of Manage¬ 
ment is excluded from the judiciously exercised 
influence of the medical staff. 

The Parasitic Theory of Oancer. 

The results which have up to the present been 
recorded of the investigations and observations now 
being carried out point to the conclusion that the 
parasitic or infectious theory of can<Mr is the only 
one which in any way satisfies the requirements of 
the pathologist and the clinician. For a very long 
time past the relation of irritation and traumatism 
to cancer formation has been discussed, and modem 
medical literature abounds in references to the fact 
that malignant growths often follow local injuries 
and local irritations. Arguments by analogy can be 
adduced in favour of this parasitic hypothesis from 
the tumours in trees and plants which are so well 
known to botanists. These tumours, which are 
sometimes spoken of as tree cancers, are caused 
almost invariably by a species of infection 
entering from without by means of some 
laceration of the protective covering or bark 
of the tree. Mr. Jonathan Hutchinson has de¬ 
scribed how a ceitain fungus is apt to destroy 
fir trees on a large scale by inducing decay of the 
medulla of the wood. The condition affects the stem 
of the tree, which stops growing and dies, when it is 
found that the fungus growth has undei^one decom¬ 
position not due to chemical action. In these oases 
there is often no traumatism to the bark to indicate 
the source of infection, but it is believed to enter near 
the roots through the agency of rodents such as 
rabbits. The rabbit burrows under the fir tree, 
nibbles the root, and thus exposes the abraded por¬ 


tion to the action of the spores of fungi. A very 
curious point in connection with this fungus life in 
trees and plants is that it is capable, under certain 
circumstances, of exhibiting almost indefinite periods 
of latency. The recently published monograph by 
Max Schuler embodies powerful argument in favour 
of the view that oancer is due to an extrinsic cause, 
that is to say, him a parasitic infectious origin. 

Tendon Transplantation. 

The great strength and preponderating influence 
of the flexors of the thigh contribute to make 
contracture of the knee a not uncommon affection* 
and an unfortunate circumstance which accompanies 
the trouble is that the condition is very intractable 
and often as painful as it is disabling. The princi¬ 
ple of tendon transplantation which has proved 
itself so useful in other regions has been applied by 
Heusner to the knee-joint. According to the results 
published in the Deut. Med. Woch., for May 30th, 
Heusner has succeeded in obtaining excellent func¬ 
tional results, the pain so frequently notioed in these 
cases of contracture being relieved, and the disabling 
deformity corrected. The muscles most available 
for the purpose are the bleeps on the external side 
with the gracilis and semitendinosus on the 
inner side, and final success is more certain 
of attainment if the incisions through which the 
tendons are dissected out are made ample and 
carried half-way up the thigh so that the structures 
to be freed may be freely liberated from surrounding 
parts; after this they should be subcutaneously dravm 
into another incision in the patellar region through 
which they are sutured to the quadriceps tendon. 
This surgical procedure is evidently an operative 
method that has a wide sphere of usefulness in front 
of it, and will be sure to find many adherents. 

Fatality at a Hypnotic Exhibition. 

There is a large section of the public who flock 
to exhibitions by so-called “professors” of hypno¬ 
tism, and sit through the usual disgusting perform¬ 
ance of seeing the wretched “ subjects '* devour filth 
under the impressson that what they are eating is 
sweet and toothsome. We are glad to pot on record 
that one of these “ professors ” has been put under 
arrest concemiog the death of a “subject” who was 
lately killed during the performance of the feat of 
resting the head and the heels on the backs of two 
chairs with a 6001b. stone on the abdomen which it 
was pretended a blacksmith broke to pieces with a 
sledge-hammer. The cause of the fatality was the 
slipping of the chair away from tiie head of the 
“ subject,” who thus fell to the floor head first, and 
the stone, rolling on his head, crashed it. It must 
be obvious that this particular performance Is cha¬ 
racterised by fraud, and the stone which is appa¬ 
rently broken with such violence by the sledge¬ 
hammer of the blacksmith must, as a matter of 
fact, be previously broken up and cleverly pieced 
I together for the purpose of deception. The only 
I effective method of dealing with the debased curiosity 



JcLJ 24 . 1901 . 


NOTES ON CURRENT TOPICS. Th* Mxdical Psbm. 95 


that linds pleasure and even mirth in the contem¬ 
plation of the infirmities of these wretched eub- 
jecte,” moat be by educating people to a bif{ber 
ethical standard, and this, unfortnna'ely, is a long 
and uncertain process. 

Undesirable Proeecntions. 

Uiniss there be Tery good reason for suspecting 
deliberate evasion of the law on the part of medical 
practationers in reg^axd to the notification of infections 
diseases, it is unquestionably bad policy to institute 
police proceedings for mere failure to notify. It is 
open to ereryone to orerlook the infectious nature of 
the UlnMs, or it may be simple oversight. In the 
first event the law does not require a practitioner to 
do more than act to the best of his ability, and in the 
second it would, in most instances, he sufficient to 
warn the forgetful practitioner. These remarks are 
prompted by the report of some abortive proceedings 
brought agfunst Dr. Harry Whittome, of Camber¬ 
well, for neglecting to notify a case of scarlet fever. 
The defence set up was that at the time there was no 
reason to suspect that the illness was of that nature, 
and eventually the summons was dismissed. Had 
the authorities taken the trouble to apply to Dr. 
Whittome for an explanation, no doubt a satisfactory 
one would have been forthcoming, and much vexation 
and trouble would have been obviated, trust 
this and one or two other cases of a similar kind 
which have come before us within the last few days 
will impress upon sanitary authorities generally the 
fact that there is nothing to be gained and much to 
be lost by reckless proeecutbns. 

Reciprocity with Italy. 

The profession in Italy do not appear to have 
received the news of the step taken by the Privy 
Council in regard to the recoguition of Italian prac¬ 
titioners in this country with the enthusiasm one 
might have expected. We must not, however, dis¬ 
guise the fact that the advantages of reciprocity are 
vastly in favour of British practitioners, so many of 
whom practise, or may be desirous of practising, in 
that country. Moreover,'provided that there is defacto 
reciprocity, it matters little what the profession in 
Italy think of the matter. There is always, even in 
this land of liberty, a minority of narrow-minded 
persons who are unreservedly wedded to protection¬ 
ism, though the application of these views to the 
practice of such a calling as medicine is absurd and 
indefensible. 

False Teeth for Paupers. 

The plight of an elderly pauper whose teeth have 
“ gone by tbe board,” and who is thereby deprived 
of the ability to masticate tbe not over succulent 
food which boards of guardians supply, is one 
which may well appeal to the charitable. To ask 
that all the inmates nf our workhouses whose denture 
b defective should be supplied with substitutes 
would be to add considerably to the burden under 
which ratepayers groan. Occasionally a compas- 
uonate board of guardians goes the length of 


ordering a set for some specially deserving or 
unhappy inmate, and we note with sympathy and 
approval that the guardians of Abingdon have 
establlebed aprecedent In this direction. It would he 
more to tbe point if a scheme were devised whereby 
the aged and indigent poor could be supplied with 
artificial teeth by a local charitable agency working 
in concert with tbe dentists of the neighbourhood. 
A working set of teeth is almost ss necessary as a 
wooden leg or a pessary, and fully as conducive to 
comfort and health. Tbe inmates of workhouses 
do not exclusively belong to tbe woitbless and 
mprovident; they are bnt too often persons who 
are compelled by hard circumstances to wind up a 
life of unremitting toil in the chilling atmosphei'e of 
the poor-law, and they merit our compassion. 

An Ineligible Antivaocinationist. 

In spite of all the influence that has been hronghb 
to bear, tbe Local Government Board has adhered 
to tbe view that an antivaccinationist is not eligible 
for the post of medical officer of health, and Dr. 
Scott Tebb’s appointment stands annulled. Cer> 
tainly, if there be one post more than another in 
which men with cranks would be out of place it is 
that of medical officer of health. He is brought 
'uto daily contact with tbe local practitioners, with¬ 
out whose cordial co-operation it would he quasi* 
impossible for him to fulfil his manifold duties, and 
there are plenty of sources of friction without 
importing one so peculiarly objectionable to the 
majority of medical men as a hostile attitude 
towards vaccination. Moi'eover, what would be such 
an officer's position in tbe event of an epidemic of 
small-pox? Would he sink bis most cherished con¬ 
victions and go in unblushingly for vaccination, or 
would he discourage the practice as far as he could P 
We do not want cranks in any department of public 
life, for wherever they are they lead to endless loss 
of time and temper by attaching undue importance 
to wh»t are more often than not iosignificant details. 

Still More Penaliaing of the Medical 
Profession. 

Last week we drew tbe attention of our readers to 
a proposal by Sir Fortescue Flannery, M.P., to add 
a clause to the Factory and Workshop Acts Amend¬ 
ment Bill, whereby the medical attendant in a case 
cf suspected anthrax shall be obliged to take a 
specimen of blood from the patient and send it for 
microscopical examination to some bacterio¬ 
logical expert.” We pointed out the heartless 
and extraordinary character of the proposal, to do 
this contrary to tbe wishes of the patient and his 
friends, with tbe patient possibly tn extremis . . . the 
whole proceeding being useless so far as benefiting 
the patient or diagnosing his case. We trust that it 
will suffice to have called attention to tbe proposed 
enormity to ensure its rejection. We have now 
to record a further most objectionable proposal 
by Sir F. Flannery. He has proposed a 
clause in the same Bill to make it obligatory 
on the practitioner lo notifyT any injury in- 
D!...;izeclby'**iO'' Vi 



96 ThS MkDICAL PbS88. 


NOTES ON CURRENT TOPICS. 


Jdlt 24, 1901. 


curred in a factorj or workshop. Here, again, we 
have the enforcement of penal obligation against 
medical men to work for the State, against which 
we protest. Moreover, the work here demanded 
is not professional work at all, for how can a 
medical man saj where an injury was inflicted 
nnlesB he was presentMust he take the word of 
the patient, and relying thereon sign a certificate 
that the man was injured in somebody’s factory or 
workshop ? The thing is too ridiculous, and 
Sir Portescue Flannery is doing himself an ill 
service by proposing such impossible and useless 
amendments. Not the least offensive part of 
this amendment is Sir Fortescue Flannery’s idea 
that medical men in performing this offensive task 
should be classed with every herbalist or impostor 
who may apply a piece of sticking plaster to a cut 
finger, which treatment would come under the surgi¬ 
cal aid referred to in the clause. The quack and the 
medical man are alike referred to as under obliga¬ 
tion to certify. We trust the profession will com¬ 
bine and once for all put a stop to these encroach¬ 
ments on the rights and privileges they should enjoy. 
It is certainly a hardship that the attempts to 
subject the profession to further indignities should 
be going on secretly in committee-rooms of the 
House, only to be discovered by accident. 

The Housing of the Working Cla9se8. 

A y important discussion upon the housing ques¬ 
tion took place in the Commons in the coitrse of the 
debate on the Vote for the Local Government Board. 
Several important points were brought forward' 
Perhaps one of the most striking was the fact that 
the London County Council charged from 5s. 6d. to 
7s. 6d. a week for one room, from 8s. to lOs. for two 
rooms, and from lOs. to 128. for three rooms. Rente 
of that kind are clearly prohibitive for the very 
poor, and show that there is some flaw in the present 
system. It was suggested in the House that the 
land values required drastic treatment, in answer to 
which Mr. Long answered on behalf of the Local 
Government Board that to treat land separately from 
buildingswouldrequirefresh legislation. Thatattitude 
is so far encouraging in that it recognises the need 
of some reform in the direction indicated. So, too. 
with the proposed extension of time for repayment 
of loans by local authorities. Mr. Ijong advanced 
certain principles of the utmost importance. As 
trustee for a posterity that could not be consulted, 
but would have to pay the bill if presented at a 
postponed date, he said that municipal Corporations 
would have to show the most ri^d economy with 
regard to the purchase of land and the suifioiency of 
the buildings they erected. Other lemarks of the 
right honourable gentleman revealed a hitherto 
unsuspected sympathy with advanced liberal opinion 
on this great social question. The extension 
of the period of repayment from fifty to one 
hundred years is regarded in the most diverse ways 
by different investigators. At the Ipswich meeting 
of the British Medical Association it was rejected by 


vote of the State Medicine Section, on the ground, 
apparently, that any redaction of rent g^ned 
thereby would be too small to be of practical 
value. In the Commons Dr. Macnamara stated that 
the granting of the longest statutory period for re¬ 
payment now permissible would enable the Council 
to reduce rents by 3d. or 4d. a week. The statutory 
limit of sixty years has been reduced in practice to 
forty by the Board, as against a proposed extension 
to 100 years, as in Pimssia. The latter extension 
could notfml materially to reduce rents. It is really 
time that this point, which is capable of mathematical 
demonstration, should be settled definitely once for 
all. 

A Judge on Doctors’ Bills. 

The large perceutage of bad debts made by medi, 
cal men in general practice affords a striking testi- 
mony to the readiness with which they respond to 
the call of suffering. At the same time it testifies to 
the extreme unreadiness of a great majority of the 
public to recognise the value of services rendered by 
the payment of the fees that have been incurred on 
account of medical attendance. It is an undoubted 
fact, for instance, that many a busy medical man 
is unable to take a holiday because he cannot collect 
debts owing in many cases from folk who are 
ready to live up to their incomes in ways that 
do not fall under the heading of the necessaries of 
life. The sordid side of human nature is nowhere 
more grimly disclosed than in county court proceed¬ 
ings for the recovery of medical debts. In hearing 
such a case recently. Judge Owen, in a South Wales 
court, remarked to the defendant The last person 
you think of paying is the doctor, and when you are 
ill you fall down and worship him, but when he sends 
in his bill you don’t pay it.” It would be well if this 
vigorous, if somewhat homely, criticism were cir¬ 
culated widely among the multitudinous class which 
seems to think that the maxim, “ Virtue is its own 
reward,’’ was specially framed to adjust the relations 
of patient and medical man. 

More Arsenic in Liverpool Beer. 

The year 1900 should be marked with the 
blackest of letters in the annals of the brewing 
trade, for there can be little doubt that the disastrous 
outbreak of arsenical beer poisoning in the North of 
England has dealt a lasting blow against the popu¬ 
larity of beer. After all the outcry, the exposure of 
a long roll of injury and death, and the subsequent 
prolonged series of judicial prosecutions, it seems 
hardly credible that a Liverpool publican should still 
be selling arsenical beer. That such is the case, how¬ 
ever, was proved a week or two ago before the local 
Stipendiary, who imposed a fine of £10 and £5 15b. 8d. 
costs upon a publican for the offence mentioned. The 
analyst at Somerset House found the incriminated beer 
to contain one-seventieth of a grain par gallon. The 
Stipendiary, Mr. Stewart, did not think the Act was 
intended to apply to a case of that kind, “ where 
things had not been deliberately put in for the pur- 

Diu , . J byGoOgIC 




JuM 24, 19C1. 


NOTES ON CURRENT TOPICS. 


Thk Mkdical Pbkm. 97 


pose of making an inferior article equal to sometliing 
it was not.” With every sympathy for that legaj 
opinion, we may perhaps be pardoned for congratu* 
lating the public that an Act of Parliament may 
sometimes protect their lives by departing from the 
intmition of its framers. For a Liverpool publican 
to be still seUing arsenic to hie customers is simply to 
fly in the face!of Providence. 

The Contc^ousnesB of Alopecia Areata. 

The contagiousness of that form of circumscribed 
baldness known as a^ojiecia areata has long been the 
subject of discussion in dermatological circles. It 
has been obstinately denied by competent observers 
over and over again, in spite of the fact that it cer¬ 
tainly tends to occur in epidemic form in regiments 
and schools. The obvious conclusion is that the 
divergence of opinion arises from the observations of 
the various investigators having borne on diseases 
similar in clinical appearance but differing in their 
pathological cause. The balance of skilled opinion 
at the present time appears to be in favour of a 
certain degree of contagiousness, but it is conceded 
to be unnecessary to insist upon the same stringent 
precautions as in the case of ringworm. It is 
sufficient in a geneial way to keep the infected areas 
covered with a dressing of some sort, and to avoid 
the promiscuous use of brushes, towels, &c. It 
is important that this view should be made 
generally known, because the affection is one, 
which runs an exceedingly protracted course 
and if isolation be insisted upon its successful treat* 
ment necessitates so prolonged an absence from 
school or factory as to cause much inconvenience 
and, it may be, suffering. 

The Queen and the Nurses. 

Heb Majesty has always taken the keenest inte¬ 
rest in nursing questions, and gladly avails herself 
of every opportunity to testify to her continued inte¬ 
rest in the welfare of ^ese handmaids of medical 
benevolenee. On Friday last Her Majesty received a 
large number of members of the Royal National Pen¬ 
sion Fund for Nurses at Marlborough House, to 
whom she presented their certificates of member¬ 
ship. Over a thousand nurses put in an appear¬ 
ance, and the weather being fine the reception was a 
great success, many of them affording, says the 
Time* correspondent, ocular demonstration that the 
axt of making millinery attractive is not incompatible 
with the practical requirements of a hospital costiune. 

Death of Mian Ormerod. 

The death of Miss Ormerod, the distinguished 
entomolc^ist, deprives us of one of the most assiduous 
and devoted students of insect life, especially in its 
agricultural bearings. The deceased lady manifested 
a passion for the study from her earliest infancy 
and the services which she has rendered to agricul¬ 
ture are quite inestimable. By the attentive study 
of their lives’ history she was enabled to deteet the 
insects which were responsible for the damage to 
crops, and to surest means of circumscribing their i 


ravages. Miss Ormerod died, after a long and 
honourable career, on Friday last, from cancer of the 
liver, at her home at St. Albans. 

The Congress on Tubercalo.«)is. 

The labours of the Congress are now in progress. 
Already on Saturday the reception rooms at the 
Queen’s Hall were thronged by applicants for regis¬ 
tration, and again on Sunday crowds, largely com¬ 
posed of foreigners, besieged the offices. The labour 
of registration proceeded rapidly and smoothly, and 
each member was presented with a list of members 
and delegates, a programme of the proceedings, scien¬ 
tific and social, together with a bulky volume, being 
the descriptive catalogue of the Museum, reaching to 
close upon two hundred pages. On Monday the Con¬ 
gress was formally opened by H B.H. the Duke of 
Cambridge at the request of Hie Majesty the King, 
at the first general meeting which took place at St. 
James's Hall, in the presence of a larger audience 
than the hall could conveniently hold. Yesterduy 
Tuesday) the sectional work commenced, and the 
second general meeting took place, when an address 
was delivered by Professor R. Koch, of Berlin. So 
far as number's go the Congress bids fair to be a 
phenomenal success, and, jud^ng from the titles of 
he papers, the discussions promise to be worthy of 
the occasion. 

The Portrait Advertisement. 

Thebe exists a not unnatural confusion in the 
minds of the public between the General Medical 
Council and the British Medical Association. This 
is of some importance, because the two bodies 
occupy a very different position in regard to the 
profession. A clearer understanding of this fact 
would have cut short much correspondence and 
editorial comment in the lay press on the prohibition 
of medical men allowing their portraits to be pub¬ 
lished in lay journals, a practice which is eminently 
unethical. If it could be shown that the publication 
took place with the consent, or at the behest, of the 
practitioner, the Council might possibly have some¬ 
thing to say to it; but as conclusive evidence of con¬ 
sent must necessarily be exceedingly difficult to 
obtain in such cases, the Council has, so far, taken 
, no action. 

Doctor V. Medical Guardian. 

A NICE little problem is awaiting solution at the 
hands of the Newton Abbot Board of Guardians. 
It seems that Dr. Culross, the medical officer of 
the workhouse, has taken umbrage at the conduct of 
Dr. Ley, one of the gpiardians, who, he alleges, 
systematically inquires into the cases in the infimary, 
and occasionally challenges the diagnosis and treat¬ 
ment, in the course of his visits as guardian. If 
such be really the case. Dr. Ley’s conduct would be 
deserving of the gravest censure, and would, in fact, 
constitute a serious abuse of his position as guar¬ 
dian. The subject is under investigation, and we 
hope it will turn out that the allegatiuns have no 
more serious basis than nurses' gossip. 

:)ogIp 


Digitized ; 



98 Thi Msdical Pribs. 


MEDICAL NEWS. 


JTri.T 24. 1901. 


Traumatic Scarlatina. 

Thb ocourrence of scarlet fever in a patient after 
an injurj bas suggested to Dr. Lippmann tbe possi* 
bility of tbe germs of infectious diseases lying latent 
in tbe organism ready to become active under cer> 
tain circumstances. This is by no means a new 
theory, but the difficulty of proving conclusively 
that tbe case ia propter hoc and not merely hoe 
is practically insurmountable, and, moreover, the 
number of well-authenticated cases is far too limited 
to corroborate tbe theory, which is in opposition to 
all that we know concerning tbe genesis and i atural 
history of such diseases. 

The King held an Investiture at Marlborough 
House on tbe 16th inst., when tbe honour of Knight 
Commander of tbe Royal Yictorian Order was con¬ 
ferred upon tbe following gentlemenSir Thomas 
Smith, Bart., F.R.C.S.Eng.; Deputy Surgeon- 
General Henry Julius Blanc, and Mr. William Henry 
Bennett, F.R.C.S.Eng. Tbe following gentlemen 
were invested with the 1 nsignia of Commanders of the 
OrderMr. Donald William Charles Hood, M.D., 
Cantab.; Mr. John Hammond Moi^an, FxB.C.S. 
Eng., and Mr. Charles Arthur Morris, F.R.C.S.Eng. 

At the competitive examination held last month 
for sixty resident medical officers (tn^mies) in tbe 
Pai'is hospitals, two of tbe successful candidates 
were women, Mesdemoiselles Arviset and Bonnet, 
both M.D. of Paris. 

PERSONAL. 

Mb. J. W. Bowden, M.B. C.M., F.R.C.S.£d., has been 
appointed Assistant-Sargeon to the Edinburgh Royal 
Infirmary. - 

The Earl of Dbbbt will take the chair at tbe 
dinner to be given to the foreign vice-presidents and 
delegates to the Congress on Tuberculosis at tbe Hotel 
Cecil on tbe 26th in&t. 

Sib Fbancis Lakino, Physician in Ordinary to tbe 
King, has been elected consulting physician, and Mr. 
T. Pickering Pick, F.R.C.S., consulting surgeon, to the 
Victoria Hospital for Children, Chelsea. 

Ba. J. J. R. Maclbod, Demonstrator of Physiology in 
tbe London Hospital Medical College, has been awarded 
the Maokinnon Studentship by the Council of the Royal 
Society, for tbe purpose of enabling him to carry on 
researches in pathological chemistry. 

One by one the many appointraMits held by the laf^ 
Mr.Thos. Bond, F.R.C.S.,are being filled, the last being 
by the Secretary of State, who has appointed Br. John 
Norton, surgeon to the A Division of Metropolitan Police 
attached to Great Scotland Yard, Westminster. 

Mb. G. L. Bbuce, M.A., F.L.S., Mayor of Oxford, Pre¬ 
sident of tbe British Pharmacentical Society, will pre¬ 
side at the awnna.1 Conference, to be held this year in 
Dublin on the 29th, 30th, and Slst inst. The Lord 
Mayor of Dublin will welcome the members of the Con¬ 
ference, the meetings of which will be held in the rooms 
of the Royal Dnblin Society. 


^cotlani. 

[FBOK OUB own OOBBBSPONOKrr.] 


Slandbb Action against a Glasgow Doctob.— Aoase 
peeenting some very painful and even discreditable 
features hu just been before tbe Court of Session in 
Edinburgh. A Mrs, Wallas, with oonsvntof her husband, 
Joseph Wallas, jun., 72, Preston Street, GovaDhill, Glas¬ 
gow, raised an action against Dr. James W. Wallace, re¬ 
siding at 67, St. Andrews Drive, Pollokshields, for j^OO, 
as damsgee for alleged slander Tbe pursuer has a son. 
aged two years, who for a year had been under treatment 
by a[Govanbill doctor. The defender in February last 
was consulted regarding tbe child's condition, and at 
bis request be was rei eatedly oonsnlted. He informed 
the pursuer that the GovanhiU doctor's diagnosis wa< 
wrong, and the treatment was, therefore, wrong, and 
bad aj^ravated the chUd's ailment, and if continued 
the child would not long survive. Later on the de¬ 
fender informed the mother that he had seen and oon¬ 
snlted with tbe GovanhiU doctor, and had poinb^ oat 
to him tbe errors in the treatment. He also informed 
her that the GovanhiU doctor had often to make use 
of bis assistance in difficult cases. The pursuer learned 
from the GovanhUl doctor that the defender’s state¬ 
ments were absolutely false, that be had no meeting 
with the defender, and that the defender had never 
been consulted by him in any case. Dr. Duncan, of the 
Victoria Infirmary, confirmed the diagnosis, and 
approved of tbe treatment carried out by the Govan- 
hUl doctor. The pursuer’s statements were embodied 
in a declaration made before a Justice of the 
Peace, and the matter was thra brought before 
a committee of tbe Southern Medical Society, of which 
both doctors were members. Before this was done an 
opportunity was gi*en the defender of explaining hia 
position. He then stated that the pursuer’s declai^ion 
was false, and it is alleged be called her a liar, and made 
other statements relating to the pursuer and her family 
which were derogatory. In Court the defender’s counsel 
asked that the reference to what had taken place 
before tbe committee of the Southern Medical Sooety 
should be struck from tbe record. The judge declined 
to do this, and rightly so. The case bas been settled 
by the defender paying .£101 and expenses. Evidence 
has not been led in tbie case, but tbe fact that tbe 
defender has tendered such a payment as the above 
would naturally lead one to infer that the serious alle¬ 
gations were in some measure at least true. That being 
so, tbe case is a very bad one indeed, and anything but 
creditable to the defender. It would be interesting to 
the profession at large t) know what took place before 
the Committee of the Southern Medical Society. With¬ 
out entering into detail, we venture to suggest, if such 
allegations are true, that it is perhaps tbe duty of a 
Society to ask for the resignation of a member who 
could be guilty of such conduct. 

Will op Db. Jab. Dcnlop, op Glasgow. —The will of 
tbe late Br. James Duntop, 16, Carlton Place, Glasgow, 
has just been lodged with the Sheriff Clerk of Lazwk- 
shire. It amounts to j£ 20,849 168. Dr. Dunlop, although 
well advanced in years, volunteered for active service in 
South Africa at the beginning of tbe war, and for some 
time was attached to t^e hospital at Wynberg. Soon 
after bis return to Glasgow he began to complain, and 
died a few months ago. 


Scarlet Fever In Birmingham. 

Thb Health Committee of the Birmingham City 
Council are much disturbed by the serious prevalence of 
scarlet fever and additional accommodation is urgently 
required. For some weeks past the average weekly 
number of cases has been 238, with a weekly avera^ in 
hospital of 344, that is to say, 100 more than tbe average 
for last year. It is unusual for scarlet fever to aeaume 
an epidemic form so early in tbe year, and tbe committee 
are not unnaturally anxious as to what will happen 
should the normal autumnal increase in the retoru be 
Buperadded. 

D... Googie 


JtTLT 24, 1901. 


COHRE8PONDBNOB. 


Thi Mioical Puss. 99 


®0rre0pottb«ta. 

CWedo not bold onnelTearesponaiblo (or th« oplniono o( onr 
eoiraopondestB. ] 

" HIGHER” DENTAli DEGREES. 

TV tkt Editor of Thk Mbdical Psbss and Cibcdlab. 

Sib,—T he aanonnoeoieiit in yonr editorial notes 
to-day (July 17th) that the University of Birmingham 
has decided to institute a new degree to be styled 
** Bachelorship of Dental Snidery,” will, I believe, 
oome ae a sorprise to most of your readers practisiog 
IB that speciality, and I venture to affirm that if those 
destal surgeons who have valid claim to speak with 
authority on professional questions could be polled 
an overwhelming majority would be found to agree with 
you in denoonoing the step os unnecessary, uncled for, 
and likely to prove as injurious to the dental branch as 
to the whole medical profession. The licence in dental 
su rg ery forms a first-rate special qualification. Students 
who have consdentionsly worked through the ourricu- 
Inm and passed the examinations are probably better 
prepared for the pursuit of their caHing than the 
votaries of other specialities for whom no special train¬ 
ing is provided by the authorities, and who are left to 
thi^ own devices. 

Extra ooursee of anatomy, physiology, or other 
medical subjects will not make the dent^ licentiate 
one jot better as a practitioner, nor will a ** higher ” 
degree based on a litue knowledge of that kind advance 
the "bachelor of dental surgery” in the estimation of 
his professional brethren. The first thing is to become 
sm accomplished dentist. After that, if higher pro- 
feesional position is sought for, the proper course 
is to tske degrees in arts, adenoe, or medi¬ 
cine; and this is what an increasing number of 
dental candidates now strive for. A fair propor¬ 
tion of the younger generation of dentists are now 
graduates in arts or science of one or other university: 
and many of them hold medical or surgical qualifica¬ 
tions. These are ti^e "higher” degrees which are 
valuable to the individu^ in making him a 
broadly-educated professional man, standing in wealth 
of general culture and in special knowledge on a level 
with practitioners of other departments of medicine. 
This status he will not be able to claim from a degree 
of the kind described in your note. It is certainly 
astonishing that the University of Birmingham, which 
everybody has understood was to have been atwve all 
things a pattern of practical sound sense, should have 
lent iteelF to the promotion of a scheme so omde, so 
valueless, and even injurious. 

I am. Sir, yours truly, 

A Past I^isidbnt Odontolooical Socibtt. 

July 17th, IVOl, 

THE CHELTENHAM MEETING. 

To (beEditor of Thi Mbdicad Paxes and CiacuLAB. 

Sib,—1 shall esteem it a favour if yon will state in 
your next number that there will Iw a meeting of 
members of the B.M.A. interested in its reform, on 
Monday evening, July 29th, at 9 o'olock, at Cheltenham, 
to discuss the proposals of the Beoonstitntion Committee, 
notably witii regard to co-option by the Council, the 
Referendum, and Finance. The place of meeting will be 
duly announced by circular. The object is to decide upon 
the attitude to be adopted on presentation of the 
report to the general meeting. 

I am. Sir, yours truly, 

Jahxs Bbabskt Bbibblxt. 

Alma House, Old Trafford. 


A Chcmlst-Apothecazy Fined. 

Mb. W. M. Jsnkins, a chemist at St. Clears, Cannar- 
tiien, was fined £20 last week for practising as an 
apothecary. It was proved that he bad examined 
patients and then preecribed for them, this having 
transpired at the inqueet on one of his patients who had 
died. The ^fence was that be had charged for the 
medicine supplied and not for the advice, but this fiction 
did not find grace with the jury. 


J^itcrarp anb (Iobbi^i. 


^ A Nxw seriee of articles dealing with the practical 
side of micrOBcopy, together with notes and queries, 
correspondence, and description of new apparatus are 
appearing each month in Knowltdgo, under the editor¬ 
ship of Mr. M. I. Cross, joint author of the well-known 
hand-book," Modem Microscopy.” 

%* 

Ant anuouncemenc of a new work from the pen of' 
80 brilliant a surgeon as Prof. Mayo Robsou is of in¬ 
terest to the profession. He has now in the press a 
work on Diseases of the Stomach and their Surgical 
Treatment,” in the production of which he has been 
assisted by Mr. B. G. A. Moynihan, F.'RC.S., Arris and’ 
Gale Lecturer on Surgery, Royal College of Surgeons. 
Messrs. Bailli^re, Tindall and Cox will be the publishere. 

Ae previoely noted in these columns, a proposal has 
been put forward having for its object the foundation of 
a new monthly Journal of Obstotries and Qynmeology. A 
meeting was held last month in the rooms of the Me^oo- 
Cbirumical Society of London and adjourned until to¬ 
day (Wednesday) at 5 p.m., when it is proposed to elect' 
a committee of ” ways and means.” 

%• 

Db. Solomon Solis Cohxn, A.M.. M.D., Professor of' 
Medicine and Therapeutioe in toe Philadelphia Poly¬ 
clinic, is engaged in editing a " System of Phyeiolc^c- 
Toerapentioe ” by American, English, French, and 
German anthors. The work will be complete in eleven 
volumes, and will be published by Messrs. P. Blakiston’s 
Son and Co., Philadelphia. 

••• 

Sacbs and Brooks think that much oau be done to 
record the progrees of oases of mnsonlar dystrophy. 
They report several oases in the American Journal of the 
Medical Sdencee for Jnly, in which great benefit accrued 
from systematic mnsonltf exercises Scudder describes, 
in the same journal, a case of a snperaumerary ureter 
ending blindly, causing acute abdominal symptoms in a- 
child, ac^ twen^ montos. This is only the ninth 
recorded case. 

•e* 

Thi new " Texb-book of Military Hygiene,” by 
Sn^eon-Capt. Munson, is, we hear, attracting consider¬ 
able attention in army medical circles. Founded as ib 
is on modem warfare, and dealing fully with future 
requirements in connexion therewith, it is neoessarily of 
a revolutionary charscter when compared with the old 
standards. Bnt the recent American-Spanish war and 
the present Boer oonfiict have punctuated inherent 
defects and made reforms necessary. 

••• 

”Thx Belfast Health Journal” is one of the latest 
aspirants for public favour, and it has gone the right 
way to secure it by giving an excellent series of articles 
on its specialty and numerous good iUostrations, also for 
traits of worthy health pioneers and philanthropists,, 
of whom Belfast contains many, some being of 
worldwide repute as generous donors and sagacious 
philanthropists. Onr contemporary has commenced 
well, is deserving of success, and we have little doubt 
that it will be attained. 

*•* 

Trxbb are not many new books in medicine usually 
issued during the de^ season, bnt the publication of' 
another edition of ^se and Carless’s " Surgery ” has 
been rendered necessary because of the rapid disposal of 
the previous edition, for which reason also the new 
volume will be little more tbau a reprint, with correc¬ 
tions to date. New editions are also announced as ready 
in a few days of Mr. de Marie’s " Syphilis and other 
Venereal Diseases,” and of Dr. Macnanghton-Jones’a 
" Practical Points in Gynseoology.” 

%• 

'Ws are reminded of the steady flight of time by the 
appearance of Vol. CXXIII. of " Braitbwaite's Retromect 
of Medicine.” This last half-yearly volume is full of toe- 
usual interest, and no who wishes to keep abreast o 



100 Tbk Mbdical Pbxbs. 


LITERATURE. 


JpLT 24, 1901. 


profeenonal matters, whether geoeral or special, can afford 
to be without this roost trusty old friend upon his book¬ 
shelves. It is not too much to eay that the whole series 
of volumes, ranging as it does over sixty years, contains 
the history of medical progress during that remarkable 

K riod of scientific progress and enlightenment. It is to 
hoped that Braithwaite's will thrive vigoronsly into 
an age not less prolonged than that attributed to the 
wandering Jew of fable. ^ ^ 

Little that is new can be said by way of description 
of that attractive health resort, Carlsbad, sometimes 
termed the “ Mecca of Europe,” because of the thousands 
who journey there for the 'healingviatera year aftery^r. 
Apart from its attraction for invalids, the town, riling 
as it does in terraces among the pine and fir clad 
bills, is extremely picturesque and well deserving the 
encomiums passed on it by artists and travellers. ^To 
make it still better known to English folk the Munici¬ 
pality of Carlsbad have just issued a volume of about 
200 pr^es, edited by Dr. Josef Buff, which they present 
gratis to visitors, or will send on application to anyone 
intending to visit the spot. In this book will be found 
descriptive and pictorial accounts of the various springs, 
bathing establishwents, excursions, travelling routes, 
hotels, expenses, Ac., so that a little optical and mental 
labour is all that is necessary. 

*•* 

The " Atlas of the Anatomy and Physiology of the 
Child," with explanatory text by D’Arcy Power, M.D. 
Oxon, P.E.C.S., displays, in the superimp^d, pictorial 
form, the special features of child anatomy, in the manner 
which has long since become familiar to students of 
the well-known series published by Messrs. Bailli^re, 
Tindall and Cox. The text is evidently designed for 
popular consumption, and is written in simple, xmtecb- 
nical English, suitable for the purpose, and it would 
be well for future generations if the mothers of to-day 
<!Ould be induced to follow its teaching. Some people, pro¬ 
bably the large majority, are satisfied with a remarkably 
small acquaintance with the details of their anatomy and 
■the play of their functions, but there are others who yearn 
to know something of the wonderful organism of which 
they are the temporary possessors. To such this Atlas 
will bo welcome, for with a minimum tax u^n the 
intelligence it illustrates the mechanism and its com¬ 
ponent parts. At three shillings—the price thereof— 
such knowl^ge is now placed within the reach of all. 


NEW BOOKS AND NEW EDITIONS. 

The following has been received for review since the 

publication of our last monthly list:— 

3AILLIBBI, Tikdall, aito Cox (Eenrletta Street, Strand, London). 

The Theory end Practice o£ Military Hygiene. By Surgeon- 
Oapt. E. L. Mnneon, M.A.. M.D. Pp. 971. witi 8 plates and 
SOo engraTings. Price 3Ss. 

Manual of Public Health, Laboratory Work, and Food InspM- 
lion. By O. W. Andrews, M.B., M.B.C.8., DP.H.Camb. Pp. 
292. Price 7s. 6d. net. « 

The Commonwealth of Cells. By H. O. F. Spnrrell, B.A.Oxon* 
Pp. 126. Price2s.6d. „ 

An Atlas of the Anatomy and Physiolc^ of the Child. By 
D’Arcy Power, M.B., F.B.C.8. Price 3«. 

'Bale, Sorb, asd Darielbor, LmtTBD, (London). 

The Association of Ingninal Hernia with the Descent of the 
Testis. Bradshaw Lecture. Deeemhtr, 1900. By John 
Langton, F.B.C.S, Pp. 68. Price 6e. 

■Gbubchill, J. arp A. (Qmat Marlborough Street, London). 

St. Thomas’s Hospital Beporte. ToL xzvid. Price not stated. 

Schoolboys’ Special Iromorabty, By Maurice C. Hime, M.A., 
LL.D. Third Edition. Price Is. 

The Ophthalmoscope, a Manual for Students. Fourth Edition. By 
OustaTUs Hartrioge, F.B.C.8. Pp. 152. Prioe 4s. 6d. 

Chables OsirnR arp Co (London). 

Outlines of IHsee'es of Women. By John Phillips, H.A., M.D. 
Cantab., F.B.C.P. Third Edition, revised. Pp. 280. 

Lewis, H. K. ((3ower Street, London). 

Pnrulent Nasal Disohaiges: their Di^osis and Treatment. By 
Herbert Tilley. M.D., ko. Priee 4s. 

Macmillab arp Co., Lixitep (London). 

APBsthetics and their Administration. By Frederic W. Hewitt, 
M.D.Cantab. Second Edition. Pp. 528. Price 15 b. 

Scort, Qbberwood arp Co. (London). 

Pnctical X-Bay Work.* ^ Frank T. Addyman, B.So., F.I.C. 
Pp. MO, wim 12 plates, race 10s. 6d. net. 


SiKPxiR, Marshall, Hamiltoh, Kert Atrp Co. Limited (London). 
The Half-vesrly Betroepeet of Medicine. Vol. 123. Edited by 
James Brsithwaite, M.D.Lond., and E. F. 'Trevelyan. M.D. 
Lend., F.E C.P. Pp. 467. Price 6s. 6d, 

Smith, Elpeb abp Oo. (London). 

A Betroepeet of gnrgery during the Past Century. By John 
Poland. F.B.C,S. Pp.97, PiiceSs. 

S WAV, SORRERSCHEIR ARP CO., LlMTTEP (LondOn). 

A Treatise on Plague. By Major Oeo. 8. Thomson, M.B., M.A.O. 
Boy. Dniv. Irel. Pp. 299. Price 7s. 6d. 

Weight amp (^. (Bristol). 

Golden Buies of Hygione. By F, J. Waldo, M.A., M.D.Clsfitsib. 
Pp. 69. Price Is. 


ICitnature. 


FBEYEE'S STRICTURE OF THE URETHRA, (a) 

The author of this volume states that it coosista of a 
series of lectures which he delivered at the Medical 
Graduates’ College and Polyclinic in November last, and 
that he has published them in book form at the sn^ee- 
tion of many of his hearers. 

The book contains six lectures, three of which deal 
with stricture of the urethra and its treatment, and 
three with enlugement of the prostate and its treat¬ 
ment. 

Mr. Freyeris method of dealing with his subject is 
clear aod concise; every lecture shows that he hsm 
a thorough grasp of the practical side of what be is 
writing a^nt, and the treatments (advocated are those 
which have bran thoronghly tested by himself and many 
others. Of course there are some few points which may 
not please everybody, such as his classification of 
strictures, his evident hankering after the malarial 
origin of many cases of urinary fever, and his advocacy 
of vasectomy in the treatment of severe forms of pron- 
tatic enlargement. 

Very properly the author does not write his lectures 
to advocate any fads of his own, and the practitioner 
who treats his patients according to the directions 
given will treat them well, and the surgeon who reads 
, these lectures will, when next lecturing his' hospital 
class, give a clearer and more concise account of modem 
urethral surgery than be would if Mr. Fieyer had not 
given ns this very excellent little book. 


WANKLYN’B ARSENIC, (b) 

Pbof. Wanklyn may well claim to have been a 
pioneer in the methods of chemical analysui, and 
although u veteran in the world of chemical literature 
bis energy and enthusiasm is still unabated, as evi¬ 
denced by this excellent and most timely little work, 
wbicb,aB the author indicates, "has been called forth 
by the recent mysterious epidemic of chronic arsenical 
poisoning in Manchester, Liverpool, and other towns in 
the North of England." The outbreak of peripheral 
neuritis and other manifestations of arsenioal poiaoning 
have very rightly attracted the attention of all sorts 
and conditions of men, but the medical and chemical 
aspects have given rise to mnch discuBsion and will 
afford matter for extensive investigation. A book, there¬ 
fore, such as the present, is in every way opportune, and 
its perusal cannot but prove hel^nl and highly sng- 
gesHve. 

The chemistry of arsenic is first carsfolly dealt with, 
the ohs^actsrs of arsenic both in the free and metallio 
state, and also in the form of arseniona and arsenic acid, 
and their salts fully detailed, and interesting reference 
is, moreover, made to the organo-metallio componnda of 
anenic and kakodylio acid and its salts. 

The methods for the detection and measurement of 
srsenio are de^t with at length. Such various views 


(o) “Stricture of the TJrethie and Hypertrophy of the Frostats.” 
By F, J. Fieyer, M.A., M.D., M.Ch., SaiKOon to St. Feter’e Hor 

K "s], London, Lieut.-Colonel, Induii MadiCBl Service (Betd.). 

ndon: Bailliere. Tlndsh, and Cox. 1901. Demy 8 vo, pp. L1&. 
40 UluBtrationa. Frice 5s. 

(ill ‘ Arsenic." By J. Alfred Wasklyn, M.B.C.S., formerely 
Lvctnier on Chemistry ud Physics at St. (JeorEe't Hoe^aL 
Profassor of Chemistry in the London Institution. London: 
Kcgan Paul, Trench, Tmbner, and Co., Limited. 190L Price 
2s, 6d. Fp. 99. 



Jui,T 24, 1901. 


MEDICAL NEWS. 


Phi Msdical Pbsss. 101 


bare been promolgated respeotiog the moat coBvenleut 
teat for the presence of arsenic in beer and such like 
compcnnds, that it is valnable to have a clear state* 
mest as to the exact character of the teste which have 
in ordinary work so long been relied on, bat which in 
the special cases recently arisen seem to have been 
proved wanting. The original account of Marsh’s 
method is here given, extending over some ten pages. 
Beiasch’s test is also fully described, and its usefulness 
and limitations indicate. Unforriinately. Outzeifs 
test is not described, although it has recently been 
shown to be particalarlj convenient and trustworthy. 
Particular attention is devoted to the testing of arsenic 
in special organo<metallic conditions when the ordinary 
testa fail, except such as involve deetmotion of oi^ano- 
metallic compounds. 

Professor Wankiyn advocates the employment of a 
red'heat, which, breaking up oi^no-metallic combina¬ 
tions, should always be employed where the formation 
of organo-metallic combinations is suspected. Full de¬ 
tails are given of the author’s method of dealing with 
suspected beer by his wmbnstion method. The con¬ 
cluding chapter deals with *' The Manchester Epidemic 
of Arsenical Poisoning, and the Lessons to be Learnt 
from It,” and mainly consisis in extracts from already 
published accounts, together with a stroog oondemnation 
of the method employed by Professor I>el4pine “to 
estimate approximately the quantity of the poison.’* 
The work is peculiarly timely, fairly oomprenensive, 
based on wide and exceptional chemical experience, and 
interesting and sttractive in style and general pre¬ 
sentation. We heartily commend its consideration 
to all medical men and cbemiste having to deal with the 
still perplexing problems which arsenical contamination 
of fo^ products have recently brought into such pro¬ 
minence. 


LOCKWOOD’S APPENDICITIS, (o) 

W* have carefuUy read through the pages of this 
work and have derived a considerable amount of infer* 
mation on this important surgical subject. Whatever 
the reason ia, appendicitis is a disease which appears to 
occur far more frequently nowa^^ys than it did twenty 
years ago. A.t any rate, the affection is far more stndiea, 
end ita conditions seem better understood and more 
quickly recognised, than it wag in years gone by. The 
author enumerates the hi*tories of eighty-three casee of 
apjwndioitis which came under bis own personal obser¬ 
vation, and as far as possible he has given the niimVAl 
history, morbid anatomy, and morbid histology of the 
casee in detail, and has then specifically commented on 
each individual case, as he states that it seems to him 
to be the only way by which to learn how to infer the 
morbid condition of the appendix from the clinical 
symptoms, and ultimately to place the treatment of 
appendicitis upon a roientifio basis. 

Mr. Lockwood divides his subjeot into twenty-one 
chapters and the work runs to 287 pp., including a very 
complete index. The last balf-dosen chapters are very 
practical, and conttin a vast amonnt of Enable infor¬ 
mation. We, therefore, strongly recommend this work 
to those operating sm^^ns pti^oalarly interested in 
appendicitis. The matter treated is well printed on 
good paper, and the book is neatly bound and refieots 
credit on the author and publishers alike. 


A Snrgleal Overslglit 

Ak inquest was held a few days since at Bethnal 
Oreen on the body of a child, aet. 8, who had sustained 
a wound of the cheek which was dressed at the North 
Eastern Hospital for Children. The woond became 
inflamed, and the child was certified to be suffering 
from erysipelas, but examination of the wound after 
death reveled the presence of a piece of wood which 
had not been detected when the wound was attend^ 
to. A verdict exonerating the medical ofBoer from 
blame was returned. 

(•) “ Appendicitis, its Pathology and Surgery.’’ Uy Charles 
Bsn^t Logwood, F.B.G.8., Asaiataat Surgeon sad Leotorer on 
l>CKriptiTs and Sorgioa) Anatomy in St. Bartholomew’s Hocrital, 
Ac. Fp. 287. Prioe Ida net Pablished by Manmnun ud Co., 
I'Ondon. 1801. 


5Cab0ralott} ^otes. 


CHIVER’S CAMBRIDGE LEMONADE. 

Wb have submitted the Cambridge Lemonade which 
Messrs. Chivers and Son, Limited, are introducing this 
season to a critical chemical examination, and find it to 
consist of fine sugar crystals coated with the natural 
constituents of lemon juice, namely, the essential oil of 
lemoos together with citric acid and a very small per¬ 
centage of other organic acids usually found in lemons. 
We have verified the statement that it is free from any 
added acid. Lemonade prepared according to the 
directions given with each bottle affords a very refresh¬ 
ing and palatable summer bevert^e. 

ABBEY'S EFFERVESCENT SALT. 

Abbbt’s Effervescent Salt is described as “ an ideal 
laxative.” On examination, we found it to be a skilfully 
granulated product, oontaioing the usual calino 
constituents in due proportion. It hag an agree¬ 
able acidulous taste, and, in doses of from one 
to two teaspoonfuls, procures an easy action of 
the bowels. Its palatableness will ensure its popularity 
with a large class of persons who object to naoseons 
salines, and are averse to drastic purgatives of vegetable 
origin. 

APOMORPHINE AND STRYCHNINE TABLOID. 

Mbbbbs. Buhboughs Wbllcohk and Co. have added 
to their list a tabloid containing apomorphine hydro¬ 
chloride, gr. in association with strycbulne hydr^ 
chloride, gr. This tabloid is intended for admini¬ 
stration by tbe hypodermic method. The drawback 
hitherto attending the use of apomorphine, a drug 
possessed of nsef^ therapeutical properties, has been 
the depression, sometimes very marked, which follows. 
Moreover, as it is not a very stable salt in solution, the 
latter requires to be freshly prepared. The association 
with strychnine effectively obviates tiie tendency to 
depression, and the tabloid form facilitates the prmara- 
tion of a fresh, and therefore active solution. 'These 
tabloids are put up in tubes containing a dozen. 


j^etDS. 


The Dublin Hospitals. 

Tub mtituJ report of the Board of Superintendence 
of the Dublin hospitals has just been laid on tiie table 
of the House >f Commons. It states that during the 
year ending March Slst., 1901, no culpable irregolarity 
on the part of nursee or attendants was brought under 
the notice of the Board, nor had it any serious or well- 
founded complaint from the patients, while the members 
of the Board are gratified to speak with cordial approval 
of the work done in the Dublm hospitals. The opinion 
is advanced that the efficiency of these hospitals would 
be enhanced if more frequent visits were made by the 
Governors at irregular times. While the Board recog¬ 
nises that under existing ciroajnstances it is not possible 
to exclude from hospital treatment patients who are not 
in a financial sense legitimate objects of charity, they 
feel that discrimination should be exercised to ensure 
that the funds provided for oharitable relief should not 
be spent on persons who are competent to pay for 
such advantages. The Board are glad to observe that 
the medical staff of each hospital (with the exception of 
one) is now represented on the Governing Boards by 
some of its members. The Board again point out to 
the hospital authorities the importance of haviug pro¬ 
perly qualified cooks to prepare invalid cooking for 
special cases. The report records a regret that in seve¬ 
ral hospitals scarcely sufficient care is bestowed on this 
subject^ which is frequently even more important than 
the adruinistration of medicine. The fignree in the 
report show that on April 1st. 1900, there remained 921 
pstients in the hospitals which are nnder the snpervision 
of the Boa^. The number admitted daring ihe year 
was 11,601, makin g the whole number under treatment 
12,622, of whom 11,611 left the wards either cured or v 
reliev^, or were discharged from other caasea.)il^ [ 


102 Ths Mbdical Pusa. 


MEDICAL NEWS. 


JuLT 24. 1901. 


deaths numbered 480. On March Slat last there were 
911 patients nnder treatment. Exolnsive of incurables 
the mortality was 8 98 per cent, on 11,118 oases, esti- 
mated on the numbers who were discharged, or who 
died, or whose cases had been treated to a termination. 
'Hie total daily aTerage number of beds occupied in 
the hospitals corered by this report was 946'05. 

The Medico-Psyoholoslcal Association. 

Thb annual meeting oommenoee on Thursday 
morning, July 25th. at Cork, and is at first occupied 
with the tmnsaction of formal business. At 2 p.m. the 
annual meeting reassembles. The President for the 
ensuing year. Dr. Oscar T. Woods, will be introduced by 
the retiring President, Dr. Fletcher Beach, and the 
President deliver his Address, after which medals and 
prizes will be distributed. Following the President’s 
Address papers will be read by John Carswell, 

L. KC.P.Edin., L.F.P.S.GUsg. (Convener of Committee 
on Inebriates Corporation or Glasgow), On the 
Working of the inebriates Act”; Thomas Drapes, 

M. B., Medical Superintendent District Asylum, 
Enniscorthy, Ireland, “ Insanity and Phthisis ”; 
J. Michael Nolan, L.B.C.P.I., M.P.C., Medical Snperin* 
tendent District Asylum, Downpatrick, " Besidusl Luna¬ 
tics and Beoent legislation; ” F. W. Edridge-Green, 

M. D., F.B.C.8., Hatohoroft House, Hendon, London, 

N. W., " Evolution of the Colour Sense.” E. D. O'Neill, 
L.B.C.P.T., Medical Superintendent the Asylum, Lim¬ 
erick, “ The Superannuation Question—its Effect on Asy¬ 
lum Officials,with suggestions for further legislation on 
the subject.” On Friday, July 26th, the meeting re. 
assembles at 10 a.m., whee the following papers will be 
readProfessors Dixon and Bergin. ” Stereoscopic 
Badiography.” Joseph Shaw Bolton, M.D., B.S., B.So. 
Lond.,ClaybnryHall,Woodford Bridge,EsBex. willgivea 
lantern demonstration—"Gross Lesions of the Cerebrum”; 
George Bevington, M.D., TTniv. Dubl., M.P.C., Medioal 
Superintendent Central Criminal Asylum, Dundmm, 
Ireland, will read a paper on " Ment^ Conditions Be. 
suiting in Homicide”; W. C. Sullivan, M.D., B.U 1., 
H.M. Prison, Pentonville, London, N., will read a paper 
entitled “ Crime in Gene^ Paral^ics ”; 2 p.m.—John 
Eeay, M.B., Medioal Superintendent District Asylum, 
Inverness, will initiate a discussion—"On the Care 
of the Insane at Night”; A. B. Uiquhart, M.D., 
F.B C.P.E., Physician Superintendent James Murray’s 
Boyal Asylum, Perth, will read a paper on 
*‘^ect Upon Patients of Changes of Asylums”; 
Daniel F. Bambaut, M.D., Univ. DnbL, Assistant 
Medioal Officer and Pathologist Biohmond District 
Asylum, Dublin, will read a paper entitled " A Case of 
Cerebral Hemiatrophy”; KB. Leeper, F.B.C.S.l., Besi- 
dent Physician, Ht Patrick’s Hoepitel, Dublin, will read 
a paper entitled "Three Cases of Melancholia presenting 
Symptoms of Unusual Clinical Interest,” and he willshow 
microscopic specimens and photographs. ThePresident, 
Dr. Oscar T. Woods, smd Mrs. Oscar Woods will be “ At 
Home” to members and their friends on Friday, July 
26th, from four to seven o’clock, at the District Asylum, 
Cork. Saturday. July 27th, an excuieion has been 
arranged to Killamey. The annual dinner will take 
place at the Imperial Hotel, Cork, on Thursday, July 
25tb, at 8 p.m.; tickets, £1 Is. each. 

Fete of Messrs. Burroughs Wellcome and Co. 

The annual gala of the employes of Messrs. Burroughs 
Wellcome and Co. took plaM on Saturday last, in the 
spacious grounds attached to the factory at Dartford. 
Athletic and aquatic sports were carri^ on from 11 
o’clock in the morning until dark, when the grounds 
were illuminated. Luncheon was served to over 1,000 
employes in a spacious marquee, which gives one an idea 
of the enormous growth of the drag trade and accessories 
connected with this firm. The present occasion was 
made additionally interesting by the presence of Mrs. 
Wellcome, daughter of Dr. Barnardo, of Surbiton, the 
newly •ma^ bride of the principal, the toast of prosperity 
to the firm and happiness to the newly-wedded pair 
being proposed in felicitous terms by Mr. Passmore 
Edwards, and drunk with enthusiasm. Mrs. Wellcome 
subsequently presented the prizee at the conclnsion of 
the sports, and during the day there was an exhibition 


of relics and photographs from Omdurman and otJier 
parts of the Soudan, collected during the past winter by 
Mr. Wellcome, whi(^ atbacted considerable attention. 

Summer Trains de Luxe for the Holidays. 

The International Sleeping Car Company issues its 
programme of trains de Irute services, composed of 
sleeping and restaurant oars only, for ^e present 
season. The Engadine Express runs daily vta Calais to 
Sargans, Bagaos. and Coire, in connection with the 11.0 
a.m. train from Victoria and Charing Crose. A section 
of this train runs through to Lucerne on Tuesdays, 
Wednesdays, Fridays, batnrdays, and Sundays. 
Another section runs through to Berne and Interlaken 
on Mondays and Thursdays. The Ostend-Swiss Express 
runs daily via Ostend to Bile, and Lucerne in oonneo* 
tion with the 10.0 a.m. train from Charing Cross and 
Victoria. The Carlsbad Express runs daily to Nurem¬ 
berg, Eger, and Carlsbad, via Ostend, in connection 
with the 10.0 a.m. train from Charing Crossand Victoria. 
On Wednesdays and Saturdays only, passengers by this 
train may leave London by the 11.U a.m. train, smd 
travel via Calais. 

Boyal College of Baigsons, Ireland. 

The following is a list of Scholarships smd 
prizes awarded for the Summer Session, 1901:— 
Carmichael Scholarship, £16: W. B. Ormaby. Mayne 
Scholarship, £16: J. P. Byrne. Gold and Silver Medals 
in Operative Snrgery: Gold Medal, C. W. Ewing; 
Silver Medal, A. Cbarle*. Stoney Memorial Gold 
Medal in Anatomy; B. W. Burkitt. Practical His- 
tology: A. M. Cawford, first prise, £3, and medal ; 
J. b. Sheill, second prize, £1, and certificate. Prac¬ 
tical Chemistry: E. J. Cl^ke, first prise, £3, and 
medal; J. M. ^yes. second prise, £1, and certificate; 
Public Health and Forensic Medicine : Miss J. C. Har¬ 
grave, first prize, £8, and med^ ; 8. B. Hanbury, 
second prise, £1, and certificate. Materia Medioa: J. S. 
Sheill, first prize, £8, and medal ; J. M'Qnillan, second 
prize. £1, and certificate. Practical Pharmacy; Misa 
C. O’Meara, first prise, jB8. and medal; J. M. Alcorn, 
second prize, £1, and oertiScate. Biology: B. Bury, 
first prize, £3, and medal ; F. X. Costello, second prize, 
£1, and certificate. The Schools of Snidery will resnme 
work after the summer reoets on Tuesday, October let. 

Tlie New Physiological Laboratory for Edinburgh. 

On Saturday last the new physiological laboratory 
which has been built by Mrs. Cux in memory of her 
father, the late Professor John Hughes Bennett, H.D., 
F.B.S., was formally handed over to the University in 
the presence of a briUiant academic gathering. Sir 
William Muir, the Principal, oresided, and among the 
members of the University audotbers who were present 
were Sir J. Burdon Sanderson, Sir J. Batty Take, M.P., 
Sir James Crichton Browne, Sir William Tnrner, Sir 
William Oairdner, Sir Henry Littlejohn, Sir Ludovic 
Grant, Professors Chiene, Simpson, Stockman, Schafer, 
Boyce, Ac. Apologies for absence were received, 
among others, from Lord Lister and Sir Michael Foster. 
The laboratory is designed for the teaching of experi¬ 
mental physiology, and consists of two rooms—one 
fitted with all the apparatus necessary for practical 
work by individued stodents, the other a small theatre 
where the lecturers may give demonstratious to a class. 
After the opening ceremony, Sir J. Bnrdon Sanderson 
delivered an address on the life and work of Dr. Hnghee 
Bennett. 

Vital StatisUca 

The deaths registered in the week ending July 
13th, in 36 large towns of Great Britain and Ireland corre¬ 
sponded to an annual rate of 16'6 per 1,000 of their 
aggregate population, which is estimated at 11,463.026 
persons in the middle of this year :— 

Birkenhead 26, Birmingham 17, Blackburn 12, Bolton 
17, Bradford 16, Brighton 18, Bristol 10, Burnley 16, Car¬ 
diff 12, Croydon 10, Derby 10, Dublin 21, Edinburgh 16, 
Glasgow 17, Gateshead 18, Hsdifax 9, Huddersfield 16, 
Hull 11, Leeds 18, Leicester 10, Liverpool 26, London 14, 
Manchrater 17, Newcastle-on-Tyne 19, Norwich 13, 
Nottingham 16, Oldham IS, Plymouth 10, Portsmouth 20, 
Preston 21, Salford 19, Sheffield 14, Sunderland 18, 
Swansea 16, West Ham 14, Wolverhampton 13. The 
C 




Jolt 24. 1901. 


MEDICAL NEWS. 


Phi Midioal Press. 103 


liiglieet a-nTiTiai deatb-ratoe per 1,000 liviiig, as measttred 
1)7 last week’s mortality, were:—From meeiales, 2*3 in 
Birkenhead i from whooping>ooagb, I'l in Swansea and 
1*3 in Bradford; and from diarrboeal diseases, 2*2 in 
Fortsmonth and in Leeds, 2‘3 in Preston, 2’9 in Shef¬ 
field, 6*0 in Liverpool, and 6 6 in Birkenh^wi. In none 
of the large towns did the d^th-rate from scarlet fever 
or from ‘'fever" reach 1-0 per 1,000. The 66 deaths 
from diphtheria inclnded 24 in London, 6 in Liverpool, 
6 in Manchester, 4 in Leicester, 4 in Leeds, 3 each in West 
Ham, Cardiff, Salford, and Sheffield. One death from 
small-pox was registered in Liverpool, one in 0-lasgonr, 
bnt not one in any other of the large towns. 

Lotos Arablons. 

Tbaditionallt the lotas has a sinister repotation; 
and in practice the military and civil anthorities in 
IgTP^ have found that it is highly poisonons in certain 
stages of its growth to the horses, sheep, and goats for 
whom it has been used as fodder. Some time back 
investigations were ondertaken by Mr. Wyndham Dnn- 
stan, F.B.S.. and Mr. T. B. Henry to discover the 
poisonons element in the Ej^ptian lotos— Arabieus, 
and they found that its poisonons oonstitnente inclnded 
pmssio acid. The poisonons property of the lotos 
appears to be due to the action of an enzyme, lotase, on 
a glncoeide, lotnsin, which breaks np into pmssic acid 
and other constituents. The amount of pmssio acid 
given by the plant differs according to the stage of its 
groi^. The formation of the poison seems to reach its 
marimnm at about the seeding period, and after that to 
d im in i sh rapidly. The Arabs are aware that the plant 
i^lf is safe to nse aa a fodder when the seeds are quite 
ripe, bnt not Iwfore. Daring the ripening of the seeds 
the lotxuin which contains the prosaic acid disappears. 

Frledenheim Hospital 

Ak influentially signed apmal has been issned on 
behalf of the “ Home for the Dying ” at Swiss Cottage, 
the present financial position whereof is very precari- 
ODB. Additional accommodation for the nnreing staff is 
urgently required, and the building itself is in great 
neM of repairs. 

The Society tor the Study of Disease in Children has 
recently held a meet snooe^nl provincial meeting at 
Liverpool. Although the association is still in its 
infancy, no lees than seventy-three members attended the 
gathering. The progr*mme inclnded a number of 
papers on practical subjects connected with pediatrics 
some of them being of a conspicuously advanced and 
swOTtifio nature. There was the nsnal dinner, held in 
^8 2?“ Adelphi Hotel, under the presidency of 
Dr. Emeet Sansom. Several exonrsions were organised 
and it may safely be said that the problem of how to get 
over the meet ground within a limited time could hardly 
have been more conclurively answered. The Honorary 
Secretary of this most energetie society is Mr. Sydney 
Stephenson, who wJl be pleased to furnish any required 
information as to its scope and organieation. The next 
ptovmdal meeting is to take place at Manchester in 
June, 1902. 

“Jelly a la Lemoo.*' 

It onp readers want an excellent and very nourishing 
jelly we should recommend the followingPut into a 
Bteran one quart of cold water or veal stock, the rind 
of half a lemon, four cloves, a dessertspoonful of salt 
^ a teaspoonful of peppercorns, a dessertspoonful of 
tarr^n vmegar, a small onion, a sprig of parsley, 2 oze. 
M 1^ gelatine and the well-beaten whites and shells 

three eggs. Let all this come to the boil, the aoTitv. 
nsing to the top, then draw aside the pan and cover it 
for five minutee. Poor a little boiling water through a 
jelly bag and th«i strain the jelly through it and add a 
teaspoonful of Lemco. 


Glasgow University Medical Passes. 

The following have passed the fourth (final) profer 
sioual examination in medicine at Glasgow Univereitv 
For M.B., C.H.—Duncan Davie, William Henr 
FOTran, SfanshiJ Kumar Boy, John Poynter Small, Davii 
Wallace 

For M.B., Ch.B.—Martha Adams, John Anderson 


Thomas Anderson, William Archibald, James O. Barclay, 
John S. Barr, William H. Brown, William M. Brown, 
George Frederick Buchan, Ernest C. Burnett, Patrick 
T. Cairns, Samuel J. Cameron, Bobert D. Campbell, 
James B. W. Cook, Ernest H. Cramb, Andrew Currie, 
David B. Davidson, James Davidson, M.A., G. H. G. 
Davie, Alexander Doig, Beginald N. Dunlop, Geoi^ B. 
Eadie, William Elder, William W. Farrar, John Forrest, 
John A. Garden, Andrew P. Granger, John Gregor, 
Geo^ P. Harlane. Francis J. Henry, Douglas W. 
Hunter, Matthew Hunter, William J. lebistor, Thomas 

H. Jack, Daniel B. Kilpatrick, David Kyle, M.A., John 
Lambie, F. J. Lochrane, James W. M'Dougall, Thomas 
M'Laren, Hugh A. M'Lean, George W. M'Millan, James 
M'Fherson, M.A., Edward Magoveny, Jacob Mains, 
James G. Miller, Bobert H. Mills, William A. 

Samuel J. Moore, Alan H. Muir, Bobert Paterson, John 
Paton, James K. Patrick, Bobert Bamsay, Peter M. 
Beid, William Boberteon (Kilmarnock), 'Hiomae B. 
Bodger, Charles J. Boss, B.A., David Shannon, Donald 
Steel, John Strathearn, Alexander D. Thompson, James 
Nathaniel Todd, J oseph G. Tankinson, John W. Tomer, 
Bobert W. Valentine, Albert E. Wainwright, James 
W^ker, George S. Wallace, Peter M. Waugh, W. W. W. 
Wileon, Martha Adams, Mabel Hardie, Alice Moorhouse, 
Mary J. Pirret, Agnes B. Sloan, Elizabeth M. Sloan. 

The following attained distinction. S. indicates sur¬ 
gery and clinical surgery; P. practice of medicine and 
clinical medicine; M. midwifery:— 

John Anderson (P), William Archibald (P), Bobert 
Wellwood Anld (P), James Oastler Barclay (P), John 
Stoddart Barr (P), William Herbert Brown (P), William 
Macalister Brown (P), George Frederick Buch^ (P) 
Samuel James Cameron (PM), Edward Seymour Chap¬ 
man (P), David Beattie Davidson (P), James Davidson, 
M.A. (PM(. Beginald Naim Dunlop (M). Janet Bisland 
Higgins (P), Douglas William Hunter (P), David Kyle 
M.A. ( 8 P), James M'Phereon, M.A. (P), Edward Mago¬ 
veny ( 8 P), Jacob Mains (P), William Alexander Milne 
(P). Alice Moorhouse (P), Alan Howie Muir (P), Bobert 
Bamsey (M). Peter Mackeuzie Beid (F), William Bobert- 
BOD, EUmamook (P), Agnes Benkier Sloan (P), Donald 
Steel ( 8 ), Alexander Dey Thompson (SPM), Joreph 
Goodwin Tomkioson (P), Bobert Warden Valentine 
(M), Albert Emeet Wainwright (P), James Walker 
PM). 

Society of Apothecaries of London, July, KOL 

The following candidates have passed:—Surgery._ 

C. H. Allan, Sections 1. and II.; A. O. H. Anthonisz; 
Section 1.; F. A. Beattie, Sections I. and II.; P. C. 
Burgess, Section I.; C. E. C. Child, Section I.; T. J. M. 
Clapperton, Sections I. and II.; £. A. Dune, Section 
II.; J. P. E. Henery j H. C. Hooken, Section II. 5 C. E. 

A. Huddart, Sections I. and II.; B. L. Jones, Sections 

I. and II.; F. P. Joscelyne, Section II.j C. C. Morgan, 
Section I.; fi. E. Sansom, Section II.; 0. V. Smith; 

P. P. Tobit, Section I.; F. I. Trimmer, Sertiona I. 

II.: A. G. Wilson, Sections L and U.; £. Yoxall. Se<s 
tion I. 

Medicine.—F. A. Beattie, Sections I. and II.; J. E. 
Bolton, Section 1.; G. M. Crockett, Section I.; K. A. 
Dawson, Section I.; E. A. Dunn, Section II.; H. C. 
Hocken, Sections I. and II.; F. P. Joscelyne, Section 
II.: A. E. Malaher; M. E. Martin, Section I.; E. S. 
Perkins; H. Biebardson, Sections I. and II.; F. 6 . 
Sheppard, Sections I. and II.; J. E. Skey, Section I.; 

A. G. WilsoD, Sections I. and II. 

Forensio Medicine.—F. A. Beattie, J. E. Bolton, G. 
M. Crockett, K. A. Dawson, E. H. Forjett, C. J. Francis, 

H. C. Hooken, M. E. Martin, E. S. Perkins, F. P. Bose, 

J. E. Skey, and A. G. Wilson. 

Midwifery.—P. A. Beattie, F. G. Bennett, F. J. Birks, 

P. J. B. Buoknill, W. V. Braddon, A, N. Collier, W. H. 
Crossley, W. E. Davies, C. W. Gibson, J. M. King, E. A. 

Le Malstre, D. E. Lockwood, M. B. Oliver, J. A. W. 
Webster, A. G. Wilson. 

The L.S.A. diploma of the Society was granted to the 
following oan£datee, entitling them to practise 
medicine, surgery, and midwifery.—F. A. Beattie, F. J. 
Birks, P. J. B. Bucknill, £. A. Dunn, H. C. Hocken, F. 

P. Joscelyne, A. E. Mailer, C. V. Smith, and A. G.Wil- 

OOgli 


D 


104 Th. Mmical Pb« 8. yOnOES TO CORRESPONDENTS._ July 24> 1901. 


fiaticts to 

®0rre«jr0nben±0, Shfftt ’jCettcro, &c. 

COBUIPOBDIVTS reqairinff a raplj in tUa oolnmn ai« par 
tlaolarlj reqnaatod to make ose of a diftincUoa $iffnatwr€ or 
and avoid tha praotioa of aiffnin^ themaelTea '* Beader,” 
"Sabaerlbar,” “Old Sabaotiber,** do. Ifuoh oonfoaion will bo 
aparod by attontion to thia mle. 

BaPBiirra.—Beprinta of articloa appearinfr in tbia Journal can be 
had at a reduood rate, providing autbora give notice to the pub* 
Uaber or printer before the type ha a been distributed. Thia ahonld 
be done whan retumin* corrected proofs. 

TEAINBD MEN POE THE AEMY MEDICAL COBPS. 

To tht Editor of The Medical Pbesb axd Cibcvlab. 

Sib,—T he following ofBcial information baa been sent us for pub* 
lication“ Train^ men are required for the Boyal Army Medical 
Corpa for one year's aervioe or the duration of the wm. JMl par- 
tionlara he obtained from the Chief Becruiting Btao Officer, 
8t. George’s Barraoka, London. W.C.’’ 

O. F. Datidbom, Colonel. 

Chief Becruiting Staff Officer. 

St. George’s Bamcka, lAudon, W.C., 

July 2Snd. 1901. 

Mbs. 8. O. M.—Ton had better apply to a local medical man who 
may be willing to imnart the necessary tnatmotiou in return for 
your daughter’s aerricea. It would, however, be better for her to 
nwpare for the “minor’’ qualifl‘*ation of the Pharmaceutical 
B^ety, informatiOB respecting which can be obtained at the 
Offices, Bloomsbury Square, W.C. 

X. y.—We shall be pleaa^ to publish the case if you will forward 
us the detidls. It ought not to 1 m difficult to veil the identity of 
the patisnt sufficiently to set ill qualms at rest. 

N. T.—The subject of your article is well worthy of considera¬ 
tion, bat the data upon which your sweeping stricturee are baaed 
do not appear to ns to wamnt so much declamation. The matter 
is of pore^ scientific interest, and should be approached in a 
Bcieiitmc spirit, leaving individuals out of the question. We are 
unable to make use of it as it stands. 

Db. M.—Such visits are purely a matter of courtesy, and yon 
have no right to feel aggrieved if they are not made. It la highly 
nndeairable to make every little social omission a pretext for 
eoltivati^ ill-will both in yonr Interest and in that of the new¬ 
comer. 

Db. Poujxt, —We have no knowledge of the anti-tuberonlous 
teeatment in question, There are many “ on the market, ’ all 
equally untrustworthy. Ton would hardly be justified in exjieri- 
mentlng with a “ serum’’ until you had taken stepe to ascertain its 
precise nature and effects, and this yon should proceed to do. 
Tour patient's wish does not exonerate yon from all responsibility, 
as you seem to imagine. 

giarg for the SScefe. 

ENGLAND. 

Daily thia week, the Congress on Tuberculosis at the Queen’s 
Hall, London. 

FaiDAT, JuLT 26 th. 


McClsabt, G. F.. M.B.Camh., LS.A.. Medical Officer of Health 
of Battersea Metropolitan wrough. _ 

Meacbeh, G. NoaHAH, M.B., B.BLond., M.B.C.F.Bdin., M.B.C.S., 
Clini^ Assiatant to the Hospital for Diseases of the Skin, 
Blackfriars. 

MiLLABD, C. E., M.D.Edin., Medical Officer of Health of Ldceeter 
County Borough. 

Muibhkap, Jams, M.B., B.S.l>nrh., Senior Honse Physician to 
the Boyal Infirmary, Newcastle-on-Tyne. 

O’Beibh, D. J., L.B.C.P., L.B.C.S., Certifying Surgeon for the 
Dorrow Dispensan District. Qneen's Coun^. 

Pbitcbaed, W. O., L B C.P., L.B.O.8., Certifying Surgeon for the 
Betheeda District of the Coonty of Carnarvon. 

South Ahamd, M.D.. B.8.. F.B.aP.Lond., Consulting Physician 
to the Samaritan Free Hospital for Women. London 

Tbedihhicx, a. 8., L.B.C.P.Lond., M.B C S.Eog., Certifying Sur¬ 
geon for the Melbourne District of Derbyeblre. 

IBacaitctts. 

Blackpool Corporation.—Medical Officer of Health for the Borough. 
Salary A40D, rising to £S00 per annum. Age not to exceed SO 
yean. Candidates most devote bis whole time to the duties. 
Forms of application to be obtained from the Town Clerk. 
(See Advt). 

CmnWland and Westmorland Asylum, Garlands. Carlisle.—Senior 
Assistant Officer, nnmarned. Salary <150 a year, 

rising to £180, with board, lodging. Ac. 

Devon County Asylum, Exminster, near Exeter.—Third Assistant 
Medical (officer. Salary £125. rising to £150. with board, lodg¬ 
ing. Ac. Applications to the Medical Superintendent. 

Halifax Union Hospital, Salterhebble.—Beeident Medical Offlow. 
Salary £140 per ansnm, with apartments, rations, and waah- 

Ho^& for Sick Children, Newcastle-on-Tyne.—Beeident Medktl 
Officer. Salary £100, with board, lodgings, and laundry. 

London Hospital, Whitechapel, E.—Assistant Director of the 
Patbolo^l Institute. Ssl^ £200 per annum. 

North Wales Counties Lunatic Arylom, Denbigh.—Second Assist' 
ant Medical Officer. £120 per annum, increasing to £160, with 
board, resldenoe. and washing. - « .j * o 

Nottingham GenenU Dlapensary.—Two Assistant Besident Sur- 
geona. unmarried. Salaries £160 per annum each, increasing 
by £10 every year, with famished apartments, attendance, 
light, and fuel. ^ j o i 

Boyal Cornwall Infirmary.-House Swgwn, nnmarto^ S^ry 
£100, increasing by £10 a year, with board (excluding stimu¬ 
lants) and apartmenta. , . 

Eural District Oonncll of Bishop Anokla^—Medical Offlw M 
Health for the Eural District. Salary £350 per annum. Whole 
time to be devoted to the office. Applications to the Clark 

of the Cooncil. Bishop Auckland. « j — t. 

It. Matthew, Bethnal Green Infirmary, Cambridge Bead, 

Fint Assistant Medical Officer, unmarried. Salary £150 per 
annum, with board, lodrbg, and lannd^. . ^ , 

Dniversity of Sydney, New South Wales.—Professor of Pathology 
SalaiT £900 per annum. Pension £400 per annum after twenty 
years'servioa £100 allowed for paaawre. Further particulan 
of the Agent-General for New South Wales, 9, Victoria Street, 

Wolvem^pton and Staffordshire General Hospital.—AsaistMt 
House Physician for six months. Honorarium at ra^ of 
per annum, with board, lodging, and washing. Also Assistant 
House Surgeon for six months; same bonorarinm. 


Socixrr roa the Studt or Diseases is CEaDBXR.—Annual 
meeting at 11 Chandos St.. London, W., 5.30 p.m.: Presentation of 
Beport and Election of uffleers. 

Tpbspat, July 30th to Feidav, AcausT 2 sd. 


Bbitish Medical Absociatiox Annual meeting to be held this 
year at Cheltenham. First general meeting Tuesday, st 2.30 p.m. 
Sectl''Bsl and general meetings daily. On Saturday, excursion to 
Wye Valley. 

IBELAND. 


Tbubbdat, Jvlt 25th, amd Fbipat, July 26rH. 
Mxdico-Fsycholooical Absociatioh op Gbhat Bbitaih abd 
Ibslakd.— Annual meeting to be held this year at Cork. Honrs of 
meeting, 10 a.m. and 2 p.m. 


Mohday, Jcly 29ts, Tuesday, July SOth, Wedhxbday, 
July SIst. 


Bbitish Phaemackutical CosnsEscE. to be held this year in 
Dublin. Sessions of Conference in Lecture Theatre, Boyal Dublin 
Society, 10 a,m. to 1 p.m. and 2 p.m. to 4 p.m. each day. 


,|4iir0hTtment0. 

Caboill, L. Vebhok, F.B.C.S.Eng., L.B.C.P.Lond., L.8.A., Sur¬ 
geon to the Boyal Eye Hospital, Sonthwark. 

DUHLIA, M. P., M.D., B U.L, Certifying Surgeon for the Biverstown 
District in the County of Cork. 

Faoaii, P. J.. L B.C.P.Irel., liectorer on Elementary Physics in the 
(ilatholic University Medical School, Dublin. 

Hakiltoh, W. M , M.D., B.UJ., M^cal Officer of Health of 
Eccles Monicip^ Borough. 

Hayes, W. B., M.D., B.U.I., Certifying Surgeon for the Union of 
Tr^ee, in the tlounty of Kerry. 

Hooo, J. A., M.B.C.8.£ag., L.B.C.P.Lond., Medical Officer of 
Health of Shardlow Bnial Sanitary District. 

Mason, J. J., L.B.C.P.EdiD., L.B.C.S.Ediu., Medical Officer of 
He^th of Bollington Urbu Sanitarv District. 

Maddbvxii, J. C., M.D.Glasg., Certifying Surgeon for the Brown- 
hiUs and Aldridge District of Staffordshire. 


girths. 

EF 5 BTT.- On Jnly 19th, at 33 Vancouver Bead, Fo^ HUl, 8.B.. 
.A .ra. a ATn_ n T. 1> r* t> V V a P f\f a. 


Memy.-O n July 21st, st 2 Chiswick Place, Esstboume, the wife 
of W. J.crMerry.M.D..ofsson. ^ „ .v . 

SiiHHEB —On July 17th, st Bank House, Bye, Sussex, the wife of 

Ernest W. Skinner, M.D., of a daughter. __ 

White.— On July 16th, at the Dower Rouse, B'ghrooke, Noitt- 
amptonftbire, the wife of Percy Stanhope White, MeB.C.S.p 
LeK.CeP.IiOnd., of a daughter. 


^ftanriaflea. 


IsBTiB— Old.— On July 18th, at 8t Augustine's Church, Kiibnm 
Axtbur Frederick uervis, M.B.C.S.. L.B.C.P., of No. 1 Slew’s 
HamiMtWd, son of Frederick H. Gervis, M.B.C.S., to 
EtheJ, eldest daughter of Charles Old, of Brondesbury. 

Eisiix-Mise™.—O il July 80th. at the Parish Church, Elth^ 
Kent. Ernest Miakin. M.B., M.B.C.8., L,B.C.P., son of l^ 
Miskln, of Slade House, Kenciogtou, to Mabel (Caroline, only 
daughter of W. P. Hiskin, Eltham. Kent. 




Bxoo.—At Hout Kop, near Vereenigiag, on July llth, C^Ies 
^gg, aged 21, killed in action, eldest son oi Charles Begg, 
M.B.. C.M.Edin.,of Bath. „ .. 

UiDDLETOH.- On July 20th, at the Boyal Infirmary, Preston, BmU 
Charles Middleton, M.U., Ch B., eldest son of Charles E. Mid- 
dletoo. Adlington,Lanca,aged25years. , , - 

Neale —On July I6tb, at London Bead, Leioester, John Headley 
Neale, M.B.Edin., M.B.C.F.Lond., 51 years. 

Peaese —On July 19th, at The Bookery. Blofleld, Arthur Peatee, 
M.D.. formerly of Boteednle, Suffolk, aged64 years. 
Biooi.-On July 12th, John Arthur Bigge, M.B.C.S.Eng., L.B.C.P. 
Loud., L.S.A., of Uenley-on-Thames. 


Coogle 



ik ittetol Wtm a«4 



••SALUS FOPULI SUFBEMA LEZ.’ 


Vot. oxxni. WEDNESDAY, JULY 3 1, 1901. 

(DrtQinal CcntmmticattBns. 


THl 

COMBATING OF TUBERCULOSIS 

IN THE LIGHT OP THE EXPERI¬ 
ENCE THAT HAS BEEN GAINED IN 
THE SUCCESSFUL COMBATING OP 
OTHER INFECTIOUS DISEASES, (a) 
Bj Geh. Med.-Bath Professor Dr. ROBERT XOCH, 

Diraktor dea Inctitata far Infektions EranUieiten in Barlin. 

Wb xmderstand by tnbercolosis only those morbid 
conditions which are caused bj the tubercle bacillus. 
In bj far the majority of cases of tuberculosis the 
disease has ite seat in the lungs, and has also begun 
there. From this fact it is justly concluded that the 
ifennsof the disease, i.e., the tubercle-bacilli, must 
hare got into the lungs by inhalation. As to the 
cnestion where the inhaled tubercle-bacilli come 
mm there is also no doubt. On the contrary, we 
know with certainty that they get into the air with 
the scutum of consumptiye patients. This sputum, 
especially in advanced stases of the disease, almost 
^ways contra -1 ^ bercle bacilli, somefames in 
incredible quantities* By coughing, and even speak¬ 
ing. it is flung into the mr m little drops, t e., in a 
moist condition, and can at once infect persons who 
happen to be near the coughers. But then it may 
sIm be pulyerised when driM, in the linen or on the 
floor for instance, and get into the air in the form of 
dost 

In this manner a complete circle, a so-called 
cireulua nitoana, has been formed for the process of 
infection, from the diseased lung, which produces 
nhl^m and pus containing tubercle-bacilli, to the 
formation of moist and diy particles (which, in virtue 
of their smallness, can keep floating a good while in 
the w), and fin^y to new infection, if particles 
pcmtrate with the air into a healthy lung and 
originate the disease anew. But the tuMrcle-baoilli 
niay get to other organs of the body in the same 
wa;^. and thus originate other forms m tuberculosis. 
Tub, however, is a considerably rarer case. The 
sputum of consomptive people, then, is to be re¬ 
gard^ as the main source of the infection of tuber- 
culoeis. On this point, I suppose, all are agreed. 
The question now arises whether there are not other 
sources too, copious enough to demand consideration 
in the combating of tuberculosis. 

Ormt importance used to be attached to the 
hereditary transmission of tuberculosis. Now, how- 
srer, it fau been demonstrated by thorough investi¬ 
gation that, though hereditary tuberculosis is not 
absolutely non-existent, it is nevertheless extremely 
rare, and we are at liberty, in considering our prac- 

(■) Abctnet of AddroM nod before the 3iitieh Confreee on 
Tnbareoloeie, London, Jnlj, 1901. 


Na 5. 


tical measures, to leave this form of origination 
entirely uut of account. 

But another possibility of tuberculous infection 
exists, as is generally assumed, in the transmission of 
tbs germs of the disease from tuberoulons animals to 
man. This manner of infection is generally regarded 
nowadays as proved, and as so frequent thM it is even 
looked upon by not a few as the most important, and 
the most rigorous measures are demands agmnst it. 
In this Congress also the discussion of the danger 
with which the tuberculosis of animals threatens man 
will play an. important part. Now. as my investiga¬ 
tions have led me to form an opinion deviating from 
that which is generally accepted, I beg your per¬ 
mission, in consideration of the great importance of 
this question, to discuss it a little more tooroughly. 

Qeuuine tuberculosis has hitherto been observed 
in almost all domestic animals, and most frequently 
in poultty and cattle. The tuberculosis of poultry, 
however, differs so much from human tub^ulosis 
that we may leave it out of account as a possible 
source of infeotiou for man. So, strictly speaking, 
the only kind of tuberonloeis remaining to be 

considered is the tuberouloeis of cattle, which, if 
really transferable to man, would indeed have fre¬ 
quent opportunities of infecting human beings 
through the drinking of the milk and the eating of 
the flesh of diseased animals. 

Even in my first oiroumstantial publication on the 
' etiology of tuberoulosis I expressed m^lf r^^rding 
the identity of human tuberoulosis and bovine tuber¬ 
culosis with reserve. Proved ^ts which would have 
enabled me sharply to distinguish these two forms 
of the disease were not then at my disposal, but 
sure proof of their absolute identity were equally 
nndisooverable, and 1 therefore had to leave this 
question undecided. In order to decide it, I have 
repeatedly resumed the investigations relating to it* 
but so long as I experimented on small animals, such 
as rabbits and guinea pigs, I f^ed to arrive at any 
satisfactory result, though in^cations which rendered 
the difference of the two forms of tuberonloeis pro¬ 
bable were not wantii^. Not till the oomplaisance 
of the Ministry of Agnonlture enabled me to experi¬ 
ment on cattle, the only animals really suitable for 
these investigations, did I arrive at absolutely con¬ 
clusive results. Of the mcperimente which 1 have 
carried out during the last two years along with 
Professor Shiitz, of the Yeterinary College in ^rlin, 

I will tell you briefly some of the most important. 

A number of young cattle which had stood the 
tuberculin test, and might tiierefore be regarded as 
free from tuberculosis, were infected in vanons ways 
with pure cultures of tubercle-bacilli taken from 
cases of human tuberculosis; some of them got the 
tobercnlons sputum of consumptive patients direct. 
In some cases the tubercle-bacilli or the sputum 
were injected under the skin, in others into the 
I peritonw cavity, in others into the jugular vein. 

Dir;:T;zed : 





106 TbB MiDKUL Pb186. 


ORIGINAL COMMUNICATION. 


JCLT 81, 1901 


Six animals were fed with tnbercaloiis sputum almost 
daily for seTen or eight months; four repeatedly 
inhmed great quantities of bacilli, which were dis' 
tributed in water and scattered with it in the form 
of spray. None of these cattle (there were nineteen 
of them) showed any symptoms of disease, and they 
gained considerably in weight. From ^ to 
eight months after the beginning of the ex¬ 
periments they were killed. In their internal 
oi^^ans not a trace of tuberculosis was foxmd. Only 
at the places where the injections had been made smaU 
suppurative foci had formed, in which few tuberole- 
bamlli could be found. This is exactly what one finds 
when one injects dead tubercle-bacilli under the skin 
of animals liable to cont^on. 8o the animals we 
experimented on were affected by the living bacilli of 
human tuberculosis exactly as tney wouldnave been 
by dead ones; tiiey were absolutely insusceptible to 
them. 

The result was utterly different, however, when the 
same experiment was made on cattle free from tuber¬ 
culosis with tubercle-bacilli that came from the lunge 
of an animal suffering from bovine tuberculosis. 
After an incubation-period of about a week the 
severest tuberculous disorders of the internal oi^ans 
broke out in all the infected animals. It was all one 
whether the infecting matter had been injected only 
under the skin or into the peritoneal cavity or the 
vascular system. High fever set in, and the animals 
became weak and lean; some of them died after a 
month and a half to two months, others were killed 
in a miserably sick condition after three months. 
After death extensive tuberculous infiltrations were 
found at the place where the injections had been 
made, and in the neighbouring lymphatic glan^, 
and also far advanced alterations of the internal 
organs, especially the lungs and the spleen. In the 
case in which the injection bad been made into the 
peritoneal cavity the tuberculous growths which are 
so characteristic of bovine tuberculosis were found 
on the omentum and peritoneum. In short, the 
cattle proved just as Bus<Mptible to infection by the 
bacillus of bovine tuberculosis as they had proved 
insusceptible to infection by the bacillus of human 
tuberculosis. I wish only to add that preparations 
of the orgws of the cattle which were utificially 
infected with bovine tuberculosis in these experi¬ 
ments are exhibited in the Museum of Pathol<^^ 
and Bacteriology. 

An almost equally striking distinction between 
human and bovine tuberculosis was brought to light, 
by a feeding experiment with swine. Six young 
swine were fed daily for three months with the 
tuberculous sputum of consumptive patients. Six 
other swine received bacilli of oovine tuberculosis 
with their food daily for the same period. The 
animals that were fed with sputum remained healthy 
and grew lustily, whereas thoeelthat were fed with the 
bacilli of bovine tuberculosis soon became sickly, were 
stuntedin their growth, and half of them died. After 
three months and a half the surviving swine were all 
killed andexamined. Among the animale that had ^n 
fed with sputum no trace of tuberculosis was found, 
except here and there little nodules in the lymphatic 
glands of the neck, and in one case a few grey nodules 
m the lungs. The animals, on the other hand, which 
had eaten bacilli of bovine tuberculosis had, without 
exception (just as in the cattle experiment), severe 
tuberculous diseases, especially tuMrculons infiltra¬ 
tion of the greatly enhu^ed lymphatic glands of the 
neck and of the mesenteric glands, and also exten¬ 
sive tuberculosis of the Innra and the spleen. 

The difference between human and bovine tuber¬ 
culosis appeared not lees strikingly in a similar ex¬ 
periment with asses, sheep, and goats, into whose 
vascular systems the two hinds of tuWrole-bacilli 
were injected. 


Our experiments, I must add, are the <mly ones 
that have led to this result. If one studies the older 
literature of the subject, and oollates the reports 
of the nummcns eneriments that were ma^ in 
former times by Obauvean, Gunther and Harms, 
Bollinger, and others, who fed (^ves, swine, 
goats with tuberculous material, one that the 
animals that were fed with the mUk pieces of 
the Innge of tubercnlons cattle always fell ill of 
tubeicnloeis, whereas those that received human 
material with their food did not. Comparative in- 
vestirations regarding human and bovine tubercu¬ 
losis ^ve been made very recently in North America 
by Smith, Dinwiddle and Frothingham, and their 
result ^reed with that of ours. The unambiguous 
and absolutely oonolusive result of our experiments 
is due to the fact that we chose methods of infection 
which exclude all sources of error, and carefully 
avoided every^ing connected with the stalling, feed¬ 
ing, and tending of the animals that m^ht have a 
disturbing effect on the experiments. 

Considering all these fa^, I justified in main¬ 

taining that human toberoolosis differs from bovine, 
and cannot be transmitted to cattle. It seems to 
me very desirable, however, that these experiments 
should be repeated elsewhere in order that all doubt 
as to the correctness of my assertion may he removeA 

But now, how is it with the susceptibility of man 
to bovine tuberculosis P This question is far more 
important to ns than that of tiie susceptibility of 
cattle to human tuberculosis, highly important as 
that is too. It is impossible to give this question a 
direct answer, because, of course, the experimental 
, investigation of it with human beings is out of the 
question. Indirectly, however, we can try to approach 
it. It is well known that the tniHr and butter con¬ 
sumed in great cities very often contain large quan¬ 
tities of the bacilli of bovine tuberculosis in a living 
condition, as the numerous infection-experimento 
with such dairy products on animals have proved 
Most of the inhabitants of such cities daily consume 
snob living and perfectly virulent bacilli of bovine 
tuberculosis, and unintentionally carry out the ex¬ 
periment which we are not at liberty to make. If the 
bacilli of bovine tuberculosis were able to infect 
human beings, many cases of tuberculosis caused by 
the consumption of ailments containing tubercle- 
bacilli could not but occur among the inhabitente of 
great cities, especially the children. And most 
medical men believe that this is actually the case. 

In reality, however, it is not so. That a case of 
tuberouloris has been caused by aliments can be 
assumed with certainty only when the intestine 
suffers first—t.e., when a so-called primary tuber- 
cnlosis of tile intestine is found. But such cases are 
extremely rare. Among many oases of tubercoloeis 
examined after death, I myself remember having seen 
primary tuberculosis of the intestine only twice. 
Among the great post-mortem material of the 
Charite Hospital in Berlin ton cases of primary 
tuberculosis of the intestine occurred in five years. 
Among 933 cases of tuberculosis in children at 
the Emperor and Empress Frederick’s Hospital for 
Children, Baginsky never found tuberculosis of the 
intestine wit^ut simultaneous disease of the lungs 
and the bronchial glands. Among 3,104 post-mor¬ 
tems of tuberculous children, Biedert observed only 
sixteen cases of primary tuberculosis of the intestine. 

I conld cite from the literature of the subject many 
more statistics of the same kind, all indubitabiy 
showing that primary tuberculosis of the intestine, 
especiaUy among children, is a comparatively rare 
disease, and of these few cases that have been 
enumerated, it is by no means certain that tbe^ were 
due to infection by bovine tuberculosis. It is just 
as likely that they were caused by the widely pro¬ 
pagated bacilli of human tuberculosis, which may 

e 


o 


JuLT 81, 1901. ORIGINAL COMMUNICATIONS. Ths Msdioal Pbxss. 107 


have got ioto the di^tive canal in some way or 
other—>for instance, oj swallowing salira of the 
the month. Hitherto nobody could decide with CAr> 
tainty in each a case whether the tuberculosis of the 
intestine was of human or of animal origin. Now 
we can diagnose them. All that is necessary is to 
cultirate in pure culture the tnberole*baoilli found in 
the tuberculous material, and to ascertain whether 
they belong to bovine tuberculosis by inoculating 
cattle with them. For this purpose I recommend 
subcutaneous injection, which yimds quite specially 
characteristic and convincing results. For half a 
year past I have occupied myself with such investi¬ 
gations. but, owing to the rareness of the disease in 
question, the numMr of the cases I have been able 
to investigate is but small. What has hitherto 
resulted from this investigation does not speak for 
the assumption that bovine tuberculosis occurs in 
man. 

Though the important question whether man is 
susceptible to bovine tuberculosis at all is not yet 
absolutely decided, and will not admit of absolute 
decision to-day or to-morrow, one is nevertheless 
already at liberty to say that, if such a susceptibility 
really exists, the Infection of human beings is but a 
very rare occurrence. I should estimate the extent 
of infection by the milk and flesh of tuberculous 
cattle, and the butter made of their milk, as hardly 
greater than that of hereditary transmission, and I 
therefore do not deem it advisable to take any 
measures against it. 

So the oiQy main source of the iofection of tuber¬ 
culosis is the sputum of consumptive patiente, and 
the measures for the combating of tuberculosis must 
aim at the prevention of the dangers arising from its 
diffusion. Well, what is to be done in this direction P 
Several ways are open. One’s first thought might be 
to consign all persons suffering from tuberculosis of 
the lungs, whose sputum contains tubercle-bacilli to 
Boitable establishments. This, however, is not only 
absolutely impracticable, but also unnecessary. For 
a consumptive who coughs out tubercle-bacilli is not 
necessarily a source of infection on that account, so 
long us he takes care that his sputum is pi'Operly 
removed and rendered innocuous. This is certainly 
true of very many patients, especially in the first 
stages, and also of those who belong to the well-to-do 
classes, and are able to procure the necessary nursing. 
Bat how is it with people of very small means? 
Every medical man who has often entered the 
dwellings of the poor, and I can speak on this point 
from my own experience, knows now sad is the lot 
of consumptives and their families there. The 
whole family have to live in one or two small, ill- 
ventilated rooms. The patient is left without the 
nursing he needs, because the able-bodied members of 
the family mast go to their work. How can the 
necessary cleanliness be secured under such circum¬ 
stances ? How is such a helpless patient to remove 
his sputum, so that it may do no harm P But let 
us go a step further and picture the condition of a 
consumptive patient’s dwelling at night. The whole 
family sleep crowded together in one small room. 
However cautious ho may be. the sufferer scatters 
the morbid matter secreted by bis diseased lungs 
evety time he coughs, and his relatives close beside 
him must inhale this poison. Thus whole families 
are infected. They die out, and awaken in the minds 
of those who do not know the infectiousness of 
tuberculosis the opinion that it is hereditary, whereas 
its transmission in the cases in question was due 
solely to the simplest processes of infection, which 
do not strike people so much, because the conse¬ 
quences do not appear at once, but generally only | 
uter the lapse of years. Often, under such circum- I 
stances, the infection is not restricted to a single | 
family, bat spreads in densely inhabited tenement- ' 


houses to the neighbours, and then, as the admirable 
investigations of Biggs have shown in the case of 
the densely peopled parts of New York, regular 
nests or foci of disease are formed. 

If we are not able at present to get rid of the 
danger which small and overcrowded dwellings in¬ 
volve, all we can do is to remove the patients from 
them, and, in their own interests and that of the 
people about them, to lodge them better; and this 
can be done only in suitable hospitals. But the 
thought of attaining this end by compulsion of any 
kind is very far from me; wbat 1 want is that the 
consumptives may be enabled to obtain the nursing 
they need better than they can obtain it now. At 
present a consumptive in an advanced stage of the 
disease is regarded as incurable and as an unsuitable 
inmate for a hospital. The consequence is that be 
is reluctantly admitted and dismissed as soon as 
possible. The patient too, when the treatment 
seems to him to produce no improvement, 
and the expenses, owing to the long duration 
of bis illness, weigh heavily upon him, is himself 
animated by the wish to leave the hospital soon. 
That would be altogether altered if we bad special 
hospitals for consumptives, and if the patiente were 
taken care of there for nothing, or at least at a very 
moderate rate. To such hospitals they would will- 
ingly go; they could be better treated and cared for 
there than is now the case. As however, unfortu¬ 
nately, the aid of the state, the municipalities, and 
nch Mnefactors will probably not be fortncoming for 
a long time yet, we must for the present resort to 
other measures that may pave the way for the main 
measures just referred to, and serve as a supplement 
and temporaty substitute for it. 

Among such measures I regard obligatory notifica¬ 
tion as specially valuable. In the combating of all 
infectious diseases it has proved indispensable as a 
means of obtaining certain knowledge as to their 
state, especially their dissemination, their increase 
and decrease. In the conflict with tuberculosis also 
we cannot dispense with obligatory notification; we 
need it not only in order to inform ourselves as to 
the dissemination of this disease, but mainly in order 
to learn where help and instruction can be given, and 
especially where the disinfection which is so urgently 
necessary when consumptives die or change their 
residences has to be effected. Fortunately it is not 
at all necessary to notify all cases of tu^rculosis, 
nor even all cases of consumption, but only those 
that, owing to the domestic conditions, are sources 
of danger to the people about them. 

There is another measure, closely connected with 
notification, viz., disinfection, which, as already men¬ 
tioned, must be effected when consumptives die or 
change their residence, in order that those who next 
occupy the iufected dwelliug may be protected 
against infection. Moreover, not only the dwellings 
but also the infected beds and clothes of consump¬ 
tives ought to be disinfected. A further measure, 
already recognised on ail hands as effective, is the 
instructing of all classes of the people as to the 
infectiousness of tuberculosis, and as to the best way 
of protecting onself. The fact that tuberculosis has 
considerably diminished in almost all civilised states 
of life is attributable solely to the circumstance that 
knowledge of the contagious character of tubercu¬ 
losis has been more and more widely disseminated, 
and that caution in intercourse with consumptives 
has increased more and more in consequence. 
Another measure, which has come into the fore¬ 
ground of late, and which at this moment plays to a 
certain extent a paramount part in all efforts for 
the com^ting of tnbercolosis, works in quite another 
direction. I mean the founding of sanatoria for 
consumptives. 

That tuberculosis is curable in its(Wly stages 

D C 



108 Th> Medical Fbsss. ORIGINAL COMMUNICATIONS. 


JULT 81,1901. 


must be regarded as an uodisputed fact. The idea 
of curing as many tuberculooB patients as possible 
in order to reduce tbe number of those that reach 
the infectious stage of consumption, and thus 
to reduce the number of fresh oases, was there¬ 
fore a very natural one. The only question 
is whether the number of persons cui^ in this 
way will be great enough to exercise an appre¬ 
ciable influence on tbe retrogression of tubercu¬ 
losis. I will try to answer this question in tbe 
light of the figures at my disposal. 

If now, in conclusion, we glance back once more 
to what has been done hitherto for the combating 
of tuberculosis, and forward to what has still to be 
done, we are at liberty to declare with a certain satis¬ 
faction that very promising beg^ninn have already 
been made. Among these I reckon toe consumption 
hospitals of England, the legal regulations reg^ding 
notification in Norway and 8axony, the organisation 
created by Biggs in New York, the sanatoria, and 
the instruction of the people. All that is necessary 
is to go on developing these beginnings, to test, and 
if possible to increase their influence on the diminu¬ 
tion of tuberculosis, and wherever nothing has yet 
been done, to do likewise. 

If we are continually guided in this enterprise by 
the spirit of genuine preventive medical science, if 
we utilise the experience sained in conflict with other 
pestilences, and aim, with clear recognition of tbe 
punose and resolute avoidance of wrong roads, at 
striking tbe evil at its root, then the battle asainst 
tubercdosis. which has been so energetically begun, 
cannot fail to have a victorious issue. 


MEASURES FOR THE 

PREVENTION OF C0NSUMPTI0N.(^^) 

By Professor BROUARDEL, 

Deaa of the Fmcnltj of Hediciae of Paris, Member of the InsUtate. 

Tbe mortality from tuberculosis varies according 
to tbe country. In some cases it is accountable for a 
sixth, a fifth, and sometimes a fourth of the total 
mort^ity. Havoc such as this makes it compulsory 
that all nations and governments should strictly in¬ 
quire into, and adopt, measures to arrest the propa¬ 
gation of a disease which, in these days, is the 
greatest enemy of tbe human race. Tbe wonder is 
that the voice of alarm has been so long in making 
itself beard, and that for centuries our ancestors 
have looked impassively on the disasters going on 
around them. There were several reasons for this 
apparent indifference. Tbe struggle was considered 
aaelesB; the disease incurable; it was not known bow 
it spread. Exaggerating tbe import of some observa¬ 
tions, it was agreed that phthisis is hereditary. They 
were lulled to sleep by this formula, which served as 
a pillow for idleness and exempted them from inves¬ 
tigating tbe origin of the mischief. 

But when, on December 5th, 1865, VilJemin showed 
experiments at the Academy of Medicine, which 
proved tbe real presence of the contagion, when our 
Illustrious colleague, Professor Robert Koch, had 
discovered and demonstrated to the medical world 
the agent of this contagion, everyone felt that a new 
way was opened to humanity, and every nation wished 
to profit for the public good, by the recent scientific 
discoveries. Before the scientists I have just men¬ 
tioned bad actually made known their discoveries, 
the English people had already begun the struggle. 
Convinced by observation that tulwculosis thrived 
in dark and damp dwellings, in 1836— nearly seventy 
years ago—you passed a law providing for the con¬ 
struction of healthy houses, and since that date your 


zeal has not abated. The grounds for tbe prevention 
of taberoulosis are identical in every country. On 
this question the entire medical pr^ession of the 
world is united. Tuberculosis is avoidable and 
curable. With r^ard to legislation, it is only possible 
to bring a law into force that interferes with our 
daily life, that disturbs inveterate habits, and that 
has to be carried out in the bosom of the domestic 
hearth, when it is called for by public opinion: when 
all are convinced of its benefits, and everyone reoog- 
nises the danger of his vicious habits, and is rea>^ 
personally to reform them and to require hie neigh¬ 
bour to do tbe same. 

Gradually in all countries tbe public are beginning 
to realise that personal care and cleanliness are 
necessary to obviate contagion, and are also realising 
that other idea, to my mind equally important, that 
a consumptive patient is only <!aDgerous if the 
necessary precautions are not taken around him, and 
if he himself does not take them to protect his rela¬ 
tives, friends, and fellow-workmen from contagion. 
The danger is in the sputum, which contains thou¬ 
sands of contagious germs. To expectorate on the 
ground is a disgusting and dangerous habit Once 
this habit has quite disappeared, tuberculosis will 
decrease rapidly. 

What roU does this sputum play in the subsequent 
propagation of the disease P Collected and shut up 
in a private, or common but antiseptic, spittoon, 
destroyed by incineiation or some other measure, it 
is dan^rouB to no one. Thrown into dry and well- 
lighted surroundings, exposed to the rays of the sun, 
it will soon lose its dangerous properties. But if it 
remains in damp and dark surrouDdings, it will 
maintain its activity for a long time. Thus it is 
that tuberculosis claims more victims from gloomy, 
ill-ventilated, dark dwellings. All nations have 
recognised this, but England uas the double merit of 
recognising tbe primary importance of this problem, 
and of having solved it in a manner peculiarly her 
own. Recognising that insalubrious dwellings are 
one of tbe most potent agents in pr^agation of 
tuberculosis, the legislations of the different coun¬ 
ties have kept this cause of insalubrity well in 
view, and have made laws ordering the destruction of 
nnb^tby dwellings. 

If tuberculous germs fall in an ill-lighted, damp 
bouse they maintain their activity for a long time, 
whether the house is in town or country. In these 
surroundings population is often very dense. It is 
no uncommou thing to see one room in Paris occu¬ 
pied by five, six, eight, and sometimes twelve persons. 
They are continually coming in contact with one 
another, chances of contagion are increased by this 
fact alone, and in addition to the limited space has 
to be added tbe dirtiness of the occupants, or. as 1 
should say, tbe impossibility of keeping sufficiently 
clean. Tbe small tuberculous foci are created which 
invade tbe whole house; tbe workmen and employe 
carry the germs of disease into their workshops and 
offices and soon make a large tuberculous focus of 
the town. 

Tbe evils of an unhealthy dwelling are not con¬ 
fined to the risk of contagion just referred to. The 
want of air and light acts on the nutrition of tbe 
inmates, children go off, pine away, tbe strongest 
men cannot withstacd it, every human being living 
in these places is tbe destined prey of infectious 
diseases; and if we only consider phthisis they 
become predisposing causes of consumption, trans¬ 
forming the strongest man and putting him on a par 
with the condition of those bom of tuberculous 
parents. In the latter, heredity is not direct; one 
is not bom ituberculous. but predisposed to tuber¬ 
culosis. Moreover, unhealthy dwellings are not 
pleasant to pass tbe time in, and tbe workman stays 


(a) Addreu to the Britisli Consresi on Tuberculosu, July, 1901. 



JtFlT 31, 1901. 


OBTGINAL COMMUNICATIONS. Thi Medical Pbess. 109 


in his home as lifctle as possible, spending the Test of 
his time in the pnblic-house, and we can add that the 
pnblio'honse is the pnirejor of tnbercnlosis. Alco* 
hol^ is, in fact, the most potent factor in propa¬ 
gating tabercnlosis. The strongest man, who has 
once taken to drink, is powerless against it 

measures. State or indmdoal, tending to 
limit the ravages of alcoholism will be onr most 
DTecions anxiliarieB in the omeade against tubercu¬ 
losis, but the question is too lai^ a one to deal with 
here. 

The duigers surrounding a man in an unhealthy 
home are the same when for his work, his duties, bis 
pleasure, through illness, or under constrain^ he 
hves all or part of the day in a centre where other 
people are assembled, where unhealthy conditions 
and overcrowding exist. If he is well, his com¬ 
panions are dangerous to him; if he is ill, he is 
dangeroue to them. Now the conditions of modem 
life compel a man to live in such centres. As a 
child there is the school; as an adult, the barracks; 
a workman, the workshop; a student, the lecture 
ball, the libraries, laboratories; the employ^ or 
official, the bureau and the offices. If be moves about 
be uses vehicles, railway carriages, too often contami¬ 
nated. 

At the hotel where he stops he has frequently been 
preceded by a sick person, and no precautions have 
been taken to prot^t the new arrival from possible 
contagion. If he is poor and ill he goes into a 
hospital, where be is surrounded by contamination on 
every hand. This peril from common life, insepar¬ 
able from advance in civilisation, is continually 
growing; it is the ransom, and accounts for the 
threateoing increase in tuberculosis. 

Before touching on the question of the cure of 
tuberculosis I should like to say a few words about 
measures adopted to prevent tuberculous contagion 
by food. Since Cbauveau showed that it was possible 
for tuberculous germs in food to produce tubercles in 
the intestinal ^rac^, attention has been turned to pre¬ 
cautions for preventing the consumption of meat 
and milk from tuberculous animals. As far as meat 
is concerned, surveillance of the slaughter-houses in 
large towns achieves this. In Belgium this measure 
is also made to apply to the country; but 1 do not 
know of any other kingdom where private slaughter¬ 
houses are inspected, and in them it is that phthisical 
cows, measly pigs, and diseased animals of any kind 
are slaughtered, and are able to escape inspection. 
This injurious food is consumed either as fresh meat, 
or in the form of p&t^ or sausages from which the 
tuberculous viscera have not been removed. Another 
danger is the hawking of meat in pieces. It is rife 
especially in the large towns. Butchers receive daily 
quarters of meat despatched by provincial butchers. 
This meat escapes inspection. With no wish to ex- 
a^erate the danger of the propagation of tuber- 
cmosia by meat, it cannot be overiooked. It is easy, 
by means of legislation, to protect the population 
from this method of contamination. Belgium has set 
us the example. That the milk of cows with tuber- 
c^ous inflammation of udders is used is very clear. 

It is well to add that in large concerns the milk 
from different sources is mixed, and one cow only 
need be the victim of tuberculous mammitis in order 
to contaminate all the milk with which its milk is 
mixed. To prevent this method of propagation, 
strict inspection measures should be adopted, such 
as have been in use for several years in Denmark, 
Sweden, and Norway, to the great advantage of pub¬ 
lic health. Until such necessary measures are 
actually adopted there only remains the simple mode 
of avoiding risk from milk by boiling it, and this 
should be widely made known, in spite of a too wide¬ 
spread prejn^ce, which wrongly nolds that boiled 
milk is IM nutritious and indigestible. If a man is 


the victim of tuberculosis everything possible should 
be done to cure him, for he can be cured. The idea 
that tuberculosis can be cured dates back to Hippo¬ 
crates : “ Phthisis, if treated early enough, gete 
well,'’ said the Father of Medicine. 

At the Moi^e, in Paris, where I frequently make 
post-mortems on accidental dea^s, I can state that 
m half the cases, if the person on whom the post¬ 
mortem is made has lived in Paris for about ten 
years, I find healed tuberculous lesions, either in the 
form of cretaceous transformation or fibrous cica¬ 
trisation. These lesions, moreover, in the majority 
of cases, are not phthisis in an early stage manifested 
by small disseminated foci; they are cicatrices of 
laz^ foci, sometimes of wide completely cicatrised 
cavities. Phthisis therefore is curable, even in its 
most advanced stages As a tuberculous patient can 
be cured, everything possible must be done to bring 
this about by careful organisation. Tbs doctor being 
himself firmly convinced that bis patient can 
be cured will make the necessary modifications in his 
way of looking at the disease. 

The doctor shall tell the patient and his family at 
once that he has a serious disease, but that it is 
curable. 

And now as to the methods of treatment. In this 
address I am only dealing with the disease as it 
affects working men and employes. 

The remedies to be recommended vary according 
to the stage to which the diaanse has got, and also if 
the patient is single, married, orfather of a family. 

Three distinct periods may be defined. In the 
earliest the patient coughs and has a cold, and it is 
this stage of the disease which interests us most, 
when intervention is of use. 

In what way can we be of use to a patient in the 
first stage P In Germany there are polyclinics for 
tuberculosis in the large towns, where a doctor, pro¬ 
vided with the things necessary, attends to the 
patients who come to consult him, either throughout 
their illness, or till the patient can be admitted into 
a sanatorium. A committee, composed of benevo¬ 
lent men, and women in lai^ numbers, looks after 
the patient at home, tells hie wife what to do, sees 
that his home is kept clean, and looks after neoe 8 Bai 7 
prophylactic measures. As far as possible, the 
misery consequent on the breadwinner being out of 
work is relieved from a bank, kept up like the sana¬ 
toria banks to assist such cases. Mens. GiJmetto 
conceived the same idea, but be went farther, and 
advised that, instead of waiting for the workman to 
come for advice, they should go and meet him by 
inviting him to come to a dispeosary, run on the 
same lines as the German polyclinics. 

As far as I can see, the best way to ferret out dis¬ 
ease would be to have one or more agent-workmen, 
foremen-workmen, if it were possible. They are the 
ones to notice when their comrades cough; they 
could advise them to go to the dispensary. Alive to 
the dangers of a badlv-kept workshop or yard, they 
superintend ite being kept clean and in order; they 
actually carry out unti-tuberculons education. 
Those who visit the dispensary receive the 
necessary attention from tne doctors, and are 
told the danger of dissemination by sputum, 
alcoholism, &c. They are looked after, they 
get meat gravy—-one or two meals, as far as funds 
will allow. Their families are helped and their home 
is kept an eye on from the hygienic point of view; 
as far as possible, the misery by which the poor ma-n 
is threatened is kept away from him. Among these 
patients some are found who must be sent to a sana¬ 
torium. If the patient is an unmarried man, and if 
be can be sent to a sanatorium, bis chances of re¬ 
covery are ve^ groat; but for a married man to to 
means that his wife and family must be provided tor 

C 


110 Thi Msdxcal Pbkbs. OBIGINAIj COMMUNICATIONS. Jxjlt 81, 1901. 


daring his absence, and bis mind relieved of all | 
anxiety on their account. 

Belief banks for assisting the families of the in¬ 
mates are most uecessary to sanatoria. And in many 
cases sanatoria are essential to complete the work 
began at the dispensary. 

All nations have obeyed the same generous im¬ 
pulses, and the time will come when, instead of the 

{ >oor tuberculous patient being given up to his sad 
ot, he will find that if he is only in the first stages 
of the disease, that oy means of dispensaries and 
sanatoria there is always hope and often realisation 
of his recovery. If the patient is beyond the first 
two stages when he asks for admission to the hos¬ 
pital. it must not be overlooked that he may still be 
cured, provided he can be made to see things asthey 
are. He may be isolated, in order that he may not 
be discouraged by the spectacle of bis comrades' 
sufferings. 

1 have been asked to consider the question from 
the international point of view. I do not think that 
it is possible to deal with consumption in this resnect 
as plague, cholera, and yellow fever have been dealt 
with in order to prevent their being brought into a 
country. I do not know how any doctor can state posi¬ 
tively that a traveller at the frontier or the port is not 
consumptive. But it would be possible to take interna¬ 
tional steps in another way. Bailway carriages might 
be disinfected, as well as steamboats and hotels, and 
the traveller no longer exposed to germs of con¬ 
tagion. That would m of truly international import. 
In several countries, partic^rly in the United 
States, hotel kee^rs who receive a consumptive 
client have to notify it to the municipal authorities, 
and compulsory disinfection of the room has to be 
gone through. The Minister of the Interior in 
Germany has brought in even more stringent 
measures. Every doctor who attends a case of pul¬ 
monary or lar 3 mgeal tuberculosis is bound to report 
it in writing to tbe police as soon as he has made 
his diagnosis. After death from tuberculosis the 
room in which the patient has died has to be disin¬ 
fected as well as his belongings. Hotel proprietors, 
furnished house " keepers, asylums, and other 
public institutions are compelled to notify at once 
every case of tuberculous disease which arises in their 
establishments. Notification, disinfection, salubrity 
of hotels, carriages, and steamboats, are questions of 
an international character, which might be advan¬ 
tageously dealt with by lapresentatives of the 
different nations. 

The lesson to be drawn from the efforts that have 
beeu made by all nations to carry out a crusade 
against tuberculosis is that in conversation, in tbe 
public prints, and in specially prepared pamphlets, 
we should make it universally known that tuberculous 
contamination can be avoided, and that in addition 
the disease can be cured. 

HUMAN AND BOVINE 
TUBERCULOSIS, {a) 

By Professor McFADYEAN, 

Of the Bojral TeterinuT College, 

Afteb some preliminary I'emarks in regard to the 
supposed identity of the organism of tuberculosis in 
man and animals, the Professor observed that tbe 
view that bovine and human tuberculosis are identi¬ 
cal diseases was generally supposed to have been 
finally determined by Dr. Koch himself, when he 
discovered that tbe human and the bovine lesions 
contained bacilli that were identical in morphological, 
tinctorial, and cultural characters, and showed 

(a) Ahatract of Addreu deUvered before tbe Britieh Cosnen on 
TnberonlosU, Jnlr, 1901. 


that the artificial cultures from both sources pro¬ 
duced indistinguishable effects when they were 
employed to infect a variety of animals. He 
pointed out that tuberculin produced a specific 
reaction in tuberculous cattle, whether human or 
bovine bacilli bad been employed in its preparation. 
In sbort, tbe identity of tbe bacilli from tbe two 
sourcee appeared to ^ as firmly established as any 
other generally acoeptod opinion regarding the iden¬ 
tity or non-identity of bacteria associated with disease 
in more than one species of animal. Opinions vatied 
as to tbe frequency with which this transmission of 
tuberculoBiR from one species to tbe other occurred, 
but practically never within the last eighteen years 
reading the possibility and probability of reciprocal 
infection. What then were the grounds upon which 
they were asked to discard convictions that appeared 
to rest on such a solid basis ? He would endeavour 
to state them briefly, as he understood Dr. Koch’s 
train of reasoning:—(1) The bacilli found in cases of 
bovine tuberculosis are much more virulent for cattle 
and other domesticated quadrupeds than the bacilli 
found in cases of human tnbercnlosis. (2) This differ¬ 
ence is so marked and so constant that it may be re¬ 
lied upon as a means of distinguishing the bacilli of 
bovine tuberculosis from those of the human disease, 
even assuming that tbe former may occasionally be 
found as a cause of disease in man. (3) If bovine 
bacilli are capable of causing disease in man, there 
are abundant opportunities for tbe transference of 
the bacilli from tbe one species to the other, and 
cases of primaiw intestinal tuberculosis fiom tbe con¬ 
sumption of tuberciUous milk ought to be of common 
occurrence. But post-mortem examination of human 
beings proves that cases of primary intestinal tuber¬ 
culosis are extremely rai*e in man, and therefore it 
must be concluded that the human subject is immune 
against infection with the bovine b^illi, or is so 
slightly susceptible that it is not necessary to take 
any steps to counteract tbe risk of infection in this 
way. 

He admitted that what may be called bovine 
tnbercle-bacilli are as a rule distinctly more virulent 
for cattle and other domesticated animals than 
human bacilli, or that the results of experiments 
indicate that in natural circumstances there is little 
danger of cattle becoming infected from human 
beings. But it could not ^ admitted that tbe low 
virulence of human bacilli for cattle proves, or even 
makes it probable, that bovine bacilli have only a 
feeble pathogenic power for man. That might have 
been held to be probable if it Uad been shown that 
bovine bacilli were very virulent only for cattle; but 
since it is well established that these bacilli are 
highly dangerous for such diverse species as the 
rabbit, horse, dog, pig, and sheep, and, in sbort, for 
almost every quadruped on which they have been 
tried, it appeared to be highly probable that they are 
also dangerous to man. At any rate, it was impossi¬ 
ble to cite any ascertained fact relating to other 
bacterial diseases that made the contrary conclusion 
robable. It was well known that the majority of 
isease-exciting bacteria are harmful to only one or 
two species, but all those that are common to all 
the domesticated animals are also pathogenic to man. 
With regard to the view that the difference between 
human and bovine bacilli in respect of virulence for 
cattle is of sneh a fixed and constant character that 
it may be relied upon to distinguish the one from the 
other, it need only be said fliat that was very far 
from proved. It appeared to be quite possible that 
what might be called the normal or average viru¬ 
lence of Mvine bacilli for cattle might be reduced by 
pass^e through the human subject. Besides, there 
were very great differences in the vimlence of tuber¬ 
cle-bacilli round in animals of the same^species, and 
if a low degree for virulence for cattle were to be 
C 



July 31, 1901. ORIGINAL COMMUNICATIONS. Thi Mbdicai. Pa«b 8. Ill 


taken aa the distinguishing feature of human 
bacilli, there would be no. difficulty in proving that 
the hnman disease is sometimes transmitted to the 
lower animals. 

The third proposition in Ur. Koch's argument was 
the only one which was really germane to the point 
at issue, viz., that only cases of primary intestinal 
tuberculosis can possibly have had their origin in 
infected milk or meat, and that “ such cases are ex* 
tremely rare." Dr. Koch referred to several series of 
post-morteoi observations that appeared to justify 
this statement, and added that he could have cited 
many more pointing to the same conclusion. He 
pointed out that statistics were not by any means 
unanimous, and those that were likely to appeal 
with most force to the people in this country were 
not at all in accord with those quoted from Ger¬ 
many. During the last few years the evidence 
obtainable from the post-mortem records of two of 
the largest hospitals for children in this country had 
been analysed with great care, in order to see what 
evidence they afforded as to the relative frequency of 
the different methods of infection in tuberculosis. 
In the case of the Hospital for Sick Children in 
Great Ormond Street this bad been done by Dr. 
Geor^ Still, and in the case of the RotsI Hospital 
for Sick Children in Edinburgh by Dr. Sbennan. 
The conclusion at which Dr. Still arrived was that 
in 29*1 per cent, of the cases of tuberculosis in 
children primary infection appeared to have taken place 
through the intestine. That was very far from being an 
insignificant proportion, and it was a striking fact 
that Dr. Shennan arrived at an almost identical con¬ 
clusion, and estimated that 28'1 per cent, of the 
cases of tuberculosis among children in Edinbur>ih 
are due to alimentary affection. In face of these 
statistics it was not possible to assent to the state¬ 
ment that cases of primary tuberculosis of the 
alimentary canal are eztrmely rare. Precisely the 
contrary conclusion was the one that must in the 
meanwhile be drawn with regard to the state of 
affairs in this country, viz., that, at least in chil¬ 
dren, primary infection by way of the alimentary 
canal is comparatively common. In respect of the 
proportion of these cases which ought to be ascribed 
to tubercle-infected milk, he re -ailed the fact that 
the late Sir Richard Thome Thome, in the Harben 
Lectures on the administrative control of tuber¬ 
culosis. which he delivered in 1898, expressed his 
conviction that tuberculous milk was the main 
cause of tabes mesenUrica in children, and he 
characterised the loss of child life from this cause as 
appalling. On the strength of the Registrar- 
(^neral's returns, which showed that during the 
last fifty years there had been a marked decline in 
the death-rate from human phthisis, which is the 
form that tuberculosis generally takes when the 
bacilli are inhaled. On the other baud, during the 
same period there had been only a slight decline in 
the death-rate at all ages from that form of tober- 
cnloais which is ascrlbable to alimentary infection, 
and among children under one jear of age there 
had been a notable increase in the mortality from 
that form of the disease, which be attribut»'d to 
infection through milk, which had remained un¬ 
checked. He was, however, prepared to admit that 
there were several weak points in this argument. 

He pointed out that about 30 per cent, of all the 
cows giving milk in this country were tuberculous in 
some degree, and about 2 per cent, of the cows had 
tuberculous udders. Now, the milk secreted by 
a tuberculous udder always contained tubercle- 
bacilli, and it sometimes contained enormous 
numbers of them, and when these facts were ap¬ 
prehended one began to realise the seriousness 
of the danger to which, in the present state of 
affairs, those who drink uncooked milk are exposed. 


The Professor concluded his remarks by urging 
the necessity for educating the public in the nature 
of the disease, and of instituting a system of inspec¬ 
tion of cows. He insisted on the fact that the 
inhalation of tubercle-bacilli expelled from the bodies 
of human patients was doubtless the great cause of 
human tuMrcnlosis, and every practicable means of 
preventing infection in that way ought to be em¬ 
ployed ; but, at the same time, they ought not to 
concede to the milkmen the right to sell us tubercle- 
bacilli, even if we were assured that—like Dr. Koch’s 
experimental pigs—we had nothing to fear beyond 
the development of " little nodules here and there in 
the lymphatic glands " of our necks and *' a few grey 
tubercles ’’ in our lungs. 

REMARKS ON THE 

DEGENERATIONS AND COMPLICATIONS 

OP 

UTERINE MYOMATA, {a) 

By H. MACNAUGHTON-JONES, M.D., 
M.A.O., M.Ch., &c. 

It is unnecessary for me to remark that the 
importance of a subject connected with the de¬ 
generations and associated complications of uterine 
myoma can hardly be exaggerated; it is the turning 
point upon which future practice will in great mea¬ 
sure depend. 1 have gone to the trouble of having 
the museums of some of the largest London hospitals 
searched with refei'ence to the subject, and also the 
museum of the Royal College of Surgeons. The 
point 1 wish to make is that gynsecologists are 
really beginning a new era in connection with that 
disease. The great majority of specimens shown at 
various societies are presented as proofs of the 
operator’s skill and dexterity, and no doubt are in¬ 
teresting from their size and from the point of view 
of technique, as illustrating the difficultf of removal. 
Numbers of these tumours have been looked at and 
not even opened, and without any report having ac¬ 
companied them as to the pathologi^ nature of the 
growth removed. Countless numbers of valuable 
specimens must have been destroyed as useless which 
would have materially altered the view which has 
been taken with regard to the treatment of myoma 
if these had been preserved and reported upon. 

In the Museum of the Roval College of Surgeons 
of England there are in all 47 specimens marked 
definitely as fibrous tumours of the uterus. Of these, 
33 are described as having undergone ulceration, de¬ 
generation, or been complicated by adhesions, preg¬ 
nancy, or ovarian tumours. These we may divide as 
follows:—Pressure of ureters, 1; ulceration of the 
tumour, 3; ulceration of the vagina, 1; calcific<tion, 
3; cystic degeneration, 1; with complications of the 
adnexa, 6 ; with pregnancy. 6. 

In St. Bartholomew's Hospital Museum there are 
examples of the following degenerations and compli¬ 
cations:—Cystic deijeneration, 3; calcification, 2; 
myoma complicated with diseases of the adnexa, 5 ; 
myoma with cancer, 1; degenerating myoma with 
cavity containing serous fluid, I. 

In University College Hospital Museum there are 
the following;—Sloughing myoma, 1; fungoid de¬ 
generation with ulceration, 1; suppurating myoma 
with calcareous degeneration. 1; calcareous degenera¬ 
tion with adnexal complications, 2; calcareous de¬ 
generation alone, 5. 

In the Westminster Hospital Museum there is I 
specimen of calcareous degeneration. In St. Geoi^e's 

(<() Bemarks made ia opening the DincuwioD on Dr. Charlee 
N ihle's paper at the British Gjotecological Society, on Jnly 

nth, 1901 . 


112 Thb Hsdioal Pbbm. 


CLINICAL RECORDS. 


JcLT 31, 1901. 


Hospital MoBeam there are 4 specimens of cal¬ 
careous degeneration of mjoma, 2 of myoma compli¬ 
cated with pregnancy, 1 of myxomatous degeneration, 
and 1 of fibro-cystic degeneration. 

In King's College Hospital Knseum there were 
none. Mr. Cheatle has kindly lent me one of carci¬ 
noma and myoma, 

In St. Mary’s Hospital Museum are the 6 speci¬ 
mens exhibit^ here to-night. 

Those from the Cancer Hospital were also before 
the Society, 10 in number (Mr. Jessett’s). 

T think that the infei'ence is clear from the enor¬ 
mous number of cases which must have passed 
through these hospitals, that a huge mass of material 
has been unobserved or unrecord^. 

In future I trust that specimens which are pre¬ 
sented of myoma or of complicated myoma will be 
accompanied by a proper pathological report, not 
only setting forth the inherent characteristics of the 
tumour itself, but the adnexal or other complications 
that have been associated with it. Then gynscolo- 
gists will hare sometbing definite to rely upon. 

Dr. Charles Noble, in his paper, has referred to the 
menopause. I take it that no one now advances the 
argument that the danger of a myoma is lessened by 
the menopause. On ^e table is a tumour which 1 
exhibited at the Society, removed from a woman who 
had been suffering from profound aneemia, so bad 
that it was with great apprehension T thought of 
operating upon her. The woman was restored to 
perfect health. There had been mucoid degenera¬ 
tion, and the tumour, a multiple myoma, weighed 
eight pounds. A very important point about the 
menopause is the following. We speak of climac¬ 
teric insanity; and if there be one point settled 
among psychologists more than another it is the 
fact that myoma has very frequently a distinct effect 
on the mentalisation of the woman. Of that I have 
no doubt whatever. I have seen two or three 
instances of actual dementia, and one of 
mania complicating myoma at the menopause. 
There is thus a distinct danger at this time, a 
point not dwelt upon by Dr. Charles Noble as 
fully as it might have been. One most con¬ 
sider carefully the mental effects of the tumour 
on a Woman, not only from the constant introspec¬ 
tion induced by the presence of the tumour, but also 
the constitutional and other conditions, including 
profound anamia, which Dr. Noble has referred to. 

Dr. Noble has said in hie paper that the penetra¬ 
tion of the capsule of a fibroid by adjacent carcinoma 
is very rare. On the table is a specimen of mine 
in which that invasion is manifested. There is a dis¬ 
tinct passing in of the carcinomatous tissue into the 
myomatous growth. I admit that the condition of 
sarcomatous degeneration does occur, but it is very 
rare. 

Another point 1 wish to allude to is borne out by a 
specimen of mine cn the table, where there is a tumour 
resembling adeno-myoma of the uterus, in which 
there is complicating it adeno-myoma of the ovary. 
And so closely does that assume malignant cbarac- 
tenstics that a special Committee was appointed 
to investigate it. The decision arrived at was that 
it was adeno-myoma. It illustrated another sei'ious 
consequence of myoma. When a woman arrived at a 
certain time of me, if she has pain in walking and 
on taking exercise there ensued a deterioration of her 
general health, and thus in a certain proportion of 
cases of myoma the first thing the woman complains 
of is that snecannot walk. The patient in question had 
such pain in the hip that there was a strong suspicion 
of joint disease. The myoma was discovered. The 
adeno-myomatous ovary was found at operation 
jammed down on the nerve, causing the pain and 
lameness. 

In regard to cardiac complications it is right to 


mention that a Fellow of the Gynecological Society 
fifteen years ago drew attention particularly to the 
complications of myoma with cardiac conditions, 
namely. Dr. Bedford Fenwick, in a paper which he 
wrote on the subject. 

Another very important matter which is often 
foi^tten in connection with these tumours is the 
question of mistaken diagnosis. It is all very well 
to take it for granted that a myoma when it occars 
is always diagnosed; but in many instances it is not 
correctly differentiated or diagnosed. Other tumours 
are constantly mistaken for myomata, and by the 
most experienced gyumcologists. Sarcomatous and 
carcinomatous ovaries bad often been mistaken for 
myomatous tumours, and thus, under the idea that 
the tumour is harmless, interference is postponed 
until operation becomes impracticable, or possibly 
death intervenes to settle the question. 

I believe the crucial point is not the percentages 
which can be brought forward by an operator to 
show his skill and the ease with which such tumours 
can be removed. These are now matters of ancient 
history. What we have to decide is our attitude 
to the treatment of these growths in consequence 
of the patholoeical fact which cannot be denied, that 
many of the tumours contained in themselves or 
in their complications, the inherent elements of 
future death, or at all events of invalidism, of 
misery in life, to many of torture, and the rendering 
of the woman useless to herself, useless to her fam ily, 
and uselesr to society. Such a woman is an oppro¬ 
brium to the surgical art. 

Ollinicitl ^ecotiis. 


BRADFORD UNION HOSPITAL. 

Notes on a 

Case of Idiopathic Gangrene of Penis. 

By JOSEPH BEARD, F.R.C.S.E. 

In November of last year I admitted a man, Robert 
C., set. 62. into this hospital, suffering from lobar pneu¬ 
monia. He was extremely ill and disinclined to answer 
questions. 

On examination 1 found him suffering from acute 
lobar pneumonia of right lung, and in a very weak and 
collapsed condition, his heart sounds being scarcely 
audible, breathing very difficnlt and shallow, with aim 
nasi in active condition. Temperatnre 101^ F , pulse IQO, 
hard, small, and irregular. Respiration 30 per minuce. 
On farther examination 1 found that he had something 
wrong with his penis, which he said began to go black 
five weeks before and began to hum and pain him 
when he passed urine. 

This organ was now in a state of total dry gangrene, 
black and shrivelled np, and close to the pates was a 
well-marked line of demarcation which above and at the 
sides had nicerated throngh the skin and areolar tissue 
down to the corpora cavernosa. On the ander aspect, 
where it was somewhat moist with the passage 
of urine over it, the ulceration had extendi 
throngh the corpus spongiosum and through the 
urethra. I passed a catheter through the proximal 
portion of the urethra into the bladder and drew off 8 oss. 
of urine, which had a specific gravity of 1015, and con¬ 
tained albumen and sugar and was acid in reaction. 

Next morning his condition was worse, and he was in 
a semi-oomatose oondition in spite of treatment. 

At noon I infused 50 oza. of saline solution into his 
median basilic vein. He rallied for a couple of hours, 
and then died comatose. 

I obtained permission for a post-morten examioatioD, 
which revealed extensive degeneration of arteries chiefly. 
In fact, with the exception of the cerebral arteries 
every visible artery was markedly oaloareons, and on 
dissecting ont the dorsal arteries of the penis they 
were extremely tortuons and reduced to mere brittle 
cords, which broke when touched. 

The pneumonia was verified, and the heart was soft and 

C 


JCLT 81. 1901. 


TRANSAOliONS OP SOCIETIES. 


Thi Midioal Puss. 113 


toneless. The lirer was the or(^ showing most ohanse 
of a pathological nature, being hard and fatty, weight 
70 OS). The bladder was very enlai^l^ed, and easily held 
60 OSS. of water. The other organs were in fair condi* 
tion. Pancreas was perfectly normal to the naked eye. 

I should mention that the man told me that for some 
months he h^ twen passing large quantities of water, 
uid that he was always thirsty. 

Death in this case, of course, was due to heart failure, 
secondary to the acute pneumonia, but that would not 
account for a gangrene of the penis of fire weeks’ dura¬ 
tion, and if asked for the solution I should say that the 
gangrene of the penis was due to the arterio-sclerosis 
following upon diabetes mellitus. 

True idiopathic gangrene of the ponis is a very rare 
disease, and Demarquay, who specially directed attention 
to it, found but few instonoes of it in the records of snr- 
ge*7- 

Gangrene is not uncommon in diabetes, and is asso¬ 
ciated eepecially wiGi arterio-sclerosis. Wm. Hunt 
analysed 64 cases, and in 60 the localities were as 
follows : -Feet and 1 ^, 37; thigh and buttock, 2 ; lungs, 
3 : nucha, 2; exitmal gemitala, 1; fingers, 8; back, 1; 
eyes, 1. 


^ran6acti0ng erf gocitties. 

BRITISH GYNaiCOLOGICAL SOCIETY. 
HnrriNo held Jolt 11th. 1901. 

The President, Dr. J. A. Manbill Moullik. in 
the Chair. 


ExHismoK OF Spscimbnb. 

Thb Prisidbnt drew attention to a number of 
interesting specimens brought together by Dr. Mac- 
nanghtoQ-Jones, and exhibited in reference to Dr. 
Noble's paper. The collection included tumours which 
bad undergone calcareous, cystic, mucoid, and teleangi- 
ectactic degenerations, others which were entirely 
isdematons, or into which hemorrhage had taken place, 
seToral complicatiag pregnancy, and several in which, 
in addition to the myoma, a carcinoma, sarcoma, or 
cysto-sarcoma was present. 

Dr. Chablss P. Noble, of Philadelphia, read a 
paper on 

THE COMPLICATIONS AND DEOENEBATIONS OF FIBROID 
TDUOOBS OF THE UTEBCS, 

which we published in full last week. 

Dr. Macnauohton-Jones then opened a discussion on 
the paper. His remarks will be found on p. Ill of our 
present issue. 

Mr. Bowbeman Jebsett, who followed, remarked 
that the Fellows of the Society were much indebted to 
Dr. Noble for having come to this country to deliver 
his admirable address. While not by any means advo¬ 
cating the removal of all myomatous tumours, he (Mr. 
Jessett) could not help thinking that the excessive con¬ 
servatism of some leading obstetricians was detrimental 
to the best interests of women. Four years ago he curetted 
an uterus, and the material removed from the fundus 
proved to be carcinomatous. He then removed the 
growth, which had not since recurred. The patient in 
this instance had suffered for two or three years from 
successive hsmorrhagee, and yet had been assured, or 
at any rate encour^ed to believe by more than 
one obetetrioian in a leading position, that the tumour 
won’d disappear at the menopause. In skilled hands 
the mortality after operation for myomata should be 
lees than 5 per cent., and he thought that this low rate 
of mortality was in part due to the late Mr. Lawson Tait, 
inasmuch as he first ceased the iudisoriminate adminis¬ 
tration of opium, and gave an aperient two days after 
operation. With regard to complications, he had seen 
a case of appendicitis closely simulate ovaritis, but he 
bad never seen the former as a complication of myoma. 
He could not agree with Dr. Noble as to the 
nrity of sarcoma. He bad at least four speci¬ 
mens showing the presence of saroomatous 
cells, two of which were before the Society. As 


to carcinoma, he had not seen more than two or three 
cases, and was inclined to think tuat where present 
with a myoma there was no relationship between them 
The question of pr^an^y might be a very serious one. 
On one occasion on which he found two large fibroids, 
and suspected pr^fnancy, he advised the woman to post- 
pone any active interference. Three weeks later 
the patient was taken suddenly ill, had a severe 
rigor, and appeared in great danger. He per¬ 
formed hysterectomy, and found a fmtus present, with 
two fibroids. The patient made an excellent recovery. 
He would remark, however, that if the patient goes to 
full term and is delivered safely, the fibroid becomes 
reduced in size. When operation was necessary he 
considered the removal of the uterus to be pre¬ 
ferable to abortion. The question of the effect of the 
menopause had been worn threadbare. In a few cases 
tumours decrease in size, while iu somC they undergo a 
marked increase. There were two other points which 
should be borne in mind when considering the advis¬ 
ability of operatiOQ —the social position of the woman 
and the situation of the tumour. A tumour might 
incapacitate a poor woman from obtaining a livelihood 
and consequently call for operation, whereas in the case 
of her wealthier sister it might occasion inconvenience 
only. Sub-peritoneal fibroids grew less quickly, and 
caused less urgent symptoms than those of submucous or 
intra-mural origin, and therefore rendered operative 
interference less necessary. When, however, severe 
hsemorrhage occurred, the patient became anaemic and 
lost strength, or sepsis snperveoeu, operatim should be 
resorted to as early as possible. 

Mrs. 8chablibb believed that a oertaiu number of 
fibro-myomata did decrease in size at the menopause, 
yet waiting for that event, and the very problematical 
benefits pridnced by it involved serious risk*. In this 
connection she quoted the case of a lady, considerably 
over fifty years of age, with an apparently qaiesoent 
myoma lea^ng to the level of the umbilicus, who had 
consulted her twelve months or more previouriy. The 
patient had passed the menopause and was in a fair 
state of health. She promia^ to return in a short 
while, but failed to do so. Recently she had been 
called to her in response to an urgent summons, and 
found her suffering from pleurisy, thrombosis of both 
femoral veins, and severe abdominal pain and sickness. 
Her pulse was rapid and her t*mperature 102^ to 
105°, uer whole condition indicating that there was 
considerable septic absorption, and being such as to 
render immediate sui^ii^ relief hardly practicable. 
After the lapse of a month her condition had somewhat 
improved, and Mrs. Scharliebremoved the myoma which 
contained several cavities filled with offensive fluid. The 
patient made a complete though tedious recovery, and 
Mrs. Scharlieb regretted she had not advised operation 
when she had first been consulted. As to Mr. 
Noble’s youngest patient was 17. She had removed wi^ 
Mrs. Stanley Boyd, a tumour from the anterior wall of 
the uterus of a girl, set. 14, brought the edges of the 
incision iu the muscle together, and left the patient 
with her uterus, ovaries, and tubes complete. 

Mrs. Stanlet Botd referred to the great difficulty of 
determining the original nature of a tumour said to have 
undeigone sarcomatous degeneration, especially in hos¬ 
pital patients who usually came with a temour already 
large. For example, a patient, »t. 60, recently came 
uuder her observation with a large tumour producing 
severe bsmoirbage From the fact that it had first 
appeared six months after the meuopanse, and from the 
rapidity of growth, it was suspected to be of a sarcoma¬ 
tous nature, and such it proved to be. In such a case 
it was not possible to say whether the growth was sar¬ 
comatous ^ isiVio, or Hm been a fibroid at an earlier 
stage, and had recently become sarcomatous, and. con¬ 
sequent on the change, had grown rapidly and become 
evident. Curetting she regarded as an extremely 
unsatisfactory method of arresting the hsemorrhage 
produced by a fibroid. Its effects were never permanent. 

Dr. Hetwooo Smith thought that fibroids did un¬ 
doubtedly decrease after parturition, though possibly 
there was an initial increase during pregnancy. He 
thought the surgeon might with advantage avoid inter- 



PRANCE. 


JCLT 81. 1901. 


114 T ub Hidical Pbsss. 

feriDg were pregnancy a probable contingency, aod if 
the uterDB were not mach enlarged, or if the tumour 
were flattened. Curetting ehonld be entirely euppreesed 
in cases of fibroid tumour. 

Dr. Hkbbxbt Snow said there were four ways in 
which a fibroid tumour of the uterus might be related 
to malignanoy, only one of which could properly be 
spoken of as a process of degeneration. A tumour might 
b« of the soft, solitary, cedematons rariety. These began 
at an early age, were always attended by hypertrophy 
of the uterus, and in their later stages by an immense 
secretion of serum, so that the tumour on section lost 
about one-fourth of its bulk. At the last meeting he 
had suf^eeted the term “monoma'’for such tumours. 
They were malignant from their first appearance, inae- 
mu<^ as, though not of a sarcomatous nature, they 
invariably proved fatal in a comparatively short time, 
unless removed! Then there was the common, bard, 
multiple fibroid, which in a few rare instances became 
myo-saroomatous. Such a change might truly be 
spoken of as degeneration. Thirdly, a myoma misht be 
present, merely as a coincidence, in a uterus in which 
there was a carcinoma. Lastly, a myoma might, by the 
irritation and oongestion which it produced, induce the 
development of carcinomatous disease. In reference to 
the oausee of death, he agreed with Dr. Noble and Dr. 
Macnaughton-Jones as to the importance of early 
operation, and of not relying upon any beneficial results 
which might follow the menopause. At the same time ' 
he would point out that a number of corpulent women 
of advanc^ age had multiple myoma which apparently ' 
produced no symptoms. 

Dr. Macphxbson Lawbik believed that fewer opera- 
ations would be performed for myoma uteri in years to 
come than at the present time, though in poor women 
he quite ^reed that operative measures might be mote 
frequently necessary. 

Mr. Skbni Ebith pointed out that when a fibroma 
was present the menopause rarely took place before the 
age of 54. He was convinced that fibrous tumours did 
diminish in size after pregnancy. He recommended 
operation in a certain number of oases, but he held very 
strongly that the majority of fibrous tumours of the 
uterus did not require operation. 

Mr. Stanlst Botd said that the etiology of certain 
complications was obvious, as for example, necrosis, and 
other changes described as taking plaro in fibroid 
tumours. Again, inflammation might easily spread 
from the uterus to the Fallopian tubes, and endo¬ 
metritis be followed by salpingitis, the contents of 
the tube becoming subsequently infected with pyo¬ 
cocci or the bacillus coli communis. But such 
a condition as cancer could hardly be regarded 
as a complication, it being of epiblastio origin, while 
flbro-myomata were of mesoblastic. Though it was con¬ 
ceivable that the irritation produced by a myoma 
might give rise to cancer, he did not believe that in¬ 
creased vascularity tended to do so, seeing how very 
much more vascular othorregiouswere without increased 
liability to such a obsnge. No developmental difficulty 
presented itself with re^ud to sarcomatous degeneration. 
Mesoblastic tissue already growing abnormally might, 
without violating the laws which embryology seemed to 
have eetablished, become malignant in nature. 

Dr. Noblx, in reply, said that one point he had 
endeavoured to emphasise by his paper was that a 
fibroid tumour should not be regarded as an isolated 
entity ; but in conjunction with the many complications 
with which it was in a large percentage of cases asso¬ 
ciated. He did not maintain, and it was not his object 
to establish, that if a woman had a fibroid she ne¬ 
cessarily developed appendicitis, ovarian disease, 
cancer, etc, but merely that in his experience, aod as 
far as he could arcertAin, in the experience of others 
who had equally carefully recorded their cases, 
in any 100 cases in which fibroid tumours were 
taken just as they presented themselves without 
selection, some other disease would be present, and 
that Uiat fact bad a very material bearing upon the 
line of treatment which should be followed. He agreed 
with Dr. Haonanghton Jones that where a fibroid 
tumour had been long present, and the patient ansemic. 


the mental condition of the patient was not normally 
stable. He thought the term “ expectant ” should re¬ 
place the word “ conservative ” as applied in gynsoo- 
logy. As to sarcomatous degeneration it was a ques¬ 
tion for pathologists to decide, but he had been 
assured by those in whom he reposed much confidence, 
that true sarcomatous degeneratiou was very rare. He 
quite agreed with Dr. Heywood Smith’s remarks on 
ooretting, and regarded it as palliative at best. 

cfrancc. 

[paou ouB OWN cobbxspondknt.] 

pASts, July 28th, 1901. 

OPBTHALlflA NSONATOBUH. 

At the Acad4mie de M^deoiae M. Pinard read a paper 
in answer to a circular received from the Oovenunent 
on the prophylaxis of ophthalmia in new-born infants, 
in wbicffi, after developing the subject, be proposed the 
following resolutions to be approved by the Academie:— 

1. To disbribute in all the town halls, with the birth 
certificate, a short notice indicating the causes, sym¬ 
ptoms, and dangers of ophthalmia of infants. 

2. To take measures for the immediate notification of 
purulent ophthalmia everywhere, and in every case. 

8. To attach to all the xnatemity hospitals and clinics 
oculists charged with the direction of the treatment of 
purulent ophthalmia, and the instruction in the affection 
of students, doctors, and midwives. (Adopted.) 

Tbxatuxnt of Jovknili Acnx. 

Bicarbonate of soda, grs. vj; 

Calcined magnesia, g^s. iv; 

Powder of oasotra sagrada, grs. iij; 

Benz, napbthol, grs. iij. 

For one wafer. Two a day at meal times. 

Nsphtbol B., grs. vj; 

Besorcine, grs. iv; 

Savon noir, grs. iv ; 

Prepared chalk, grs. x; 

Sublimated sulphur, grs. xxx ; 

Vaseline, 3vj. 

To be need at night. 

Each morning pass over the face— 

Borate of soda, 5iij ; 

Camphorated sulphuric ether, 5^3; 

Eau de roses, 5iz> 

Cacodtlic Mbdication. 

M. Gautier read a paper on the above subject, iu which 
he established that tiie preparations of cacodylate of 
soda administered by the hypodermic method rendered 
good service in consumptive affections such as pulmonary 
tuberculosis in the first and second stages, osseous 
tuberculosis, diabetes, neurastheuia, chronic paludism, 
pronounced anaemia, Ac. 

The principal counter-indication to the use of the 
drug lay in hepatic affections, cancer, congestion, hyper¬ 
trophy, jaundice, cirrhosis. 

The symptoms of interference were intermittent con¬ 
gestion of the face, sensation of pain in the abdomen, 
rarely fever. 

In women the caoodylio treatment hastens the return 
of the menses and renders them more abundant. Some¬ 
times even metrorrhagia is provoked if the agent is not 
eu«pended four or five days before the appointed time. 

I One of the surest signs that the proper dose has been 
I exceeded is the noises in the ears complained of by the 

Dll..,. 




JuLT 81, 1901, 


AUSTRIA 


patient. The cacodylatee can be employed for any 
len^i of time proTided they be suspended from time 
to time. They acted by exciting the reproduction of the 
cells in multiplying the hematin, in rejuvenating the 
tissues, and in conferring on the economy an extraordi¬ 
nary resistance to morbid affections. 

Amongst the adjuvants of cacodylic medication 
iodides take first place. The speaker advised the adminis¬ 
tration to the patient an hour before dinner a dessert 
spoonful of a solution containing one drachm of chloride 
of sodium, fifteen grains of iodide of potassium and of 
bromide of potassium in three and a-half ounces of 
water. 


Ths Medical fsEss 115 


few applicatioos, provided general treatment be kept 
up at the same time. If, on the other hand, the endo- 
metritis is due to general disturbance, but little is to be 
expected from local treatment. There must be a 
rational combination of general and local treatment in 
some cases. He mentions the contra-indication to the 
treatment, which will be obvious to anyone who gives 
the matters thought. When there is malignant change 
in the endometrium the treatment is unadvisable. 




[FBOM OtTB OWN COBBB8FONDSNT.J 


ftermanB. 

[Fbom Ocb Own Cobbespondbnt.] 

Bselik. July 87th, 190L 

In the Arehiv. /. Oyn., Bd. 63, C. Menge has a very 
practical article on the 

Tbeatkent or Cbbonic Endomxtbitis in General 
Pbactice. 

He believed the reason why this disease is so much 
neglected by the general practitioner lies in the want of 
technical dexterity. The writer was .led by this oonvio- 
tion to search oat a method of treatment that would be 
equally useful in all forms of the disease, that would be 
as free from danger as possible, and that would demand 
the least possible amount of manual procedures. The 
treatment should admit of Iwing carried out rapidly in 
the consulting room, and without previous dilatation of 
the cervix. After tonching upon the usual methods of 
treatment, be proceeded to describe that practised by 
himself, which in the ooxuse of years has proved to 
answer all the requirements both on the side of the 
general practitioner and of the patient. A solution of 
formaline, from 30 to 60 per cent, in strength, has proved 
a useful and non-painfnl intra-uterine application. For 
the purpose of applying such a solution he has had con¬ 
structed a smooth, hard mbber sound, thinner towards 
theend, armed with a thin layer of absorbent cotton to a 
distance of 40 otm., and kept for use in a cylinder filled 
with the formaline solution. The canstio is never 
applied after a bimanual examination, but always some 
days afterwards. It is applied in the following way: 
A freshly boiled Trelat or Neng^baner speculum is 
introduced into the vagina. After the os is found it is 
wiped with a pledget soaked in perchloride solntioo. 
The anterior lip of the nterns is now hooked for the pur¬ 
pose of steadying it—not to draw it down. Two or 
three formaline sounds are now introduced one after 
the other and passed in all directions, so that the 
bottom of all the folds of mncons surface shall be 
reached. A atrip of gauze ia now introduced for the 
purpose of draining the cavity of superfluous fluid. In 
the early part of the treatment it ia lieet to wait until 
the mncons surfsoe is renewed before applying the 
canstio a aecond time. Later on, however, it may be 
applied at intervals of a week. The formaline caustic 
had a beneficial effect in chronic endometritis whether 
following labour or abortion, provided that no placental 
remains were in utero. These should not be burnt off with 
the caustic, but after one or two applications they 
ehonld be removed with the cniette, Post-gonorrhceal 
endometritis may often be cured in this way after very 


Tiksxa. July 27th, 1901. 

Knee-Joint Contractions and Ankylosis. 

At the meeting of the “ Naturforscher ” Lorenz gave 
his experience of 300 cases which had been treated 
operatively for correction of knee-joints by rational 
orthopedics. There are two fundamental principle 
which he considers should always be kept in view— 
oor^tion of the vertex of the deformed angle and 
rigid protection of the skeletal parts, even at the cost 
of the soft tissues. In straightening the limbs he pre¬ 
fers the nse of a caoutchouc upholstered plate or pad— 
" Lorenz Eedressenr." This instmment is fitted on to 
the lower part of the femnr, the padding stops at the 
knee-joint; from this a fixture passes on to the tibia, 
and is also, by means of a screw, slowly pressed out¬ 
wards and downwards until the leg is straight. This 
usually termed central correction. 

When the injury is eccentric and much of the soft tis- 
806 destroyed, the correction maybe effected more rapidly, 
graduaUy altering the apparatus every three quarters of 
an hoar. He snmmarises the advantagM of thisoperation 
as: freedom from danger; retention of all the skeletal 
strength, easy locomotion, as well as a final mobile 
joint. During the last five years he had treated 300 
contracted and ankylosed knee-joints with the best 
results. 

In the discussion that followed Mailer expressed sur¬ 
prise that Lorenz never speaks of having awakened new 
inflammatory action in a joint that has been quiescent, 
as moet of these ankylosed joints oocnr in strumous 
or tuberculous patients prone to this new evolution. 

Lorenz replied by saying that his practice was not to 
touch a joint untU all inflammatory action had ceased. 

LtJXATio Patella. 

At the same meeting Bardenhener described his mode 
of procedure when the patella became habitually luxated. 
He lays the knee-joint bare without opening it. By a 
crescentic incision the capsule is opened on the inside 
the ligamentum patellse proprinm is divided, while the 
posterior part of the oapsule is drawn forward over the 
anterior portion and fixed with a suture, while the whole 
is finally attached to the vastns intemns. The inner 
margin of the biceps tendon is often turned over and 
fixed, thus shortening this muscle also. 

Trendelenburg thought that most of the habitnal Inx- 
ations were ongenital, particularly the genu valgum, 
which was best treated by McKwen’s operation. In one 
case recently, after trying many remedies, he found the 
tuberosity of the tibia with the ligamentum patellse, and 
finally made a groove with the chisel over the front of 
the external condyle, into which he ^drove on ebony ^ 



116 Th» Ubdical Pbb88 congress ON 

wedge. He is onsble yet to say what the final effect 
may be, although the method anawera well at the present. 

Injubt to thk Cbntbb or Spbbcb. 

Longard showed two oases to the meeting where com* 
plicated fractures of the left parietal bone had taken 
place two to three oentimetree above the ear. In the 
first case speech was almost lost for fourteen days after 
the injury, which might correctly be termed monophasia, 
as every question was answered by *' Bitte, Bitte.” the 
patient having no power to say more. For six weeks after 
the accident he gradually improved, so that after that 
time speech had so far recovered as would lead a stranger 
to believe that nothing bad occnrred. No paralysis or 
other untoward symptom was present, which was strange 
after losing upwards of a tablespoonful of brain matter 
from such an important part of the brain as the central 
convolution. At the time of exhibition nothing defec¬ 
tive could be observed. 

The second case had slight paresis of the right upper 
arm and a little spastic step, motor aphasia, and agraphia. 
Three weeks after the accident he suffered from trau¬ 
matic delirium, which soon passed off and has left him 
perfectly well. 

Ctsts in Ovabial Bbuains. 

Fischer and Waldstein in Schauta's clinic have re¬ 
cently drawn attention to the frequency of cysts form¬ 
ing in the remains of the adnexa after tubes and ovaries 
have been carefully removed. Fischer relates a case as 
an example where both tubes and both ovaries were 
carefully removed. The following year he had to 
remove a cyst about the size of his fist, and one from 
the right side the next year. 

Waldstein records four such cases of bis own 
that had to be operated on again at different 
periods after the primary operation for cystic 
recurrence. It has been observed that these remnants 
have power sooner or later to develope cysts until per¬ 
fect atrophy has destroyed cystic degeneration. 

Lioatubxs and Sutdbbs. 

Catgut has not given the satisfaction to surgeons that 
would inspire confidenoe, hence the search for some 
snbstitute. Katzenstein has introduced an instrument 
for applying silver wire in the form of rings, for which 
he claims many advantages. 

Greife, of Moscow, has discovered that the hair of the 
reindeer is perfectly germ free, and an excellent snbsti¬ 
tute for catgut. To remove the fat the hairs are placed 
two days in ether, subsequently in oil of juniper, alcohol, 
and sublimate. 

Special Article. 

THE CONGRESS ON TUBERCULOSIS. 

Thb organisers of the Congress which ran its normal 
course last week may be congratulated upon having 
done their work well. The whole machinery moved 
smoothly and we have heard no complaints of short, 
comings, not even from our fellow pressmen, who are 
usually, and not unreasonably, prone to criticise. Pro¬ 
fessor Koch’s paper, which we publish elsewhere, on the 
non-identity of bovine and human tuberculosis had for 
effect to throw into the shade many valuable contribu¬ 
tions dealing with, or based upon, the views which the 
eminent pathologist has challenged. It is obviously 
idle to discuss the degree of infectivity of milk and meat 


TUBERCULOSIS. Jult 31, 1901. 

at a time when the infectivity itself is in ques¬ 

tion, nor do measures for sterilising, or preventing the 
sale of, such aliments commend themselves for discnssioii 
when, it may be, they will shorUy be proved to be 
unnecessary. In the feeling of surprise at Professor 
Koch’s unexpected announcement, which will remain the 
clou of the Congress, one is apt to ezsiggerate the import¬ 
ance of the point at issue. Whether the bovine disease 
be communicable to msn or not, no one doubts that maw 
to man infection is by far the most important means of 
propagating the disease, and wo must act accordingly. 
We were possibly in danger of overlooking the vastly 
greater scope of hnman infection in our endeavours to 
prevent contamination of animal origin. 

Mow at any rate we have no excuse for failing to 
grapple the problem in a scientific spirit. We know 
that the expectoration of tuberculous subjects is the 
prime source of infection, and it is for ns to devise plans 
for depriving this igenoy of its lethal power. The 
plan of campaign comprises several general prin¬ 
ciples and a number of precautions of detail. An 
united effort must be made to prevent promis¬ 
cuous expectoration, less by repressive legislation, 
which would be difficult to obtain and still more 
difficult to enforce, at any rate so far as the streets 
are concerned, than by impressing upon the public the 
benefit to the community which would accrue were this 
disgusting habit voluntarily put a stop to. The next 
point is to remove phthisical patients of the working 
classes from their unsanitary sarroundings, partly with 
a view to preventing the spread of the disease to other 
members of their families, partly also with a view to 
their cure. We must bring our inflaence to bear upon 
our consumptive patients to induce them to prevent 
their becoming a source of danger to the community. 
This can be done by telling them what to do and what 
not to do, and also by famishing them with a portable 
spittoon. These recommendations, so far as they go, 
will commend themselves as easy of application and of 
nndoabted efficacy. When, however, we come to con* 
eider the conditions under which hnman bein^ 
fall a prey to the disease we are confronted with 
difficulties of another order. Susceptibility to 
tuberculosis may be inherited or acquired. Heredi¬ 
tary predisposition maybe minimised by careful atten* 
tion to the laws of hygiene, but there remains the fact 
that the circumstances and conditions of labour of the 
labouring classes, at any rate in oar large cities, ate 
often such as to favour the evolution of the disease. 
Overcrowding, want of cleanliness, alcoholism, imperfect 
ventilation, &o., all tend to depreciate vitality and so 
throw open the doors to infection. Here we are face to 
face with a problem of such immensity and complexity 
as to discourage all but the meet robust. Legislation 
has done much to ameliorate the conditions of life of the 
workiog classes, but how mneb more remains to be done! 
Still, tbongb it may not be possible to cleanse the 
Augean stables forthwith, it behoves ns to attack the 
problem resolutely and persirtently. The danger is not 
confined to any one class of the community, for society 
may be likened to an organism which suffers as a whole 
when one of its organs is diseased. 

Among the questions discussed was the system of 
voluntary notification of cases of phthisis. Obviously 
it would be idle to adopt notification unltss this step 

Di;.,„zeclb. lOO^ C 




JVLT 81. 1901. 


THE OPERA.TING THEATRES. The Medical Pbbbs. 117 


were to be the pielnde to farther stepe. And what are 
these stepe ? Apart from the fact that a knowledge of 
the local distribntion of phthieb would call public 
attention to the prevalence of the dieeaee in certain 
areas, thus inviting more efficient sanitary inspection, 
it would enable the sanitary authorities to give advice 
as to the sterilisation of the sputum, and to secure the 
removal to sanatoria of those whose oiroumstances are 
such as to preclude adequate care at home. It would 
enable them to insist upon thorough disinfection of the 
premises and the remedying of obvious sanitary short* 
comings. The opinion of Congress was in favour of its 
adoption wherever it was practicable to take the con* 
sequential measures. 

There was a good deal of discussion on the question of 
compensation to breeders and others for the slaughter of 
animals recognised to be tnbercnions, hat in fnture it is 
probable that only animals suffering from general tuber* 
cnioeis will be condemned, in accordance with the 
general principle that the meat of diseased animals shall 
not be sold, so that the question of compensation will 
hardly be brought forward. The owner of a diseased 
animal cannot expect to be recuperated from public 
funds any more than he himself would claim compensa¬ 
tion when from illness he is unable to attend to his 
business. 

Incidentally attention was called to the importance of 
providing better accommodation for cattle. They, like 
human beings, suffer from overcrowding, inadequate 
ventilation, and insufficient nourishment. The import* 
ance of the segregation of infected animals is as im¬ 
portant with apiTTiftl s as with human beings. It is to 
neglect of cattle hygiene that we owe the fact that over 
half the total number of cows in this country suffer to 
a greater or less degree from tnberonlosis. That is a 
deplorable fact from a merely commercial point of 
view, and breeders of animals must be made to nnder* 
etand the importance of maintaining their cattle in a 
good state of health quite apart from any question of 
their communicating their disease to human beings. 

The concluding general meeting took place on Fri¬ 
day, when a number of resolutions were agreed to. (1) 
Becognising the extremely infective nature of tuber¬ 
culous expectoration, and in favour of euppressing pro- 
miacuons expectoration; (2) urging that patients with 
phthisis should be provided with a portable spittoon and 
given printed instructions of the precautions they 
should take; (3) affirming the good resultsto be obtained 
by voluntary notification if utilised to prevent the 
spread of the disease; (4)recogni8ing that the provision of 
ssnatoria is an indispensable part of the measures neoes- 
aary to the diminution of tuberculosis; (5) urging medicil 
officers of health to continue their efforts to prevent 
the spread of tuberculosis by meat and milk, (6) urging 
the Government to set on foot an inquiry in view of the 
doubts thrown on the identity of homan and bovine 
tabereulosis. Passing over several reeolutions of sub¬ 
sidiary importance the Congress recommondsd the orea- | 
tion of a permanent International committee to co- ^ 
ordinate Gie labours of the various bodies having for i 
object the advancement of the cause. j 

'The Congress indisputably owes much of its success 
to the coidial support which Bis Majesty has given to | 
the movement. The foreign delegates were received by 
Majesty at Marlborough House on Thursday last, 
when he thanked them for their co-operation in the good 


work, and called their attention to the fact that cancer 
was another fell disease which had eo far baffied the 
scientific and medical men of the world. 

Every evening daring the week there was some fane* 
tion of interest to occupy our distinguished visitors. On 
Monday the President of the Council, the Earl of Derby 
and the Executive Council held a reception. On Tuesday 
the Lord Mayor and Lady Mayoress received the 
members and delegates at the Mansion House. On 
Wednesday evening the Countess of Derby and the 
Ladies’ Reception Committee gave a garden party at 
the Boyal Botanical Gardens. On Thursday Lord and 
Lady Derby bad a reception at the Victoria and Albert 
Museum. On Friday afternoon Sir J. Whittaker Ellis 
invited the members to a river party at Bichmond; 
while on Saturday afternoon, as a graceful close to the 
proceedings, the Duke and Dnehess of Northumberland 
gave a garden party at Syon Honae. 

‘3[kf ©pnratittfl ^heatrcfi. 

ST. THOMAS'S HOSTITAL. 

Mb. Battle's Operation fob Femoral Hernia.— 
Mr. Battle operated on a yoong man, tet. 21, for the 
radical cure of left femoral hernia. There were many 
unusual circumstance attending the case, which ren¬ 
dered a diagnosis of the swelling difficult. The patient 
stated that he had noticed the tumour suddenly about 
two years before, that it was the same size then as it 
was on admission, that it had not varied in size on any 
occasion since it had appeared; he had had no pain or 
discomfort about it, and in fact it caused him no incon¬ 
venience. The tumour, situated in the left groin, occu¬ 
pied the femoral region.it was flattened, of Bomew hatirre- 
gnlaroutline, appeared lobnlated, and had a fairly defined 
mai^n. One or two enlarged glands could be felt near, 
but there was no distinctfluctnationintheswelling itself. 
It did not vary with the position of the patient, it could 
not be diminisbed in size by ptessnre, and there was no 
impulse on coughing. When first examined the impres¬ 
sion given was that of a chronic abscess of the glands 
in the groin; but its duration was against this; more¬ 
over, the sense of fluctnation was not clear. Then the 
question of fatty tumour had to be considered; the 
swelling resembled a fatty tumour in many ways, 
bat it was not thonght to be one from the want of 
distinct lobulation and the age of the patieot. The 
duration of two years was against nsevo-lipoma. After 
the patient had been in hospital for a few days the 
swelling appeared to become softer, and it was possible 
to feel that there was an attachment in the position 
of the saphenous opening, and although the feel was that 
of a fatty tumour, the texture app^red to be more 
loose. There was still no impulse on coughing, nor 
could any difference in size be produced by taxis. The 
opinion expressed before operation was that the tnmour 
was probably a hernia in spite of the unusual occur¬ 
rence of a femoral hernia in a young man of this age. 
This proved to be the case, for when a vertical 
incision had been made over the swelling a hernial sac 
was reached, but was fonnd to contain nothing bat 
omentum. This was redneed into the abdominal cavity, 
the sac dissected np and ligatured at its neck. The 
npper part of the incision was retracted, and the 
operation continued as follows :—An incision was made 
through the aponeurosis of the external obliqne 




118 Trb Mbdical Pkxsb. 


LEADING ARTICLES. 


Jdlt 81. 1901. 


from the external riog outwards; the lower pillar 
of the ring was then separated from the cord 
down to Foupart’s ligament and the femoral ring, 
the neck of the sac was then freed from the ring and 
brought above Poupart's ligament, the ligature round 
its neck was cut short and the body of the sac cut away; 
the internal pillar of the ring and the 'cut aponeurot'is 
oontinnons with it was brought down and sutured by 
means of three sutures to the fascia over the Peccinens 
behind the femoral canal, to Poupart’s ligament on the 
outer side, and to Gimbemat’s ligament on the inner 
side; the external pillar of the riog was then sutured to 
the internal pillar and aponeurosis which had been 
passed behind. A stitch was placed outside the 
femoral canal to approximate Poupart's ligament 
to the fascia of the Pectineus. The femoral ring 
was unusually large, admittiog two fingers. The 
external wound was closed in the usual way. Mr. 
Battle said the case was an unusual one from the fact 
that this form of hernia was extremely rare at this age 
in a male; he had once had to do a radical cure for a 
boy, set. 16, with a femoral hernia, and in both that case 
and the present one the cause of the hernia was 
probably the same, namely, want of development of 
Gimbemat’s ligament. The hernia also, he pointed 
out, was unusual in its characters, as was shown by the 
history and by the absence of most of the signs which 
are relied upon for the diagnosis of any hernial protrn> 
sion. The only definite things were: the presence of a 
swelling in the femoral region which had apparently 
become softer whilst the patient had been under 
observation, the feeling of omentum conveyed to 
the fingers, and the difficulty in moving it from 
the femoral region. It has, he said, been noted that the 
femoral opening was large, and it was necessary to use 
some method of cure that oould be relied upon to act 
in the case of a man who would be called upon t) do 
hard work. The method employed fulfils the purpose, the 
sac is obliterated, and between the ligatured neck and 
the upper part of the femoral canal a shutter of strong 
fibrous character is interposed, and any traction which 
might be made on this shutter during extra exertion is 
transferred from the outer margin of the external ring, 
and aponeurosis to Poupart’s ligament. The extra 
stitch which closes the femoral ring is possibly unneces¬ 
sary but helps to consolidate the parts outside the canal. 

The patient made an uninterrupted recovery. 

Two Opbbatioss for Epithelioma op the Lip in 
THE BAMS Patient. —The same surgeon operated on a 
man, set. about 50, for epithelioma of the upper lip and 
cheek on the left side. The growth was of some size, 
extending for about an inch and a-half inwards from the 
left angle of the mouth. It was typical in appearance. 
About an inch above it there was a raisedj red portion 
of cheek which was very hard, and above this near the 
angle of the nose the skin was broken and asmall malig¬ 
nant ulcer was forming. The glands underneath the 
jaw in the left side could be felt, they were evidently 
diseased. The month was small as the result of a former 
operation two years ago for the removal of an epi¬ 
thelioma of the right half of the lower hip; the 
scar of that operation was healthy. When Mr. 
Battle .operated for epithelioma of the upper lip on 
the present occasion the operation was necesssrily rather 
exteniive; he removed the glands under the jaw in the 


first place through a long incision parallel with and below 
the lower margin; he also divided the facial artery so 
as to diminish bleeding in the second stage. The tumour of 
the lip and cheek was removed by means of two incisions, 
which formed an oval, and extended about half way up 
the side of the nose and laid bare the upper jaw. The 
stitches when inserted pulled on the cheek so as to raise 
considerably the upper margin of the subnuxillary in¬ 
cision, but the loose skin of the neck was brought 
upward, and united without tension. The operation 
made the month very small, therefore an incision was 
made to the right from the angle of the month for half 
to tbree-qoarters of an inch, and the mucous membrane 
stitched to the skin. Mr. Battle stated that it was 
unusual for epithelioma to show itself in more than one 
place on the lips, and it was curious that this man 
should have allowed the growth to reach the large size 
it had done, because the previous operation had been a 
severe one simply because it was done for a large growth. 
The probability was thought that he had been induced by 
his friends to try some so-called cure. Epithelioma of 
the lip, he pointed out, if taken early can undoubtedly be 
cured. 


Bcoistebed fob rSAHSMISSlOtl Abboau. 

^hc ^ciiical $vtBS anb Circular. 

Published erery Wednesday mominx. Price M. Pest free, Bid. 


ADVSRTISEMEMTS. 

Pom OsB IsBssTioiiWhole Psye, ^ Os. CkL; Half Pays, 
£2 lOs. Od.; Quarter Paxe, £l 5s.; One-eixhth, IBs. 6d. 

For a Staiks or iBssanoasWhole Pax*, thirteen insertioDS 
(weekly, fortnixhtly, or monthly), at £) 10s. Od. ; twenty-ais 
insertions (weekly or fortnixhtly) at £S Se. Od.; fifty-two 
insertions (weekly) at £3 each. Half Psxe, thirteen insertions 
at 35a.: twenty-sis at Sis.: flfty*two inssrtions at SOs. each: 
Qoarter-paxe. thlitean iusertiona at 18s. twsnty-slx insertions 
at 16s.: fifty-two insertions at 15a each. 

Small announcements of Practices, Aaeistanciee,Vacancies, Bookr, 
Ac.—Beren lines or under, 4e. per insertion ; fid. per line 
beyond. 


<^cbical frees anb dircuiar. 

''8ALDS PUPULI fiDPBBMA LEX.” 


WEDNESDAY, JULY 31, 1901. 


PROFESSOR KOCH ON BOVINE AND 
HUMAN TUBERCULOSIS. 

The announcement of an address on a subject so 
peculiarly his own by the justly celebrated German 
bacteriologist was an important item on the pro¬ 
gramme of the Congress on Tuberculosis, and it did 
not fail to attract a large and appreciative audience. 
The address itself, though characterised by the per¬ 
suasive decision of an investigator who is dealing 
with facts within his own knowledge, came upon the 
audience like “a bolt from the blue.” Hitherto the 
problem of preventing the spread of pulmonary 
tuberculosis has been based in very great measure 
upon the assumption that human beings are infected 
to an unknown but piesamably considerable extent 
by the ingestion of contaminated articles of food, 
notably tbe milk and fiesh of diseased animals. In 
other words, it has all along been assumed that tuber- 
Di..,„zecl t:- C 




JVLT 81, 1901 


LEADING ARTICLES. 


The Medical Pbess. 119 


colosia in man and animals is one and the same dis* 
ease, and as tbe process of restricting tbe sale of 
infected food presents vastlj less practical diffi* 
cnltj than that of preventing its spread from man 
to man, a bnge superstructure of preventive measures 
has been erected on this basis. Judge then of tbe 
surprise which was felt when Professor Koch calmly 
asserted that bovine tuberculosis is distinct from 
human tuberculosis, that the disease cannot be 
transmitted from man to animals nor, inferentially, 
from animals to man; in fact, he regards infection 
by tbe milk and meat of tuberculous cattle and the 
buttermadeof theirmilkas a negligible quantity. It 
is impossible not to experience a shock at this bold 
attack on a series of conclusions which we fondly 
thought had been definitely established, thanks to 
tbe costly researches of two Royal Commissions 
fortified by independent observations from 
all parts of the world. Tbe non-transmissi- 
bility of human tuberculosis to animals Pro¬ 
fessor Koch claims to have clearly demonstrated* 
but he is less emphatic with regard to the possibility 
of tbe transmission of bovine tuberculosis to man. 
simply becatise direct experiment could not be re¬ 
sorted to. It is obvious that conclusions of this far- 
reaching importance cannot be accepted without the 
closest scrutiny. The prevalence of intestinal tuber¬ 
culosis among infants, presumably of alimentary 
ori^n, certainly suggests possible infection by con¬ 
taminated milk; but in regard to this question, H. 
Koch's statistics are strikingly at variance with our 
own. Before discrediting the conclusions em¬ 
bodied in the Report of the Royal Commission, it 
behoves ns to await further independent inquiry. 
In the meanwhile we must refer our readers to the 
address delivered by Professor McFadyean, an ab¬ 
stract whereof we publish elsewhere. This is virtually 
a reply to Professor Koch’s indictment, and although 
it does not invalidate his conclusions it shows that 
there are many and weight; reasons for suspending 
judgmeot. It is hardly necessary to point out that 
even if the non-trausmissibility of human tubercu¬ 
losis to animals bad been placed beyond the reach 
of criticism, it by no means fellows that tbe converse 
is troe, viz., that the tuberculosis of animals is not 
transmissible to human beings. Itwould seem that the 
tuberculosis is a more virulent disease in animals than 
in man, and it is conceivable that in passing through 
human beings it undergoes attenuation, to such an 
extent indeed as to render its retransmission to cattle 
difficult though not impossible. The question, so 
far as it relates to the amenability of human beings 
to infection by tbe germs of animal tuberculosis, 
will have to he worked out in the light of clinical 
observation, a process which presents considerable 
difficulty and no small degree of uncertainty. Pro¬ 
fessor Koch deserves credit for having had the 
courage to proclaim such heterodox views, and 
whatever conclusion we may ultimately come 
to with regard to their accuracy he will 
have rendered the immense service of having 
called attention to the vastly greater import¬ 


ance as a factor in the dissemination of tuberculosis 
of man to man infection. In our anxiety to stamp 
out alimentary tuberculosis it may be that we were 
OD the point of going off on a false scent, false in 
the sense of attaching thereto an importance in 
excess of its merits. This Congress will be memor¬ 
able in tbe history of the movement in that tbe rudder 
has been shifted and we have been invited to rectify 
an error of direction. 


A NATIONAL CONCERN. 

The continued destruction of our army in South 
Africa by enteric fever and dysentery is a subject 
of vital national importance. It is with tbe object 
of remedying this destruction that a Committee of 
hygienic experts are at present holding an inquiry 
in South Africa. This subject is a highly interesting 
one, and forms the theme of a recent publication by 
Dr. Leigh Canney, of London, (a) That the death- 
rate from these diseases in the present war has been 
far greater than from all other causes put together 
none will deny. It is apparent to any observer of 
the weekly casualty lists. Enteric fever and dysen¬ 
tery have from time immemorial been tbe scourges 
of all armies in tbe field, and there was no 
reason to expect their absence in this cam¬ 
paign. In fact, it was known for a long time 
before the outbreak of hostilities that enteric 
fever was endemic in South Africa. The 
Arm; Medical Department fully recognised this, 
and expected epidemics of it at certain periods of the 
year. Tbe relationship between tbe Army Medical 
Department and tbe War Office is a peculiar one. In 
tbe event of any war being threatened, the Adjutant- 
Gteneral communicates with the Director-General of 
the Army Medical Service, and informs him where 
the war is to take place, and the strength of trooops 
likely to be employed. It is then the duty of the 
Chief of the Medical Department to submit a pro¬ 
posal as to the medical requirements. After this 
proposal has been discussed by tbe Army Board, the 
Diiector-General submits a memorandum showing 
the probable diseases likely to be eucountei-ed, 
the kind of supplies and the kind of pro¬ 
visions likely to be got, and all details con¬ 
nected with the sanitary part of the campaign. 
Having done this, tbe Medical Department has to 
wait its turn and get its recommendatiuns sanctioned 
by the Army Board, on which the Director-General 
has neither seat nor vote—a most curious anomaly ! 
He merely acts as a spectator and rarely reaps any 
benefit if the campaign is a successful one, whilst be 
is certain to have to bear the brunt of anything 
which goes wrong. Dr. Leigh Canney fully recog¬ 
nises this state of affairs in bis recent publication 
“ Typhoid the Destroyer of Armies and its Aboli¬ 
tion,” and brings before the pnblic the facts which 
stand in the way of any suitable prophylactic 
measures being adopted against these diseases in 
war. He attributes tbe lack of preventive 

(a) “ Typhoid, the Deitroyer of Arnilei, and iu Abolitloo." By 
H. E. Leigh Canney, M.D.Lood. Ballllere, Tindall 

Digitized t. 


and Cox. IMU .la. 


120 TbB USDICAL PbXB8. 


LEADING ARTICLES. 


Jolt 81, 1901- 


mnasures, not to the Armj Medical Depart* 
ment, which advised everything necessary, bat i 
to the persons who would not act upon this ' 
advice, namely, the Commander>in-Chief at the time 
the war brokeout. LordWolseley’sattitudetowards 
our professional brethren in the Army is well known. 
In the past it has been responsible for the difficulty 
of filling the ranks of the B.A.M.G., and now it 
would seem to have led him into even g^ver errors 
of omission. In the course of his remarks Dr. 
Canney says: The danger was known and calculated 
upon, be (the Commander-in-Chief) made no ade¬ 
quate provision to meet it.” Such a rSle is not sur¬ 
prising of the man who condemned the sanitary 
officer as a " useless encumbrance’’in time of war. 
We do not, however, wish to dwell upon errors which, 
are, we trust, over. The future, under the control 
and with the sympathy of, the present Com- 
mander-in-Cbief is of more practical importance. 
The Royal Commission on South African Hospitals 
has suggested what Dr. Canney now suggests, and 
what has been recommended over and over agaiui 
namely, the appointment of young, able, general 
sanitary officers of high rank from the officers of 
the B.A.M.C.” How often has this advice been 
tendered to the War Office P How often has it been 
ignored P Now is a suitable opportunity for reform 
Mr. Brodrick’s “ Committee on the Army Medical 
Service" is sitting in London at present; let it 
consider this among thelmany.reforms needed. Let 
them select from their officers the men most quali¬ 
fied for these posts, and give them some stimulus 
for their work—extra pay, and sufficient study leave, 
to keep their knowledge up-to-date. Dr. Canney 
suggests a scheme for sterilisation of water on field 
service which is worthy of the closest consideration. 
He has devised a machine which can supply fifty 
men in less than twelve minutes with fifty pints of 
boiling water, and this water can be cooled for 
drinking by a special apparatus in five minutes. 
His boiler fitted in a case with a cooling apparatus 
weighs seventy pounds. Six pints of petroleum, 
sufficing for four pints of boiled water daily for each 
of the fifty men for four days, weighs seven and a 
half pounds. Two such machines and double the 
supply of petroleum can be carried by a mule and 
should accompany each unit of 100 men. Further, 
Dr. Canney advocates the formation of a “ Water 
Corps ’’ to take charge of this outfit and look after 
all water supplies. Petroleum has undoubtedly its 
advantages, but its inflammatory nature and the 
consequent danger of its proximity to a waggon 
laden with lyddite must not be lost sight of. Indeed, 
it is very questionable if any of our generals in view 
of grass fires and stray shells would view its intro¬ 
duction with equanimity. The weight of the outfit 
is also a cause of difficulty. Each company of a 
regiment would require one mule, a battalion thus 
requiring ten mules. As two pack mules per batta- | 
lion are only allowed for ammunition, and two per 
battalion for machine guns, it is very questionable if 
the military authorities would sanction the increase 


which to convey apparatus entails. It will take many* 
years of education to win over the lai*»et-boire sec¬ 
tion of onr combatant officers and men, and we are 
afraid that the saying “ Tommy will drink when he 
likes,” will hold good for many a campaign to 
come. Still, we think that even our military 
chiefs will some day learn that if a preventible dis¬ 
ease Can destroy an army more rapidly than the 
strongest enemy, it is worth their while to allow steps 
to be taken which will make the prevention of enteric 
fever an accomplished fact, instead of a subject for 
red tape and departmental obstruction. 

RURAL MEDICAL OFFIOEBSHIPS OF 
HEALTH. 

There is every reason to be proud of the position 
taken by the United Kingdom in the practical ad¬ 
ministration of public health matters. By common 
consent this country has been awarded the first 
place among the nations with regard to that detail 
whereby the vital welfare of the community is so 
profoundly influenced. At the same time it is 
necessary from time to time to review the situation 
and to remind ourselves of the fact that a great 
space intervenes between present imperfections and 
the future sanitary millennium. One of the most ob¬ 
vious matters that demand attention is the inequality 
of standard between urban and rural sanitation. 
That such should be the case is not altogether sur¬ 
prising when we take into consideration the 
differences in wealth, density of population, general 
enlightenment, and other essential conditions that 
closely affect not only the public spirit but also the 
centralisation and decentralisation of local govern¬ 
ment. In sparsely-inhabited rural districts it is not 
too mu ih to say that sanitary administration is often 
of the most primitive and perfunctory character. In 
the majority of cases the duties of the medical officer 
of health are entrusted to a country practitioner who 
receives a small and not infrequently a paltry salary 
in return for his services. The conditions of such an 
appointment are clearly not conducive to thorough 
and energetic action on the part of the medical 
officer. His duties with regard to bad housing, bad 
water supply, bad drainage, defective dairies, and 
the hundred and one details that fall within the pur¬ 
view of his office are no less manifold than import¬ 
ant. By carrying them out, however, with anything 
like vigour and impartiality he would find himself 
arrayed against landowners, tenants, members of 
local governing bodies, in short, against the mmn 
body of his patients, high and low, throughout 
the district. It would be too much to expect uf frail 
human nature to undergo an ordeal of that kind. 
The usual result is that the rural medical officer of 
health draws his salary, and as far as possible lets 
sanitation look after itself. The outcome of this 
temporising attitude is writ lai^'in the numerous 
Local Government Board inquiries from time to time 
upon the sanitary state of this or that rural dis¬ 
trict. Many of the plague spots thus brought to 
light have been described in the columns of the 
Di(. . - ^ 



JuLT 31 , 190L_yOTEti ON CURRENT TOPICS. Thi Mkpioal Pbibb. 121 


Medical Fsess and Circular. Tbeir existence 
is enoneb to warrant a good deal of heart* 
searching among those public health experts who 
plume tbemselree upon the advanced preventive 
standai'ds that have been attained in the United 
Kingdom. There can be no doubt that the Local 
Oovemment Board would be able to help on reform by 
insisting that in all cases on adequate salary should 
be pmd to the rural medical officer of health, and 
that he should have a tenure of office not less stable 
t hsu that of bis urban brethren. Still more, again, 
would be effected by bringing pressure to bear 
upon County Coimcils to appoint medical officers 
for their districts. By amalgamating a number of 
petty rural appointments it would become possible to 
secure the whole services of a specially qualified and 
well-paid man for a county. These considerations 
are of the utmost importance in view of the close con¬ 
nection that has of recent years been recognised as 
existii^; between town and county sanitation. A 
large proportion of the food of the urban population 
comes from rural districts. Again and again has 
the epidemic disaster of the towns been tiaced to tbe 
sanitary sins of the country. In spite of Pro¬ 
fessor Koch’s views, the English sanitarian will 
continue to believe that bovine tuberaulosis lies 
at the root of much of the human tuberculosis that 
decimates the inhabitants of our cities. The rigid 
and systematic inspection of farms and dairies is 
demanded in order to protect the urban population 
from the great scourges of tubercle, enteric fever, 
and scarlet fever, not to mention others. Of late 
years the need of close concerted action between the 
sanitary authorities of town and country has been 
widely recognised. Obviously, however, the value of 
such an arrangement will depend on the strength of 
the combining organisations. It is necessary, there¬ 
fore, on this important ground as well as others 
already mentioned that the sanitarians of the United 
Kingdom should forthwith set tbeir rural sanitary 
house in order. 

JtoUs on Currntt Sopite. 

Complimentary Dinner to Suig^eon-General 
Jameson, C-B. 

A COMFLIHENTABY dinner was given to Surgeon- 
General Jameson on Wednesday last, with Sir Wil¬ 
liam Church, Bart., President ot tbe Royal College 
of Physicians, in the chair, in tbe Grand Hall of the 
Hotel Cecil, at which upwards of 150 representative 
medical men assisted. The Chairman, in proposing 
tbe toast of “ Our Guest ” reviewed this distinguished 
officer’s career from tbe days when be took part in 
repellingthe Fenian raiders in Canada to his appoint¬ 
ment to the post of Director-General of the Army 
Medical Department in 1896, a post which he had 
held daring a very eventful and trying period, m re. 
spect of which every credit was due to him and to his 
department. Snrgeon-General Jameson, in replying 
to the toast, dwelt upon the difficulties with which he 
bad to contend during the strain of the war, and 


pointed out that with regard to supply the medical 
department was only responsible for medicine and 
medical and smgical appliances, food and so-called 
medical comforts being snpplied on requisition to tbe 
Army Service Corps. Consequently tbe blame, if 
any, should be apportioned to those on whom it pro¬ 
perly fell. With respect to ambulance arrangements, 
he pointed out that tbe post of medical officer had 
been abolished against tbe advice of tbe medical 
department. Then, again, the selection of sites for 
hospitals in camps was tbe duty of the Royal 
Engineers or of the barrack depai'tment, but as a 
matter of fact the medical department had bad to 
imdertake tbe adaptation of buildings at a time when 
tbeir bands were full of their own work. A large 
increase of medical transport was indispensable in 
future if war was to be carried out on humanitarian 
principles. Lastly, he remarked that tbe Director- 
General was not a member of the War Office Conncil 
or of tbe Army Board, so that matters concerning 
bis department were discussed in his absence, only 
coming to hie knowledge after considerable delay. 
Sir William McCormac, in proposing the toast 
of “ Tbe Public Medical Services,” expressed re¬ 
gret at tbe fact that there was not at present 
a single candidate applying for admission to tbe 
Services. He thought tbe Army Medical Depart¬ 
ment had done ite work extremely well under cir¬ 
cumstances of considerable difficulty. They had 
received blame which belonged to other departments, 
and it was strange, he observed, that tbe Govern¬ 
ment bad allowed Surgeon-General Jameson to leave 
tbe Army without the customary recognition given 
to every one of his predecessors and without one 
word of thanks or acknowledgment. The speeches 
were listened to with great attention, and as an ex¬ 
pression of admiration and respect for the late 
. Director-General tbe dinner was eminently suc¬ 
cessful. 

Nasal Reformation. 

At a recent meeting of the medical board of tbe 
Massachusetts General Hospital Dr. J. P. Clark 
showed a patient who had applied to him for 
relief in respect of a nose which sinned against 
her {esthetic soul in tbe direction of too pro¬ 
nounced a Roman outline. Tbe prominent angle 
which characterises this variety of nasal appendage 
is due to the projection forward of that part of the 
septum, and, as shown by Dr. Goodale, this can be 
remedied without tampering with the skin. Dr. 
Clark followed bis procedure, which consists in pass¬ 
ing a pair of short curved scissors into tbe left 
nostril, one blade being made to perforate tbe 
septum just below the lower end of the prominence. 
Then, with the convexity of the scissors upwards, he 
frees the septum opposite the prominent partof the 
nose, following as closely as possible the contour of 
the nose. He next snips off tbe projecting piece of 
septum by tbe aid of a pair of straight scissors, and 
saws through tbe nasal bone as nearly as possible at 
its junction with the nasal process of.the superior 

Dip::ized by Gooo ; 


122 Thi Mxdioai. Pbbbs. 


NOTES ON CURRENT TOPICS. 


July 31, 1901. 


maxUIarjr bone, care being taken not to injure the 
skin. The process is repeated on tbe other nasal 
bone, and then a few tape on the external pro¬ 
jection is sufficient to break down the frontal 
articulation. The bones can then be depressed into 
contact with the revised septum, and the deformity, 
if it is to be regarded as such, subsides. The result, 
judging from the photographs shown, was very satis- 
factoi^. It may be that in operations of this kind 
surgeons may find the means of occupying their time 
daring the dead season if only tbe public can be 
induced to take enough interest in their personal 
appearance to consent to their too prominent con¬ 
tours being rounded off. Hitherto surgeons in this 
country have limited their efforts to tbe restoration 
of noses which have been eaten or blown away, and 
in rare instances to the ablation of redundancies of 
fibrous tissue in the subjects of chronic alcoholism. 
Purely cosmetic operations offer a much wider scope, 
but, so far, ladies display marked reluctance to 
modify tbe features bequeathed to them by undis- 
criminating sires. 

Death flrom Cocaine Poisoning. 

An inquest was held last week at Cromer on the 
body of a young married woman who had succumbed 
to the effects of cocaine injected in view of a dental 
extraction. Tbe assistant, an unqualified man, made 
three injections, equivalent to one grain of the alka¬ 
loid, and shortly after the teeth had been extracted 
convulsions set in, and death supervened within an 
hour without consciousness having been regained. It 
is remarkable that death should have resulted from 
this comparatively small quantity. According to 
Dr, Murrell recovery has followed the injection 
of as much as fourteen grains, though any¬ 
thing over half a grain may give rise to 
very unpleasant symptoms of cardiac oppression. 
The most unsatisfactory feature of the case is the 
administration of the drug by an unqualified assistant, 
who ran some risk of being committed for man* 
slaughter, but tbe jury tempered justice with mercy 
by describing it as an accidental occurrence. 

Army Hospital Accommodation in London. 

Day by day the public attention is being called to 
some fresh flaw in the administration of the Army 
Medical Department. During the past week tbe 
Daily News has made a fierce frontal attack upon 
the army hospital accommodation for the metro¬ 
polis. It seems that scarlet fever has broken out 
among the men of the 1st Life Guards, now sta¬ 
tioned at Knightsbridge barracks. The significance 
of the outbreak lies chiefly in the fact that the con¬ 
struction of the barracks in question is bad from a 
sanitary point of view, and that the building is over¬ 
crowded. There is no special army fever isolation 
hospital, so that the fever patients are sent to the 
public infectious hospitals, a proceeding which 
is, doubtless, most advantageous to themselves 
n.Ti<l to everyone else concerned. The fact 
that the barracks are not open to control 


by tbe district local sanitary authority, however, 
constitutes a standing menace to tbe public safety. 
As a class, army medical officers are not, and prob¬ 
ably never will be, sanitary experts. Why, then, 
should not the barracks be banded over to the dis¬ 
trict medical officer of health P It may safely be 
predicted that were public sanitary authorities en¬ 
trusted with the supervision of military quarters tbe 
present system of bousing would speedily be 
revolutionised. The Metropolitan Station Hospital 
in Rochester Row has been condemned over and over 
again by boards of inquiry, yet .it still furnishes 
an object-lesson of military maladministration. The 
British Army, which is the most costly in the world, 
is provided with a wretched hospital that no civilian 
would tolerate for an hour. Tbe problem before the 
reformer in army medical matters appears to be 
where to begin sweeping out the Augean stable. 

The Government Tax on Quackery* 

A WEEK or two since an enterprising tradesman 
was fined by tbe Rochdale magistrates for selling 
medicine in tbe market-place, first, without a stamp, 
and secondly without a license. It appears that tbe 
defendant vended some stuff called “ Critchley’s 
Indian Balm,” whereby he professed to cure indiges¬ 
tion, at the extremely moderate price of sixpence a 
bottle. As to tbe merits of that particular prepam- 
tion it is, of course, impossible to pronounce abso¬ 
lutely, but it may fairly be assumed that the “ balm ” 
was about as worthless as most of the cures for dys¬ 
pepsia sold under cover of a quack labeL More¬ 
over, the varieties of dyspepsia are legion, and 
demand an infinite variety of skilful treatment, a 
fact that may be commended to those who pin 
their faith to ignoraut charlatans with their 
“ cures ” for indigestion. Tbe Rochdale prosecution, 
however, contains an even profounder moral. The 
proprietor of the balm in question, it appeal's, bad a 
license to sell his precious stuff in Oldham but not 
in Rochdale, whence aruse the police-court trouble. 
The position of a Government that issues a license 
for tbe sale of quack medicines is peculiar. In re¬ 
turn for a paltry annual payment permission is 
granted to* any quack to sell his worthless and 
fraudulent wares. If it be shown that such stuff is 
injurious to the health of His Majesty's lieges then 
the Government most clearly becomes accessory to 
a felonious act. This view of the matter may be 
commended to Truth, tbe only lay journal with the 
courage of its opinions in dealing with quack medi¬ 
cine vendors. 

An adjourned meeting of a number of members of 
the profession practising obstetrics and gynsecology 
was held in London on July 24tb, under the pre¬ 
sidency of Sir John Williams, at which it was 
unanimously resolved to establish a new journal, to 
be called The British and Colonial Journal of 
Obstetrics and Oynsecology, and to raise the funds 
required for its publication by the formation of a 
limited liability company. 

Dk. . hvCjOOglC 



July 81, 1901. 


NOTB8 ON CtTERENT TOPICS. 


Thb Msdioai. Pum. 123 


A '* Herbalist ” Sentenced to Death. | 
The receat eenienoe to death of a “ herbalist** at 
Hartlepool for the wilfol mnrder of a wouian hj 
illegal operaiioa ohUs for some comment. The 
oocapation of a “ herbalist *’ is an anomalous one, 
and there can be no doabt that the title is in many 
eases simplj a cloak for nefarious practices. That 
the man who carries on that kind of business is often 
an abortionist is notorious. It would be well, there* 
fore, for the police to keep a tight rein on all 
** herbalists.” There are manj ways in which 
such men might be brought to book, in spite 
of the deficiencies of the Medical Acte. A 
few well*directed prosecutions might drire away 
this sort of charlatan from a town before he com¬ 
mitted the more serious offence of procuring abor¬ 
tion. The herbalist trade, however, at its best must 
be a wretched fraudulent kind of quack medical 
practioe, and as such should be suppressed by law. 
What we really want is a bracing up of the Medical 
Acts, so that all unqualified practice could be 
promptly and efficiently suppressed. The present 
Acts are rendered inoperative for the most part 
amply because an offender to become liable must 
style himself a medical man. The simple amend- 
m^t of that particular would strike a death-blow to 
an enormous amount of quackery now practised at 
the cost of life and health to the nation. 


Death from Fright (?) 

Airr departure from the stereotyped formula of 
“weak heart” as an explanation of death under 
chloroform is welcome, but we question the possibility 
of diagnosing death from fright while under chloro¬ 
form from death due to asphyxia, the usual cause of 
death in fatal cases of chloroform narcosis. At an 
inquest held a few days since at Stockport, on the 
body of a who had died ” before he had inhaled 
it in any great quantity,” the convulsions were attri¬ 
buted to fright, and this view was endorsed by the 
jury. It would have been more to the point if the 
jury had inquired how much chloroform had been 
administered, by what means, and with what precau¬ 
tions, though in all probability they would not have 
been any wiser for their trouble. 

BritiBh Medical ABsooiatioo. 

The sixty-ninth imnnaJ meeting of the British 
Medical Association was opened at Cheltenham 
yesterday (Tuesday), under the presidency of Dr. 
George Bagot Ferguson, who delivered his presi¬ 
dential address last evening at the Princess Hall of 
the Ladies’ College. The meeting was preceded by 
a special service at 11.30 o’clock at St. Matthew’s 
Church, when the sermon was preached by the Dean 
Gloucester. To-day (Wednesday) Dr. James 
Frederick Goodbart, F.R.C.P., is to give an address 
in medidne at 8 p.m. in the Princess Hall. On 
Thursday Sir WiUiam Thomson, O.B., M.D., 
Honorary Surgeon to the King in Ireland, will give 
an address in surgery at 2.30 p.m., after which the 
Stewart Prize will be presented to Dr. Patrick 


Manson, F.R.S., for hie researches in the pathology 
of tropical diseases, especially in regard to the 
malaria of man and to the life-Mstory of the malarial 
parasite both in man and in the mosquito, and in 
recognition also of the stimulating influence which 
he has exerted for many years on the study of tro¬ 
pical diaftftaaa in the British Empire. The sdentifio 
work of the meeting is being conducted in thirteen 
sections. The first general meeting of members was 
held in the Princess Hall of the Ladies’ College on 
Tuesday at 2.30 p.m., when the report of Council and 
the reports of committees were considered.. 

The Privacy of Medical Examinations. 

It been more or less the custom at medical 
examinations under the Workmen’s Compensation 
Act for the solicitors of the parties to be present, a 
practioe which presents obvious inconveniences, but 
one agmnst which it was difficult to effectually prO' 
test. Thanks to the action of Judge Addison, of 
the Southwark County Court, an official pronounce¬ 
ment b«« been obtained, which will serve as a guide 
in future. In a case recently before him, in which 
the medical evidence was contradictory, the matter 
was referred to the Home Office referee. The 
solicitors wished to be present at the e x a min ation, 
and permission having been refused a request was 
made for a copy of the referee’s report. This 
the judge also refused, and applied to the 
Home Office for an opinion on his ruling. 
We are pleased to learn that hie Honour’s ruling has 
met with the cordial approval of the Home Office, 
and it is now laid down that medical examinations 
are to be made privately, and that the referee’s 
report, being primarily for the guidance of the 
Judge, is of the nature of a confidential document, 
though he can communicate it at his discretion. 
Apart from the economy of law costs which will 
lesultfrom this deoision,it is obviously desirable that 
medical examiners should not be hampered by the 
presence of lawyers whose interference could only 
have for effect to add to the difficulty of making 
the inspection thorough, searching, and impartiaL 

Plague at the Oape. 

It may be doubted whether we at home 
have ever properly estimated the danger of the 
plague at the Cape. A rigorous press censorship 
kept back the news of the arrival of the malady 
weeks after it had been announced in the Conti¬ 
nental journals. In spite of official repression, how¬ 
ever, information has leaked out of cases of plagiie 
in various places up country. We cannot help 
thinking that a policy of candour would be better 
calculated to maintain the confidence of the public. 
There has recently been a marked remission in the 
amount of disease at Cape Town, but that the scourge 
is still potent for mischief is shown by the fact that 
three fresh cases were notified in the last week under 
official report. From the beginning of the epidemic 
to the end of the period mentioned there have been 
altogeher 772 cases of plague and 368 deaths 

DigiiizedL. oog 




124 Th* M«dioal Pb»88 NOTES ON OPSBBNT TOPICS._ Jtot 81. 1901. 


Anyone conTersant with the oonditione of plagne 
most at once reoog^nise the menace oontuned in 
that statement. The total Tolnme of specific in* 
fection thns inTolTed is enorinons, especially in 
a country with sncb imperfect sanitary adminis¬ 
tration as the Gape. It is to be hoped that the 
authorities at the War Office will not allow them, 
selves to be lulled into a false sense of security by 
the apparent diminution of the numbers attacked 
by the malady. 

The Inwudness of the Horses’ Sun-bonnet. 

Soars years ago the attention of the medical pro¬ 
fession was first drawn to the straw hats used for 
the purpose of protecting the heads of horses from 
the sun. Since that time the fashion has not only 
grown in popular favour but has farther blossomed 
out into a crop of eccentric and fantastic vagaries. 
The original headgear made out of a plain peaked 
straw hat, with holes cut for the ears, has de¬ 
veloped into hats of manifold pattern decorated with 
ribbons and artificial flowers, and in variously 
shaped contrivances slung in the air at angles more 
or less calculated to p rotect the cranium of the noble 
a.niTnft.1 beneath. All this ingenuity is a good sign 
of the humanity that underlies the outer shell of 
mankind. The horse may be mercilessly whipped, 
or under-fed, or overworked, or tied up with bearing- 
reins, but at any rate here is an opportunity for | 
showing that we do not altogether neglect his bodily 
comfort. As to any beneficial effect to be derived 
from the equine sun-bonnet it is open to question 
whether any additional safety is thereby conferred 
upon the long-suffering animal concerned. Science 
has shown that sunstroke is not due to heat but rather 
to micro-organisms. The part played by hot weather 
consists in providing the conditions necessary for 
the development of the “sunstroke” organisms. 
All riie same it is advisable to protect the skull from 
the rays of the hot sun, whether tropical or other¬ 
wise, and on that ground the use of the sun-bonnet 
for horses may be consistently upheld. One word 
of caution may perhaps be added. The openings in 
the headgear should be so made that there is not the 
least friction or pressure upon the ears. Those most 
sensitive organs are in constant motion, and any¬ 
thing that restricts their free movement must prove 
a source of never-ending irritation to a horse, to say 
nothing of the actual galling that may ensue. If 
this fashion is not to rank among the most foolish 
of modem freaks it should be followed with some 
regard to the dictates of common sense and to the 
laws of physiology. In other words, it should not 
be allowed to become a completely feminine fashion. 

The Interpreters of Professor Kooh. 

At the combined meeting of Sections 2 and 3 of 
the Congress on Tuberculosis, held at the Boyal 
Hedical and Chirurgical Socie^, on July 24th, much 
diversity of opinion was expressed on the value or 
otherwise of the use of tuberculin. Dr. Heron gave 
his results, and Dr. Theodore Williams, in recount¬ 
ing his experience, was in direct opposition, both as 


to fact and theory, to Dr. Heron. Dr. Heron’s views 
were practically ^oee of Prcffessor Koch, and when 
the latter replied, at the end of the discussion, in the 
German language there was a very loudly expressed 
wish that his views should be then and there ex¬ 
pounded in English to the meeting. Whether it 
was difficult to follow Professor Eocb, or whether 
the gentlemen who attempted to convey his meaning 
to the section failed to comprehend his argument, 
it is diffi cult to decide; but it was amusing for the 
section,though disconcerting to the interpreters, to see 
Professor Koch shake his head at the various attempts 
made to explain his views. There was no lack of 
volunteers to enlighten the meeting as to what they 
thought Professor Koch meant, but as time was 
precious and the translators did not seem to find 
favour as regards accuracy in the eyes of Professor 
Koch, the chairman brought the amusing incident 
to a close. The amateur interpreters must be cts- 
dited with firm belief in their ability to correctiy 
translate the views of Professor Koch, for the mem¬ 
bers present indulged in remarks which were painful 
and frequent and free, and by no means uttered in 
low tones, on the respective merits of the different 
performers. The sections sat from half-past nine to 
half-past oue, and the unofficial entertainment pro¬ 
vided was much appreciated. 

Expectation and Expectoration. 

The ceremony of inaugurating the British Con¬ 
gress on Tuberculosis was naturally a very serious 
and dignified affair, and the wonderful patience of 
the number of ladies who sat the decorous function 
rightthroughis much to be admired. St. James’s Hall, 
in which the ceremony of opening the Congress took 
place, became, on account of the weather, terribly 
hot, and by the end of the function many of the 
audience were observed to be quietly slumbering. 
Those who were able to keep awake were rewarded 
with one amusing incident; a most worthy and dis¬ 
tinguished foreigner, of great scientific repute, was 
addressing the audience in English, and he spoke 
remarkably well, but in his excitement in delivering 
his peroration he expressed the hope that the Con¬ 
gress would come up to their expectoration. Quick 
though he was to correct himself his audience had 
recognised the humour of the verbal slip, and the 
roar of laughter prevented the speaker from con¬ 
tinuing his discourse for some little time. 

Vegetarianism and Phthisis. 

Lobd Dbbbt must be congratulated on the mar¬ 
vellous tact with which he was able to deal with un¬ 
expected interruptions in tile course of the conduct of 
the business of large public meetings. He presided 
at the final meeting of the British Congress <m 
Tuberculosis on July 26th, and was skilfully securing 
the successful acceptance by the assembly of the 
very wordy and non-committal series of amendments 
which were laid before the members and delegates, 
when suddenly he found himself addressed by a lady 
whose name was understood to be Hademoiselle 
Yergelle, and who spoke clearly and to the point. 

D....Google 



July 81a 1901* ITOTS8 OIT Ou aBlEITT TOPICS* Tsb MxDXCAia PBBSb* 125 


Sbe addreesed the meetiiig because, in her opinion, a 
great deal oonld be done towards stamping out 
tnbereulosis if the medical profession were to paj 
greater attention to the Talue of prescribing a yege- 
table diet. Lord Derby listened with the utmost 
oourte^ to all that the adyocate of Yegetarianism 
had to say, and baying waited for a short time to see 
if anyone wished to continue the theme, he pleased 
the audience by passing on at once to the business of 
the meeting, and thus succeeded in preyenting any 
waste of time without subjecting the courageous 
lady to any feeling of mortification. The meeting is 
to be congratulated on haying secured such a tactful 
chairman, and Lord Derby complimented on his 
gallantry. 

The liiabilitj of Sanitary Officers. 

Okb of the yerboee resolutions passed at the final 
meeting of the Congress on Tuberculosis was to the 
effect that sanitary officers should be encouraged in 
their efforts to preyent the increase of tuberculosis. 
Some gentleman whose name did not transpire, 
epeahing from the midst of the crowded audience, yery 
pertinently suggested that the meeting should pass an 
expression of opinion that the sanitary officers should 
be freed from their present liability in respect to 
their efforts to preyent the sale of taberculous milk. 
The speaker was greeted with loud cries of dissent, 
which he very successf ally met by showing the neces¬ 
sity of doing what he adyised, and gave as an example 
the fact that a Sanitary Officer at Warwick had been 
subjected to legal proceedings for slander because he 
had done bis duty in his official capacity for the pro¬ 
tection of the pnblic. Perhaps the fact that the 
meeting was detained from attending a popular water, 
picnic at Hiobmond may baye accounted for the cold 
wdcome accorded to the yery reasonable proposaL 
The matter, boweyer, is of some importance, and most 
not be allowed to drop. 

The Plague. 

Thx reappearance of the plague in Honolnln in 
spite of the yery comprebensiye precautions taken 
against the epidemio is, to say the least of it, em¬ 
barrassing, but the obstinacy with which the infec¬ 
tion continnes to make iteelf manifest in Cape Town, 
not only among the coloured races, but equally so 
among the whites, leather with the reports 
concerning the seyenth recrudescence of the 
pl^;ne in Hong Kong, renders a consideration of 
the present outlook a far from cheerful one. There 
is not much consolation in the information that 
when once a town baa been infected recurrences 
must be expected, and the worst of it is, judging 
from Hong Kong, the attacks by no means seem to 
decrease in yiralence os they increase in number. As 
&r as can be judged from the facts to band, this last 
outbreak in Hong Kong threatens to be the most 
eerious calamity that that district has as yet suffered. 
Por anyone to accept as proyed the assertion that 
modem scientific methods are perfectly able to cope 
with plague requires either yery robust faith or a 
large measure of obstinate prejudice. ‘ 


Bxcessive Oough in PhthisiB. 

Thb treatment of exoessiye cough in a taberculous 
patient requires mnoh judgment. A certain amount 
I of cough is undoubtedly in a large number of oases 
I indispensable and baa a saintary inflnenoe. The 
treatment ot this symptom was disonssed by Dr. 
Huggard, of Dayos Platz, before the Congress on 
Taberonlosis, and as he yery well put it, the problem 
is to secure the remoyal of the pulmonary and bron¬ 
chial secretion with tbe least amount of yiolent 
exertion or fatigue to the patient. The difficulty is 
that sometimes the secretions are yery abundant and 
sometimes too scanty. The balsams and the tere- 
bintbinates diminish secretion and apomorpbine in 
small doses loosens the secretions. The recently 
introduced morphine derivatives, heroin and dionin 
diminish cough and expectoration, are devoid of 
constipating effects, and do not disturb the diges¬ 
tion. The indication appears to be that Dr. Hag¬ 
gard's views are in accord with others, and in a 
clinical lecture lately delivered at St Bartholomew’s 
Hospital Sir Lauder Bruuton mentioned heroin as a 
useful therapeutic agent for cough, under the cir- 
cumstanoee described. 

Tlie Di^fnosis of Tuberculosis- 

A UEANS of diagnosis in pulmonary tuberculosis 
is found in tbe attentive study by means of the 
radioscope of the function of the diaphragm and 
inspiratory muscles. If one examines a patient 
apparently in a good state of health, or timply 
affected by weakness, and the movements of the 
longs are studied together with the degree of clear¬ 
ness of tbe lungs, and especially tbe action of the 
diaphragm, a diagnosis may be arrived at in the pre- 
tnberculoxis period. The opinion is formed by 
noticing anomalies in tbe synchronism and ampli¬ 
tude of movement of the two halves of the diaphragm 
in their rise and fall or in their curvature, and it is 
possible, in the absence ot any other sign, to give a 
diagnrsis of a predisposition to, or commencement 
of) taberonlosis, unless an evident cause for these 
anomalies can be disooyered. This subject has been 
exhaustively treated by Dr. Bonnet Leon, of Paris, 
and he has communicated bis views to the British 
Congress on Tubercnlosis. 

The Next International Congress of 
Medicine. 

Thb fourteenth International Congress of Medi¬ 
cine will be held at Madrid from the 23rd to tbe 
30th April, 1903, under tbe patronage of King 
Alpbonso Km. and tbe Queen Begent. Tbe anb- 
scription is thirty pesetas (equivalent to twenty-four 
shilliugs). Ladies acoompanying members will be 
able to obtain the privileges of members, t.e., redac¬ 
tions on tbe Spanish railways, Ac,, on payment of 
twelve pesetas, or ten shillings apiece. The National 
Committee for Great Britain and Ireland remains 
the same as at the Paris Congress, Sir William 
MaoCormao, Bart., K.C.B., K.C.Y.O., being the 
President. The honorary secretarira are Dr. Peroi 
val Horton-Smith, of 15 Upper Brook Street, 


126 Th» Mbdkul PaiB*. NOTES ON OUBSENT TOPICS. _ July 81, 1901. 

Qix>BTenor Square, W., Mr. D’Aroy Power,! An inquest was held on the 22nd inst, at Birming* 


F.B.C.S.Eng., ci 10a Ohandoe Street, Carendish 
Square, London, W. 

Oompensation for Oondemoed Meat. 

Thx members of the Yeterinaiy Section of the 
Congress on Tuberculosis were very much in evi¬ 
dence at tbe fifth general meeting of the Congress. 
Every seat in the Queen’s Hall, where the meeting 
was held, had placed upon it a copy of the resolu¬ 
tions submitted to the Yeterinary Section in regard 
to the confiscation and destruction of condemned meat. 
Mr. J. Bowen Jones tried without avail to persuade 
the Chairman to allow these resolnrions to be sub¬ 
mitted to tbe meeting, but Lord Derby said he was 
unable to do so because they contained so much 
matter of an argumentative nature. Mr. Bowen 
Jones was assured that the resolutions would be 
considered by the proper authorities, and like a wise 
man, seeing it was hopeless to press the matter 
further at that moment he acquiesced in the in¬ 
evitable. 

The Sale of Cocaine. 

Thx suicide of two young women in London by 
taking cocaine has served the useful purpose of 
directing public attention to the ease with which 
comparatively large quantitiesof this highly poisonous 
drug can be obtained. There is reason to fear that 
the practice of using the alkaloid as an intoxicant is 
on ^e increase. In reply to a question in Parlia¬ 
ment by Mr. Macdona, it was stated that a committee 
of the Privy Council has been appointed to consider 
the first schedule of the Poisons Act (1868), and that 
the expediency of placing cocaine in that list will be 
referred to it. 

Liability for Domestic Servants. 

In an action brought by Dr. Williams, of North 
Walsbam, Norfolk, against a servant for medical 
attendance the claim was opposed on the ground 
that the girl's master had sent for the doctor, and 
not the patient herself, and on that ground the 
judge gave judgment for the defendant. The juris¬ 
prudence in snob matters is now pretty well estab¬ 
lished, and it would be well in every instance for the 
practitioner who has been nailed to a servant to have 
a clear understanding as to who is going to be re¬ 
sponsible for the fees. 

We are requested to call the attention of those of 
our readers who purpose availing themselves of the 
“tour of instruction ” organised by Dr. Carron de la 
Carrie through the watering-places of Southern 
France, to the fact that all applications must reach 
him at his address. No. 2, B>ae Lincoln, Paris, before 
August 15th. No more favourable opportunity could 
be offered for visiting these picturesque sites and of 
becoming acquainted with the therspeutioal value of 
their springs. The cost of the round trip, including 
travelling and hotel expenses, carriage journeys. Sic., 
is 300 francs (£12). 


ham, on the body of a man who had succumbed to 
chronic brass dust poisoning, and the coroner 
intimated his intention of representing to the Home 
Office tbe desirability of instituting an inquiry into 
the subject. We have no knowledge of specific 
intoxication as the result of inhaling brass dust, and 
it is probable that the deleterious effects with which 
it is credited are in reality due to the irritating 
effects of the dust, as such, on the air passages. 

Two patients supposed to be suffering from 
plague were landed last week at Plymouth from 
the Orient liner Ormuz, and a number of pas¬ 
sengers were vaccinated as a precautionary measure, 
all the crew having undergone this prophylactic 
measure during the voyage. Bacteriol(^cal exam¬ 
ination, however, did not confirm the suspicions, and 
all restrictions have now been removed. 

The death is announced of Dr. Edward S. Morley, 
J.P., of Blackburn, at the age of 70. Dr. Morley in 
his younger days was an enthusiastic athlete, and 
took an active part in the local organisations having 
in view the development of the various sports, but be 
was also a much esteemed physician, and his death 
has excited widespread regret. 

PERSONAL. 

Dr. E. J. Maolxan has been appointed Gynseoologist 
to the Cardiff Infirmary out of six candidates. 

Dr. John Jonrs, who recently returned from South 
Africa, has been appointed Medical Officer to the Mond 
Nickel Works, Clydaoh. 

Mr. R. Whitxbidx Stathav, M.R.C.S., has beeu 
appointed Deputy-Coroner for North Somerset, vies Dr. 
J. Wallace, who has resigned. 

The Fellowship of the Royal College of Physiols. 
London, was bestowed on Dr. W. J. Tyson, of Folke* 
stone, whose Membership is dated 1889. 

It appears that Dr. Isambard Owen has not seen his 
way to accept tbe offer of the post of Principal of the 
Cardiff University College which was offered to him. 

Mibb Aonbs Brtmnbr Sinclair, M.B., Ch.B.01aBg., of 
Clarenceville, Longsight, Manchester, has been ap¬ 
pointed Resident Medical Officer to the Carlisle Dis¬ 
pensary. 

Thx Colonial Office has notified tiiat Dr. E. Bowmaker, 
of Sunderland (an old snbBoriber and contributor to this 
journal), who was in the Ashantee Expeditionary Forces 
died of fever on July 6th at Parmn, Gold Coast 

Interior. 

pRonssoR Robert Koch was entertained at dinner on 
Wednesday evening last at the HAtel M4tropoleby the 
Royal Institute of Public Health, when be was presented 
with the Harben Gold Medal for 1900 and the Honorary 
Fellowship of the Institution. 

Thb “ Baly Gold Medal," which is presented every 
alternate year by tbe Royal College of Physicians of 
London for special distinction in the science of physio- 

Digitized by 


JPLT 81. 1901. 


C0RRE8P0NDB^ CE. 


Ths Hsdicai. pBitt. 127 


logy, hM been this year awarded to Dr. F. W. Pavy, 
F.B.CJ*., F.E.6., oonsnlting physioian to Guy's Hos¬ 
pital. 

Ths Coxmoil of King’s Coll^, London, have eleoted 
Dr. B. Tanner Hewlett, of the Jenner Institute of Pre¬ 
ventive Medicine, to the Professorship of General 
Fatboh^ and Bacteriology; and Dr. 6t. Clair Thom¬ 
son to be Assistant Physician for Diseases of the 
Throat. 

Da. A. Davidsoh, late Senior Assistant Medical 
Officer at the Dorset County Asylum, on his resigoing 
that appointment to enter the Colonial Medical Service, 
has been presented by the medical officers and staff with 
a valuable tea service in silver in recognition of his 
“ sealous work and kind attention." 

Da. Norman Moobk has been selected by ti>e Boyal 
College of Physicians, London, to deliver the Harveian 
oration on St. Luke’s Day, October 18tb, and Dr. Judson 
Bury the Bradshaw Lecture in November. Dr. G. F. 
Still has been appointed Goulstonian Lecturer, Dr. F. T, 
Boberts Lumleian Lecturer for 1902, and Dr. C. £. 
Beevor Croonian Lecturer for 1903,to the same college. 

Da. 8 . WaiB Mitchxll, it is announced, has just 
returned to the States from a trip around the world. 
Evidently the doctor has the reputation of being a 
worker, for a newspaper asserts that six long novels, 
forty-nine sonnets, 103 quatrains and ceveral other 
poems, not to mention four books of sketches, a treatise 
on nervous diseases, fifteen or twenty short stories, were 
dashed off by him at odd moments during his trip. All 
these precious works, we are informed, are now in the 
possession of Bichard Watson Gilder, who has hired 
eight detectives to watch the stuff. 


CorrtBponbme. 

[We do not bold oorselTeareeponaible for the opinions of oar 
oorrespondents.] 

THE PBOPOSED NEW JOUBNAL OF 
OB8TETBICS AND GTN.SJCOLOGY. 

To fAe Editor of Tex Medical Pbiss and Cibculab, 

Sib, — In one of your "Leading Articles" in to-day’s 
issue yon draw attention to a proposal to start another 
Journal of Obsletriet and Ogiueeolog)f, and as there is 
no advertisement or public announcement of the meet¬ 
ing to be held to-day, I suppose it is more or lees of a 
private oonoem. Now we have had some experience of 
a gimilnr effort lu The Ohttetrical Journal, which ran for 
eight years (1878-1800) and then expired. Nearly all 
the gynseoologioal societies in tiiis country issue Proceed¬ 
ings or Tranaaotions, in the main limited to reports of 
tbeir owrn work, but we have already the experience 
of a journal. The Sritith Oynmcolotfical Journal, 
which covers exactly the ground that is pro¬ 
posed to be included in tb^e new journal, and 
has been in existence sixteen years. This jounial 
is not only British, but it is cosmopolitan, and contains 
not only the Transactions of the British GynsBCological 
Society, but also reports of Gie various gynecological 
societies of the Ei^ire, together with material from 
foreign countries. 1 do not see, therefore, where is the 
need or room for another journal on identioal tines, nor 
what prospect it has of a great success, inasmuch as no 
private issue is likely to carry the weight or preside 
that attaches to a society that has done such go^ work, 
or has so world-wide a reputation as the British 
Qynieoologioal Society. Any new journal on these 
lines will be run mi^y in opposition to the Brit%$h 
Gynmeological Journal, and it will require to be some¬ 


thing espedally good to have muoh ohanoe of s ucoess 
against a journal that has mu into sixteen volumes. 
Perhaps one devoted exclusively to obstetrics might do 
better. 

I am, Sir, yours truly, 

Hbtwood Smith. 
Harl^ Street, W., July 24th, 1901. 


To the Editor of Tax Mxdical Pbbss and Cibculab. 

Sib, —Though there are many points raised in your 
leader referring to the proposed journal, there is but one 
that I desire through your columns to comment upon. 
Most emphatically the proposed journal will not be 
representative " of the entim obstetrical and gyneco¬ 
logical world of Great Britain and Ireland." Already a 
large number of prominent obstetricians and gyneeoolo- 
ists, in the metropolis alone, feel that they have bera 
eliberately excluded from all participation in the move¬ 
ment. A meeting, to which they were not invited, was 
summoned by invitation to consider the matter, and its 
proceedings were limited to a favoured few. Further, 
it is an open secret that this journal has been conceived 
and taken in hand mainly by those who are openly and 
avowedly hostile to the British Gynecological Society 
and ito JounuU. Whether under these circumstances 
the promoters of this one-sided undertaking will suc¬ 
ceed in creating "a universal journal" is a point which 
time will prove. One thing is certain—that it never 
will be, in the traeat sense, " representative of British 
obstetrics and gynaecology." 

I am. Sir, yours tmly, 

A LiONDON Obstxtbician and Gtnmcolooist. 

[We can only repeat what we have already said. In 
our opinion there is room for an " imperial" journal of 
obstecricc and gynecology. The more tmly imperial 
the new journal is, the less it will interfere with the 
interests of individual British societies. If, as our oor¬ 
respondents say, the meeting of last Wednesday was 
" more or lees of a private concern," we fear it does not 
augur well for the future snocess of the proposed 
jonmaL Who is responsible for the assumed privacy P 
—Ed.] 

UNDESIRABLE PBOSECUTIONS. 

To the Editor of Thx Mxdical Pbbss and Cibculab. 

Sib,— With regard to your comments (Mxdical Pbbss 
AND Cibculab. July 24^ on the "aMrtive proceed¬ 
ings" against Dr. H. W^hittome instituted by the 
Medical Officer of Health for Camberwell,that gentleman 
no doubt according to his lights performed his duty, or 
at least what he thought such. It should be remem- 
beied, however, that the law forced upon the 
medi(^ profession the exceedingly delicate and difficult 
task of notification, hence very s^ng evidence indeed 
should be forthcoming ere the law is set into motion 
gainst any practitioner. Speaking generally of notifi¬ 
cation, mescal officers of health may take it that the 
tendency nowadays is to notify precipitately; at least it 
is certain that innumerable doubtful cases are recorded 
and sent away at enormous public expense that would 
rapidly recover under the most simple treatment if the 
diagnosis were only delayed for a day or two, and this is 
proved by the fact that so many turn out futile. 

I am. Sir, yours truly. 

Clxmxnt H. Sbbs. 

130, Queen’s Bead, Peokham, S.E., July 24th, 1901. 


FEMORAL CYSTOCELE. 

To {As Editor of Thb Mxdical Pbxss and Cibculab. 

Sib, —As femoral oystooele is very uncommon, I copy 
the following from the Am. Journal of iSurcrery and 
&ynmc6logy A woman with a lump protmd^g from 
the left femoral ring, exquisitely sensitive, the size of a 
small hen’s egg, hard, and somewhat nodular,' came 
uniter observation. There was no finotuation, no impulse 
on coughing, no differmioe in size on the woman tiddng 
the upright position, no history of constipation, and no 
pain during the action of the ImwoIs. 



128 Thi Mbdioal Pbbss. 


MEDICAL NEWS. 


July 81, 1901. 


On the operation table the lump was exposed by 
dissecting nt> a small oironlar flap. The operator 
consider^ toat he had to deal with an omental 
hernia, or, perhaps, an orarian one. After remoring 
the fatty tissue, together with the adhesions that 
had formed round the sao, it was evideot that 
the mass did not oontain an ovary, but resembled a 
thickened piece of omentnm. A snip of the piece was 
made for microscopic examination, and the issue of some 
dear fluid told that a cyst of some sort had been opened, 
probably the urinary bladder. The diagnosis was oon- 
flrmed by the passing of a sound through a very small 
incision. The instnunent was distinctly felt in the 
bladder. The opening was sutured and the bladder 
returned to the abdominal cavity. The patient made a 
good recovery. 

I am. Sir, yours truly, 

Dublin, July27tb. Gsobqs Fot. 


THE ANDERSON FUND. 

Thb Committee formed to app^ for aid on behalf of 
die widow and two sons of Mr. B. 6. Anderson, F.B.C.S. 
(see Mbdical Pbbss ani> Cibculab, July 10th, pp. 49 
60), beg to gratefully announce the following list of sub¬ 
scriptions to July 26th, amounting in all to ^2 lOs.:— 

^ s. d. 


The Earl of Stamford (Chairman) 
Timothy Holmes, Esq., F.R.C.S. (Hon. 

10 

0 

0 

Treasurer) . 


6 

0 

0 

H. E. Jnler, Esq., F.B.C.S. 


2 

2 

0 

Dr. Higham HiU . 


1 

1 

0 

Dr. Lorimer Hart. 


1 

1 

0 

Dr. Alfred Cox . 


1 

1 

0 

Dr. Wheeler O’Bryan . 


0 10 

6 

Dr. Milner Brown. 


0 10 

6 

Walter Monnington, Esq. (Hon. Sec.) 


1 

1 

0 

Lord Lister. 


10 

0 

0 

Dr. Herbert Owen. 


1 

1 

0 

Dr. Duka . 


1 

1 

0 

Dr. W. Domett Stone . 


1 

1 

0 

Dr. John Brown . 


0 

10 

0 

A Friend . 


1 

0 

0 

Thomas Smith, Esq. . 


6 

0 

0 

Sir R. M. Craven . 


1 

I 

0 

E. £. Llewellyn, Esq. 

J. Granville Hotoridge, Esq. 


1 

1 

0 


1 

1 

0 

Dr. C. Crawford . 


1 

1 

0 

J. H. Waddington, Esq. 


0 10 

6 

W. Smith, Esq. 


0 10 

6 

Dr. 0. Coates . 


2 

2 

0 

Dr. G. F. Blandford . 


3 

3 

0 

Total 


^852 

10 

0 


The Eabl of SrAWFoaD, Chairman. 

Tixotht Holxbs, Esq., F.B.C.8., 

Hon. Treasurer. 

Waltbb Monnimoton, Esq., 7, Fig 
Tree Court, Temple, E.C., Hon. Sec. 

Donations for *' latt R. B. Anderson Fund *' should 
be sent and made payable to The Manager, Union Bank 
of London, Chancery Lane, London. 

NOMENCLATURE OF DIARBH(EAL DISEASES. 

Thb Registrar-General for Ireland has issued the 
following circular letter to the medical profession in 
Ireland:— 

General Register Office, 

Charlemont House, Rutland Square, 

Dublin, July 19th, 1901. 

Gbntlbhbn, —I beg to bring under your notice the 
fact that the Diarrhcea Nomenclature Committee of the 
Royal College of Physicians, London, at their meeting 
hddonNovemb6r20th, 1899, recommended the Collegeto 
authorise the use of the term ** epidemic enteritis ” (or, 
if preferred by the practitioner, zymotic enteritis '*) 
as a synonym for epidemic diarrhcea ("Nomenola^ 
ture of Diseases,” p. 9, ed. 1896) and further recom¬ 
mended the entira disuse as synonyms of epi¬ 
demic diarrhcea, in medical certificates of death, of 
such terms as " gastro-enteritis,” ** muoo-enteritis,” or 
** gastric catarrh.” This recommendation was submitted 


to the Royal College of Physicians, London, and unani¬ 
mously adopted at a meeting of the Fellows held cm 
Januaiy 26ti>, 1900. 

I nad the honour of bringiiv the matter under tha 
notice of the Royal College of Physicians, Ireland, who 
have endorsed the opinion of the London coll^. May 
I ask the favour of your kind oo-operation in carrying 
out the views of the heads of the m^oal profession. 

I am. Sir, yours truly, 

R. E. ^TBBBON, Registrar-GeneraL 


©bitURTB- 


8URGE0N.MAJ0R FBEDERTCE ROBINSON, 
M.D., F.E.C.P. 

Thb death is announced of Dr. Robinson, at East¬ 
bourne, an old and much respected member of the Army 
Medical Service (retired). He entered it in 1847 as 
assistant-suiweon in the 74th Foot, in which regiment 
he continued until his transfer to the Scots Fusilier 
Guards in 1862. He became battalion surgeon in the 
year 1867, and surgeon-major of the battaSon in 1867. 
Dr. Robinson accompanied the Scots Fusilier Guards to 
the Crimea in 1864 as senior assistant-surgeon, and 
served uninterruptedly with the battalion until the ter¬ 
mination of the war. During a great part of the time 
he was in medical charge of the battalion. He was 
present at the Battles of the Alma, Balaclava, and 
Inkerman, and at the si^e and fall of Sevastopol, and 
the sortie of October 26th, and had the British medal 
with all the clasps for these engagements, in addition to 
the Medjidieh and Turkish m^als. For distinraish^ 
conduct in the field at the Battle of the Alma ne waa 
recommended for the Victoria Cross by Colonel Walker 
and was personally complimented for his conduct during 
the campaign, on the field at Inkerman by Lord Raglan 
and by the Duke of Cambridge after the Battle of the 
Alma. 

MB. J. A. BIGGE, M.R.C.8., L.B.C.P., OF HENLEY. 

Thb deceased, who had been in failing health for some 
time past, died of pneumonia a few days ago at toe early 
age of 41. He was held in very high esteem by all 
classes in the town and neighbourhood, and his death is 
much deplored. He was an enthnsiaetio Volunteer, and 
also served on the Town Council for three years. He 
had been for some years the medical officer of the Hen¬ 
ley Workhouse, and was also connected with the Hearts 
of Oak Benefit Society, and his kindness and courtesy 
made him a very popular officer. The funeral took place 
at Biz churchyard on Wednesday afternoon, amid every 
token of respect. 




Medical Oold HedaUlsts. 

Thb results of the July Intermediate Examination in 
Medicine at the University of London were published 
on the 23rd inst., and the following are the students to 
whom medals have been awarded:— 

For Anatomy : Ernest Edgar Maples, St. Bartoolo- 
mew^s (gold medal), and William Gordon Taylor, Mid¬ 
dlesex (medal and exhibition). Seymour Gilbert Barling, 
Birmingham University, is marked “ deserving ^ 
medal.” 

For Physiology and Histolo^ : George Hall, Univer¬ 
sity College (medal and exhibition), and Thomas de 
Smith (CamMdge University and London Hospital 
(gold medal). 

For Mate^ Medica and Pharmaceutical Chemistiy : 
Arthur Campbell Stark, Westminster (medal and exhi¬ 
bition). 

The Dublin Death Bate. 

It is with unfeigned pleasure that we note a fall in 
the Dubin death-rate, which is a shade under 20 deathw 
per 1,000. Indeed, the present weather seems to have 
generally lowered the deato-rate throughout Europe 
and Amerioa, tlie rates being: London, 16*J per 
1,000 ; Gla^w, 18'6; Paris, 17'G; Amste^am, 11*9; 







JCLT 81,1901. 


PASS LISTS. 


Phb Mcdioal Pbi88. 129 


19'2. Thiit 7 .ieTen of tbe persona whose deaths were 
regi^red daring the week were nndei five years of age, 
twentjr-fonr being infanta under one year, of whom five 
were under one month old. It would be interesting to 
know bow many of these little ones were nursed 
ohildren, and how many were insured. 

Boyal Appointments. 

Mbssbs. CATfTSBLL AKD CocBBAMK ask US to announce 
that they hare been honoured by the appointment under 
apeoial warrant of purreyore of mineral waters to TTin 
Majesty the King. The waters supplied by these manu- 
faotorers are ao uoiversally known and appreciated that 
they have gained as many as thirty-two gold and prise 
medals. We recently put two or three of these waters 
under laboratory tests, and found they responded to the 
most searching investigation for purity. 

Boyal College of Physicians, London. 

At the quarterly comt^'a of the College on Thursday 
last the following Fellows were elected officers of the 
College for the ensuing year:—Censors, Thomas Tillyer 
'Whipham, M.D., Sir Dyoe Duckworth, LL.D., M.D , 
Tbomas Henry Green, M.D., George Vivian Poore, M.D.; 
treasurer. Sir Dyoe Duckworth, M.D.; Emeritus regis¬ 
trar, Sir Henry Pitman, M.D.; registrar, Edward 
Liveing, M.D.; Harveian librarian, Joseph Frank 
Payne, M.D.; library committee, Samuel Gee, M.D., J. 
Wickham Legg, M.D., Norman Moore, M.D., William 
Henry Allohin, M.D.; curators of the museum, W. 
Howship Dickinson, M.D., E Charlton Bastian, M.D., 
William Cayley, M.D.. John Abercrombie, M.D.; finance 
ommittee,^. Tillyer Whipham, M.D., A. Lewis Galabin, 
M.D., and Stephen Mackenzie, M.D. The examiners 
for the ensuing collegiate year were elected at the same 
meeting. 

The following candidates having passed the required 
examination, were admitted members of the college:— 
Thomas Bushby, M.B.Edin., Univ. Coll., Liverpool; 
Arthur H. W. Clemow, M.D.Edin., Univ. Coll., Liver¬ 
pool, and Leipzig; John C. M. Given, M.D.Lond., 
Liverpool Boyal Infirmary, Univ. ColL, London, and 
Vienna; Thomas W. Griffith, M.D.Aberdeen; Arthur 
D. Heath, M.D.Lond.. L.B.C.P., and M.B.C.S., Univ. 
Coll.. London; Thomas MoCrae, M.B.Toronto, L.BG.P., 
and M.B.C.S., Toronto and Gottingen; Frederick C. 
Moore, M.D.Viot., Owens CoU., Muohester; Harold 
D. Singer, M.D.Lond., L.B.C.P., and M.B.C.S., St. 
Thomas’s. 

The College of Preceptort. 

Aooobdimo to the report just issued the number of 
osmdidatee for the professional preliminary examination 
in March last was 172, a mark^ increase on the figure 
for the previous year. 

Leprosy in Russia. 

Thx measures taken to stamp out leprosy in Bnssta 
have not, so far, been attended by much snccesa. In 
Lithuania, for instance, there are 609 cases under 
medical enpervision, and there are 201 in Conrland, 124 
in Astrachsn and 121 in the Kuban district. Last year 
a marked increase is stated to have taken place in the 
Cancasns, Central Asia, and East Siberia. In addition 
to the official easee there is every reason to apprehend 
that the disease exists in many other distriots, and steps 
are being taken to invesrigate its prevalence. 

SmaU-pox at ChUd's HUL 

Thskb have been ten oasee of small-pox in all at 
Child’s Hill, the disease having been imported from 
Port Said. The sufferers were promptly isolated in an 
open-ur camp, and the outbreak is now believed to ^ 
at an end, although a number of snspeots are still under 
obeervarion. 

Hetropolltan Asylnms’ Board. 

Dubino 1900 the numbers of patients suffering from 
fever, diphtheria, small-^x, and "other dimases,” 
admitted into the hosjntals of the Board were as 
follows:—Scarlet fever, 10,848; diphtheria, 7,878; 
enteric fever, 1,728; ^phns, 4; small-pox, 66; and other 
diseases (ezMusive of the non-small-pox oases detained 
at South Wharf or sent home at once), 1,707. The 
mortality per cent, was as follows:—Soariet fever, 2^; 
diphtiieria, 12*27; enteric fever, 14*09; ^phui, 22*28; 
small-pox, 4*36; and other disMscs (exolusiTe of the 


non-small-pox oases), 9*90. The bnlk of the 66 oases of 
small-pox owed their infection to persons who them- 
sdves had contracted the disease abroad or in the pro¬ 
vinces, and were taken ill soon after their arrival in 
London. During the financial year ended at Michael¬ 
mas, 1900. the managers spent £832,466, an increase 
of £66,682 over the preceding year. 

Typhoid tn South Africa. 

In reply to a question by Sir Walter Foeter, M.P., it 
was stated that from returns received since June 26th 
the deaths for the four weeks ending April 26th are now 
given as 194. For the five weeks ending May 81st the 
admissions were 2,300 and the deaths 326. 

Here Offloers for Volunteer Medical Staff Corps. 

It has been decided, in order that each Division or 
Company of the Volunteer Medical Staff Corps may have 
on its establishment a sufficient number of officers to 
supply the full quota on mobilisation, that additional 
Lieutenants shall be appointed, and officers so appointed 
will be granted outfit ^lowanoe. 




Boyal College of Physicians and Boyal College of Surgeons 
Ireland. 

The following oandidatee have passed the Second 
Professional Examination: — 

(al In all snbjeots.—J. Grace. 

(b) Completed examination.—P. Donnellon. A. H. B. 
Duncan, H. B. Evans, D. Gillies, B. D. Gibson, M. 
Harley, L. F. Kelly, T. Keogh. A. C. Lewis, F. J. Moore, 
J. O'Doherty, J. P. O’Doanell, D. J. O’C. Kelly, P. P. 
Byan. 

The following have passed the Second Professional 
and Third Professional Examinations ;— 

Second Pbofessional, Pabt II. 

(a) All Bubjeots.—Honours: M. J. Byan. Pass: C. P. 
O’B. Butler, B. G. Griffin, L. B. Hanbury, Jas. Hayes, 
B. A. Murphy, L. P. Stokes. 

(b) Completed examination.—H. E. F. Hastings, J. 

B. H. Macmanns, V. H. MaeSwiney. 

Thibb Pbofessionai.. 

(a) All Bubjeots.—Miss L. N. Alexander, J. E. Brere- 
ton, A. Charles, T. A. Dillon, Jas. Dwyer, C. Foley. Miss 
H. A. HaU, W. B. A, Moore, C. E. O’Keeffe, P. W. Power, 

C. Waters. 

(b) Completed examination.—Miss M. E. Biidgford, 
S. Brown, J. Cuffe. Mies H. A. Driver, G. Laoy, J. J. 
Molnemey, S. B. M'Cansland, 0. F. M. Ormsby, W. 
Soott, G. y Sexton, 8. A. Tucker, G. B. Wilkinson. 

The following candidates have passed the final exa¬ 
mination :— 

(a) All subjects: 

1. Honours in order of Merit: P. I. Hanafin, Ed¬ 
mund Glenny, Miss M. J. Shire, A. H. B. Hartford. 

2. Pass; aJphabetioaUy,—^H. L. A. Barry, J. P. Byrne, 
F. J. Cahill. M. J. Johnston, J. F. L. Keegan, I. M. S. 
Levis, J. Longhrey, D. J. O'BeiUy, John White. 

(&) Completed the Examication.—A. J. Connolly, 
P. L. Croebie, C. H. Felvey, J. S. Lane, M. E. Lynch, 
B. F. MaoMsJion. 

University of Aherdesn. 

At the Graduation Ceremony on Wednesday last, 
July 24th, the following Degrees in Medicine were oon- 
fen^:— 

Dbobbb of Doctor of Medicine (M.D.). 

John Baker, M.B., C.H.; William John Byree, M. A., 
M B., C.M.: Clarence I. Ellis, M B., C.M.; Douglas Ver- 
ooe Haig, M.B., C.M.; James Selkirk Laing, M.B., C.M.; 
Harry OUphant Kicholson, M.B., C.M (New Begolations); 
James Porter, MA.., M.B., C.M., B.B.; James Wallace, 
M.A.. M.B.. C.M. 

The Thesis of Mr. H. 0. Nicholson was awsuded 
" Highest Honours,” the Thesis of Mr. J. 8. Laing was 
awarded " Hononrs,” and the Theses of Messrs. John 
Baker and Douglas V. Haig were awarded "Commen¬ 
dation.’' 

The Lord Beotor’s prize for the best Thesis for M.D. 
of the year has bm awarded to Mr. H. 0. NioholsML 



130 Thi M»dioal PBwa. KOnOES TO COBBESPONDEyTS. _ Jplt 31 . i.,„. 


fiotiaa t0 

Corr£0iwmbwita, Short ^CcUtra, Ac, 

COMKSFOKOiVTB reqairiogT b >^pl7 in this oolnmn nre par- 
^taatulx raqaeated to maka naa of a di<tinoMP« lignatun or 
<«<tia{f, andaroid tha practioa of ai^ningr tbemsalTea’* Beadar,’* 
'*Sabaorlbar,” “Old Sabaoribar,'* Ao. Vncb oonfoslon wUl ba 
apared by attention to this mla. 

BBPKiKTa.—Beprints of articles appearinfr in this Jonmal can be 
had at a rednoel rats, providing authors grive notice to the pnb> 
lUher or printer before the type has been dittribnted. This should 
be done when retuminq oorraoted proofs. 

Oatsiaai. Articles or LaTTsas intended for publication shonld 
ba written on one side of the paper only, and mast be authenticated 
with the nameand address of the writer, not neoeesarilyfor publica¬ 
tion bnt as aridence of identitr, 

BiiDiso Cases.—C loth board cases, pilt lettered, containing^ 
twenty-ria strinffs for holding the numbers of Tsb Ubdical Press 
ABO Circular, may now be had at the office of this journal, 
price 28. 6d. These oases will be fonnd very useful to keep each 
weekly numberintact, clean, and flat after it has passed through 
the post. 

SBOWLEDOE AND WISDOM. 

Tbb keen comment of TennyMn’a when he said, " Knowledge 
eomes, bnt wisdom lingers," indicates the difference between the 
twe, a difference never better expressed than in the well-known 
lines of Cowper: 

“ Knowledge and wisdom, far from being one. 

Have ofttlmes no connection. Knowledge dwells 
In hea^ replete with thoughs of other men; 

Wisdom in minds attentive to their own. 

Knowledge is proud that he has learned so mnch; 
Wisdom is humble that he knows no more.” 

Ib a recent number of the Journat of (As Amsrtcsn Medicai Asso¬ 
ciation the first item in the index is as follows: “ Poverty and 
Pregnanoy; Their Cause, Prevention and Core. N. 8. Davis, M.D., 
Chicago.” A glance at the article shows the printer's evil geuios 
has been “ at it again.” Pregnancy shonld read *' degeneracy." The 
peccant genius must have bMn very bad that day I 

PuROAiiTEB.— Salines operate in three orfonr bonn; croton oil 
in one or two hours; jalap, gamboge and senna in three or fonr 
honn; rhubarb and castor oil in from four to six hours; aloes and 
mandrake in from ten to fourteen hours. Some pills in two or throe 
yean. 

home mistaken impbessions in begabd to GENITO- 

UBINABT TEODBLK8. 

Tbb special mistakes noticed by Dowd are: the belief in 
the frequency of cystitis due to gonorrhcea, the frequency of 
vaginitis, the recognition of albnminnria and casts as always 
inucating nephritis, while they oconr frequently during orethi^ 
inflammation with no other disease, and the common notion of the 
greater serionsoess of syphilis as compared with gonorrhsa; he 
also meniions the common belief ihat: twisting or screw-like 
formation of urination as it emerges is Indicative of stricture, which 
is not the case.—N. Y. Mtdical Rtcord, 

A Queer Verdict.— A despatch from St. Louis to Tht New York 
Time* says that the head of a man, wrapped in an old coat, was 
found recently in East St. Louis, and when the coroner held an in¬ 
quest over it a verdict of suicide was returned. We fancy we have 
osen tbi« story before, or something very analogous thereto. 

Dr. Mobde.—T hyroid extract has been employed with success in 
some recorded cases of alopecia areata, but it has failed in the 
hands of others. It is probable that under this designation are In- 
olnded inore than one variety of localised baldness, and in any 
event the constitution of the individnal sufferer is a factor not to m 
lost sight of. 

Bbixtoh.—T he charge is a fair one underthe exceptional circum¬ 
stance. 

Edimburgh Studebt.— 1. We understand a revised edition is in 
the press. 2, A question we are unable to answer; write to the 
publishers. 

Mr. F. Debbab.—T he su^eon named died about two years 
since. We have no copies of the number containing the obituary 
notice left. Yon will find bound copies for reference in your 
oolite. 


Allek, W. T. D., M.B., B.Ch., B.ir.1., Medical Officer for the 4th 
District of the Parieffi of Liverpool, vice S. Caldwell, M.B.C.S., 
resigned. 

CoLLiBBOB, Harold, M.B.Lond., M.B.C.S., L.B.C.P., Beaident 
Casualty Officer to the General Infirmary, Leeds. 

Crawsbaw, E. £., M.B.C.8., LB.C.P., BesidentObstetrio Officer to 
the General Infirmary, l^eeds. 

FLEMiiia, A. D., M.B., M.S.Edin., Certifying Surgeon under the 
Factory Acts for the Kelso Distriot of the ^nnty of Bozburgh. 

Fowler, H. W., M.B.Bdia . Assistant Medical Electrician to the 
Boyal InfirmaCT, Edinburgh. 

Nash, J. T. C., M.D.Edin., D.P.H.Cantab., Medioal Officer of 
Health for the Borongh of Southend-on-Sea.1 

OaroRD, T. C.. M.B.O.S.. L.B.C.P., Besident Medical Officer to the 
Salford Union Infirmary. 


Boris, Obo., M.B.. M.Ch.Edin., Senior Assistant Medioal Oflloer to 
the Dorset County Asvioin, DorobesW. 

Buthervord. B. a.. LB.C.P., L.B.C.S.Edin.. Gertifylog SurgeoB 
under the Factory Acts for the Klnlongh Dispensary District of 
the Ballyshaunon Union. 

Spares, J. P., M.D.I>urb., Medioal Officer of Health of Wldtlsv 
and Mookseaton Urban Sanitarv Districts. 

Stevbhbob, Edoar. M.D. Aberd., Demonstrator in Opbthalmologr 
at University Collsge. Liveroool 

Strbeten, F. E.. L.B.C.F.£<lin., M.B.C.S.Eng.. Medical Ofioar of 
Health of Swindon Urban Sanitarv District. 

Turbzr, D. F. D., M.D.Edin., Medical Eleotrlcinn to the BojrI 
Infirmary, Edlnbnnth. 

Wiohab, j. H., L.B.C.P.Edin., L.B.C.S.Edin., L F.P.8.O., Medioal 
Officer of Health of ^nth Molton Municipal Borough. 

WiLEiBS, A. O.. M.B., Ch B., Beadent Medical Officer to the 
Salford Union Infirmaiy. 

WILZIBSOB, J. HOWABD- M.B.C S.Bng.. L.ILC.P.Lond.. D.P.H. 
OxoD., an Honorary Snrgeon to the Guest HospitU, Dudley. 


^ocancteB. 

Devon County Asylum, Ezminjter, near Exeter.—Third Assistant 
Medical Officer. Salary£l25. rising to £150, with board, lodg¬ 
ing, Ac. Applications to the Medical Superintendent. 

London Ho^ital, Wbltecbapel, E.—Assistant Director of the 
Fatbotogical Institute. ^Isty £200 per annum. 

North Wales Counties Lunatic Arylum, Dmbigh.—Second Assist¬ 
ant Medical Officer. £120 per annum, increasing to £160, with 
board, residence, and washmg. 

Nottingham General Dispensary.—Assistant Besident Surgeon, 
unmarried. Salary £160 per annum, incressing £10 every year, 
with furnished ap^ments, atteudance, light, and fuel. 

Oxford, Combined Bural and Urban Distriot ConnoUs of. — Medical 
Officer of Health. Salary £750 per annum. 

Boyal Sea-Bathing Hospital, Blasts.—Two Besident Surgeons, a 
Senior and Jonior. Salary £120 and £80 per annum respec¬ 
tively, with board and rosideuca. 

Bubery Hill Asylum. Barat Green, Worcestershire.—Junior 
Assistant Medical Officer. Salary £130 per annum, with t>oard, 
furnished apartments, Ac. 

Bural District Council of Bishop Auckland.—Medical Officer of 
Health for the Bural District, ctelary £350 per annum. Whole 
time t > be devoted to the office. Applications to the Clerk 
of the Council. Bishop Auckland. 

St. Matthew, Bethnal Green Infirmary, Cambridge Boad, N.E.— 
First Assistant Medical Officer, unmarried. Salary £150 per 
anuum.with board, lodging, andlaundiw, 

Somerset and Bith Lunatic Asvlum. Wells, Somerset.—Medical 
Superintendent. Salary £600 per annum, with famished house 
and allowanoes. 

University of Sydney, New South Wales.—Professor of PatboloCT. 
Salary £900 per aonum. Pension £400 per annum after twenty 
years' service. £100 allowed for passage. Further particnlan 
of the Agent-General for New South Wales, 9, Victoria Street, 
London, S.W. 

Whit^aven and West Cumberland Infirman.—House Surgeon. 
Uala^ 4120 per year, and £30 per year fCr Dispensing, with 
furnished apartments and attendance. 


^Qirtho. 

Obubb.—O n July 23rd, at Neuenahr, Oennany, tiie wife of Karl 
Grube. M.D., L.B.A Lond., of a son. 

Maceib. -On July 24th. at Wellington, Shropshire, the wife uf 
George Maokie, M.B., of a son. 

Mabsell-Woodhouss.— On July 2lit, at 18, Beaumont Street, 
London, W.. the wife of Waiter Mansell-Woodhonse, M.B.C.S. 
Eng., L.B.C.F.Lond., of Wantage, Berks, of a son. 
Willums-Frebmab.— On July 23rd, at Weyhill, Andover, ths 
wife of John F. WUliams-Freemas, M.D., of a daughter. 


4itono9e0. 

Gillak—S zRiMBHiRE —On July 25th, at St. Andrew's Church, 
Holt, Norfolk, Joseph B. Olllam, M.B., B.Ch.Cantab., to 
Dorothy Jane, elder daughter of J. Trusoott Skrimshire, M D.. 
of Holt. 

HoRSPALL—C ampbell.— On July 24th, at Holy Trinity Church, 
Melrose, Chas. E. Horsfall, M.B., of Bedale, Yorks, son of ths 
late Hy. Horsfall, M.D,, to LlUas Marianne, daughter of B. 
Hume t'ampbell, of Glendaruei. 

Hill—Freud, - On July 2ith, at St. Psnenu Church, Loudon, 
Joseph Shnter Hill, L.B.C.F., M.B.C.S.. of 22, Mecklenburg 
Square, eldest son of tbs late Samuel Hill, M.D,, to Bebecoa 
Billingriey, widow of A. B Frend, Esq. 

Howat—Keox.— On Julv 24th, at All Saints' Church, BakewsU, 
Bobert King Howat, M.B, F.B.C.S.Ena., eldest son of Andrew 
Howat. HiUhead, Glasgow, to Mabel Mary, elder daughter of 
John Knox, M.D., Cnurch House, Bakewell. 


Seothe. 

Black.— On July 23rd, at Fete dn Lion, Valtonrnanche, Italy (the 
result of an accident), Bobert Black, M.D., of 14, Pavilion 
Parade, Brighton. 

Oobbal;,.— On July 18th, after a long and ^nfnl illnesa. John 
Hanklnaon Gomall, M.B.O.S,. L.8.A., J^., during 21 yean 
Medical Officer of Health of the Borough of Warringtou 

Shettli.—O n July 21st, at Nailsworth. Oloaossterahire, Bichard 
Charles ShetUe, M.D., aged 76, for 28 years Physician to ths 
Boyal Berkshire Hospital. 

Wavbll.—O n July 24th, at 6^ High Street, Newport, Isle of Wight. 
Jane Seurle, Irldow of Bobert Miller Wavell, M.D., J.P., aM 
93 ysart. r:- 



tm an! ®wntte. 



**8ALnS FOPULI SUPBEMA LEX/’ 


VoL. cxxni. 


WEDNESDAY, AUGUST 7, 1901. 


No. 6. 


CDnQtndl CammtmicBtiona. 

NINETEENTH CENTURY 
PROGRESS IN OBSTETRICS AND 
GYNECOLOGY, {a) 

Bt JOHN W. BTERS, M.A., M.D., M.A.O. 

(Hon. Causa); 

Profewor o( BQdwiferr uid OyiuecoloCT, QiiMii'a Coll^, Belfast! • 
Fwidaat of the SMtion. 

This bein/^ the first meeting of the Association 
held in a new century, it is only natural that we 
should seize upon the present as a snitable ime to 
look backward and to ask bow have obstetric 
medicine and gynaecology advanced during the Nine¬ 
teenth Century, a period more fertile in the results 
of scientific research than that of almost all the 
years that have gone before. It was during tbe 
century that has recently come to a close that 
the ^reat obstetrician, Simpson, discovered the 
practical application of aneesthesia in labour, and 
that tbe methods of antisepsis and asepsis were 
gradually evolved; and these two all-important aids 
have really been'the causes of the enormous advances 
in both OMtetrics and gynsscology daring the past 
quarter of a century. By their combined help ope¬ 
rations (such as the Csesarean section, and symphy- 
sbtomy) which had formerly been abandoned with 
regret, owing to their high mortality, have been re¬ 
established as recognised safe measures of practice, 
and many new and improved methods of ti^tment 
have b^, from time to time, successfully introduced. 
Conditions which before were regarded as incurable 
were treated with marvellous success, and, as a 
result, both diagnosis and technique have been almost 
revolutionised, because during these operations the 
obstetrician or gynsecologist was brought face to 
face with situations hitherto undescribeC while, as a 
further result the morbid specimens removed have 
given to the science of pathology an enormous 
impetus by affording an opportuni^ for the study 
ofmtereeting material wluch has not before been 
described. 

In tbe early part of the Nineteenth Century 
Naegele’s brochure on “ Tbe Mechanism of Labour ” 
gave us what Tyler Smith called the “ Euclid of 
Obstetrics ’’; in more reoent years Barbour’s Ana¬ 
tomy of Labour,” as studied in frozen sections, has 
done much to make our knowledge of that interest¬ 
ing process more oorreot. WMle the Eighteenth 
CmtiOT will always be remarkable for the work done 
by 'William Hunter on obstetrical anatomy as in- 
'Twtigated by dissection, tbe Nineteenth Century has 

(a) addnHdeUvuvdftttheopmiiafof thvBwtton of Obttvttioa 
^ OVBBooIogT th« Anaau Keettaif of the Mtieb Kedlosl 
SMOdktioB et Chettanhsm, UOL 


enormously advanced onr ideas of the subject by 
enabling ns — thanks to improved methods — to 
observe it as presented in a series of frozen 
sections. By a careful study of these sec¬ 
tions, taken at successive stages, we have 
the whole progress of labour pla^d before onr 
eyes, and we can follow it step by step as we read the 
pages of a book. Several of the leaves are still 
wanting in this volume of sectional anatomy, hut, 
when it is complete, we shall have what I may term 
a sort of cinematograph representation of the whole 
progress of labour, which undoubtedly will exercise 
a most important infinenoe on olini<^ work. Tbe 
Nineteenth Century will always have associated with 
it the practical application of abdominal palpa¬ 
tion wbiob is BU<^ on addition to aseptic mid¬ 
wifery, by limiting tbe necessity for frequent vaginal 
examinations. 

It was during the century that is gone that the 
axis-traction forceps was invented, that the manage¬ 
ment of the third stage of labour was placed on a 
scientific basis, and that we have leamea better how 
to deal with such complications os the hsemorrhages 
which may occur both before and after the birth of 
the child. Almost all our knowledge of the diagnosis 
and treatment of extra-uterine pregnancy and of 
deoiduoma malignum has been gained, and by tbe 
perfection of other operative measures, craniotomy 
on a living child has t^n, we hope, banished. Some 
in this room remember when it was thought that all 
lying-in hospitals must be closed owing to tbeir 
iMing hotbeds of puerperal fever; at the mose of the 
century we had to admit that in no place is a par¬ 
turient woman so safe. Turning to the sister 
science, gynaecology, what rapid and brilliant strides 
it has m^e in the l^t twenty-five years! Diagnous 
has been rendered more exact by the bimanual 
method of examination in the dorsal posture. 
Proper views have arisen as to uterine displacements, 
and, owing to the success of ovariotomy, not only 
have thousands of years been added to the sum totu 
of woman’s life, but as a result the great triumphs of 
abdominal and pelvic surgery have followed. 
Tamnal coeliotomy has been established as a most 
uselnl alternative in many cases to abdominal sec¬ 
tion, and, largely owing to the Trendelenburg 
position, abdominal hysterectomy for fibroids has 
become a more and more snooessfm prooeeding. Our 
ideas as to the inflammatory diseases of the appeal- 
d^fes and of pelvic hsmatocele have been revolu¬ 
tionised; but with all this enormous prc^fress, there 
are two subjects about which, unfortunately, we 
cannot boast—^puerperal fever and uterine cancer. 

It is indeed a terrible blot on onr obstetric art, 
that while within the memory of many of ns puerpe^ 
fever has been banished from matmiuties, m which 
formerly it was so prevalent, the same good raidta 
have not followed in generid practice. 1 will give 
statistics from the tiiree kingdoms. .-v y-. I /-v 

Digitized by VjOOQ IC 






132 Tbb BisDioAi. Pbiss. ORIGINAL GOMMtJNIOATlONS. 


Avo. 7, 1901. 


Mortalitt from Fubrfkral Fbtbr IK Ekoland 
AND Wales. 

In 1847>1856 the mortality from puerperal fever 
was in England and Wales 1'8 per 1,000. It rose to 
2*28 in 1875-1884, and to 2*46 in 1886-1895. 

The following figures, which I owe to the kind¬ 
ness of Dr. Bozall, who has taken such an interest 
in this question, give the more recent ayailable 
statistics. 

Year. Dasths from Dasth^rote from PnarpanU 

Poarpanl Favar. Fererpar 1,000 Birtha. 

1896 ... XS49 . ... 20 

1896 ... 2,063 2*2 

1897 ... 1,836 1*9 

1898 ... 1,707 1-8 

1899 ... 1,908 . ... 20 

Dr. John Tath^, Stati^cal Superintendent, 

General Register Office, has kindly supplied me with 
the following most inteiestii^ details 

Deaths of women at all ages from puerperal fever 
a^ other aoddents of childbirth per 1,000 registered 
births in England and Wales. 

1871-80 . 4-72 per 1000. 

1881-90 . 4-73 „ 

1891-99 . 6 12 

Irblakd. 

The following return showing the number of 
deaths in Ireland tabulated under parturition (acci¬ 
dents) and puerperal fever, 1 owe to the courtesy of 
Hr. B. E. Matheson, Registrar-General of Ir^and:— 

Yasn. TotaL Death-rate per 1.000 

Births Beflstered. 

1896 ... 769 . 7-2 


1896 ... 679 . 

1897 ... 696 . 

1898 ... 560 . 

1899 ... 601 

For the same years the deaths from puerperal 

fever for the whole of Ireland were:— 


6-3 

6*5 

53 

6*8 


Tear. 

1895 


Bata per 1,000 

. 3*0 

1896 

• •s 

. 2*3 

1897 


. 2*1 

1898 


. 1*7 

1899 


. 2*0 


I am obliged to the Registrar-General of Scotland 
iar giving me the following table showing the 
death-rate from puerperal fever in Scotland miring 
the five years 1895-1899 


Tear. 

Number of 
Deakha. 

Proportion in 
eveixlOOOOO 
of female 
population. 

ProportiOBln 
ereix 10,000 
epecified 
eansee of 
Death. 

1895 

253 

12 

62 

1896 

220 

9 

63 

1897 

205 

9 

62 

1898 

227 

10 

59 

1899 

214 

10 

54 


When we contrast these lamentable statistics with 
th <0 following retoms for the last two years of the 
practice of the Rotunda Hospital, the largest lying- 
in charity in the three kingdoms. 

Mortality at the Rotunda Hospital for the 
Tears 1898-99 and 1899-90. 


latam ICaternitp. 

ISOS-W. 

ISM-IMO. 

Total cases . 

1,691 

1,560 

Total mortality. 

10 

6 

Percentage mortality. 

0*62 

0*38 

Mortality from sepsis (2 of 



these admitted septic) ... 

5 

0 

Exton Sbtemitv. 



Total cases . 

2,163 

2,109 

Total mortality . 

8 

5 

Percentage mortality 

0*36 

0*23 

Mortality from sepsis 

2 

0 

Total cases . 


3^ 


0*27 


Total percentage . 0*47 

For two years, total ... 7,423 

Percentage . 0*39 

they should make those of us who are teachers 
feel how great is our responsibility, and that our 
efforts should be redoubled in urging upon students 
the importance of regarding the prooess of labour 
as a natural one, and not to be lightly interfered with 
unless nature herself should fail, and that if inter¬ 
ference became necessary they should use exactiy 
the same antiseptic precautions that they see 
employed in any gyneecological operation. It is W 
the observation of these two principles—the avoid¬ 
ance of meddlesome interference and by the rigid 
use of antiseptic principles—that we may hope wat 
in the present century the occurrence of puerperal 
fever will eventually be as rare in private practice as 
it became in the Nineteenth Century in lying-in 
horaitals. 

The other subject in regard to which, I am afraid, 
we cannot congratulate ourselves, is cancer of the 
uterus. How does it originate? Why is it so 
common P Nay more, why (at least this is my 
experience) is it becoming more prevalent ? 
These questions, sorely demand solution. I 
am reluctantly forced to agree with a state 
ment made by a distinguished American con¬ 
frere, Dr. Baldy, in a paper read before the 
Section vf Gymeoology, College of Physicians of 
Philadelphia, February 2l8t, 1901:— “ Cancer 

affecting the cervix uteri is one of the most deadly 
diseases with which medical men have to deal, By 
far the largest proportion of these patients eventu¬ 
ally die of cancer, oe it from the primarv lesion or 
from a recurrence. And this in spite of ail that has 
been done for them either suigii^y or medically.” 
No doubt some gynecologists may say the explana¬ 
tion is that operation is not done early enough, but, 
as Dr. Baldy fairly asks, “What is sufficiently 
early?” Every gynecolo^t of experience must 
admit he or she hM met with cases where recurrence 
took place rapidly in what seemed to be at the time 
of operation a most promising condition, while, 
again, women with ext^ive disease have remained 
well for years after operation. We have passed 
through the stages of vaginal and of abdominal 
hysterectomy for cancer of the cervix, but I 
ask have we up to the present made much real 
progress? It is not the immediate results of the 
operation we want to know; it is the subsequent 
hUtory of the patients. At the present time we can, 
unfortunately, suggest no other plan of treatment 
of cancer of the cervix except by operation, but 
surely we cannot boast much if the statement of 
Baldy is correct that the most recent statistics, those 
reported in OoUen’s work on “ Cancer,” and the re¬ 
view of cases by Winter of Konigsberg, show that in 
reality less than 5 per cent, of all cases applying for 
treatment of cancer of the uterus are savM by opera¬ 
tion. The obvious lesson is that to ensure any real 
Buccees we must urge on practitioners the enormous 
importance of earty diagnosis, and that the one 
symptom which should always be regarded with 
suspicion is abnormal hsmorrhage. Any woman 
wiw abnormal hsemorrhage at any age, and especially 
if she is over 35 years, demand ^e most careftd 
clinical examination. Let us hope for greater pro¬ 
gress in the future. 

Having glanced in what, 1 am afraid, is a very 
cursory survey, at the progress of these subjecta 
which specially concern us, let me turn to another 
question of the greatest interest ^o the State, as well 
as to the medical profesmon. During the present 
year the public press has been calling special atten¬ 
tion to the falling birth-rate. It would sppear that 
in England and Wales, in 1861-71, the birth-rate per 

Di;....zecl t- 








Ava. 7 . 1901 . 


OBJOINAIj COlfM U r) IGATIO^S. Tex Mxdioal Pxbm. 133 


1,000 vas 34-8. In 1871-81 it was 34 7, in 1891 i 
was 31’4 per 1,000, and since then it has steadily 
gone down, until in the last year of the century, 
1900, it was only 29 per 1,000. in 1875, 35 cbildr^ 
were bom in the United Kingdom for each 1,000 of 
the population, while in 1900 there were only 29. In 
otiier words this means for our population of 41^ 
millions we are losing 249,000 onildren annually, 
and the birth-rate has fallen by 2'67 in the last ten 
years. The actual increase of the population of 
England and Wales is due to the fall in the death- 
rate and the increase of immigration. 

We are thus rapidly in England approaching the 
condition preruling for some time in France and 
America. It is not for me at present to discuss the 
oanses of this declining birth-rate, rather my duty is 
to ask what remedy can we as doctors su^i^est to 
combat a state of matters which,from a natioi^ and 
imperial standpoint, must be regarded as unsatis- 
fB<^oa 7 . If fewer children are, in the future, to be 
bom in this oountry we must r^ouble our efforts to 
lower the awful death-rate of infants which, daring 
the first year of life amounts in England to 154 per 
1,000, by teaching the people to pay much greater 
stiantion to rear their children properly, and by 
uripng the public authorities to provide an adequate 
supply of pnre milk. Our American friends are far 
ahead of us in such matters, and they showed their 
usual extraordinary enterprise last summer when 
they sent pure. non-eterilisM milk from various rarts 
of the States (IllinoiB, New Jersey, and New York) 
to the Paris Exhibition, where it was actually pro¬ 
nounced better than the average milk sold in the 
grounda Quite recently tiie “ B^kfeller Institution 
for Medical Research,** founded by a gift of £40,000 
from the millionaire whoee name it bears, has decided 
that the first investigations to be xmdertaken by tbe 
scientific experte connected with it will be to co¬ 
operate with tbe New York Board of Health in study¬ 
ing the milk supply and the contaminated article as 
s sonrie of danger. But we may a'so attack this 
serious problem in another way by taking greater 
precautions when a woman is pregnant that she may 
give birth both to a living andhe^thy child; in other 
words, we must take more care to combat those 
conditions which are so danmroue to the child’s 
life before and during its oirth. I am afraid 
it is still too frequently the practice of the 
present day, when a patient engages a medical 
man to attend at her confinement, simply 
to note the engi^ment, to give a few gener^ 
directions, or perchance none at all, and, perhaps, 
in some caeee to examine the urine. May I urge 
that obstetricians should give a much more careful 
attention to patients who are pregnant, and especially 
n the case of those looking forward to their first 
confinement. A pregnant woman, when she engages 
a doctor to attend her, should be examined as care¬ 
fully as if she were an applicant for life insurance; 
in this way he may at an earl^ date detect a flaw in 
some of her organs (heart, kidney, lungs, &c.), tbe 
knowledge of which may lead him to adopt a 
jadicioua prophylactic treatment. We should in¬ 
struct our pregnant patients on such questions as 
diet, exercise, and management of the secretions; and 
s most careful examination should be made uf the 
urine fnun toe fourth month onwards, not merely as 
to the presence of albumen, but in reference to its 
total amount and the reduction of urea. In this 
way a form of toxemia (eclampsia), so fatal to mother 
and child, may from its earlv detection be carefully 
▼arded off, for it must be a^itted that, in the vast 
niaiority of oases, the treatment of eclampsia, like 
post*partam hemorrhage, is its prevention. To¬ 
wards tbe end of gestatiton a most careful abdominal 
examination ■boold be made, so that we may learn 
tbs position of the fcetiu, the amount of liquor amnii, 


the presence or not of an abdominal tumour, and, if 
there is the least suspicion of deformity, the pelvic 
cavitv should be most carefully measured. We must 
also he on our guard against the dread mfluence of 
the syphilitic poison, and the injurions effects of 
anemia. In the case of multiparm, an accurate his* 
toiy of previous pregnancies and labours is of the 
utmost importance. In this way, by a careful, and, 
if necessary, by a repeated examination of the 
patient, we may by an early detection of complica¬ 
tions ward them off or keep them in such abe-rance 
that their danger is .minimised; and if there should 
be any deformity of the pelvis we can make up our 
mind what method ci delivery is best suited for 
each particular case. By all these measures we hope 
that not only a living but a healthy child mav oe 
bom, and tliat by our careful management of the 
patient during and after her confinement no subee- 
quent gynecological disease may ensue which so 
often mvea rise either to a permanent sterility or to 
an early subsequent miscarriage. 


THE RELATION OF ALCOHOLISM 
TO TUBERCULOSIS, (a) 

By T. N. KELYNAOK, M.D., M.R.O.P., 

Of tbe Boral Inflrmair eod the Owtne Collese, Uuwbeetar. 

Alcoholism and tuberonlosis stand foremost 
amcmg the causes hampering human progress and 
limiti^ man’s happiness. Through them toe evolu¬ 
tion of the race has been impeded, and, unfortunately, 
in spite of numerons restraining and restricting 
agencies, tbeir baneful influence is still accountable 
for a bigh degree of mortality and an immense 
amount of sickness and suffering. 

Three views are possible: (1) That alcoholism is 
antagonistic to tuberculosis; (2) that alcoholism 
beaiB no spedal relation to tuberonlcois; (3) that 
alcoholism definitely predisposes to tuberculoeis. 


1. Alcoholism antagonistic to Tubbbcclosis. 

Before the true nature of tuberculosis became 
apparent, the opinion was somewhat widely held 
that babite of aJcobolio excess were antagonistic to 
tuberculosis and even preventive. This impression 
still exists among a Im-ge section of the public, and 
is apparently in part due to opinions expressed by 
many of the earlier writers on pulmonary tube^- 
losis. Inde^, in some medical quarters such a view 
is still held- Thie view was clearly expressed by Dr. 
Richard Payne Ootton many, years since in his 
Fothergilliam Essay : “ It is worthy of remark that 
the habitual drunkard—he who is wwaye in his cups 
—is not very often the subject of phthisis; such, at 
least, is the result of my own ohwrvations.” The 
idea that alcoholism was antagonistic to tubercu¬ 
losis may, perhaps, in part account for the advocacy 
of its persistent and even excessive use in phthisis. 

The abolition of alcohol from man^ modem sana¬ 
toria, however, seems to indicate that, as Dr. Iten- 
some well expresses it, “ Owing to the terrible 
consequences of excess, and to the proclivitjr of 
mankind to its excessive employment, it (alcohol) 
AftTi only be recommended in ^ected cases with 
many cautions.” (5) 

II.—Many hold that alcoholism hears no special 
relationship to tuberculosis and only exerts an 
indirect influence in so far as it leads to a lowering 
of general vit^ity and places the individn^ under 
oonmtions particularly favourable to the infection 
of tubercle. And certainly the circumstances 
attending the life of the chronic alouholio are 


(o) Abatnct of papsr nod before th« British Cosfnsi on 

^^^oTwstBoat of Phthlita.” Bjr Arthar Bsbsosm, M.D, 
■ondoD, 18M. P. M. 


obgI( 



134 Tm Mxdical Pbbss. ORIQINAJj OOMMUNICATIONS. 


Ano. 7.1901. 


generallr snoh as to speciallT expose liiin to the 
risks of toberonlosis. His habits lead in great 
measure to an indoor existence, the maintenance of 
an inaanitai 7 enrironment, insufficiency of suitable 
food, oftentimes to the influence of depressing 
emotions; and not infrequently his indulgence 
necessitates his following an occupation under con¬ 
ditions which are peculiarly mimical to health. 
Thus, while the influence of overcrowding, neglect, 
uncleanliness, malnutrition, and nerve influences 
cannot be overlcx>ked, very <K}nBiderable difficulty 
attends any attempt to estimate the effect of alcohol 
per se in rendering the tissues peculiarly vulnerable 
to the tubercle bacillus. 

III.—The view that alcoholism definitely predis¬ 
poses to tuberculosis has of recent years received 
much support. Indeed, the tendency of modem 
opinion is to recognise alcohol as an agent, which 
renders the tissues specially prone to tuberculous 
infection. 

The close association of tuberculosis and alco¬ 
holism has now been widely recognised, not only by 
British physicians, but also particularly by American 
and French observers. Yarious suggestions have 
been made in explaining the liability of alcoholics 
to tuberculosis. There can be no doubt but that the 
non-hygienic surroundings and nutritional impair¬ 
ment and lowered vitality of the drunkard greatly 
predispose him to tuberculous invasion. But it is 
contended by some that, even besides these factors, 
there are special influences arising from the action 
of the alcohol and its associatea Professor Sims 
Wo^head has recently shown that alcohol has a 
marked influence in altering or determining altera¬ 
tion of the cells of animals subjected to the action 
of certain pathogenic organisms. Professor Abbott, 
of Pennsylvania, and also Dr. Del^rde, working in 
the Institut Pasteur at Lille, have recently shown 
that alcoholised utiiTnala are more readily infected 
by many organisms than non-alcoholisea animals, 
and other investigators have also shown that alcohol 
produces a marked ne^tive chemiotaxis. It has 
also been found that animals brought into a state of 
chronic alcoholism are much less readily rendered 
experimentally immune to microbial infection. 
Attempts have also been made to show that alcohol, 
througn its influence on nervous structures, ren¬ 
dered the tissues, and especially the lungs, prone to 
invasion by tubercle, (a) 

lY.—In order to compare some of our Manchester 
experience with the views and opinions above in¬ 
dicated, I have endeavoured to analyse and express 
the results of observation of hospital cases for a 
number of years. A refeience to pathological data 
probably affords the most reliable basis for the 
formation of sound views as to the relationship of 
alcoholism and tuberculosis. 

Alcoholic Nsubztis and PHtHisis. 

Some time since I analfsed a number of fatal cases 
of peripheral neuritis occurring in chronic alcoholics. 
Eight cases were subjected to pathological examina¬ 
tion during a period of three years; they formed 1'6 
per cent, ot all the medical cases examined during 
that period. Pulmonary tuberculosis was met with 
in seven. This gives a percentage of over eighty- 
seven. All the cases were females. In only one sub¬ 
ject were there distinct tuberculosis lesions elsewhere 
than in the lungs, and then the intestines were also 
affected. In one subject there was an old tuberculous 
focus at the apex of the lung, but it seemed prob¬ 
able that the active phthisis was rather due bo a 
fresh infection than from this latent patch. In five 
oases both lungs were more or less involved; in two 

(a) Bee “Pnlmoaur Conmunptioii, TusoBonis, and AlUad 
DiMues of the Longs." fij Thomu J. Msjs. New Twk. 1901. 
Pp. 61. 


the left was the only one showing any distinct tuber¬ 
culous process; in three of the cases the oonme 
seemed to have been rapid; in four it seemed to 
have lasted for several montiis. One subject, it was 
stated, had “spat blood’’ six months before her 
death; in one case one long only was studded with 
small tubercles, the injection evidently having been 
recent; in two there was more or 1 o«b extmiaive 
caseation; four presented evidences of softening and 
cavitation; and in two of these there was some 
fibrosis, (a) Since collecting the above I have gone 
over my more recent pathologic^ notes. IVo 
further cases of alcoholic multiple neuritis have oome 
to autopsy. In one, a male, st. 35, the subject also 
of hepatic cirrhosis, both lungs were studded with 
recent tubercles. There was no softening, but 
caseous foci at the apices were apparent of older 
formation than the tuMrcles elsewhere. In the other 
case, a female, set. 32, in whom there was alM a 
fatty and cinhotio liver, the lungs, ^though cou¬ 
nted, oedematous, and presenti^ pat^es of 
Droncbo-pnenmonia, showed no ^tin^ evidences of 
tubercle. Thus out of ten fatal oases of alcoholic 
neuritis-~nine females and one male—eight, or 80 

K r cent, were the subjects of pulmonary tubercu- 
lis. 

In connection with the recent remarkable out* 
break of arsenical neuritis in Manchester and dis¬ 
trict, and occurring principally in alcoholics among 
the poorer classes, it is interesting to note that in a 
considerable number of the fatal oases active pulmo¬ 
nary tuberbulosis was present, and in some un¬ 
doubtedly much hastened the end. 

Tuberculosis is also of frequent oocurrenoe in the 
subjects of alcoholic cirrhosis of the liver. In many 
cases it is manifestly of the nature of a terminal 
infection. 

In order to throw light on this matter, the records 
of 3,053 medical cases examined in the Patholo^cal 
Department of the Manchester Royal Infirmary have 
been analysed. I have collected 121 examples of 
commoD cirrhosis of the liver. All doubtful and 
complicated cases were omitted. Cases associated 
with cardiac or such chronic affections as seemed to 
have led to secondary changes in the liver were ex¬ 
cluded. All examples of “biliary” cirrhosis ai^ 
those in any way connected with syphilis have be^ 
passed over. Alter omitting severu doubtful cases, 
in 28 tuberculosis—either active, latent, or obsolete 
—was present. Thus over 23 per cent, presented 
evidences of tuberculosis, active phthisis was pre¬ 
sent in 14, 12 males and two females; and active 
peritoneal tuberculosis in 12, nine males and three 
females. Of these, six males and one female had in¬ 
volvement of both lungs and peritooeum. In five 
males and one female the lungs alone were affected, 
and in two males and two females the peritoneum 
alone. No less than 12, or nearly 10 per cent, of the 
121 cases, appeared to die directly from tuberculosis. 
The average age of those in which active tubercu¬ 
losis was limited to the lungs was just over 44 
years. 

AN INVESTIGATION INTO THE PRE¬ 
SENCE OF INFECTIVE MATERIAL 
IN DWELLINGS OCCUPIED BY 
CONSUMPTIVE PERSONS. (6) 

By HAROLD COATES. M.D., D.P.H.(Vict.), 

Senior Aeeiatnnt to the Hedical Officer of Heelth for the City of 
j Uenoheiter. 

I It is now eleven years since Comet published the 

(a) Eelytiaok, T. N. *' On the Oco u rrenoe of Pnlmonerj TobB- 
onloBi in the Sabject* ^ AloohoUo NenritU."— Tk$ Mtdieal 
CKronide. ISSSe. Vof. ir.. pp. 180. 

(b) Abctnot of Pnper rend la the State Seetioa of the Biitieh 
COBfreee oa Tnherinuoeie. 


Auo. 7, !901. ORTGIKAL COMMUNjCATIONS. I’m Mioioal Passb. 135 


resalt of bis investigations into tbe infectivity of tbe 
dost fonnd in the dwellings of consnm^tives in 
Berlin, and up to now no work of a similar cha¬ 
racter has been done in England. In 1895 an 
investigation of this kind was commenced under the 
direction of Professor Delepine at Owens College, 
but was interrupted by otner engagements. The 
establishment of a scheme of voluntary notification 
of phthisis in 1899 presented a favourable oppor¬ 
tunity for taking up tne investisation, and acting on 
the suggestion of i)r. Niven, for whose administra¬ 
tive scheme the reliability of Comet’s results was all 
important, the Hospims Sub-Committee of tbe 
Manchester Corporation resolved that I should carry 
out tbe work under tbe direction of Professor 
Delepine, who had previously offered me special 
facilities for resuming this investigation. Although 
tbe pLin of the investigation is somewhat different, 
the methods of experimentation were, in tbe main, 
similar to those of Comet, although modified in some 
respects st the suggestion of Professor Del4pine. 

Specimens of dust were collected from situations 
in which dust from tbe atmosphere had settled 
naturally, and where there would be no likelihood of 
direct contamination with expectoration or bj 
infected articles, except in the disinfection experi¬ 
ments. 

Tbe method employed to determine the pre8enc,e 
or absence of tuDercle-bacilli in the dust was that 
of tbe inoculation of a susceptible animal, viz,, tbe 
guinea pig. 

The honees in which investigations were carried 
out are classified into the following groups :—I. 
Houses which are in a dirty conditions, and in which 
a consumptive patient is living who is taking no pre¬ 
cautions to dispose of his expectoration so as to 
prevent infection of the atmosphere, but who spits 
freely on to the floor, or into nis pocket-handker¬ 
chief. Ac. II. Houses which are in a very clemi 
condition, hut in which a consumptive patient is 
living who is not sufficiently careful as to the dis¬ 
posal of his sputa. III. Very dirty houses, in which 
there has been no case of tuberculous disease for 
several years past 

In every house the following details were noted:— 
1. Date of visit. 2. Dimensions of the room exam¬ 
ined. 3. Number of persons habitually occupying 
tbe room. 4. Tbe conditions of light and ventilation. 
5. The state of the walls, floor, and ceiling as 
regards construction and freedom from dust and 
dampness. 6. The presence or absence of carpets, 
curtuns. or other objects which afford lodgment for 
dost. 7. Length of time patient has lived here, and 
duration of illness. 8. Tbe presence or absence of 
visible signs of contamination, such as patches of 
recent or dried sputum on floors, walls, «&c. 9. Tbe 
situations from which dust was taken—always from 
such a place that direct infection with sputum would 
not occur. 

Houses to Class I. 

Infected houses in a dirty condition. Twenty- 
three houses of this class were examined, and in 
21 definite results were arrived at. In 13 of these 
houses at least one animal was found to be tuber- 
culons, and in another bouse (No. 6) tubercle-bacilli 
were present in the dust; and, therefore, in 14 out 
of the 21 houses, i.e., in 66'6 per cent., the presence 
of infective dust was proved which had at one time 
been suspended in the atmosphere, and, therefore, 
was capable of being inhaled. In seven of the 
bouses there was no evidence that the dust was 
infective. 

Altogether, 52 guinea-pigs were inoculated with 
dust from these houses:—20 of these died within a 
few days of inoculation; 17 were killed four or five 
weeks after, and found to be tuberculons; 15 were 


killed four or five weeks after, and found to be 
healthy. 

Tbe large proportion of houses—66 6 per cent.— 
in which the presence of virulent tubercle-bacilli was 
proved shows what a dangerous accumulation of 
infective material there is in this class of house. 

The effects of overcrowding are not apparent in 
these results, possibly because the series of houses is 
too short. In the 14 rooms in which positive results 
were obtained the average cubic space per head is 
457 cubic feet, while in the eases of the seven rooms 
which did not yield positive results the average 
cubic space per head is less, viz., 368 cubic feet. 
The cubic space per bead is chiefly of importance in 
connection with the provision made for renewal of 
the air of a room. A large cubic space is of little 
avail if the ventilation is bad. Tbe effects of fresh 
air and sunlight on the vitality of the tubercle- 
bacillus are well known. Taking the conditions of 
lighting and ventilation in these 21 houses which 
gave the results either negative or positive, we find 
that out of tbe 14 positive houses lighting and 
ventilation was bad in eight houses, fair in one house, 
and good in only five; while of the seven negative 
houses, the lighting and ventilation was good in six 
and fair in the other one. 

Id none of tbe houses with negative I'esults was the 
lighting or ventilation poor or bad. These facts 
point strongly to tbe beneficial effects of light and 
mr, even in the dirtiest houses, where tbe conditions 
are certainly not favourable to their action. 

In 16 of the houses samples of dust were obtiuned 
at different elevations in the room, so as to learn 
at what points tbe most dangerous accumulations of 
infective material was to be fonnd. As was to be 
expected, those samples of dust taken within one or 
two feet of tbe floor produced tuberculosis oftener 
than samples taken at higher elevations. This 
greater infectivit^ of the dust nearest tbe floor was 
not due to dii'ect infection with sputum, as all the 
samples were collected from places where this could 
not occur. Certain parts of the floor, e.g., near tbe 
bedside and near the fireplace in tbe living room, are 
the places where the sputum is deposited in target 
amount, and where the pulverisation most readily 
occurs. 

Series II.— Clean but Infected Houses were 
Next Investigated. 

Houses which are in a very clean condition, but 
in which a consumptive patient is living, who is not 
sufficiently careful as to tbe disposal of his expecto¬ 
ration. Ten houses of Class II. were brought under 
examination, and two samples of dust were taken 
from each house, and each sample was used to ino¬ 
culate one guinea-pig. Twenty guinea-pigs were 
inoculated, and of these only three died from acute 
diseases shortly after inoculation. Of the remain¬ 
ing 17 animals, six developed tuberculosis, and 
11 were found free from tuberculosis at the post¬ 
mortem examination. 

Of tbe 10 rooms examined, dust capable of 
producing tuberculosis on inoculation into a 
snsceptible animal was found in five; in one case 
both animals belonging to that room became 
tuberculous; in the other four rooms one animal 
only became affected. Thus, even in tbe cleanest 
of houses infectious dust can be found in 50 
per cent, of cases when the phthisical occupant is 
' using his pocket-handkerchief or tbe floor as a recep¬ 
tacle for sputum. It is therefore evident that ordinary 
cleanliness alone is not sufficient to prevent the accu¬ 
mulation of infectious material in tbe rooms occupied 
by a consumptive. The average cubic air space per 
head in these rooms wheie infective dust was obtained 
was equal to 336 cubic feet, and in those rooms which 
gave negative results 506 cubic feet. In the five 

>cg 


Auo. 7. 1»01. 


136 Th. Mbdioal PB.fls. OBIGINAL COMMTTyiOATlON. 


houses where the dust was not infective, in every 
instance the lighting and ventilation was good. On 
the other hand, of the five houses which gave positive 
results on inoculation of their dust, only one had good 
lighting and ventilation, two had had light and ven- 
t^tion, and in two the lighting and ventilation were 
described as fairly good. Taking the houses of 
Class I. and Class II. together, the influence of sun- 
h'ght and fresh air in the prevention of accumulations 
of infective dust is shown very markedly. In these 
houses, also, the tendency of the infective dost to 
settle towards the lower parts of the room is shown. 

I have examined 33 houses, of which no definite 
results have been obtained from two, leaving 31 
houses for purposes of comparison. 

These results are seen in the following table:— 


Beblin. 


Knmber of 
hoiuee 
exunined. 

Foeitlve 

remits. 

ffegstive 1 
reinilts. 

Peroentsge of 
pontive reanits 
ent of total. 

28 

19 

9 ^ 

67 


Manc: 

HESTEB. 


31 

19 

1 

61 


These experiments show that there is alarge amount 
of highly-infective material present in dwelling- 
houses which are inhabited by consumptive patients 
who do not take the necessary precaution to destroy 
th«r expectorations. Any house where^ there bad 
been a case of bronchitis or lung affection, menin¬ 
gitis, marasmus, strumous glands, or any case of 
Mne tnbercnlosis, was excluded. This rart of the 
work was really the one which involved the greatest 
amount of labour and care, as a very large number of 
houses had to be investigated bmore a sufficient 
number could be obtained in whiiffi these require- 
mmits were complied with. 

T^ houses chosen for these investigations were all 
very dir^, and were exactly similar to those of Class 
L, except that the consumptive patient was absent. 
Many of them were badly lightedand ventilated, and 
in all of them there was plenty of dust and diii on 
the walls, floors, &o. Ten houses were examined, and 
in no was any tuberculous dust discovered. 

Twenty guinea pigs were inoculated with dust 
from these houses, and six of these died 
within a few days of inoonlation. The remaining 
fourteen were killed four to five weeks after inocula¬ 
tion, and all were found free from tuberculosis. 
These results, taken in conjunction with the results 
obt^ed from houses in Cl^ 1. and Class II., show 
that tiie virulent dust foiuid in those houses is due to 
the presence of a consumptive patient, who is in¬ 
fecting the atmosphere with his expectorations. 
These experiments show that living and virulent 
tubercle-bacilli are present in the dust, which has 
deposited its^ naturally from the atmosphere, in 
rooms which are occupiea by phthisical patients who 
are in the habit of spitting upon the floor or into 
pocket-handkerchiefs. They also seem to show that 
this infective dust is present in greatest amount or 
is most virulent where the access of sunlight and 
the free circulation of air is prevented. Such in¬ 
fected rooms must be a source of danger to those 
occupying them. Healthy persons run the risk of 
being in&cted, and the patient himself may become 
rein^ted and his ultimate recovery be delayed or 
prevented. 

It is well known that the tubercle-bacUlus can 
retain its virulence for months in the dry state; it 
is evident, therdore, that these Rouses will rem^ 


infective for some considerable time after a patient 
leaves it. Unless there are some measures taken to 
remove this infective dust, anew tenant coming into 
a house lately occupied by a consumptive patient is 
exposed to the danger of acquiring phthisis. In the 
poorer quarters of large cities, where houses are too 
few for the needs of the population, the new tenant 
often takes possession the same or the following day 
that the late tenant leaves, and nothing in the way 
of disinfection or cleansing the walls and ceilings is 
done. There is no doubt that many persons are in 
this way unknowingly exposed to infection, and an 
infected dwelling is in many cases the origin of a 
case of phthisis which the most careful inquiry has 
failed to trace to any direct association with a pre¬ 
vious case. The same danger exists to some extent 
at the boarding bouses and hotels at health resorts 

Samples of dust collected from various public 
places have also been examined. Five specimens of 
dust were collected from the walls at various eleva¬ 
tions of the waiting-room of the out-patient’s 
department of the Hospital for Consumption in 
Mwcbester. This waiting-room, which is a lofty, 
well-lighted, and well-ventilated hall, is used by 
patiente every morning. Ten guinea pigs were 
inoculated and killed five weeks uterwaras. None 
of them showed any signs of tuberculosis. Five 
samples of dust were also examined from the waiting- 
room of one of the large general hospitals, but here 
also the results were negative. Dust taken from 
railway carriages failed to produce tuberculosis, but 
two samples taken from a general waiting-room at a 
railway station both produced tuberculosis. 

The method of disinfection in use in Manchester 
is one recommended by Professor Delepine eight 
years ago, as a result of experiments which he carried 
out to ^t the efficiency of various disinfecting pro¬ 
cesses. The method is that of disinfection by a solu¬ 
tion of chlorinated lime of the strength of I^ ozs. to 
the g^on. 


INJURIES OF JOINTS 

WITH SPECIAL EEFEEENCE TO THEIE 
IMMEDIATE AND REMOTE TREATMENT 
BT 

MASSAGE AND MOVEMENT, (a) 

By HOWARD MARSH, F.E.C.8., 

Sniyeo.! to St. Bartholomew’a HospitaL 

Both massage and movements have long been 
employed in English surgery, but lately they have 
come into much more gener^ use. Both are valuable 
remedies, but if used as a matter of routine both may 
do great harm. As methods of surgical treatment 
they must always be closely supervised, care being 
taken to watch their effect, and especially to be sure 
that no element is present in the case which renders 
their employment undesirable. 

Phyai^gy of Massage.—-It is necessary to have a 
clear idea as to what has been termed the Physiology 
of Massage—-as to the different ways, t.e., in which it 
acts. 

1. It enlarges the amount of blood circulating 
through the part concerned. This is obviously ap- 
parmit in the skin, which, instead of remaining cold 
and pale, becomes warm, and more or less red. The 
same result was experimentally demonstrated in 
regard to the muscles by Brunton and TunnicUffe, 
who showed that the amount of blood passing through 
them both daring massage, and after its cessation, 
was increased. This increase of blood is in every wa^ 
advantageous. It maintains or improves the nutri- 

(a) IntrodacUoii to a disonasion. Section of Sniserp, st the 
Cnelteoham meeting, Jnlr, ISOL 

-oge 




Auo. 7. 1901. 


ORIGINAL COMMUNICATIONS. 


Thb Mkdical PbB88. 137 


tiott of &11 the various tissues; it promotes tbe re* 
storation of the functional activity of injured 
muscles, and it plays an important part in the ab- 
80 >^tion of l^mpn and extravasated Blood. 

2. Its action is mechanicaL By kneading and 
percussion, extravasated blood and lymph which have 
Deen coagulated in the tissues, and have led to 
brawny cedema, are broken up and dislodged, while 
by stroking from below upwards they are swept 
onwards and brought within the reach of healthy 
lymphatics and a normal venous circulation, so that 
they can more readily be absorbed. 

3. It is an efficient stimulant to damaged muscles 
through its influence on tbe nervous system. In 
such minor injuries as sprains and contusions, pro¬ 
bably the small nerves ramifying in the injured part 
are seldom tom across, for they are tough rather 
than brittle, they are well protected in the subcu¬ 
taneous tissue and the deeper structures, and their 
course is tortuous, so that they are quite easily put 
on the stretch. Nevertheless they are not infre¬ 
quently so far injured that their functions, for the 
rime being, are more or less suspended, and massage 
is then a very useful agent in stimulating them to a 
reeumprion of activity. It probably acts m a similar 
manner on riie vaso-motor nerves, which preside over 
the arterial system of the part. 

4. No one who has watched its sedative effect 
when applied in cases of recent injury can doubt the 
influence of massage in reducing muscular spasm 
and relieving pain. Here it must be used very 
gently and be bmited to stroking and light friction 
for short periods riiree or four times a day. 

5. Prol»bly massage promotes the absorption of 
recently formed adhesions provided they are not too 
extensive and firm. This is a matter of considerable 
interest Just as provisional callus, formed in the 
repair of fractures, is absorbed, so is the new oon- 
ne^ve tissue which is developed after injury of the 
soft parts. Perhaps the most obvious instance of 
this is met with in the case of adhesions following 
peritonitis. Even extensive adhesions gradually yet 
completely disappear, probably as the result of con¬ 
stant disturbance and traction during peristalsis. 
Much the same result is produced by what may be 
termed the interstitial disturbance and tractiou which 
takes place during the different movemeuts employed 
in mass^e. 

As to Movemenis .—These are of three kinds: those 
performed nnder an anessthetic ; passive movements 
and voluntaiT movements on the part of the patient, 
often carried out against resistance. As to move¬ 
ments under an anssthetic They can be safely 
applied only when a careful diagnosis has been made. 
In the first place it must be ascertained that the 
joint itself is not, nor has been, actively diseased, so 
that it hw nndeugone no considerahle structural 
changes, such as follow tubercle, or osteo-artbritis, 
septicsemia, or locomotor ataxia. The oases in which 
this form of movement is most successful are those 
in which the joint itself is practically healthy, 
while it is hampered by changes in the parte around. 
Passive movements are chiefly useful in restoring 
movements that have been lost, or in prevent¬ 
ing stiffness in joints which are to be long 
disused, for instwce, a healthy ankle, the 
patient having disease of tbe hip or knee. Yolnn- 
tary movements on the part of the patient, 
especially when performed against resistance, are in 
many instances more valuable than massage. Several 
forms of apparatus have been introdnced for use in 
these movements, and many of them are very satis¬ 
factory. In all cases, however, efficient supervision 
must M maintained. 

Diagnosis .—Diagnosis is, of course, of essential 
importance. It cannot always be exact, hut it must 
he carried far enough to indicate that the case belongs 


to the general class in which these agents are useful, 
and that no element is present which renders them 
unsuitable. The conditions for which massage and 
movements ai'e suitable are sprains and contusions 
of previously healthy joints unattended with any 
serious complication such as dislocation or a fracture, 
any wide la^ration of muscle, rupture or displace¬ 
ment of tendons, or such pre-existent conditions as 
tubercle, gout, or hsemophilia. 

The treatment of recent fractures by massage was 
so fully discussed at the meeting last year at 
Ipswich that it is needless to consider it now. The 
after treatment of dislocations has of late years 
undergone a great and very advantageous change. 
In the case, e.g., of the shoulder, the arm is no 
longer bandaged to the side for a fortnight or three 
we^s, but passive movements and massage are 
regularly ubm after the second or third day. I 
have seen a patient thus treated able to move bis 
arm freely in every direction in tbe course of three 
weeks. I have alro seen a patient walk freely and 
without lameness three weeks after tbe reduction of 
a dislocation of the hip. Tbe chief symptoms which 
indicate tbe use of massage and movements are stiff¬ 
ness and pain; but before they are employed the cause 
of the symptoms must be ascertained, as to whether 
tbe mischief is inside or around tbe joints. Take 
tbe shoulder. The arm may he stiff and riiere may 
be severe pain and marked muscular wasting. Is 
this a case of disease of tbe joint itself or of adhe¬ 
sions outside P There is, I believe, only one test to 
be relied on to determine this question. This is to 
ascertain whether tbe joint is as stiff as it at first 
sight appears to be, or whether, within certain limits 
movements are free and smooth. If these free and 
smooth movements—limited though they be—are 
present, the fact is a strong indication that the joint 
is sound, and that tbe symptoms depend on sur¬ 
rounding adhesions. Cases in illustration are re¬ 
lated. As to pain it is very important to 
remember that it cannot be used to differ¬ 
entiate between real joint disease and sni> 
rounding adbesions. Indeed, in many cases 
the relued pain dne to adhesion is more severe 
than that produced by joint disease. Muscular 
wasting^a principal symptom in disease of a joint- 
may be present, though the case is one of mere 
adhesion in the capsule and surrounding parte. In 
some instances movement under an ansesthetic will 
produce a cure which there seemed at first sight no 
reason to anticipate, for though the patient com¬ 
plains of “ weakness ” and pain in the joint there is 
no appreciable stiffness ur any condition for which 
movement and massage seem called for. These oases, 
which Ixme-setters not rarely cure, by moving them 
as they move all others, are instamces of slight 
adhesions which cannot be detected, but which are 
yet sufficient to make the patient walk with lameness 
and “ weakness ” of the joints concerned. Cases are 
related to illustrate this group. 

THE PHYSICAL BASIS OF 
MELANCHOLIA, (a) 

By JOHN TURNER, M.B., 

AMdstaot Medioal Officer to the Euex Conntr Aaylam, Breatwood. 

CsBTAiK of the nerve cells of the cortex present 
an alteration in appearance in many cases of melan¬ 
cholia and dementia (alcoholia). The change is 
similar to that which follows when tbe axons of the 
fore-horn cells or those of the pontise nuclei have 
b^n severed. But examination of the axons (in the 
cord) shows that in melancholia the change is not 


(a) Abatnet of poper read 'ot the Cbeltenhva AEoetiax of tho 
Britiih Sfo^cAl Aasooiotioii, July, 1901. 



138 Thi Mxdioal Prxss. 


ORIGINAL COMMUNICATIONS. 


Auo. 7, 1901. 


produced primarily lay interference with the axons. 
The change has also been noted in melancholia by 
Wiglesworib and others. 

The distribution of the lesions were as follows 
The pyramidal and giant cells of the so-called 
motor cortex show it most clearly; in this region 
must of the cells being affected. It is commonly 
met with in the frontal and occipital regions, espe¬ 
cially in the large cells of the latter. Of all the 
nuclei examined in cross sections of the medulla 
oblongata • hypoglossal - ragus • lateral, ambiguous, 
gpracile, and cuneate, only the first escapes, the 
others show the change affecting generally the major 
proportion of the cells. 

In the cord the cells of Clarke’s column are early 
affected and ultimately in advanced cases the fore- 
hom cells. 

In the posterior-spinal ganglia, while only a few 
cells show the change yet many are altered in 
another way—densely stained and very shrunken. 

In the tracts of the cord only in very advanced 
cases is there any sign of degeneration of the myelin 
sheaths, and then it is the crossed pyramidal tract 
(axons of motor cells of cortex) which is affected. 

The pathological observations indicate that the 
cause which brings about this change is not a general 
one, operating on all parts of the nervous system, 
such, e.g., as a perverted state of the blood, otherwise 
we should expect to find all the cells of a similar type 
participating in the chan^. This, as has been 
shown, they do not. Another point brought out is 
that the change early affects the afferent cells, and 
notably those of Clarke’s columa. 

The experiments of Warrington show that this 
change can be produced in the cells of Clarke’s 
column bv division of the posterior roots, and he 
assumes that in this case it is due to depriving these 
cells of the ingoing stimuli normally passing to 
them. 

Thus it lias been established experimentally that 
this change can be set up in at least two ways. 

1. By agents having a destructive action on the 
axons of the cells in question (traumatism, and pro¬ 
bably also alcohol) and 

2. By agents which do not primarily affect the 
axons of the affected cells 

These observations indicate that the melancholic 
cases fall into the latter class, and, further, that the 
state of the mind is an essential factor in inducing 
the change. 

The deprivation of the nerve cells of their normal 
ingoing stimuli is the explanation offered in accord¬ 
ance with the writer’s hypothesis (Journal of Menial 
Science, July, 1900) that melancholic states depend 
on dissolutions of the nervous system affecting the 
sensory or ingoing section of the nervous refiex 
mechanism. Clinical observations from Griesinger 
and other are also given in support of this conten¬ 
tion. notably the very general occurrence of anccs- 
thesia in melancholia. 


SOME CONDITIONS OF SUCCESS IN 

THE TREATMENT OF 
NEURASTHENICS, (a) 

By Dr. A. T. SCHOFIELD, 

HoDonurjr Phyaician to the Friedenbeim Hospital, and Victoria 
Homes, 

As this paper deals with treatment only, the word 
neiirastbenia is here used to include all functional 
erve cases. 

The hints given are grouped around four centres— 
the physician or the personality, the patient or the 

(a) Abatract of Parer read at British medical Asaociation, 
Cheltenham, Julj, 1901. 


diagnosis, the methods of treatment, and various 
details. 

With regard to the physician, then, sympathy is 
one of the first conditions of success. It need not be 
shown, but if felt by the doctor it is felt by the 
patient, and inspires him at once with confidence. 
One cannot feel it till one baa grasped the fact that 
a disease of the imagination is not an imaginary dis* 
ease. The next qu^ification is patience, for want of 
which number of sufferers remain unrelieved. Allied 
to ibis is perseverance. Many a successful line of 
treatment fails to succeed from lack of this. Another 
is firmness in essentials combined with flexibility in 
non-essentials. The next quality is tact in mental 
touch, the “ tactus eruditns.” Another quality is 
honesty, not in its mere literal meaning so much as 
the power of acting solely in the patient’s interests 
as distinguished &om that of their families or 
friends. And lastly, success in the physician 
depends upon a mind that possesses both the powers 
of observation and of imagination. Many have the 
one or the other, but to possess both the gift of 
accuracy in details with broad and wide views is to 
be a master in one’s profession. 

With regard to the patient the point first to 
decide is the relative part played by mind and body 
in tbe disease. 

Setting aside so-called “ mental cases,” we get in 
“ hysteria ” lesions of the sub-conscious mind, and in 
neurasthenia proper, a ph^ sical disease of the nerve 
centres in brain and corA 

The value of these distinctions becomes obvions 
in treatment. 

Tbe distinction between tbe three groups is not, as 
a rule, difficult. Wbat is much harder is to discern 
on which basis of coarse physical lesion the nerve 
troubles may rest, and this is a point frequently 
overlooked. Another point with regard to tbe 
patient is that he should not have been already a 
victim of many failures. If he has, the difficulties of 
cure are greatly increased. Another element of suc¬ 
cess is confidence in tbe doctor and nurse. Tbe two 
indeed must mutually uphold each other, or tbe most 
powerful means of cure are neutralised. Again, a cor¬ 
rect estimate must be madeof tbe patient’s personality 
andm<ntal calibre, a factor which in the case of ordi¬ 
nary diseases may, as a ru'e, be neglected. In allthese 
cases tbe possible sexual basis of some of tbe sym¬ 
ptoms must never be forgotten. 

As to methods of treatment, these must be cured 
away from borne; which however much it may at 
times be a place of rest to men is never so to women, 
as it is tbe sphere of their work, and all new cases 
require rest of some sort. A good nursing home is 
a sine qua non, and is by no means easy to get. 

The nurse is a still mol's difficult factor in the 
cure, As a matter of fact, while mental attendants 
and hospital trained, certificated, and chartered 
nurses abound, the neurasthenic nurse is a rare being 
to find, and her serious trmniug has hardly yet been 
evolved. 

Finally with regard to details. While, in ordi¬ 
nary cases, rest in bed is nearly always part of the 
cure, in any with a true mental taint, however 
slight, it nearly always does barm. Isolation is 
another point that requires intelligence and not 
routine in its application, being not always desir¬ 
able. 

Massage is, in most cases, a necessity to aid diges¬ 
tion, but besidestbisit 1 B of special value <n disorders 
of circulation, wasting or weakness of muscles, stiff¬ 
ness or weakness of joints,pain, congestion of internal 
organs, and many forms of cardiac disease. 

Suggestions play a large part (without any ques¬ 
tion of hypnotism) in these cases, but seldom can be 
assimilated in a raw state, but have to be combined 

voog e 




Ado. 7. 1901. 


GERMANY. 


Thc Midical Pbbbb. 139 


with varioas forms of treatment. The manage* 
meat of dyspepsia, sleeplessness, constipation, rest* 
lessnees, depression, and con-valescence, all hare an 
imTOrUmt bearing on the success of the treatment. 

Finally, it may be said that the successfol nerve 
doctor owes less to hie teachers and more to his 
idiosyncrasy, experience, and applied common sense 
-than any other variety of medical man, 

Clinical ^ccor^js. 

TREATMENT OF WHOOPING-COUGH BY NASAL 
IRRIGATION. 

By Edward Maqttibb. M.B., D.P.H. 

Forxsblt the treatment of whooping-congh was most 
annoying and nnaatisfootory to the medical practitioner. 
Now, I think we may hope we are on the proper track 
'to combat aod conquer this most serioas and distresting 
disease. I have for a long time been of opinion that the 
fountain and origin of this complaint aere located in 
the Schneiderian membrane, and this belief was 
strengthened b> the report of a case by Dr. £. M. Payne, 
which appeared in a medical joarnal some weeks ago. 

Acttog on this hypothesis 1 have recently treated two 
•cases, a little girl, agad 2 years 3 months, and her 
brother, aged 10 months, by irrigation of the naree with 
warmed carbolic lotion in the manner and with reenlts 
as shown below. 

There can be little doobt that the disease is produced 
by a specific oi^aniam, as Afanassjew discovered large 
nnmbers of bacilli in the spntam in this disease, and 
Hewlett, in bis " Mannal of Bacteriology,” says, 
''* EopUk, by sowing the pellets on solidified hydrocele 
flaid, obtained a pure cnltnre of a small and delicate 
bacOlns measnring 0 8 to 17 ins. in length.” The bacilli 
being found in the spntnm oonid be acoonnted for by 
ths escape of mncns by the posterior narea or by the 
■extension of the disease from the Schneiderian mem¬ 
brane to the pharyngeal or laryngeal membranes. 

The strength of the lotion I used was 1-40 with a little 
glycerine added. I proonred a two-onnoe syringe with a 
Twbber nozxle, so that when it was m the nares it oonid 
not hart, no matter how the child straggled. Three fills of 
-the syringe were injected into each nostril three times 
• day. I had only once to show the mother how to nse 
the syringe, and niterwards she and the nnrse had very 
lit^ trouble in using it, althoogh the children were 
very yoong. It is a good plan to bind down the arms 
srith a towel or binder before using the syringe. 

The following diary, kept by the mother, shows the 
result of this treatment commenced June 29th 


M. 

HoO. 


June 26 Nomber of paroxysms and oonghs 7 


July 


26 

37 

28 

29 

30 
1 
2 
8 
4 
6 
6 

7 

8 
0 

10 

11 

12 

13 

14 

15 

16 

17 

18 

19 

20 
21 


P. 

HcO. 
.. 8 
.. 6 
.. 9 
.. 7 
.. 6 
.. 5 
.. 2 
.. 6 
.. 7 
.. 4 
.. 4 
.. 2 
.. 1 
.. 1 
.. 1 
.. 0 
.. 0 
.. 1 
.. 3 
.. 2 
.. 2 

. 2 
.. 0 
.. 1 
.. 2 
.. 1 
.. 1 


M P* 
XoO. 


July 22 
„ 23 
,» 24 
„ 25 
26 
.. 27 
„ 28 
.. 29 


The result in both coses tends to prove that treatment 
directed to the Schneiderian membrane by thorough 
irrigation diminishes the frequency of the paroxysms 
and oonghs, and reduces the duration of the disease 
from months to weeks. Of coarse, one must not dis- 
gnise the fact that in this mode of treatment there is a 
risk of some of the finid getting into the Eostaohian tnbe. 


(SemtaiTD. 


[From Oor Owk Corrbbpokdbnt.J 

Bbblix, August 3rd, 190L 

At the German Congress of Medicine, Hr. Hiischberg 
gave an address on the 

Operative Tbratment of Htpbrtbofhic Cirrhosis 
OF THE Liver. 

Oor knowledge of the disease was so limited that treat¬ 
ment has not come to the front. In one case, that of 
a man, st 61, with great enlargement of the liver, be had 
achieved a (access, that had now lasted for over a year, by 
operation. Previous to the operation, cirrhosis oonid nut 
be diagnosed to a certainty. It was rendered probable 
by the slow development of the disease, by the steady 
enlargement of the liver, the great and early enlarge¬ 
ment of the spleen, the intra-bepatio retention of gall¬ 
stones, the absence of ascites and of enlargement of 
snperficial abdominal veins, even in an advanced 
stage of the disease, and finally the fever and the 
rapid pnlse, amounting at times to tachycardia. At 
the operation the speaker's idea was to oondnct the 
pent np bile to the ontsida in order to obviate further 
damage to the liver stmotnres. After catting into the 
abdomen he made an opening into the liver the length 
and breadth of n finger, ont of which bile flowed freely. 
The canal in the liver wae plugged with gause. After 
its removal a fistula remained whiifii closed at the end 
of a month. The operation was weU borne, and the 
patient had since gained 25 lbs. in weight. 

Hr. Naunyn was not a pessimist as rogaided the 
disease, as recovery in both forms was not so very rare. 
But he was donbtfnl whether Hirachberg’s case was 
really one of hypertrophic cirrhosis of the liver. The 
indnration of the liver meant an infection but not puru¬ 
lent obolangeitis, a disease that was amenable to treat¬ 
ment of a snigical kind. 

Hr. Rosenstein, Leyden, in about 150 oases had never 
seen a recovery. He also doubted the accnraoy of the 
diagnosis, as there was no jaundice. As regarded the 
tnohyoardia the patient might have bad cardiac dilata¬ 
tion with liver stasis. It had not been shown, therefore, 
that operation woold be useful in hypertrophic cirrhosis 
of the liver. 

Hr. Hirschberg, in reply, said he most maintain the 
acouraoy of the di^nosis, as the type of the disease 
oonid not be otherwise gronped. Hanot himself had 
acknowledged that there oonid be hypertrophic cirrhosis 
of the liver without jaundice. In the bile that escaped 
throngh the fistula the baoteriom ooli was found, but its 
pathogenic action conld not be established. 


b. 


ooglc 







140 Thk Medical Pbbss. 


A 0 8 T R 1 A. 


Ado. 7, 1901. 


Hr. Alex. EUinger spoke on 

The Imfluemce or Bemal Injvbies on the Covbse 
or Pancreatic Diabetes in the Doo. 

The inquiiy was oondnoted in oonjnnotion witii Hr. 
Seelig. ^e resnlte were the following: If in a oaae of 
panoreatio diabetes in the dog aonte nephritis was set 
up by injection of oantharidine, the quantity of sugar 
in the urine diminithed. Not only the peroenti^^ and 
absolute quantity of sugar was diminished, but the pro¬ 
portion between the excreted sugar and the nitrogen 
becsune considerably smaller. This infinenoe of the 
oantharidine on sugar exoreticm passes away much 
more quickly than the excreted albumen. If acute 
nephritis developed spontaneously in a pancreaS' diabetic 
dog, the quantity of sugar in the urine diminished, and 
it could disappear entirely. The disappearance of the 
sugar depended on efficient excretion from the kidneys, 
as the quantity of sugar in the blood itself was in¬ 
creased. 

Hr. Naunyn intended to apply the experiment to the 
human subject. He referred to a large number of sugar 
determinations in the blood of diabetics, where in 
cachexia the sugar was not increased, bnt rather 
lessened, and also to a large number of observations 
wherein people who had become cachectic (from tuber¬ 
culosis, for instance), (had lost their sugar, although 
there was no evidence present of renal disease. People 
who showed sugar reaction whenever small quantities of 
bread were taken bore large quantities without any 
excretion of sugar. 

Jlustria. 

[VBOK oru OWN COBBSSPONDENT.J 

Tiissa, AattutSrd, 1901. 
Pbothebis fob Incontinentia Ubinh:. 

Soke time ago Gersung drew attention to the use 
of paraffin as a means of obviating the distressing con¬ 
dition of urine incontinence. It is maintained by some 
that the poison readily passes into the system, their 
belief being inferred from the nature of the aocidents 
that have sometimes followed these injections. By 
others it is held to be a dangerous procedure in that it 
tends to the formation of fatty emboli, which produce 
serious results when located in tiie brain. 

After extensive practice with paraffin the author is 
more confident than ever that its use is safe, useful, 
and beneficially lasting in effect. It should be injected 
in a semi-fluid condition, with a hypodermic syringe 
which cansea no irritation. It is neither rejected nor 
abeorbed for a very long time, by which time the parts 
are so changed as to require no further treatment. He 
relates many oases cured by this method which had 
defied all operative ingenuity. 

Total Extirpation or the Vaqina. 

Wertheim related two cases in which the vagina was 
removed entirely, together with the other oigans of 
generation, and without any subsequent trouble. 
After closing the abdominal wound he incised all round 
the vi^^inal aperture, and removed the canal in tolo. 

This opinion is confirmed by Gurnard, who 
that the hemorrhage is easily controlled. He states 
that he extirpated for myoma and only required three 
ligatures! The operation, moreover, can be performed 
in a very short space of time, which is very important 
in such cases. 


Ganobene op Lower Extbemittes. 

Burchard relates a case of some interest in midwifery. 
Having a breech presentation an effort was made to 
ease the head by dragging on the body which resulted 
in decapitation of the fcetns. In removing the head 
an incomplete rupture of the uterus occurred which 
subsequently left a htematoma in the broad ligamantain, 
and finally a thrombus in the popliteal veins followed 
by gangrene, for which both legs had to be amputated. 
The patient ultimately recovered. 

BLENNORRHOtA NeONATORUM. 

Zweifel assures us that he has tried all the reputed 
drugs, induding tiie latest, protargol, without snooees 
as a prophylactic in ophthalmia neonatorum, and con- 
dudes that nothing succeeds so well as acetate of silver 
in the form of 1*2 per cent, solution. This may be 
applied to the eyes without causing pain, the eyes being 
Bubsequentiy washed with a solution of sodium chloride. 
He instructs all the mtdwives after washing the child 
to instill a few drops d the acetate solution wherever 
(a) there is a history of a previous white discharge, (b) 
if the same mother has bad previous children suffer 
from ocular dischargee, (c) in the case of children whose 
parents are not particularly clean. 

Obesitt and the Banting Tbratxent. 

A case of Stadelmann’s has exdted a good deal 
of interest here, and is worth briefiy relating. The 
patient was a heavy drinker and suffered from alcoholic 
polyneuritis, yet in spite of the atrophic paralysis of 
the lower extremities the body weight increased 76 kilos 
in one year, so that his total weight before treatment 
commenced was 146 kilos, or 319 lbs.—nearly 23 stones. 

From this it appeared that only 1,200 calorics were 
obtained against 2,400 as a normal expression. To 
restore the rqnilibrium 1,000 calorics required to be 
taken out of the food, either as carbohydrates or hydro¬ 
carbons, and to do this a diet of green vegetables was 
adopted. Within a year the body weight was reduced 
60 kiloe, or 132 lbs. He has more faith in the per¬ 
severance of the subject in accomplishing a cure than in 
any drug. The thyroid gland, he affirms, has no influ¬ 
ence whatever on the reduction of fat. He is willing to 
admit that every individoal case must be treated on its 
merits, bnt he assures us that he knows of no specific 
drug except those that are likely to produce injurious 
effects, such as thyroid, the action of which is to produce 
glycosuria, that modifies alimentation at the expense of 
the integrity of the kidneys. 

The only effect of Oertel and Bcbweninger’s meteod of 
fluid deprivation is to reduce the appetite, and thus 
check alimentary nutrition. 

Banting’s method with Ebstein’s modification of pre¬ 
senting a mixed diet is certainly the most rational 
method of treatment for reducing fat safely. 

ClNHAUON AND TuBBRCULOSIS. 

Niehnes is not satisfied with the cinnamon treatment 
of Landerer in surgical practice. Landerer maintains 
that cinnamon, when injected into the venous system, 
produces a sort of aseptic inflammatiim or leucooytoeis, 
which Niehnes is not satisfied with, bnt rather holds to 
the opinion that the cure rests entirely on the drug 
itself or not at lUI In opening local absoeesee of a 
tuberculous nature and dressing with heterocresol and 
iodoform, more good can be done than by administering 
ninTiiAtnift acid, and this method gives 68 per cent, of 
recoveries for Landereris 90 i>er cent. 



Aoo. 7. 1901._SPECIAL ARTICLE._ Thx Midical Puss. 141 


In tiia discussion Ynlpnis said he had tried Landerer’s 
method in twenty cases, but the ri^rs and fever were 
•o narked that he has now quite abandoned the 
teeatment. 

Niehnes thought the rise of temperatnre was dne to 
the nee of the cinnamon salt of soda. 

special ^riicU. 

THE BBITISH CONGRESS ON TUBEECTJL0SI8. 

Abticli II. 

TThdib existing ciroomstanoes it hardly seems worth 
while to devote mooh space to certain subjects which, 
bat for Professor Eoch’s startling statements, would 
have attracted a very great amount of attention, viz., the 
identification of tubercle-contaminated articles of food, 
the means of restricting their sale, the prevention of 
tnberonlous disease among cattle, and the question of 
oompensation to be paid to cattle owners for the 
alaaghtv of animals recognised to be infected. The 
p^>en dealing with these and cognate subjects were 
extremely numerous, but the discussions to which they 
gave rise lacked the conviction of opportuneness. 

We may therefore pass on to the consideration of the 
influence of vairions conditions in determiningaliability 
to infection. According to Professor Koch, heredity 
may be dismissed as for all practical purpoeee as non^ 
existent as a source of direct infection. In affirming this 
truism he did but give voice to a view which has long 
commanded the assent of authorities in the matter. 
Hereditary predisposition is quite another thing, though 
opinions are still greatly divided as to the preoire aig> 
nifleance to be attributed to this factor in determining 
an exaggerated pronenees to the disease. According to 
Dr. Squire, although some 33 per cent, of consumptives 
preeent a family history of tuberculosis, there are 
statistical grounds for attributing the disease to occu¬ 
pation and surroundings in by far the grater number, 
thus reducing the possible influence of heredity to 9 in¬ 
stead of 33 per cent. Attackingtbesubject from another 
point of view, he found that out of 469 claims under life 
insnrance policies, 78 were from consumption and other 
forms of tuberculosis, and of these 78 only 7 had any 
history of consumption in the family, while a phthisical 
history was obtained in 22 cases in which death had 
taken place from some other cause than tuberculosis. 
This gives 440 cases free from consumptive taint, of 
whom 71 died of tuberonlosis = 16'13 per oent.; and 29 
cases with consumptive family history, of whom 7 died 
of tuberculosis ~ 24'13. These figures are too few, of 
course, to be of much value by themselves, but they 
are interesting as tending to confirm tbe opinion now 
very generally accepted, that the direct influenoe of 
heredity in tuberculosis is considerably loss than was 
formerly supposed. Dr. Maxok Kino, of New York, 
goes even further than this, for be inclines to the 
opinion that in many instaucee a certain degree of 
immunity is conferred npon tbe offspring of phthisical 
parents. He bases his views on 242 carefully recorded 
observations of tuberculosis in which be had oppor- 
tanity for close personal study into the immediate 
family histories and such other features of the oases as 
would throw light npon the inquiry. Of the 103 fatal 
casea among this number be notes that 76 occurred 
among individuals of non-tubercnlous parentage, tbe 
average duration of the disease in these oases from its 


oarlieet signs to death being 2 98 years. Tbe other 27 
fatal cases oconned among individnsls of tnbercnlons 
parent^e in whom the averag^e duration of the 
to a fatal issue was 4*01 years. We need not go into 
the details npon which ha bases his oonolnsione, which 
are as follows1. That the percentage of oonsnmp- 
tives having a tuberculous parentage is actually 
smaller than that not having a tnberoulous parentage, 
and is mnoh smaller than would be more than <Mvy>nTit«d 
for by the additional danger of infection to which the 
former dass is subjected. 2. Tuberoulotis in the 
parents render tbe offspring immune to a not incon¬ 
siderable extent, as shown by increased resistance to 
the progress of tbe disease and an increased tendency to 
recover among this class. 

Among oriier Motors which appear to infinenoe the 
mortality from cnberonloaia. Dr. von Eobost, of Buda¬ 
pest. incrimiuates tbe youthful age of the parent or 
parents. He found the mortality among children whore 
mother was under 20 to be 8'46 per cent. This propor¬ 
tion fell to 5 09 when the mother was between 20 and 
30: to 2'78 between 30 and 86; with a rise to 4'26 when 
the mother was over 36. On tbe paternal side tbe 
mortality among the offspring of fathers under 26 was 
5'71; between 26 and 30, 4 74 ; 8’61 between 30 and 40; 
with a similar rise to B'Ol per cent, when the father was 
between 40 and 60. These figures are not without 
interest in respect of the proper age for marriage. 

We talk of a predisposition to tubercnlosis as if it 
were a more or less fixed quantity, thongh, after all, it 
is merely a matter of appreciation. Dr. Albbbt Robin, 
of Paris, read a paper in which he showed that predis¬ 
position is not a mere figure of speech, but that it 
corresponds to certain well-defined and recognisable 
peculiarities of tbe respiratory exchanges. A study of 
these exchanges enables ns to recognise predisposed 
subjects beforehand and consequently to submit them to 
a bjgieoicand therapeutic regimen capable of modifying 
the fuactdonal and nutritive fault which is the necessary 
antecedent condition for the development of tbe bacillus. 
The respiratory exchanges are found to be increased in 
92 per cent, of tbe subjects of confirmed tuberonlosis 
and in 63 per oent. of those with tnberonlous heredity. 
Alcoholism and various forms of overwork increase tbe 
respiratory exebanges, and are thus capable of creating 
a soil for tuberonlosis in tbe same way as heredity. 
From this observation be deduces a means of testing 
the value of treatments according to their action in 
modifying the respiratory exebanges. 

Tbe treatment of phthisis by climate and by " open- 
air” being very much in vogne, a special intereet 
attaches to a paper by Dr. W. Gobdon, of Exeter, who 
has »tndied the influence of wind per se on prevalence of 
phthisis in his part of the country. He finds that tbe 
distribution of the phthisical death-rate cannot be 
explained by peonliarities of soil or rainfall, snnsbine 
or purity of atmosphere or differences of sanitation, 
OGOupation, race or intermarriage ; in short, he thinks 
the excessive mortality in certain districts can be fully 
accounted fur by the influence of expoenie to west and 
south-west winds. It would appear that the influence 
of these winds is not dne so much to their coming from 
any particular quarter or to any peouliarity in the 
matter of temperature, moisture, Ao., but to the fact 
that the prevalence of wind leads tbe inhabitants to 





142 Thi Midical Pbssb. 


THE OPERATING THEATRES. 


Auo. Y. 1901. 


keep their windows and doors shat night and day, thus 
creating a condition of non-aeration comparable to that 
which obtains in cities from deficient air space, over¬ 
crowding, &o. This argoment is not without its 
importance in that it establishes the importance of 
choosing a sheltered spot whereon to erect sanatoria. 
The thing is not to exclude any particular wind, but to 
exclude great movements of air which make living in 
the open air uncomfortable. Although wind per te does 
not directly create any liability to tuberculosis, it does 
appear to exert an inimical action on those who are 
actually suffering from pulmonary tuberculosis* 
uiother reason for excluding wind from sanatorium 
grounds. 

There remains the subject of treatment of tubercu¬ 
lous affections by drugs and sera, and this may be dis¬ 
missed in a few words. Dr. G. A. Hkboh reported 
fairly good results following treatment by injections of 
Koch’s tuberculin j sixteen out of fifty-seven cases 
having recovered. He attributed the discredit into 
which this method of treatment had fallen to its use in 
unsuitable oases and in too large doses. On the whole, 
he considered it as safe as any other potent drug. Pro¬ 
fessor Koch himself was much more guarded in his 
utterance. He stated that his tuberculin was valuable 
in cases of apical pneumonia, especially when influenza 
^^•8 suspected, also in oases of pleurisy. In eatly 
uncomplicated cases of phthisU it was, he said of great 
value and a complete cure frequently followed, but to 
obtain its maximum good effects the temperature should 
be normal before the injKstions were begun. In the 
diecuseion that followed, in which a la^e number of 
weU-known authorities took part, the almost unanimous 
opinion was adverse to the use of this substance, and 
this no doubt represents the opinion of the profession 
at large. 

The voluntary notification of cases of pulmonary 
tuberculosia, as set forth in a paper by Alderman 
McDouoali., of Manchester, has much to recommend it 
as affording the means of ascertaining the prevalence 
and distribution of the disease. Its benefits, however, 
are not merely statUtical. A knowledge of the locai 
distribution of the disease enables the sanitary 
authorities to inquire into the sanitary condition of the 
house or district, it enables advice for preventing the 
*P*^ud of the disease to be given and proper sanitary 
precautions enjoined. Then too, the sufferer, if of 
the labouring classes, can be removed to a hospital or 
sanatorium when such are available; and, lastly, it 
enables the medical officer of health to insist upon 
adequate dismfection of the premises after death or 
removal of the patient. This system can only be 
resorted to with benefit in districts where advantage 
can be taken of the knowledge thus gained to carry out 
the oonsequential measures. 

The infectivity of houses inhabited by the phthisical 
is a point upon which definite information was greatly 
needed. Dr. Habold Coatbs, of Manchester, brought 
forward some interesting observations bearing on this 
point. He classifies the houses with a phthisical 
inhabitant into dirty aod comparatively clean, with a 
third group of very dirty houses without any tuber¬ 
culous inhabitant. In twenty-three houses described as 
" dirty and inhabited by a consumptive patient ” four¬ 
teen were found to contain infective dust, equal to 66*6 


per cent. His conclusions point to the fact that while 
light and air are highly important, cubic spaoe without 
ventilation is of no avail. Of ten houses described as 
'* clean but inhabited by a consumptive patient,” infec¬ 
tive dust was found in 50 per cent. Be concludes, 
therefore, that ordinary cleanliness is not sufficient to 
prevent the accumulation of infective material in rooms 
inhabited by a consumptive. The importance of light¬ 
ing and ventilation was shown by the fact that in all 
the rooms where no infective material was found both 
were good. Out of ten houses described as ” very dirty 
but in which no tuberculous disease had existed for 
several years,” in none could any infective dust be found, 
so that the inference is that the virulent dust found in 
houses of the first two categories was derived from the 
consumptive persons. Incidentally he laid stress upon 
the importemce of the thorough disinfection of dwellings 
which have been inhabited by the phthisical, an argu¬ 
ment which will command ready assent. 

Naturally, the provision of sanatoria came in for full 
consideration. It was recognised that vastly-increased 
accommodation is required if any impression is to be 
made on the prevalence of tbe pulmonary tuberculosis 
iu our midst, not only for tbe purpose of placing tbe 
victim of tbe disease in an environment favourable to 
bis restoration to health, bnt also, and this is not the 
least important, in order to remove a potent source of 
omktamiuation from his family and the district. Tbe 
only point calling for notice in this connection is the 
fact that it is unnecessary to wait until fonds are prcv 
Tided for tbe construction of large sanatoria fitted with 
all tbe therapeutical luxuries of modem science. It 
was urged that a vast amount of benefit could be con¬ 
ferred by camp sanatoria—that is to say, by tbe pro¬ 
vision of more or less inexpensive constructions—tents, 
huts, and the like. In these medical supervision would 
be reduced to a minimum. Tbe great thing is that 
such encampments might be created all over tbe 
country with the assistance of local antboritiee or by 
private benevolence, and in view of tbe small cost of 
maintenance they might easily be made self-snpporting. 


©jjeratmg theatres. 

THE CHELSEA H03TITAL FOB WOMEN. 

Nxphbxctokt and Appkndbotokt.— Mr. Blano- 
SuTTON operated on a woman, st. 46, on account of u 
obscure pain iu the right side of the abdomen, which 
was at times accompanied by a definite *' swelling.” Tbe 
patient bad during tbe preceding five years seen several 
physicians and surgeons, who bad found it difficult to 
determme between an intermitting hydronepbroeis or 
distension of tbe csecum. Mr. Bland-Sutton, after 
careful observations ol tbe patient, found it difflonlt to 
decide whether the right kidney or the vermiform 
appendix was the source of trouble, and determined to 
explore the parts through an incision in the right lines 
semilunaris. On exposing tbe parts a very long (6 ins.) 
vermiform appendix was seen lying parallel with and 
adherent to tbe csecum and ascending colon. Its distended 
tip was in actnal contact with the gall-bladder. Tbe 
appendix was removed. The right kidney was completely 
disorganised, and its pelvis with the adjacent segment 
of the ureter was dilated into a large sm. On carefnl 
examination he assured himself that it would be 

D.. Og t 



Auo. f, 1901. 


LEADING ARTICLES. 


Thi Mbdical Pbsss. 1^3 


jndicioiu to romove this trotibleeome organ, especiallj 
•a the Mtkidaof appeared to be eonnd and efficient. 
Nephrectomj was carried ont without anjr difficulty, the 
la^ flaccid renal pelvis being oarefoUy dissociated 
from the vessels before they were ligatured. The abdo¬ 
minal incision was sutured in three layers and without 
drainage Mr. Bisnd-Sutton observed that the case 
waa of interest because pains in the right side of the 
abdomen accompanied by a swelling, permanent 
or temporary, were often puzzling. Thus a gall¬ 
bladder night be so distended with pus, and 
reach so low as to simolate an appendix abscess, 
aod be had evacuated an abscess, of which the gall* 
bladder formed part of its wall as high as the 
right costal arch, which contained the detached tip of 
the appendix. He pointed out that an ovarian abscess 
or a distended Fallopian tube adherent to cnonm simn- 
lated appendix ^nble so closely that ^e distinction 
was only possible on actual inspection. Fnrther, it was 
often extremely difficult, he said, to diagnose an acutely 
mflamed and distended gall-bladder from an acute 
hfdronephroeis, or a chronically inflamed gall-blswider 
from a movable kidney. In donbtfol conditions it was, 
be tiiought, always wise to carefolly inspect the swelling 
through au incision in the abdominal wall, and then act 
scoording to the organ which is the source of trouble : 
it msy be colon, creonm, or appendix, kidney, liver, gall¬ 
bladder, or perchance the pylorus. Often it is the 
ovary or Fallopian tube. 

The patient made an uninterrupted recovery. 


BcOlSnSEO FOB rRABSXlSSIOM ABBOAS. 

^he JHebical anb CtrotUtr. 

FabUsliad everr Wedneeday moming, Piiea Sd. Poet tree, 5id. 


AfiVflKTUEMBm. 

fOB On laeBBnowr- Whole Pege. £5 Os. Od.; Half Pat*i 
0 10s. Od.: Qnarter Page, £\ Se.; One-eighth, Ite. dd. 

Fjb a Sbbim or ijsBBnnove ■ —Whole Page, thirteen ineerttona 
IwseUy, fortnightly, or monthly), at AS lOe. Od.; twenty-eiz 
ioeestioiia (weekly or fortnightly) at £8 Se. 0^; fifty-two 
inawtiou (weekly) at £3 each. Half Pege, thirteen ineertlone 
It SSe.: tw«nty-eii at 88a.: flfty-two inaertlona at SOa. aaoh t 
Qnartarpaga, thirteen inaertlona at 18a. twanty-eiz inaartiona 
at Ita.: flf^’two inaartiona at Lie each. 

Sun annosnoementa of Pzactioee, Asalataacieo.VaoaBciea, Books, 
he.— Sevan linca or under, 4a. per inaertion { Sd. per line 
heyond. 


including, as it did, for the year 1900, the care of 
5,727 imbeciles, of 5,180 fever patients, of 1,492 small¬ 
pox patients, and of 860 children in homes, or a 
grand total of 13,266 pereons at a cost of £832,465. 
One of the most arduous additional duties consists in 
the conveyance of 33,791 infectious patients to and 
from hospital This branch of the administration 
involves a large staff of servants, and its services are 
available daily throughout the year. Some idea of 
the magnitude of its operations may be gathered 
from the fact that during the year the ambulances 
of the various stations covered in all a distance of 
232,848 miles. There are also three ambulance 
steamboats and an ambulance steam launch in 
working order, and these together have conveyed 
1,635 patients, and covered a distance of 4,757 miles. 
It is interesting to note the growing popularity of 
the infectious hospitals, which are open to any 
persons irrespective of their social position. In 
this connection the Report states that the increasing 
use of these institutions by the public has been one 
of the reasons that have compelled the Board from 
time to time to extend their building operations 
But there are other causes at work, namely, the 
additional accommodation required by imbeciles, 
and the increase in the various classes of poor 
children entrusted to the care of the Board. With 
regard to the latter point it is a matter of some 
surprise that a public body with practically un¬ 
limited funds at disposal should be obliged to record 
another year’s delay m carrying out the provisions of 
Mr. Chaplin’s famous Departmental Order. The 
task of finding accommodation for the five classes of 
Poor-law children was handed over to the Asylnms 
Board. The specified classes fell noder ophthalmia, 
ringworm, convalescent, and mentally defective and 
remand children. The present position may be 
summed up in the statement that neither ophthalmic 
nor ringworm children are yet received, although 
accommodation has been provided for 160 
of the latter class, a mere fraction of the 
total number thus affected. Homes have been 
founded at Heme Bay and at Margate for convales¬ 
cents. Some slender accommodation has been 
provided for tbis defective class, but none at present 
has been obtained in the case of children under 
remand from the police courts. After making every 
allowance for the legal and other difficulties of the 
situation the Asylnms Board can hardly be said to 
have risen to the present occasion with their usual 
energy and thoroughness. During several years 
they have been enabled to deal with Poor-law 
ophthalmic patients only by availing themselves 
of that most excellent pioneer institution, the 
ophthalmic isolation schools at Hanwell. The Board 
have secured two sites for children suffering from 
ophthalmia, namely, at Brentwood, in Essex, and at 
Swanley, in Kent. The total cost of those institu¬ 
tions will be very great, bat economy has never 
been a strong point with the Asylums Board. How¬ 
ever, the money thus spent will not be grudged by 
the patient ratepayer, provided it M shown that he 
D;...,izecl by I 


$re£B mb Cirrttlftr. 

** 8ALU8 POPDLI SUPREMA LIX.” 


WEDNESDAY, AUGUST 7, 1901. 


THE WORK OF THE METROPOLITAN 
ASYLUMS BOARD. 

The Annual Report of the Metropolitan Asylums 
Board furnishes an interesting account of the pro- 
Kressire administration of various Poor-law and 
municipal institutions. As a record of vigorous 
and enlightened administration it is of value to local 
bodies in all parts of the United Kingdom, and, for 
that matter, of the whole of our world-wide empire. 
The work of the Board U multifarious and important 


144 Thi Mkdical Fbxm 


LEADING ARTICLES. 


obtains in return accommodation of ample dimen¬ 
sions and first-rate quality. £832,465 18s. 5d. is a 
large sum to pay for the various purposes of the 
Board, but it is a relatively small sum if re¬ 
garded in the light of an insurance premium 
paid for tbe protection of the public as far as may be 
against tbe costly inroads of infections disease. In 
the course of time it may confidently be hoped that 
preventive medicine, of which the Asylums Board is 
a faithful and poweifnl handmaid, may extend con¬ 
trol over the additional scourges of measles and 
whooping-cough. In that event the Board will be 
called upon to make fresh efforts, although it may 
reasonably be expected that some of the dis ea ses 
which now tax their energies may bare notably 
diminished. Everyone interested in the problems of 
modem social life will do well to study carefully the 
admirable Report of the Metropolitan Asylums Board 
for the year 1900. 


“LATENT" FRACTURE OF THE SPINE. 

Much comment has been aroused in medical 
circles in Dublin concerning the sudden death of a 
pharmaceutical chemist, which took place on July 
20th. It would appear from the account in tbe 
public press of the evidence given at the inquest held 
on July 22nd, that the deceased told his assistant 
when the latter arrived at tbe shop at about nine 
o’clock on the morning of July 19th, that he had 
fallen down the cellar stairs. He complained of 
having hurt his ankle, but otherwise appeared to 
be in good health. About an hour afterwards 
he got on bis bicycle to ride to the Meath Hospital 
Dispensary, and this he seems to have been able 
to do without much distress. He returned to the 
shop at one o’clock, and attended to business there 
until about half-past two o’clock, complaining only of 
his ankle. A second witness who saw him at this 
hour corroborated this account. A third witness 
who had called at the shop at three o’clock to 
get a prescription compounded, deposed that 
the deceased complmned to him of having fallen 
downstairs and dislocated his ankle, and said 
that be had telephoned for a doctor but could 
not get one. The witness offered to take him 
in his trap to a doctor. The deceased bopped on 
one foot to the trap, which he entered without assist¬ 
ance. The witness subsequently returned with him 
to the shop, and, during the whole time he was with 
him, he had no reason to suppose that he suffered 
from any other injury than an injured ankle. Later 
another doctor saw him, and ordered a lotion 
which contained opium to be applied to his ankle. 
The deceased chemist's brother saw him in the 
evening just after this doctor's visit, and found him 
lying in his clothes on his bed. He complained of 
pain but without specifying where he felt it till he 
attempted to remove something from tbe pocket of 
his brother’s trousers when he made complaint of 
pmn in bis back. The deceased asked him to walk 
quietly in the room as the least vibration hurt him. 
The deceased appears to have been alone from about 


Auo. 7. 1901. 

eight o clock in the evening until eleven when his 
brother returned and remained with him. The 
deceased was alive at about 2.30 a.m. on the 20tli 
ult., but when his brother awoke at 7 a.m. he was found 
to be dead. At the post-mortem examination per¬ 
formed by tbe last doctor who saw him alive.asecond 
doctor being present, the posterior cervical r^ion 
carefully examined in consequence of a lai^o 
extravasation being noticed in that region, & 
of the left articular process of the fourth 
cervical vertebra was found with extra-dural effumon. 
The spinal cord does not, however, appear to hare 
showed signs of gross laceration or compression, 
Tbe brain was examined, but nothing else was found 
to account for death. Tbe analyses of the contents 
of tbe stomach failed to show that the deceased had 
swallowed any of tbe lotion, as was apparently sug¬ 
gested. It appears from tbe evidence that the unfor¬ 
tunate man not only attended actively to his busineea 
after the fall which injured his ankle and, it must be 
assumed, fractured the spinal articular process, bat 
even rode his bicycle, and hopped to and from a 
trap without complaining of pain in his neck or 
back. The doctor, to see whom he was driven, was 
not called at the inquest, nor was evidence taken 
from those who were on duty at tbe hospital. That 
a man may walk about almost immediately after 
having sustained a fracture of the upper cervi¬ 
cal vertebrse, and resume manual labour after 
a few days, has long been recognised, but it 
nevertheless must strike one who judges the 
case from tbe report of tbe evidence publish^ in the 
public press as extraordinary, that, with such a lesion 
as was found post-mortem, pain in the region should 
be so little complained of, and that tbe movements 
of the neck should be so free that though several 
skilled medical men and others saw the patient 
their attention does not seem to have been 
called to bis neck. It seems hard to under¬ 
stand why death should have taken place un¬ 
expectedly, even supposing that the roots of the 
phrenic nerve “ were so compressed by extravasated 
blood that it ceased to carry on its functions,’’ one 
would expect t hat its fellow would have done duty 
sufficiently long to allow warning of impending 
danger. The cord itself was apparently found to be 
compressed by tbe bsemorrhage or fragment of bone. 
Paralysis of the diaphragm alone can be but very 
rarely a cause of such sadden and unexpected death. 
The coroner was perfectly justified in his selection 
of the medical attendant—whose ability no one 
vrill question—to perform tbe post-mortem examina¬ 
tion. At the same time it would perhaps have 
been more satisfactory if, instead of the parts re¬ 
moved being brought (as was done) to a skilled 
pathologist, the patbolo^st had been brought to the 
post-mortem examination in tbe first instance. We 
are far from intending to infer that the examination 
was not satisfactorily performed; the known and 
acknowledged ability of tbe gentleman who per¬ 
formed it is a sufficit'Ut guarantee that it was, even 
' bad he not had a second medical man pi'esent during 

.,....;.zed i 





irOTES ON CTJRKBNT TOPICS. Thi Msjmcal Pksbb. 145 


A.JJO. 7, 1901. 

ita progreBS who corroborated fats evidence. It is to 
be hoped that an anthoriaed report of this extremelj 
important and interesting case will be pnblished in 
detail, as it would seem to fall tinder the head of the 
rare condition known as a “ latent ’* fracture of the 
spine—a name given years ago to such cases by 
Simon. 


SCIENTIFIO EDUCATION. 

Tex President’s Inanfraral Address at the Chel¬ 
tenham meeting of the British Medical Association 
had many features of interest, notably the learned 
and attractively written historical retrospect. On 
this alone we might comment at some length. But 
we refrain from doing so in order to throw into 
stronger relief a matter of equal interest and even 
greater importance, the plea, namely, for better and 
more widely-diffused scientific education incur land. 
I>r. Ferguson dwelt on the striking fact that many 
of our most far-reaching discoveries in connection 
with the healing art had been the work, not of the 
men in the actual practice of the profession, but of 
pure scientists, both biologists and chemists. True, 
had he chosen to illustrate the value of the work of 
practical medical men, he could have found examples 
sufficient; but let that pass. For the present we 
may follow the President's line of argument; the 
deduction from his theme was the value of a pure 
scientific education, and he found opportunity for 
znakingBome most importantcoroUaries on thesubject. 
He somewhat mournfully pointed out that the want 
of scientific technical education was driving out much 
m anu f acture fmm this country; taking as an 
example the aniline dyes, he reminded his hearers 
that while the discovery of these dyes was the work 
of an Englishman, the process of their manufacture 
now practically lay in the hands of a German firm, 
employing hundreds of analytical chemists, and 
thousands of workmen. He uttered a vrarning that 
has been uttered before, and that may require fre¬ 
quent repetition before we as a nation take it to 
heart, that an extension of this principle will mean 
untold financial loss to this country. And the loss 
will be all the greater because it is not only a ques¬ 
tion of a present pecuniary disadvantage; the worst 
feature of the business is that the mental capacity, 
ingenuity, and resources of our young men are not 
being exercised, and consequently we must neces¬ 
sarily get left further and further behind in the 
great world-competition. Dr. Ferguson warmly con¬ 
tended that a country which had produced the epoch- 
making discoverers of the last century was not 
barren either of genius or of industry; but our eons 
must have a fair chance, they must not be hopelessly 
handicapped. The moral and the remedy are clear, 
nor did the orator fail to point the one and define 
the other. We must have more scientific and tech¬ 
nical training at onr universities, available not for the 
few but for all; we must insist that the work of a 
university is not primarily to examine, but to teach ; 
and not only to teach, but principally to train up the 
students to investigation and research, and to bring 


out and develop all tbeir faculties of thinking for 
themselves. In a word, they must be taught to use 
and apply as well as to acquire knowledge. Schools 
of engineering, of applied chemistry, of technical 
industries, of biological research, must be multiplied 
and endowed. Naturally we look first to the Statet 
but the State, like Jerusalem of old, is slow to per¬ 
ceive the things that make for her good, and slower 
still to act on these perceptions when they are 
acquired. Failing the State, we must look 
to the public-spiritednesB and the generosity 
of onr wealthy men. Fortunately there are 
not wanting signs that the hour will bring forth the 
man; the recent munificent gifts to the Scotch xmi* 
versities are fresh in our memories. But must we 
long wait for the fulfilment of the aspiration tbah 
the Twentieth Century will see the establishment in 
eveiy great city in onr land of a true university, well- 
endowed and amply provisioned for thorough train, 
ing in all those branches of pure and applied science 
on the development of which commercial and social 
prosperity depends P For these things did the great 
Huxley labour and contend. May that mighty force, 
a nation's conscience, soon awake to insist on their 
fulfilment! 


on (Eurrtnt 

Signal Success of the Revolt Against 
"the Flannery Clauses.” 

It is with unalloyed satisfaction that we announce 
to onr readers to-day the complete success of the 
indignant revolt of members of the profession, 
headed by the Bradford and West Biding Medical 
Union, against the oppressive, insulting, and heart¬ 
less duties which Sir Fortescue Flannery, M.P., pro¬ 
posed to inflict on them by obligatory penal clauses 
in the Factory Bill now before the House of Commons • 
We gladly gave our support to the movement in 
opposition to those clauses, and in our issue of July 
17th condemned them root and branch. The success 
of our opposition has been complete; Sir Fortescue 
Flannery has unreservedly withdrawn his indefensible 
proposals, and we are undisputably victorious. Such 
a rapid success was hardly to be anticipated. 
One naturally supposed that Sir Fortescue Flannery 
would not have dared to propose such an unparalleled 
amendment attacking alike the sacred privilege of 
a dying patient and his friends, and the rights and 
duties ^of the medical attendant, unless he had for¬ 
tified himself with what he regarded as incontrover¬ 
tible arguments in bis favour, and we supposed be 
would have fought hard to defend bis cause. But 
we did him wrong in this. Having proposed to 
inflict unjustifiable indignities on the profession, and 
to make the sick room the scene where the doctor 
would have to struggle with patient and friends to 
secure a sample of the patient’s blood, Sir Fortescue 
has proved by bis sudden surrender that he feels he 
had no justification whatever for bis proposals. The 
absurd and unworkable character of the wording of 
his clauses is in itself proof of how lightly he I'egarded 
L.':.'::T:zed : \)0' 




AtJo. 7, IJWI. 


U6 Th« Midical Pbkob. NOTES ON CURKKNT TOPICS. 


the seriousness of what he was attempting. He is 
probably to-day a wiser and a sadder man. Had he 
not surrendered anconditionally the opposition would 
have resisted him to the bitter end, and every form 
of the House of Commons would have been employed 
against him, even to the last resource of destroying 
the whole Bill. This uncompromising attitude is 
the only one which need ever be adopted if success 
is wished for, in resisting such nefarious attempts. 
For the profession has unfortunately allowed itself 
to become a bye-word for want of power of resistance 
and apathy. Hence the increasing number of penal 
enactments to compel medical men to render obliga¬ 
tory services to the State. They alone, of all sub¬ 
jects of this realm are forced, to give to the public, 
by Act of Parliament, the fruits of their study and 
experience. To them alone has Parliament dared to 
say, “The fruits of your toil shall not be your 
own, you shall render them, to others, who 
have no right or title to them, except that those 
fruits are valuable and very useful.” The Medical 
Press and Circulab has always upheld the rights 
of the profession, and of all the medical journals 
in the country it alone has entered the liste against 
the Flannery clanses- It is with supreme satisfac¬ 
tion we record the fact and the victorious result. 
This notable'success is another illustration of how 
great is the power which the medical profession 
possesses if it will only rouse itself to promote its 
own interests. The Medical Press and Circular 
is always ready to support these interests, which 
form the object of its existence. Never have our 
columns been closed through self-interests to the 
greater claims of the noble profession whose organ 
we are. We cannot conclude without drawing the 
attention of the profession to the great debt which 
is doe to the Bradford and West Riding Medical 
Union for ite splendid service in the matter, and in 
particular to its President, Dr. Goyder, and to Dr. 
Hime, who have done yeomen’s service. It is not 
the first time Bradford men have won notable 
victories for the profession, exhibiting an example of 
unity, energy, and success which is an object lesson 
to the countiy. This contest has not been a local 
one in defence of Bradford interests. The Flannery 
clauses trampled on the rights of every medical man 
in the country. 

The Lady Doctors’ Opportunity. 

Owing to the absence at the front of so many 
young surgeons there is a striking difficulty in 
obtaining candidates for resident posts in hospitals 
and public dispensaries, especially in the provinces. 
So much is this the case that in quite a number of 
instances the only candidates have been qualified 
women, and they have accordingly been appointed. 
A contemporary points out that if the present dearth 
of candidates for the Services continues the Govern¬ 
ment may seriously have to consider the propriety 
of employing female labour. The authorities have a 
rooted objection to the employment of women, as evi¬ 
denced by their obstinacy in withholding a supply 
of nurses at the front until public opinion became too 


strong for them. We donbt, however, whether 
public opinion would view with complacency an in¬ 
novation in this direction, and the British soldier, 
who at heart is a modest being, would probably 
resent being obliged to unfold his of woe to an 
adviser of the opposite sex. One of the most dis¬ 
tressing consequences of the dearth of unattached 
medical men is the difficulty with which prac- 
titionei's, desirous of enjoying their well-earned 
repose, find in providing substitutes. Aa locum 
tenens, the lady doctor presents certain incontestable 
advantages. She is sober, assidnous, and sociEilly 
trustworthy. Nothing is farther from our idea than 
to insinnate that the male locum tenens is 
the reverse of this, but it is notorious that 
a certain proportion of the gentlemen who 
are willing to serve as substitutes present drawbacks 
of a more or less serious kind. Still the moment 
has not yet arrived when the average practitioner 
could safely entrust his clientele to the safe keeping 
of a lady substitute be she never so well suited for 
the post. 

The Mechanical Side of Surgery. 

We are constantly being reminded that there are 
a great many things which the ever busy student is 
not taught. A surgeon, inspired no doubt by the fact 
that he resides in Toledo (Ohio), complains that stu¬ 
dents are not taught how to sharpen their scalpels. 
Now it is a matter of fact that a very large propor¬ 
tion of suigeons would further impair the catting 
edge of a knife if they tried to confer upon it the 
indispensable sharpness. This consideration prompts 
the author to lay it down that no person shonld be 
allowed to practise surgery without first learning a 
mechanical trade. No doubt manual dexterity, how¬ 
ever acquired, is a precious qua'ity in every walk of 
life, but in deference to the principle of the division 
of labour we have allowed ourselves to fall into the 
habit of delegating these details to the surgical 
instrument maker. The important points to be 
remembered in “ boning ” a knife, it appears, are to 
pull it along tbe stone from heel to point with the 
cutting edge forward at an angle of about 45 degrees. 
When "stropping’’a knife, on the contrary, it should 
be drawn from heel to point away from the catting 
edge. If this information should be the means of 
obviating the necessity of any of our readers taking 
ont a course in a workshop we shall have earned 
their thanks. 

The Difficulties of Medicine. 

The address in medicine which Dr. J. F. Good- 
hart delivered at tbe annual meeting of the British 
Medical Associstion at Cheltenham is characterised 
by a Montaigne-like chattiness which made it pleasant 
to listen to in spite of ite genially cynical tone. Dr. 
Goodhart had no pet theme to discuss, and appa¬ 
rently no particular moral to enforce, bat he 
delivered himself of a series of more or less dis- 
cursory remarks on medicine as it is practised, 
which must have convinced his audience that “ the 
best of us are hut gropers in the dark,” though “any 



Auo. 7, 1901. NOTES ON CuErRENT TOPICS. Thk Midioal Pbbss- 347 

fool can gire a name to a disease/’ Fortunately Dr. notorioas that each is the generosity of medicine 
Goodhart regards the preTailing ignorance with that there is not a needy person in the whole 


philosophical indulgence, he does not twit ns with 
knowing so little, all he asks apparently is 
that, knowing so little, we should not pretend 
to know so mnch. He even goes so far as 
to palliate onr shortcomings in view of the 
difficnlties which hem in I'eeearcb on every hand. 
We have heard a good deal of late, he observed, 
about water tnbe boilers, their intricacy of working 
and their excessive wear and tear, and the difficulty of 
their repair without stopping the ship. What, he 
asks, would be the position of the engineer if such 
a vessel could be worked automatically with the 
batches down, positive knowledge of the condition of 
its mitrails being obtainable only by the observation 
and analysis of the smoke and bilge water, by post¬ 
mortem examination at the breaking up of old 
vessels and the recording where each had gone to 
pieces? Yet that is the position of the medical 
practiUoner when he attempts to modify or control 
function. Fortunately the animal organism has the 
advantage over the vessel of a certain self-righting 
power, but this again is au unknown quantity, and 
not even the wisest among us can foretell with any 
approach to certainty whether in a given case the 
disturbance is one the remedy of which it is within 
the power of the organism to compass. 

Liet the Hire be Worthy of the Labourer. 

One reason why the public as a rule set so little 
store by medical advice is that medical men weakly 
allow themselves to be cajoled into perpetuating the 
popular belief, the product of the thought which is 
child to the wish, that for every disease there is 
an appropriate remedy. None better than the 
medical practitioner knows that in the vast majority 
of cases which come under his notice it is advice and 
not medicine which is needed, yet the courage fails 
him to declare the fact and to act on it. This 
may, as suggested by Dr. Goodhart in his address 
at Cheltenham, be one reason why people ac¬ 
cept and pay for advice from lawyers readily 
enough while they fail to appreciate medical 
advice pure and simple. Advice, he exclaimed, just 
think of it! A product of so unique a value, that 
when a man of great experience in the world of 
medicine dies his knowledge dies with him; no other 
man can supply his place, and there is a dead loss to 
the community of a mine of unrealised information. 
Referring to a very very clever sig^nboard in which a 
bullock is seen gazing yearningly upon a small jar 
of meat extract and exclaiming “ Alas! my brother,” 
he said he wished he could pot brothers as they 
flitted from off the stage; his trouble was that 
his great masters died unbottled. And yet we 
** give ” advice, and there are those in num¬ 
ber wbo not only accept but ask the gift. 
And this advice, it has been asserted, is dispensed 
upon the strictest trades union principles which 
have been defined as “ doing the worst possible 
work at the highest possible price.” Why, it is 


kingdom who cannot, if he need it, obtain the best 
opinion in the country gratuitously. The clergy, the 
army, the navy, artists, actors, actresses, clerks, arti¬ 
sans, and others, pour into a doctor's room or the 
hospital asking alms in the shape of advice and 
never get a refusal. And after it all we are insulted 
by hsiug called trades unionists—“ men who do the 
worst possible work at the highest possible price! ” 
Yerily we have ourselves to thank for this in great 
measure, for we belittle the value of our advice in 
allowing the public to exalt so greatly the supremacy 
of mere physic. The labourer is worthy of his hire is 
but one side of the question, and not the best side, for 
it might be held to cover many a sordid act; the other 
and much the more important is surely this, “ See 
to it that the hire is worthy of the labourer,’’ in the 
form of the higher and nobler recompense of dignity- 
and self-respect. 

Phthisis at Bordeaux. 

The town of Bordeaux has instituted an excellent 
method of practically dealing with the cases of 
tuberculosis within its boundaries. An Anti- 
Tuberculous Society has been formed that publishes 
documents relating to tuberculosis, encourages the 
use of tuberculin in the stables from which milk is 
supplied, assists the doctors by analysing and 
reporting on sputum or other specimens iu suspected 
case 8 ;wheD necessary, carries out inoculation experi¬ 
ments in guinea-pigs for the purposes of diagnosis, 
and in every other way possible furnishes aid to the 
physicians concerned. We are glad to hearthat the 
latest reports speak in the highest terms of the suc¬ 
cess of this very sensible means of combating the 
ravages of phthisis. 

The Proposed Cancer Congress. 

With a great many people the panacea for ignor¬ 
ance in any subject is a congress, or at any rate a 
commission of inquiry. They attribute to these 
bodies sundry occult powers of discovering the 
truth, and, having voted in favour thereof, they 
fold their hands in the blissful consciousness of 
having done something to help the cause. Scientific 
men on the contrary are disposed to question 
the gain to knowledge of these ever-recurring con¬ 
gresses. It is difficult to define in these days of 
international journalism the way in which these 
gatheriogs can advance our knowledge of the subjects 
under discussion. If anything new or interestiog 
crops up which is quite exceptional, it simply means 
that a particular investigator has held over his com¬ 
munication in view of the meeting. Truths are not 
elucidated iu view of a congress, and failing such a 
meeting they would be communicated to the scientific 
world by the ordinary channels, which, after all, are 
better suited to the pui'pose. Of all subjects 
in the world iu respect of which a congress 
would be futile and indeed absurd, cancer is the 
least amenable to discussion. What we require 
is fact not discussion, and facts are being 

Digiiized by Google 



148 Trs Mbdical Pbbss. 


NOTES ON CUERENT TOPICS. 


Auo. 7, 1901. 


strenuoualj sought after bj hundreds of trained 
intelligences throoghout the civilised world. No 
stimnlns is needed in the way of prizes or rewards, 
the privilege of having been able to throw light on 
this dark comer in pathology would be, in itself, 
ample compensation for a lifetime devoted to 
laborious research. The endowment of research is 
another matter. The labourer cannot give the mea* 
sure of his skill without the proper tools, and men 
who devote their time and energy to unremnnerative 
pursuits must be provided with the means of sub¬ 
sistence. 

Resuscitation in Chloroform Narcosis. 

Ant amateur ansesthetist who has been suddenly 
called upon to “ do something ” in an alarming case 
of chloroform narcosis must wonder how it was that 
he could think of so few measures when so many 
have been suggested. Some of them, quoting from 
a recent article by Dr. A. "Wilson in the New York 
Medical Chronicle, might not occur to the average 
practitioner. We note, for instance, the application 
of Corrigan’s button to the epigastrium, dilatation 
of the sphincter ani, or the application of a hot 
sponge to the perinuum. Should none of these 
occur to the person in charge of the case he may 
stimulate the heart by intermittent pressure, rapid 
percussion, faradisation, or acupuncture. Failing 
the presence of mind to cany out all or any of these 
restorative procedures the belated physician may 
advantageously administer, subcutaneously or by 
inhalation, always supposing that the patient will 
breathe for the purpose, drugs which have the power 
of stimulating the depressed nerveoentres—ammonia, 
nicotine, strychnine, extract of suprarenal capsules, 
“and the like.” It is hardly conceivable that be 
should be unprovided with these everyday drugs, or 
that he should forget or omit to make use of them. 
Seriously, however, of all the measures suggested for 
the resuscitation of the apparently narcotised, the 
only ones likely to prove of instant avail are the 
head-low position, artificial respiration aided by 
rhythmical traction on the tongue, and percussion 
over the cardiac area. 

Popular Theories of Tuberculosis 
Prevention. 

Fob the time being the daily newspapers contain 
many “ letters from correspondents ” desirous of 
airing their views of how to prevent the spread of 
phthisis. In ninety-nine cases out of a hundred their 
arguments are rendered worthless by some plan that 
would be evident to anyone possessing a modicum of 
medical training. This persistent effort to solve 
problems that have hitherto defied the most advanced 
medical skill is not without its underlying moral. 
It shows, for one thing, how the average man prefers 
to trust his own judgment in matters of medicine, 
notwithstandiog the particular point on which he 
elects to give his decision involves a knowledge 
of facte in prevention, causation, and treatment of 
an insidious malady, to say nothing of a close 
acquaintance with pathology, bacteriology, chemistry, 


and other subsidiary branches of medicine. In many 
cases the intelligent layman not only feels himself 
capable of cutting the Gordian knot, but also of 
deciding which quack remedy of unknown composi¬ 
tion he will purchase by way of cure. Instances of 
this species of misguided sagacity on the part of the 
man in the street are “ plenty as blackberries ” (ste). 
Last week a London daily newspaper contained the 
sapient suggestion that all tuberculous sputum could 
be rendered harmless if pellets of creosote and euca¬ 
lyptus were kept in the patient’s mouth. In other 
words, he would trust the destruction of the myriads 
of bacilli buried iu the sputum to their momentary 
exposure in the month to a feeble disinfectant sur¬ 
face. Some day it is to be hoped that the news¬ 
papers generally will be educated in the rudiments 
of preventive medical science. 

Malaria and House Sanitation. 

The ancient sanitary maxim which directs every 
man to “keep his house in order” has received 
a fresh and striking illustration in the case of malaria. 
In an interesting letter addressed to the Honorary 
Secretary of the Liverpool School of Medicine, 
Major Ronald Ross has described the steps taken to 
rid Freetown, Sierra Leone, of the mosquitoes that 
carry malaria. The main attack has been naturally 
directed against the pools of water in the district, for 
those sites, as most folk know nowadays, are the 
natural breeding places of the pestiferous insects in 
question. A most important additional portion of 
Major Ross’ work, however, has been devoted to the 
houses of the town. He has organised a gang of seven 
men, who are constantly engaged in destroying mos¬ 
quito larves in private houses, and in carrying 
away tin cans, broken bottles, old buckets, and 
other receptacles in which these dangerous little 
midges breed. They clear about forty houses daily, 
and carry off in that way some ten cartloads of pots, 
of which about one-third formerly bred mosquitoes. 
This pen and ink sketch presents a most instructive 
object lesson of practical sanitation founded upon 
advanced scientific discovery. It emphasises afresh 
the old observation that tropical disease is often 
favoured by the bad sanitary environment of the 
dwelling-house. A few years ago the average intelli* 
gent European would have laughed the laugh of 
the scornful had one told him he was fostering 
malaria by throwing his empty pickle bottles and 
meat cans on the domestic dust heap. Yet nowadays 
science has demonstrated the relationship of those 
apparently absolutely diverse facte. 

Tlie Housing of the Poor. 

Mb. Floweb, one of the speakers in the recent 
debate in the Commons upon the Local Government 
Board vote, appears to entertain an exalted idea of 
the capabilities of that Department. He suggested 
that the Board should instruct the local authorities 
in the building of houses for the very poorest at 
such a cost that the rentals would come within the 
means of the class for whom the houses were in¬ 
tended. His theory of the relations that should 
Di;.,.,., 'Og C 


NOTES ON CURRENT TOPICS. Tra Mxdical Pbem. 149 


A po. 7, 1901. 

exist between the central and local administrations 
in this important particnlar is almost ideal. Unfor- 
tnnatelj, in attempting to reduce his views to prac¬ 
tice he woald find himself faced with some verj hard 
nuts to crack. Manj experiments have been made 
bj public bodies in various parts of the United King¬ 
dom to erect cheap artisans’ dwellings. Hitherto, how¬ 
ever, the plainest buildings and the cheapest materials 
have cost so much that it has been found impossible 
by means of a small rent to pay interest on capital 
and repay original capital by a sinking fund. The 
only two factors that are really capable of reduction 
are the extension of the time for repayment of prime 
expenditure and the high price of land. To deal 
with those underlying causes is clearly in the bands 
of Parliament, and not of local governing bodies. 
The attention of Mr. Flower may be drawn to these 
elementary considerations, in order that he may con¬ 
sider the advisability of going to the fountain head 
for his most desirable reform. It is, of course, within 
the bounds of possibility that he may have evolved 
some practical solution of the housing problem. In 
that case his scheme would be of advantage to the 
Local Government Board, which cannot be expected 
to play the part of blind leader to blind local bodies. 

The President’s Address at the British 
Pharmaceutical Conference. 

As might have been expected, the President’s 
Address at the Dublin meeting dealt with the 
advance of sciences collateral to pharmacy during 
the century. To do any justice to the address in an 
article is impossible, for to get an idea of its great 
range of subject, its fulness of information, and the 
learned orator's mastery of his subject, the address 
most be read. The first thing that strikes the reader 
is the fulness of details and their natural arrange¬ 
ment, fact follows fact naturally and smoothly, so 
that the reader glides along acentury’s history without 
one jarring note. Passing over theearlier passages we 
come to his story of the progress of dentistry, in 
which good work British workers bore no small part. 
Davy, Dacton, Crookes, Ramsay, Dewar, Kelvin, 
Brown, figure as fellow-workers in the world of 
science, with Reozelius, Meyer, Mendcalf, Pasteur, 
Coventon, Pelletier, and others. In this connection 
we are sorry that Kane, O'Donovan, and O'Shaugh- 
nesey are not mentioned. Kane was, perhaps, the 
very first to demonstrate that the hydrogen of 
ammonia was displaceable, O’Donovan’s papers on 
aloes were among the first detailed accounts of the 
analytical searches for a]kaloids,and O’Shaughnessy's 
researches on Indian drugs have a permanent value, 
Dewar’s experiments unfortunately failed to recall 
those of Andrews on the allotropic forms of oxygen. 
We merely mention these; in no carping criticism do 
we judge of the brilliant address. To Liebeg he 
ascribe the discovery of chloroform. We are in¬ 
clined to think that the discovery was due to 
Washington’s friend, Mr. Samuel Guthrie, chemist 
to the Army of Independence. It is, however, merely 
a question of priority, for the aniesthetic was inde¬ 


pendently discovered by Guthrie, Liebeg, and 
Soubeiran. Botany claimed a lai^e share of the 
President’s attention, and he pays a well deserved 
compliment to Dr. D. Moore’s “ Cybele Hibemioa,” 
which has done so much for Irish floor. He refers, 
among others, to Bentley and Trimen's praiseworthy 
“ Medicinal Plants,” and yet we reg^t there is no 
reference to Dr. William Woodville’s “ Medical 
Botany,” though it was published as early as 1790. 
Yet it for beauty of illustration and accuracy of 
delineation still remains facile princepa. The more 
modern study of bacteriology in its early history, its 
present development, and its fascinating story, for 
the speaker has the gift of clothing the dry bones 
and giving them form, life, and beauty, so that the 
fascination of genius robs the brain of weariness, and 
as subject follows subject the listener feels no fatigue, 
and his receptivity of the story of scientific progress 
remains nndulled. The address is a great one, 
worihy of the man and of the occasion. 

Increase of Lunacy in the Yorkshire 
District. 

The increase of lunacy is unfortunately being 
reverted to much too often in our columns, and for 
reasons which are unavoidable, and which are fre¬ 
quently spoken of. Three main groups of the insane 
are now and again coming up for notice—paying 
patients, epileptics, and idiots. No sooner is relief 
granted in one direction than it is claimed in 
another. The discussions which arise at the meet¬ 
ings of our Committees on the subject of lunacy and 
allied social and medical matters, are very interest, 
ing, especially when well reported in local news¬ 
papers, and useful in furnishing an education of the 
trend of public opinion on the subject of the value 
given to . these matters. If the camera of the 
reporter may be really taken as a correct one, we 
should say that the most clamorous views, it may be 
also the coareeat, are those of the epileptics and the 
idiots, perhaps because they are most repulsive. One 
thing is certain, a good deal has yet to be done, how¬ 
ever before our duty has been accomplished towards 
the miserable people who are able to do so little for 
themselves. 

Modem Caaualty-Booxa Work. 

Nowadays the work of the hospital casualty-room 
has become more or less modified in accordance with 
the trend of modem aseptic surgery. Personal 
cleanliness is rightly regarded as a matter of first 
importance among dressers and house surgeons; 
thus, the dresser is directed to wash and to disinfect 
his hands before dealing with any injury that either 
involves operation or presents a breach of skin sur¬ 
face. The patient’s skin is most systematically and 
carefully disinfected. Instruments are boiled from 
time to time and kept in antiseptic solutions, 
of which the one in forty carbolic lotion still 
remains a chief favourite. Sutures are of the 
non-absorbent and aseptic type, such as cal^ut, 
silkworm, gut, and horsehair, kept ready in jars of 
antiseptic lotion. A handy general dressing is gauze 

oog 


'■■zed : 



150 Thx Mboioal Pbibs. 


NOTEa ON 00 BRENT TOPICS. 


Auo. 7. 1901. 


kept in oarbolio lotion and wnmg ont before use. 
Bums are cleansed with boracio in preference to 
carbolic lotion, as the latter is painful and liable to 
absorption. Boracio acid lotion is also used almost 
exclusivelj for the eje and face. The ointments in 
vogue are chiefly boracio acid, yellow oxide of mer¬ 
cury, and eucalyptus and vaseline, or other antiseptic 
unguents. Lai^ quantities of boracio acid powder 
and iodoform are applied to wounds, while bruises 
are treated with glycerine and belladonna on lint. 
Poultices bare been entirely superseded by light antu 
septic fomentations applied under oiled silk. The re¬ 
sults of modem casualty-room work are most 
encouraging, as rapid healing is the rule, and septic 
complications are extremely rare. 

Disinfection after Cancer. 

The recent public allusion of the King to cancer 
and its possible prevention cannot fail to attract 
widespread attention to the subject. Indeed, it ap¬ 
pears to have already roused the ener^es of the Eton 
Rural District Council, as testified in their pro¬ 
ceedings last week. One of the members went so 
far as to ask the Medical Officer of Health if he 
disinfected after cancer. The official in question re¬ 
plied that in a report he was preparing on cancer 
he proposed to recommend that houses should be 
cleansed properly at his discretion. This proposal, it 
need hardly be remarked, registers an extremely high 
standard of preventive health administration. In¬ 
deed it may almost be regai'ded, in the absence of 
absolute proof as to the infectiveness of cancer, as 
somewhat transcendental in charactor. On the other 
hand, the Eton Rural Council may be asked whether 
they have adopted systematic disinfection in tuber¬ 
culous disease which is known to be due to a specific 
bacillus. Then, again, there are the familiar scourges 
of measles and whooping-cough, which probably kill 
a far greater number than cancer of the inhabitants 
of the twenty parishes that make up the Eton rural 
jurisdiction. Perhaps one day the prevention of the 
two humbler maladies may become fashionable, and 
the desirability of disinfection after their occurrence 
be more widely recognised by the local authorities of 
the United Kingdom. 

Save me Arom my Friends! 

Soars ill-advised person has written a letter to 
The Times, to which it is to be regretted that the 
editor gave publicity, complaining that a paper by 
Dr. Maguire, of the Brompton Hospital, was “ rele¬ 
gated to an obscure position ” at the Congress on 
Tuberculosis, and virtually ignored. The writer 
signs himself *‘A Layman,” and with a truly lay¬ 
man's confidence he claims that the treatment by 
Dr. Maguire’s method has produced marvellous 
results in cases ” ragarded as hopeless,” and he is 
correspondingly indignant at “ this virtual suppres¬ 
sion.” We feel sure that no one deplores this tactless 
effusion more than Dr. Maguire himself, the more so 
as any suggestion of his, supported by encouraging 
results, would certainly receive respectful attention 
at the bands of his brethren. 


A Judicious Forecast. 

Thb London correspondent of the New Tork 
Medical News may be congratulated upon the 
possession of an unusual degree of perspicacity. In 
the issue for July 13th he observed, in reference to 
Foofessor Koch ; “ It may be said of him, as it was 
said of Dupuytren, that his motto miabt be ‘ Faire 
autrement.’ He has, as far as so godlike a man can 
share in human weakness, the instinct of sensa¬ 
tionalism, and from the somewhat mysterious fore¬ 
shadowing of the lines of his address which he has 
communicated to the officials, one may gather that 
be intends to sny sometbiog that will startle the 
Congress.’* This the Professor has certainly done, 
not altogether to the satisfaction of the scientific 
world, many members of which have reached an age 
at which sudden and violent emotions are disagreeable 
and even dangerous. 

First Egyptian Congress of Medicine. 

We are asked to announce that the first Egyptian 
Congress of Medicine will be held at Cairo between 
December 10th and 14tb, 1902, under the patron^e 
of His Highness the Khedive and the Government of 
Egypt. Contributions are invited more particularly 
on diseases peculiar to that country, such as bil- 
hariza, ankylostoma, bilious fever, hepatic abscess, &c. 
Epidemiology will necessarily afford an important 
subject of discussion. The complete programme will 
be published later, when particulars will be given of 
facilities of travel accorded by the various com¬ 
panies. 

The X-Rays and Malingering. 

An unfortunate man who has been obliged to 
undergo the anxiety and suspense of three trials 
spread over the period of thirty-six months for what 
is in Russia the criminal offence of malingering has 
at last succeeded in convincing the authorities that 
he is not the arch impostor it was sought to prove. 
The man came under examination as an Army 
recruit and was found to exhibit a swollen left 
ankle and foot. He said he bad received 
a blow from a heavy weight upon the foot. The 
military surgeons accused him of malingering, and 
averred that the oedema bad been induced by 
bandaging. At two different trials he was sentenced 
to imprisonment, but at the third trial a skiagram 
proved that there bad been a fracture from the blow 
affecting the tarsal arch, and injuring the circula¬ 
tion in the part concerned. An earlier resort to 
such a very obvious diagnostic method would have 
spared the wretched patient many months of misery. 


PERSONAL. 

Mb. Thouab John Cabson, L.F.P.S. and L.M. Glasg. 
has been placed on the Commiasion of the Feaoe to 
the Borough of Oldham. 


Prof. W. B. Suith has resigned the post of Medical 
Officer to the London School Board which he has held 
for the past twelve years, v 

D!;.,„zecl t' 'O^IC 


Avo. 7. 1901. 


BRITISH MEDICAL ASSOCIATION. Thi BCbpich. Pbws. I5I 


Tbi King has been pleased to appoint Dr. William 
H^meister and Dr. Edgar Hoffmtister medical 
attendants to tlie Boyal eetablishment at Obsome. 

Thb death is annonnoed of Dr. Widmhofer, the 
Austrian Court physioian, whose name U perhaps best 
known in connection witii the trapo death of the late 
Orown Frinoe Sndolf. - 

Th> Gi lfill a n prise has been gained bj a lady for the 
first time, and was awarded last week at the Edinborgh 
TTniversity Oradnation Ceremonial to Miss Agnes Moore 
Hamilton, M.B., B.Ch. A fnll list of prise winners and 
9 old medalists will be fonnd in another oolnmn. 

Thx Chesterfield Medal for Dermatolc^, given under 
certain conditions as the result of a competitive exami* 
nation at St. John’s Hospital for Diseases of the Skin, 
has this year been awarded to George Borman Meaohen, 
M.B., B.S.Lond., M.R.C.P.Edin, M.E.C.S., Clinical 
Assistant to tiie Hospital for Diseases of the Skin, 
Blackfriars. - 

SuaoiON-MajoB-GiKXBAL W. A. Thomson, M.B., 
H(m. Fhys. to the King, has been selected for a Good 
Service Pension. It is nearly fifty years since this officer 
received his first Commission as an Army Surgeon. He 
has served in many parts of the world, and at the time 
of his retirement in 1892 he was Principal Medical 
Officer in India. 


‘l^hc British JRcbiral Jlssocmtioir. 

ANNUAL MEETING HELD AT 
CHELTENHAM, 

JiTLY 30 th to August 3bd, 1901. 

Fbw pleasanter or more suitable places for the meet¬ 
ing of a Congress whose votaries seek to combine work 
and pleMure could be found than Cheltenham. A fair 
town, sitnated in the midst of lovely surroundings, it 
bae, in the first place, the charm of historic associations. 
Here rank and beauty have foregathered. Bean Brnm- 
mel walked its streets, crowned heads ^ve drunk its 
waters. Nor can the medical profession ever foi^t that 
one of the greatest of its members here 1^ a bnmble 
and useful life—Edward Jenner. The British 
Association met here once before, and it is a coincidence 
of special interest, as the Mayor of Cheltenham remarked 
when welcoming us to the town, that as this meeting 
takes place in the year of the accession of onr gracious 
King Edward VII., so the hist meeting was in the year 
of aooeesion of bis illustrions predecessor. Victoria, the 
graat and good. Then the Association was in its in- 
canoy, and its members barely reached four figures; 
now with a membership of nearly 19,000, its 
bra nc h e s are found all over the British Empire, mid 
it hM become a power in the land. The inangural 
meeting derived a special interest from the presence 
of ^egstee from nearly all parts of the British pos¬ 
sessions : and as they stepped up on to the platform to 
shake hands with the President, they were lon^y cheered. 
Of the President, Dr. G. B. Ferguson, we may say that 
seldom has a more genial, eloquent, or learned President 
occupied the chair; and hio masterly address will live in 
the memory of probably every one of the Imge gathering 
privileged to hear it. 

The Mayor and Mayoress of Cheltenham deserve a 
special word of tribute to the hospiti^ty which they 
showed, and in which they were cordially supported by 
the Town ConnoU. They aooepted the visit of the 
A sso ci ation as an honour, and in so doing conferred an 
honour on their gnests. 

EHmTAlNVBNTS. 

These began with a largely-attended “ At Home” on 
Monday evenly at the WintOT Garden, where the Annual 
Museum and Exhibition were helA The opeiung oer^ 


mony was performed by the Mayor and Mayoress. On 
Tuesday, at llAO, the annual sermon was preached in 
St. Matthew's chnroh by the Very Bev. the Dean of 
Gloucester (Dean Spence), who took as his text, “ Lnke, 
tike beloved physioian” (Coloss, iv., 14). In the after¬ 
noon, after the flrat Genera Meeting, a garden party was 

g 'ren at Battledown Court by Coh Bogers, J.P., and Mrs. 

igers. In the evening ^e Preei<&nf s address was 
deemed to supply the place of entertainment, and it 
proved, indeed^ most enjoyable. 

On Wednesday, after the second general meeting, the 
Mayor snd Mayoress gave a garden party in the lovely 
grounds of Pit^iUe Park; the element of music on this 
as on other occasions throoghout the Congress being 
supplied by Herr Wurm’s excellent White Viennese 
Band. In the evening Dr. J. F. Goodhart delivered ithe 
address in medicine; and after this the Mayor and 
Mayoress again noted as host and hostess at an illnmi- 
nat^ fdte in the Montpellier Gardens. On 'llmre^y 
the third general meeting was held, and besides the 
delivery of the address in surgery by Sir William 
Thomson, C.B., it derived a special interest from the pro. 
sentation of tee Stewart Prise to Dr. Patrick Manson, 
C.B, Three garden parties then simultaneously fol¬ 
lowed LienteCol. snd Mrs. Griffith were At Home at 
Deanwood; Mr. and Mrs. MacEnight-Cranford at Full- 
wood Park; snd Alderman and Mrs. T. B. Winter- 
botbam at Cranley Lodge. 

Thnrsday evening was devoted to the itwwnal dinner 
of the association in the beantiful hall of the Boys' 
Collme at Chsltonham. Some aocoont of this will he 
found in another oolnmn. After the dinner a ladies’ re¬ 
ception was held at the same place. On Friday ^ter- 
noon an excursion to Gloucester bad been arranged, and 
in the evening a brilliant soirte was held at the Levies’ 
Coll^^ followed by dancing. An exonrsion to the Wye 
Valley brought a very delightful week to a close. 

Thb SicriONS. 

The work of the meeting was universally voted, by 
those qualified to apeak, as being fuliy up to the standard 
of tee best traditions of the As^iation. Full meetings 
were the order of the day, although none of the rooms 
! allotted for the purpose were pa^onlarly large. The 
section of obstetrics and gynecology was, as usual, well 
patronised, this being one of the branohM that appeals 
most largely to tee general practitioner as well as to the 
specialist. A pleasing feat^ of this section was the 
good attendance of lady members, who joined freely in 
the disoaseionB, and whose remarks wers always well 
received. Nothing of startling interest in the way of 
new theories or discoveries oharaotorised the prooeed- 
ings of the sections, bnt there was good honest work all 
round. It would be impossible to give here even a sum- 
maiy of the papers and discussions. Many of them 
were valnable. and will serve as landmarks for future 
reference. The columns of our oontemporary, the Brilith 
Mtdical Journal, will be well filled with them for some 
time to come, and to its p^^s we most refer onr readers 
for the bulk of the matter. We are able to present 
abstracts of a few of these papers in car oolnmne. 

Thb Excubsions. 

On Tuesday, Thursday, and Friday aftemoims arrange¬ 
ments were made for trips to Cleeve Hill by electric 
oars. On Tuesday there was au excursion to Tewkes¬ 
bury, where tea was partaken of at the Bell Inn (“ John 
Halifax's ” honse); the Vicar of Tewkesbury met the 
members at tea, and afterwards oondnotod teem over 
Tewkesbury Abbey. Cbedworth and Withington were 
visited on Thursday, and after a visit to tee Bfunim 
Villa, Mr. T. L. Bobertson entertained the members to 
tea at Withington Manor. On Friday a trip was made 
to Birdlip, where the party drove tbrongb Cranham 
Woods, whilst some proceeded to Painswiok, where Dr. 
Balfour Fergnsson received them to tea. Among the 
larger excursions we most first mention the one to 
Glonoester on Friday. One section went to tee Gnild- 
hall, where Mr. Bellows gave a short address on “ The 
PlaM of Gloucester in the Boman HUtory of Great 
Britain ” this was followed by a walk tbrongb the city, 
where Mr. Bellows showed tee chief points <d interest. 
Another section proceeded to Bamwood House, where 



Ih2 Th* Medical Pmss. BRITISH MBniCA.L ASSOCIATION. 


the Committee of Governors and Dr. and Mrs. Sontar 
received tbem at a garden partj; a feature of this was 
the performanoe of a pastoral pla 3 r, " Twelfth Night," 
hj Ben Oreefs company. A section went by a 

later train, and assisted at an ** At Home" in the Giuild« 
htdl, given by Dr. and Hiss Batten. During the after* 
noon the town clerk exhibited soma of the city charters 
and other interesting records belonging to the city; 
and the very Bev. the Dean of Gloucester accompanied 
the membm over the Cath^nd, and gave them 
a short rittmi of its history and arwiteotnre. 
On Saturdav there was an exclusion to the Wye Valley 
and Symond's Yat Detraining at Lydbrook Junction, 
the i»rty walked over the Coldwell Bocks to Symond's 
Yat, a distance of three miles, the less energetic mem* 
bers doing this part of the journey by train. After 
Ixmch boats were chartered at the Yat to convey the 
members to Monmouth, whence they proceeded to Tin* 
tern and inspected the abbey, after t^ at the Beaufort 
Arms Hotel. 

Another excursion on the same day was to Cirencester; 
after partaking of refreshments at the kind invitation 
of Mr. Oliver Fowler, at Ashcroft House, the party oon* 
tinned in brakes to Earl Bathurst’s park, prooe^ing 
thence to Sapperton to view the Golden Valley and 
inspect the church. Tea was served at Cripps’ Mead, 
by kind invitation of Mr. Wilfred Cripps, C.B., and Mrs. 
Cripps (Countess Bismark). Two other excursiocs were 
also planned, to Great Malvern and Cowley Manor 
respectively. 

Thb Bxcomstbdction of tbx Association. 

There is no doubt that a large number of members of 
tile Association were drawn to Cheltenham by their 
interest in the proposed new scheme (rf reconstruction. 
It must be gratifying to those who for twelve months 
have anxiously and laboriously consulted together in the 
drawing up of the scheme that it was adoptM practically 
in its enti^v. The main principles of the sememe were 
accepted with very little demur, and only veiy slight 
sltezations in detoils were either proposed or carried 
out. Perhaps the most closely contest^ point was that 
which referred to oo option of members of Council, and 
some of those who objected most strongly to toe prin* 
ciple nearly succeeded in securing its alteration; but 
the amendment was lost by three votes. There is no 
doubt that the acceptance of the scheme by the members 
present at the meetings was in large measure doe to the 
masterly, eloquent, and diplomatic speech of Mr. 
Edmund Owen, ably supports by Dr. Whitaker and Mr. 
Victor Horsley. It is gratifying that, considering the 
importance of the issues at stake, there was remarkably 
little indulgence in those personalities which have 
formed a somewhat regrettable feature of some of these 
meetings; and except for one little incident, in which 
two former antagonists crossed swords, wito perhaps 
more amusement to the onlookers than serious harm to 
any one, the whole affair passed off smoothly. It would 
be premature to forecast toe result of these decisions on 
the future of the Association; but no doubt the principle 
of delegation must introduce a radical change in the 
course of time. 

Tbx Annual Mdbkuk. 

Owing, no doubt, in great measure to the energy of 
the Chairman and S^retary of the Museum and Exhibi¬ 
tion Bub-Committee, Dr. H. Bramwell and Mr. Q. A. 
Peake, there was a very good show at the Cheltenham 
mee^g; indeed, we have it on the authority of the 
President of the Association that this year’s annyiai 
exhibit was a record one. One factor that made for 
success was the fact that the exhibition was well housed, 
and it appeared to be pretty freely patronised. Judging 
from the numbers of names put ^wn in toe exhibitors’ 
notebook, there will be a vart consignment of samples 
in early course of distribution. Space not allow 
anything like a comprehensive survey of the exhibits, and 
we must be content with mentioning a few ot the more 
novel and interesting objects. Ferris and Co., of Bristol, 
showed a handsome, compact, and well* filled dispensing 
cabinet; some convenient vaccination leaves} 

their universal elastic t^dages; and especially their 
newly*introdnoed pluming gauze, with the introducer 


Auo. 7, 1901. 

for toe same. The last is a neat and ingenious instni> 
ment. The Bath Corporation had a well-mllde model of 
the Boman Thermae st Bath. Cheltine Foods, Limited, 
showed their diabetic, dyspeptic, ansetnio, invalid and 
infants* foods, put up in tins and made up in bread and 
biscuits. Our old friend, Scott's Emulsion, was in evi¬ 
dence, and evidently its popularity is not on the wane. 
Among Bnrgoyne, Burbidge and Co.’s specialities we 
noted a new aneesthetio, acoin, reported to be superior to 
cocaine in being non-toxic and in giving longer anma- 
thesia. Frank Bogers showed sprays ai^ atomisers. E. 
Merck had an imposing array of pluumaoeutical pr^uote 
with names of many syllables} among toe newest we may 
note bromopin (an organic substitote for bromides),^ 
digitoxin, dionin (a mild, pleasant substitute for mor¬ 
phia), iodi^in,jeqoiritol, andlargin (an anti-gonorrhosio). 
keen, Bobmson, and Co. showed their standard prepara¬ 
tions. Among the Vichy waters was a new varied, 
" Celeetins," recommended for kidney disorders. Bovril, 
Limited, toowed their foods, inolnding their special 
emergency foods for military and other expeditions. 
Harris, a dry preparation of fresh fish, was an instance 
of the growing development of the plan of produmng 
permanent and compact forms of food-stoffs. The Liebig 
Extract of Meat Co. showed a new meat beverage, Oxo. 
The Aj^llinaris Co. had their well-known aentoed waters 
on view. Mellin’s Food, Limited, showed among other 
things a new Mellin’s food choo^te. Among concen¬ 
trate proteid products we noted Casumen and Plasmon; 
the latter has been mixed in a veiy palatable form with 
cocoa. John Weiss and Son had a large selection of 
instruments, and Down Brothers showed, in addition to 
instruments, a selection of the newest designs in operating 
tables. The preparations of red bone marrow, known as 
Virol, were on view. Stephen Smith and Co. showed 
their Hall’s Wine, Keystone Beef Wine, and Keystone 
Burgundy; and Brand and Co. showed a number of their 
well-knowq products. Somatoee was another of the con¬ 
centrated fo^>products on view. Parke, Davis, and Co. 
had reveral new preparations, such as Adrenalin, an 
alkaloid derived from the supruenai bodies; Chloretone, 
a hypnotic, antireptic and local anaesthetic ; Mercnrol, 
an antiseptic consisting of mercury and nuclein in 
chemical combination; Ferrinol, a similar combina¬ 
tion of iron and nudein; and also a nuclein solu¬ 
tion. Another important exhibit of high-class phar* 
maoentioal products was that of Bayer and Co. 
Cadbury Bros, had a cocoa exhibit, where weary sight¬ 
seers might be observed recuperating. The enterprising 
Sanitas Co. showed a number of their preparations, 
inolnding some of the latest products of Mr. Kingsettis 
ii^ennity, among which we specially noticed Kingsettis 
Sulphur Fumigating Candles, Kingsettis Sulphngators, 
consisting of rolls or band^fes coated with sulphur; 
Okol, a new non-poisonons disinfectant said to surpass 
carbolic acid in its antiseptic and germicidal propeities 
Kingsettis Formic Sulphngators, an ingenious arrange¬ 
ment for generating sulphurous add gas and formic 
aldehyde; and Formitas, which combines the properties 
of Simitar and formic aldehyde. Among the newer 
preparations of Fairchild Bros, and Foster may be noted 
Ensymol and Diazyme, besides older preparations like 
Panopepton snd PeptogenioMilk Powder. The Shredded 
Wheat Co. showed the various usee to which shredded 
wheat could be appUed in making nourishing dishes. 
Harry W. Cox, Limited, had some of their newest ap* 
paratxu tor X-ray work. The Abbey Effervescent Salt 
Co. showed their special and now well-known prepara¬ 
tion. Coeenza and Co. exhibited solidified soups; and 
the Manhu Co., Limited, showed diabetic foods. Nestld’s 
Milk was, of course, already familiar; a new form 
was, however, on view—namely, Nastll’s Viking Milk, 
which is an unsweetened form. An ingenious b^-rest 
arrangement was shown by the Automatic Bed-rest 
Co., of Leamington. Defries and Sons bad a selec¬ 
tion of filters; and toe Sinitary and Economio 
Association showed some of Dr. Bond’s invmitions, 
such as the Euthermic quilt, toe floating filter, and the 
Gelidnm ice-store and refrigerator. Allen and Han* 
burys show^a new Clover’s ether inhaler, a new inhaler 
for use wito kelene, a new three-way stopcock for use 
wito gas and ether, a new appaxatus o»ineparing small 



SPECIAL ARTICLE. 


Av9. 7, 1901. 


Tn Hkdical PBssb. 153 


quantities ot distilled water, and many things besides; 
while Oppeaheimer, Bon and Co., among their various 
w^.knoen preparatiotts, showed a new aeriser, for nse 
with their neboline compoonds, and a “ nnivers^ vapo- 
riaer.*' The Maltine Co. showed the nnmerons forms in 
whioh maltine can be combined with other remedial 
agents. Bat we most perforce come to an end, and 
those who wish for more detailed information will find 
much of interest in the ample catalogne of 120 pages 
published by the Exhibition Committee. There can be 
no doubt about the interest and information to be 
derived from a visit to such a collection of the books, 
appliances, drugs and foods which form such an im> 
portent item in medical and surgical practice. 

Thx Annual Dinnbb. 

The annual dinner of the Association was held on 
Thursday evening at the Boys’ College, when some 860 
m e mb ers and guests sat down. The President was sup- 

S uted, among others, by the Mayor of Cheltenham, the 
igh Sheriff of Glouoe^rshire, the ex President, Dr. 
XUiston, the President-elect, Mr. Walter Whitehead, 
the Prerident of Council, Mr. Boberts Thomson, Sir 
William Church, Sir William MoCormac, Sir Walter 
Foster, Sir Willjjun Broadbent, Sir William Thomson, 
Sir John Dorington, M.P., Dr. Farquharson, M.P., J. T. 
Ag^.Gardner, Esq., M.P. for the Borough of Chelten- 
hra. Sir John William Moore, Surgeon-(^neral HamiN 
ton. Dr. Parsons, Prof. G. Dock, of Michigan, W. F. 
Hi6ks>BeBoh, Esq., J.P, Professor Fischer, Dr. Darier, 
Col. Croker>Ei», Dr. Ilawson Williams, Dr. Cholmeley, 
laent -Col. Griffith, the Town Clerk, Andrew Clark, Esq., 
Dr. Saundby, Dr. Goodbart, Dr. Ward Cousins, F. F. 
Leaver, Esq., Howard Marsh, Esq., F. Brandt, E«q., J.P., 
H. T. Carington, Esq., J.P., Col. Bogers, V.D., C. T. 
Turnbull, Esq., and Malcolm Morris, Esq. A word of 
praise must be given to the very artistic menu, which 
was abundantly adorned with appropriate classical quo¬ 
tations. The usual toast* were duly honoured, but 
delightful ae is post-prandial oratory the organisers 
should bear in miod that it is possible to have tM much 
of it. 


THE MEDICO-PSYCHOLOGICAL ASSOCIATION 
AND IRISH “ AUXILIARY ASYLUMS." 

It will be remembered by onr readers that an attempt 
is at present being made to compel the Irish Govern¬ 
ment to sanotion the appointment of a layman as head of 
the proposed Auxiliary Asylum for " ohronio harmless 
lunatics ’* at Yonghal. The importance of preventing 
such a backward step from being taken will be apparent 
to everyone who considers the diass with which it is in¬ 
tended to people these asylums. We have been given to 
understand that not alone is a layman to be tbe bead 
bat that the administration of the asylnm is to be 
handed over to a religious order. Tbe Cork Medical and 
Surgical Association, at a meeting held a oonple of 
weeks ago, passed tbe following resolution:—“That 
we, the members of the Cork Medioal and Surgical 
AssooiatiOD learn with extreme regret that it is con¬ 
templated to appoint a layman as superintendent to the 
Yonghal Auxiliary Asylum, and that in tbe intereets 
of humanity we consider a medical should be 
^>pointed, as many of the patients suffer from diseases 
which at any moment may require prompt and skilled 
medical treatment toward off impending death." 

At tbe recent meeting of the Medioo-Psy<ffio1ogioal 
Aasociation held in Cork, Mr. Graham, medical officer 
of a Belfast Asylum, read a paper on “ Recent Legisla¬ 
tion in Regard to the Treatment of the Insane in Work- 
h o n ses." As a result of the disoossion which followed, 
an instmotion was sent to the Council to take into con- 
sidemtion tbe tieatment of the insane, as contemplated 
by tbe new Local Government Act of Ireland. 

On the second day of tbe meeting the treasnrer of the 
Aseocdation, Dr. H. Hayes, said that the Connoil had 
fsiken the matter into consideration that morning, and 
it had come to the ananimous oonolnsion to snbmit to 
the Association this resolution, in tbe hope that it would 
be unaaimonsly adopted It is resolved by the Uedioo- 
Pkyoholofpcal Aseocsstioo of Great Britain and Ireland 
tliat, haviag considered. tiie prorisioas of the Local 


Government (Ireland) Act for dealing with the insane, 
now in workhouses, it views with apprehension any 
scheme which will permit or favour the ^gregation of 
insane patiente requiring institutioniu toeatment, 
exoept imder skilled resident medioal supervision. It is 
of opinion that all patients in auxiliary asylums should 
be on the same footing in regard to the Government 
capitation grant as those in tbe district asylums." It 
was considered by the Council that this matter should 
not, under any oiroamstanoes whatever, be considered 
as a local affair, but as one which affect^ the Associa¬ 
tion in all its branches in the United Eingdom, 
because it was one of the first duties ot the Asso¬ 
ciation that it should do its best for the treatment 
of the insane. It had done its beet to for¬ 
ward the most liberal treatment by those who 
were treated outside under lay care. In all parts of 
the United Kingdom the single cere of patiente in homes 
had been forwwded, espeoially in Scotland, where there 
was a large amount of home treatment. There was no 
reason why the same spirit of liber^ty should not be 
accorded to patients in England or Irehmd. But it was 
a quite different matter when it came to the aggregation 
of oasee ont-ide asylums under lay oare, as it resulted in 
neglect, ill-treatment, and other di^vantagee, of these 
patients, who required oare and treatment in large in¬ 
stitutions with proper medioal snpervision. They did 
not for a moment wish that the ideu of meroy and good 
treatment were in the medical world alone, for they 
knew that many lay people had the beet insi^ots, and 
even the most moving reeolations in the matter of tbe 
treatment ot insanity had come from lay people; but 
they s^d that medical supervision was absolntely 
neoeesary in caring for large bodies of the insane. 
Dr. Bolton’s paper had shown that there were oasee 
that could easily pass skilled medioal attention, 
and how many more of these oasee would oeoape detec¬ 
tion under non-medical sapervision. It was ti>e exp^ 
rienoe of the association that tbe aggregation of Isrge 
namber« of patients without proper medioal supervision, 
was a wrong which it was their duty to combat as 
strenuonaly as they possibly oonld. (Hear. hear). 

Dr. T. 8. ClonstoD, in seconding tbe resolntion, said he 
was sore that the gentlemen who brought tbe matter 
forward had rendered a service to the insane and to 
science. (Hear,hear.) Hesnggested that copies of this 
resolntion be forwarded to every newspaper in Ireland. 
(Hesr, hear.) 

Dr. Harvey, Clonmel Asylnm, in supporting the 
motion, said that his committee had come to the con- 
dusion that it would not be for the benefit of the in¬ 
sane to start an auxiliary asylum, and they were giving 
him three blocks of buildings instead as an exk^ion. 
(Hear, hear.) 

The resolution was ^reed to nuanimously. 

On tbe motion of Dr. H. Hayes, Newington, eeoonded 
by Dr. Urqnhart, it was decided to forward copies of the 
resolntion to the Chief Secretary for Ireland, tbe In¬ 
spectors of Lnnaoy. and others. 

We tmst ^at tbe efforts of the Cork members of the 
medical profeesion and of the Medico-Psychological 
Association will meet with snooess, and that tbe groes 
error which is contemplated will be rendered impossible. 


A Visit to Bovril, Limited. 

On the invitation of Lord Dnnoanuon (the Chairman) 
and the directors of Bovril, Limited, the members of 
the British Congress on Tuberculosis visited the labora¬ 
tories and factory of Bovril, Limited, on Friday and Satur¬ 
day last. Special interest was manifested in the army ra¬ 
tions (Samples of v hich, as supplied to the N ansen, Jackson- 
Harmswortb, and Wellman Polar Expeditions, were on 
view. An interesting feature was an exhibit of samples 
of goods supplied for the Royid Antarctic Expedition, 
which starts to-day (Wednes^y). The process of the 
manofaotare of Virol, the now well-known snbetitate 
for ood-liver oil, was shown and explained, and the dele¬ 
gates expressed themselvee very pleased with their visit. 

Death from Poisoning. 

An inquest was held on the 28th nit. on the body 
of Dr. Joseph Wood, of Livereedge, who had succnmbed 

C 



MEDICAL NEWS. 


Apq. 7. 1901. 


154 Tua Mmdioal Psass. 

to an oTerdoBo of bromidia taken for the pnrpOBe of 
proonring ^ Terdtot of accidental poisonuig was 

arrired at. Tne deceased leaves a wife and child. 
ApotheoarlBB* Hall of Ireland. 

Wa are requested to annoonoe that at the annaal 
meeting of the General Coandl of the Apothecaries’ 
Hall of Irel., the following were dnlj tsdloted for and 
elected to hold office for t^ ensuing year ending July 
Slit, 1902. Governor, George A. Stritch, L.F.P.8.G., 
L.M.; Deputy-Governor, Arthur Atock, M.D., M.8., 

Directors: Hugh A. Anohinleck, F.B.O.S.I., L.E.C.8. 
Edin.; John Evans, L.S.C.S.I. { William V. Furlong, 
L.EC.S.I., L.E.CJ*.E.; J. Adam Johns. M.D.. T.O.D.j 
Thomas D. Finuoane, M.D.; Edward|Hanrah», H.B., 

B. X7.I.; Robert Montgomery, M.E.C.S.: Robert J. Mont¬ 
gomery, M.B., T.C.D., F.B.C.8.I.; Richard O. O’Flahmrty, 

L. R.C.S., M.B., T.C.D. ; James Raverty, L.B.C.8.E. ; 
Joseph A. Ryan, L.R.C.8.E.; James Shaw, L R.O.S.I.: 
Chanes R. C. Tiohbome, L. and D.P.H., R.C.8.I. 

Representative General Medical Council: Charles R. 

C. Tioh^me, L. and D.P.H., R.C.S.I. 

Becretary : Robert Mon^omery, M.R.C.8. 

Beportof the Annual Meeting of=ihe Medlco-Psychologloal 
Association of Oreat Britain and Ireland. 

Tes sixtieth annaal meeting of the Medioo-Pysi^o* 
logical Association of Great Britain and Ireland was 
held in the Queen’s College, Cork, under the presidency 
of Dr. Oscar T. Woods, Resident Buperintendent of 
Eglinton Lunatic Asylum, Cork. There were about 
sixty members present, representing all parts of the 
kingdom, and a number of important papers were retd 
on various aspects of lunacy. Committees met at 9 a.m., 
and two hours later the annaal meeting began, with the 
outgoing President, Dr. Fletcher Beach, in the chair. 
The officers and council were elected unanimously as 
follows:—President: OscarT. Woods,M.D. President- 
Elect: J. Wiglesworth, M.D. Ex-Pxesident: Fletcher 
Beach, M.B. Treasurer: H. Hayes Newington, 
F.R.C.P.Ed. Editors of Journal : Henry Bayner, M.D.; 
Al. R. Urqubart, M.D.; Conolly Norman, F.R.C.P.I. 
Auditors: Ernest W. White, M.B.; James M. Moody, 

M. R.C.S. Divisional Secretaries : South-Eastern Divi¬ 
sion, A. N. Boycott, M.D.; Sonth-Westem Division. P. 
W. Macdonald, M.D.; Northern and Midland Division, 
C. E. Hitchcock, M.D. ; Scotland, Lewis C. Bruce, M.B.; 
Ireland, A. D. O’C. Fiuegan, L.RC.P.I. General Secre¬ 
tary: ^bert Jones, M.D., B.S.,F.B.C.8. R^strar : H. 
A. Benham, M.D. The President (Dr. Oscar T. Woods) 
who was cordially received, then delivered his 
presidential address. Dr. John Carswell (Glasgow) 
read an interesting paper on *' The Working of the 
Inebriates Act," in wbiob he said that this experimental 
legislation had been a failure. A disoussion followed, in 
which Dr. H. Hayes Newington, of Sossex; Dr. Clonston, 
Dr. Fletcher Beach, Dr. Urqubart. Dr. Conolly Norman, 
and Dr. Eustace took part, in which the opinion was ' 
generally expressed that the class coming under the 
Act were mostly incurable, and further legislation was 
needed to deal with the reolaimable class. Papers were 
also read by Dr. Thomas Drapes, Superintendent Ennis- 
cortby Asylum, on "Insanity and Phthisis;” by Dr. 
F. W. Everige Green, Hatcbeoroft House. London, on 
" Evolntion of the Colour Sense; ” by Dr. E. D. O’Neill, 
Superintendent Limerick Asylum, on " The Superannua¬ 
tion Question—its Effect on Asylum Offioials, with Sug¬ 
gestions for Further Legislation on the Subject; ” by Dr. 
Graham, ** Recent Legislation in Regard to Treatment 
of Insane in Workhonses.” The meeting then adjourned. 
On the second day of the meeting, during the morning. 
Professors Dixon and Bergin exhibited some excellent 
radiographs and gave an interesting demonstration of 
X-ray stereosoo^. Dr. Joieph Shaw Bolton, of 
Claybury Hall, %sex, contributed a lantern demon¬ 
stration on " Gross Lesions of the Cerebrum.” The 
Treasurer then submitted the report of the Council 
on the treatment of the insane as contemplated 
by the new Local Government Act of Itdand. His 
remarks will found in another column. Dr. A. 
R. Urqubart, Perth, then read a paper on "Effect 
Upon Patients of Cl^gee of Asylums,” and Dr. R. R. 
Lesper.Rflsidwt Physician, St. Patrick's Hoipital,Dablin, 


oontribated a pa^r entitled "Three Caaes of Melan¬ 
cholia: Presenting Symptoms of Unusual CUnioal 
Interest,” and he also sboi^ microeoopio specimsos and 
photographs. Dr. Dawson also read a paper in which 
he gave a number of oases in which t^ drugs snpra- 
ren^ extract and thyroid extract had given moat 
satisfactory results. A cordial vote of thaw Ira to the 
President for bis services to the Association, and his 
hospitality to the members brought the meeting to a 
close. 

Dublin Death Bate. 

Thi deaths in the Dublin r^istration area for the 
week ending July 27th gives an annaal rate of mortality 
of 21-6 a 1,000. Pulmonary diseases oatised 19 deaths. 
Deaths from tnberonloeis were 32, of which 26 were 
from pulmonary tuberculosis, 8 from abdominal tnber- 
oolosis, 2 from tuberonlons meuingitu, and 1 from pero- 
phnea. Fifty of the persons who died daring the week 
were under five years of age (86 were infants under one 
year, of whom 8 were under one month old). Eight 
children were registered as having died from convaU 
rions; 7 of these were under one year old. How many of 
them were insured P 

Irish Medical Schools’ and Graduates' Association. 

The summer general meeting of the above association 
was held in the Ladies’ College, Cheltenham, on Wed¬ 
nesday, July Slst. The atten(£kDoe of members was nn- 
usnally la^, and the chair was occupied by Dr. Mspo- 
ther, Vice-President. The Council reports that since 
the annual general meeting the restrictive ru*e had been 
repealed in the case of two provincial hospitals. Sir 
J<^ WiUiam Moore (Dublin) said that the subject of 
the exclusion of tbase holding the higher diplomas of 
the Royal College of Physicians of Ireland from candida¬ 
ture for honorary appointments in English nospitals had 
for several years engaged the anxious attention of the 
College. After some remarks on the same subject from 
Professor Thompson (Belfast), the meeting adjourned. 




Bdinbnnh University Graduation Ceremonial. 

At the summer graduation ceremonial, held last week, 
the following degrees were presented;— 

Degree of Doctor of Medicine: o Robert Oswald Adam¬ 
son (M.A.), M.B, C.M., with first-class honours, 1889; 
aAlexander Cruiokshank Ainslie (M.A.), M.B., C.M.; 
John Charles Atkinson, Chili, M.B ., C.M.; a James Mar¬ 
tin Beattie (M.A.), M.B., C.M., with first-olass honours; 
c John Bowie, M.B., Cb.B.; c Henry Reynolda 

Brown (M.A.), M.B., O.M.; oHenry Grey Brown, H.B.. 
C.M.; 0 Robert Niohol Brebner, M.B., Cb.R.; Robert 
Cathoart Bruce, M.B., C.M.; a Thomas Hastie Bryoe 
(M.A.), M.6., C.M. -, Robert Dick Buchanan, M.B, C.M-; 
Morton Burnet, M.B., C.M.; cFrederick Harold Carlyon, 
M.6., C.M.: Bernard Ramsay Craig Christie, M.B., C.M.; 
o Edgar Ferdinand Cyriax, M.B., Ch.B.; Daniel Reee 
Davies, M.B.,C.M.; Walter Diokson, M.B., C.M.; Daniel 
Charles Edington,M.6.,C.M , with second-olass honours; 
b Richard Cogsw^ ElsworttC M.B., C.M.; David Smart 
Evans, M.B., C.M.; Gordon WiUiam FitzGerald. M.B., 
C.M. i b Dunoan Forbes, M.B., Ch.B., with seooud-olass 
honours; Thomas Dewar Forbes, M.B., C.M.; a Evmn 
Jobn Hewat Fraser. M.B.,C.M ,with first-lass honours; 
o Harry Edward Gibbs, H.B.,Ch.B. (in absentia); b Alex¬ 
ander Goodall. M.B.. Cb.B.; b Thomas Dunoan Green¬ 
lees, M.B., C.M.: b Geo^ Kerr Grimmer (B.A.), M.B., 
C.M.; Robert Lyall Guthrie (M.A.), H.B., C.M.; 
b A^ur Cecil Heath, M.B., Ch.B.; Alexander Hendiy. 
M.B., C.M.: b Jo^ Thomas HewetMn, M.B.. C.H., with 
second-class honours; o John Hume, H.B., C.M.; 
b Louis Godfrey Irvioe (M.A., B.Sc.), M.B.. C.M.; Cluvles 
Harold Johnson, M.B., C.M.; William Einnear (M.A.), 
M.B., C.M.; William Brc^ Eiraldy, M.B., C.M.; 
c Thomas Knowles, M.B., C.M. ; a Louis Fianos 
Befaagen Knuthsen, M.B., C.M.; oRobert Laidlaw, 
M.B. ; b Gwald Rowley Leighton, M.B., C.H- ; 
b Sreenagula Malian M.B., C.M.; o Thomas 
Muirhead Martin, M.B., C.M,: George Home Monro- 
Home, M.B., C.M.; Attelsts^ Nobbs, MB., CJH.; 
David William Horn Paterson, M.B., C.H. o Charies 


O 


Ajjq. 7, 190L 


PASS LISTS. 


Ths Mboioak Pbsbb. 155 


Edward Potter, H. 6 ., CJIf.; b John Yemon Beee 
Soberto (BAx), M.B., C.H.; b Thomaa Aitbnr Bom, 
H.B., GJu.; a Alfred CherlM Bandstein, M.B., Cb.B. 
(with flrab«laM honour*); a Satherland Simpson 
(B.Sc.), M.B., Ch.B.; o Edw SomeiriUe, U.B., Ch.B. i 
oHarry BM Sproat, M.B, Ch.B.; o 'William 
Andenon Steven (M.A.), M.B., C.M. (with firat-olan 
hononn) ; Gabriel Hend^ StSTn, U.B., C.M.; o George 
Crewdson Thomas, M.B., CM.; o William Fookes 
Thompson, M.B., C.M.; Arthur Harry Hingston Visard, 
M.B., C.M.: a Donald Bremner Waters (M.A.), M.B., 
Ch.B. (with first-class honours) $ b Andrew Bobertson 
Wilson (M-A.), M.B., CJl. (with fir.t-olass honours); 
Andrew Hamilton Wood, M.B., Oh.B. (a Awarded Gold 
Medals for their theses, b Highly oommended for^eir 
theses, o Commended for their theses.) 

D^free of Doctor of Science: Alaxmndw Wilmer 
Duff, M.A., B. 8 o.; John Yemon Bees Boberts, M.D., 
BBC. 

Degrees of Bachelor of Medicine and Master in 
Surgery: Manindra Nath Bose, Shaik Dawood, Alfred 
Thomas Gavin, Paul Eugene Hedwige Ginseppi, John 
Hally Meikle (M.A, B.So.), Wm. Henry Meyer, James 
Donaldson Suier, Walter Henry Swaffield, c Harry 
Moss Traquair, John Wallace, John Owen Williams, 
(c Didioatea that the candidate has passed the examina¬ 
tions with first-class honours.) 

Degrees of Bachelor of Ibdidne and Bachelor of 
Surg^: David Macrae Aitken (M.A.), John Finlay 
All^ Charles Madill Anderson. Bobert Yacy Cliff*^ 
Ash, a Bobert Tnllis Baillie, James William Barrack, 
a Alexander Clarke Begg, Baphael Aaron BelUios, John 
Henry Montgomearie Bw, Vivian Chaitel de Boinville, 
b Bichard James Bradliqr, Edward Seymour Brett, 
James Brocket, Edward Emslie Brown, Golflna Mande 
Brown, William Brown. James Brownlee, Bobert. 
Wilson Buchanan (M.A., B.So.), Henry Buist, b George 
Cruikahank Burgees, ^ward Percy Calder, Kirkland 
Ch^ahChariss Coley Choyoe(B.Sa) Arthur William 
Stark Christie, Bobert Yeit^ Clark (MA, B.Sa), Harry 
Leobmere Cli^ William James Crow, Barbara Martin 
Cunningbam, John Dalgliesh, b George Adam Davidson 
(U.A.), b William Henry Dickinson, a William Elliot 
Cams^ Dickson (B.So.), Thomas Gecsrge Boswell 
Dodds, Henry Dodgwn, Charles Dougl^ James Laing 
Duncan, William i^thnr Duncan. Wuliam loglis Dunn, 
John Bussell Edward, William E^^Uog (M.A), Owen 
John Evans, John William Falconer (M.A,), b Arthur 
Harcns Firth (M.A). Gavin Addie Forre^ Stephen 
Garvin, James Charles Gilchrist, Ernest Mure Gran¬ 
ville, ^bert Ashleigh Glegg, Thomas Graham, Boderick 
H'Esnzie Grant, Arthur Leopold Goemey, Arthur 
Bupert Hallam, Agnes Moore Hamilton, Bobert Hamil- 
tMi,WilliamEUmilton, Niels Carl BndolphHamsen(B. A), 
Bobert Alexander John Harper, Peroival John Hay, 
Eleanor Bussell Henderson, David Colvin Henty, CharlM 
William Howe, a Andrew Hunter (M.A, B.So), Andrew 
Edwin Hunter, Alexander Bea Johnston (M.A.), George 
Adam Jolly, Edgar Yanghan Jones, b Andrew Camptell 
Keay, James Prioe Kennedy, Percy Vance Langmore, 
Abdurrahman Eban Lauddie, William Lee, Creighton 
Butchinson Lindsay, Samuel Lyle, James Graham 
U'Bride, Lawson Tait M'CUntock, Hector Kenoeth 
Uacdontid, W illiam MaoDougall (M.A.), Patrick Frede¬ 
rick M'Farlan, b George M'Farland, Alister Forbes 
Hiiokay, Francis Dillon Scobie Mackenzie, John 
M'Eenzie, William M'Laohlan, William Mair (M.A., 
B. 8 a), George William Peak Maitland, Alexander 
Uowatt Malcolmson, Edward Charles Cecil Maunsell, 
bOeoige Bobertson Mill, Thomas MiU, William Miller, 
Joseph Miekelly, Alexander Mouat, David Munro (M.A.), 
Georg* Stawart Murray, a Peter Murray (M. A.). Wil¬ 
liam Murray, Elvin Gladstone Osborne Nixon, David 
Alexander O^ilvie, John Fraser Orr, John Louis Palmer, 
'William Paterson, Walter Scott Patton, John George 
Peebles, Sidney George Peill, George Pereira, Howard 
Oeo^ Pevel, Laurence William Pole, Edmund Thurlow 
Porta, b'William H(^g Prentice (MA.), Lloyd Tnrton 
Price, Henry St. John Bandell, Francis Lindsay Bigby, 
Hogh Horeton Boberts, b George Cook Irvine Bobert* 
•on (MA)> John Ktith Alexander Bobertson, Michael 


William Bobertson, William Axthur Bobinaon (B.A., 
B. 80 .), Andrew Lindsay Boxbnigh, Lamenoe Bnndall, 
a Caleb Williams Saleeby, b Thomaa Brown Shaw, Ebtf- 
garet Merry Smith, 'Diomaa Aubrey Smyth, Kate 
^uthon, Hmiry Larnglands Spark, WilBam Ciark Spein, 
Basil Alexander Spence, Arthur Julian de Spiganovicz, 
Charles Stanley Stevenson, Mand Moriel Stevenson, 
Donald Aiezuider Stewart (MA.), Ira Strnthera 
Stewart, John Sullivan, Matthew Aniold Swan, Paul 
Telles, George Lewis Thompson, Thomas Lander 
Thompson, John Burnett Thorbum, William Leigh 
Trafford, Edward Jamee Tyrrell, Abraham Bansome 
Wallis, Edwin Wells, a Thomas Samuel Beauohirap 
Williams, Frederick Ernest Wilson, James 'Woods, 
David Yoong. (a lodicates that the eradiate has passed 
the examination with first-class honours, b Indicates 
that the candidate haa passed the examination with 
tecottd-olass honours.) 

Special University Certifloate in Diseases of Tropietd 
Cliirates.—Shaik Dawood, M.B., C.M., Charles 'WiUiam 
Howe, M.B., Ch.B., William Miller, M.B., Cb.B. 

Thesis Gold Medallists.—Jamee Martin Beattie, M.D., 
Thomas Hastie Bryce, M.D., Evan John Hewat Fraeer, 
M.D., Alfred Charles Sradst^, M.D., Sntherlrad Simp- 
■on, M.D., Donald Bremner Waters, M.D. 

The Syme Surgical Fellowship has been awarded to 
Alfred Charlea Sradstein, MJ)., Ch.B. 

The Goodsire Memorial Fellowship has been awarded 
to Sutherland Simpson, B. 8 a, M J)., Ch.B. 

The Gnnning Victoria Jubilee Prise in Anatomy haa 
been awarded to Dunora Forbes, M.D., Cb.B. 

The Gunning Victoria Jnbilee Prise in Focensio 
Medicine rad Pnblio Health has been awarded to 
Charlea James Lewis, D.So., M.D., C.M. 

The Ellis Prise in Physiology has been awarded to 
Sntherlrad Simpson, B. 8 a, M.D., Ch.B. 

The Milner Fotbergill Medal in Therraratios has been 
awarded to Ernest Francis Baahford, MvB., Ch.B. 

The Ettles Soholanhip has been awarded to Caleb 
Williams Saleeby, M.B., Cb.B. 

The Boanoy Prise in Anatomy and Surgery has been 
awarded to Harry Moes Traquair, M.B., C.M. 

The Bachanau Scholarship in Gramcology has been 
awarded to William Hogg Prentice, MA., ILB., Cb.B. 

The Jamee Scott Soholanhip in Midwifery hae been 
awarded to Caleb Williams Saleeby, M.B., Cb.B. 

The Allan Fellowship in Clinical Medicine rad 
Clinical Surgery has been swarded to Thomas Brown 
Shaw, M.B., Ch.B. 

Ilhe Mouat Soholanhip in Praotioe of Physio has been 
awarded to James Brow^ee, M.B., Ch.B. 

The Stark Boholarsbip in Clinioal Medicine has been 
awarded to William Elliot Camme Dickson, B.So., 
M.B., Oh.B. 

The Murchison Memorial Scholarship in Clinioal 
Medicine has been awarded to Bobert Veitoh Clark, 
M.A., M.B, Ch.B. 

The Pattison Prize in Clinioal Snigery has been 
awarded to John Saffley. 

The Gilfillan Memorial Prize has been awarded to 
Agnes Moore Hamilton, M.B., Cb.B. 

The Cameron Prize in Therapeutios has been awarded 
to Patrick Manson, C.M.G., M.D., for his reeearohee on 
the transmission of diseases through the mosquito. 

Boyal CoUese of Sarseons, Bdlnbnrsb. 

Thx following gentlemen having passed the reqnisite 
examinations were, at a meeting ^ the College, held on 
July 80tfa, elected ordinary Fellows: George Alexander, 
M.B., Cb.B., WUliam H. G. Aspland, M.B.C.S.Eng., 

L. B.C.P.Lond., Alexander Girvan, M.B, C.M., Patrick 
Kinmont, M.B., Ch.B., William T. McArthur, L.B.C.S.E., 
Angus Macdonald, M.B., C.M., Stuart A. Ord-Mat^enzie, 

M. B.C.S.Eng., L.B.C.P.Lond^ Arthur Davies Peill, 
M.B., C.M., G^rge H. Pooley, L. 8 .ALond., Matthew A 
Beid, M.B., C.M., Edward Bobertson. L.B.C.S.E., 
Frederic H. Stordee, M.B.C.SJkig., L.B.C.PJiond., and 
George F. Vincent LJLC.S.E. 



156 Ths BI1D101.L Pbsm. 


NOriCBS TO COBRE8PONDEWT8. 


Atjo. 7, 1901 


fioiittsi to 

CorreoiioittietTta, Short 'jCctttro, &c. 

CoBKMrosDBrra nqoMiiB a raply l» thi« oolama are par- 
taalarip nqoeatad to nao of a diftinetiv* tignaturt or 
{a<ti«If.andaTold tha pnotiM of airniiw thamaaWeaBaadar,” 
'•Sabaorlbar," “Old Bobaoribar,’* *0. Vnoh oonfoaioa wUl ba 
spared bT attantion to tbia rnla. 

BiPaiara.—Bepriata of artlcla# appearing in this joanul oan ba 
had at a reduced rata, proridiny authors ylre notice to tha pub¬ 
lisher or printer before the type has been diitribntad. Thle shonld 
ba dona when returniny corrected proofs. 

OaioiKAP ARTICI.B 8 or Lkttebs intended for publication should 
ba written on onesida of the paper only, and must bo anthentioatad 
with the name and address of the writer, not necaasarily for pnblioa- 
-tion bnt as eridenca of identity. 

BBAome Casks.—C loth board eases, gilt lettered, oontaininy 
twenty-six strinys for holding the numbers of Tn Mbdioaj. Pubs 
AVD CiBCULAB, may now ba had at the office of this Journal, 
prioa 2s. 6d. Tbasa oases will ba found very useful to keep each 
weakly nnmbarintact, clean, and flat after it has passed through 
the post. 

JULIUS BOBEBT VOK MAYEB. 

The Assoeistion of German Engineers hnye just placed a memo¬ 
rial tablet on the bouse in Heilbronn in whiob J. B. von Mayer 
was born. He studied medicine at Tubingen. Munich, and Paris, 
and commenced the practice of his profession as a ship's pur- 
geon, and settled as a general practitioner in hi* native town in 
1S40. In IMS be publlsbed in Liebig's AnnaUn o preliminary 
statement of the mechanical theory of h*at. in which he clearly 
demonstrated tbe numerical relation between heat and work. 
Beven years before his death he was awarded the Copley medal of 
the Boyal Society, London in 1876 he was ennobled by the King 
of Wwrtemburg. He died on March 2'>th. 1878. 

It is pecoliavly gratifying to us to see the memory of deierv- 
ing members of tbe medical profewiun duly recognised, and 
we in no way withhold our own praise ; but we cannot help 
thinking of Lr. Beade, of Cork, whose house bears no memorial 
tablet, although, ia 1808 (3b years previously), be made the die- 
oovery, performed the experiment, and announced the law for 
which, to-day, a German, Mayer, it so honoured. 

Da. 8. Y. B.—It le doubtf.il whether pennyroyal, in medicinal 
doses, has anveffecton the pregoant ntorus; norhas ergot, in spite 
of theafllrmatioD of medicologiste.anysbortifacient action, except 
possibly in the later stages of gestation. The subject is one which 
urgently calls for further careful study, though the law takes cog¬ 
nisance more of the intent tbau of the actual etfects. 

X. B.—Your obrervatien is detective in that the diagnosis does 
not appear to be placed beyond question. It is obvious that any 
sbottcomlng in this respect must invalidate your conclusions, and 
for this reason we do not think it wise to publish it. 

SHOCKING I 

The newspapers state that one of the internes In a Brooklyn 
hospital is under dl^pline for having kissed, or rather for having 
been caught kiaaing, one of ths young and comely members of the 
-training schooL We trust such practioes will not spreadfrom the 
new world to the old I 

TuLHXRaBLB Pakts OF THS HPMAS AsATOXT.—Tbe murderers 
thave discovered some astonishingly vulnerable parts of the human 
anatomy of late. From a paper this morning we learn that a 
•Georgiacolonel was ” shot in tne ticket office"; the other day a 
waa fateUy shot " throngh his door," and not long ago aaother 
received a fatu wound "in his window/’—Nrtf York CommtTcial 
Adi'eriittr. 

Mb. Jambs Blaib.—W e ere anable to tmee the tllnsion to 
iodobensoyliodideofammosinm in the treatment of broncho-pneu¬ 
monia. You might apply to Merck, of Darmstedi, or his London 
sgeut. 

Db. E.—We mre not particularly interested In the subject yon 
have chosen tor your communicatiou, and the list is at your 
disposal. 

Hb. S. M. - Pressnre on onr space obliges ns to bold over your 
paper for tbe present. We hope, however, to publish it ere long. 

Db. SiKCLAiB.—Your letter received too late for insertion in 
this isBus. __ 

,|l)rp0nrtm£nt0. 

Bxlfbaoe, Stphbt H., M.B., L.B.C.P.Loud., M.B.C.S.Eng., 
Assistant Ansesthetist to the Dental Hospital of London. 
Bebbtmab, Edxord N.. L.B.C.P.Loud., M.B.C.S.Eng. District 
and Workhouse Medical Officer of the Llandovery union. 
Boboess, Abthub H., F.HC.S.Eng., M.B., (7b.B., M.Sc.Vict., 
Suntical Officer and Medical Superintendent of the Manchester 
Cancer Pavihon and Home. 

Haworte, Stbahbh B., M.D., B.Ch., B.U.I., DUtrict Surgeon of 
Btedworp, Cape Colony. 

Hewlett, Bicbabd Taeeel M.D., M-B.C.P.Lond., Professor of 
General Pathology and Bacteriology in King's College, 
London. 

Pabbxtt, Bpwabd E., IkB.C.P.Lond., M.B.0.S.EDg.. Assistant 
Medical Officer at the Brentford Infirmary, Workhouse, and 
Soboola I 


Paesobs. Cebistopwxb T., M.D.LoBd., Medical Officer for 
Beceiving School for Children at Parson's Green. 

Tbokboh, St Claie, M.D.. M.B.C.P.Lend., P.B.C.B.Eng., Aetis* 
tent Phracian for Diseases of the Thrat in King’s College 
Hospital. 

Watsom, Jakes, L.B.C.P., L.B.C.S.Edio.. has been appointed 
District Medical Offioer of the Alnwick Union. 


lacancuB. 

Birmingham and Midland Skin and Urinary Hospital, John 
Bright Street.—Surgical Assiatant for six months, renewable. 
Houorarinm at rate of SO guineas per annum. 

Brecon Infirmary.—Beeident House Surgeon, unmarried, Salare 
£100 per annum, with furnished apartments, board, and attend¬ 
ance. 

Brighton. Hove, and Susmx Throat and Ear HoepitaL CTiurdi 
Street, Queen’s Boad, Brighton.—Non-resident Houm Sargeoa. 
Salary at rate of £75 per annum. 

Bristol (ienetal Infirmary.—f^naltv Assistant Honre Surgeon. 
B^ry £50 per annum, with beard, residenoe, Ac. 

Carlow Union.—Dispensary Midwife. Salaiv £26 par annam. 
Applications, enclosing diplomamnd testunonlals, to the Pre- 
siaing Chairman. (See Advt.) 

City of Loudon Hospital for Diseases of the Chest, Victoria Park, 
£.—Second House Physician for six months Salary at rate 
of £30 per annum, with board, residenoe, and washing. 

Devon Conniy Asylum, Exmiiuter. —Third Assistant Medical 
Officer. &dnry commencing at £125. and incraasinr at the 
rate of £10 i<er annum to £155. with board, realdence, 

Devonshire Hospital, Buxton, Derbyshire.—Assistant Hones 
Surgeon. Salar;^ £50 per annum, with furnished apartments, 
board, and wuhiog. 

Quest Hospital, Dudley.—A8si«t«nt House Burgeon for six months, 
sidary £40 per annum, with residenoe, bo^, and washing. 

Kent and C^terbury Hospital. - Assistant Honre Surgeon, on- 
married, Salary £60 per aonnm with board and lodgiw. 

Lewee Dispensary and Infimary and Viotorix Hospital.—Resident 
Medical Officer. Salary £100 per annum, furnished apart¬ 
ments, &c. 

Liverjiool Dispensaries.—Aseiitaot Surgeon. Salary £100 per 
annum, with board and apartments. 

Nottingham General Dlsoensary.-Assistant Besident Surgeon, 
unmarried. Salary £160 per annum, increieiug £10 erery year, 
with furnished apartmenCs. attendance, light, and fueL 

Oxford, (^mbined Bural and Urban District Councils of.—Medical 
offioer of Health. Salary £750 per annnm. 

Boyal Cornwall Infirmary.—House Surgeon, namairied. Salary 
£100. increasing by £10 a year, with board (excluding stimu¬ 
lants) and apartmente. 

Boyal Sontb Hants and Southampton HoepitaL—Junior Boose 
Surgeon for kix months. Salary at rate pf £50 per annum, with 
rooms, boiu’d, and washing. 

Bubery Hlli Asylnm. Barnt Green. Woroeeterehire.—Junior 
Assistant Medical Offioer. Salary £130 per annnm, with board, 
furnished apartments, Ac. 

Somenel and Bath Lunatic Asylum, Welle, Somerset,—Medical 
Superintendent. Salary £600 per annum, with furnished house 
and allowanoea 

Unirerslty of Glasgow.—Examiner for Degreee in Medicine and 
Scieniv. Salary £30 per annum. ApplJeationa, enclosing 
testimonials, to Alan E. Clapperton, Secretary. (See Advt.) 

Urlingford Union.—Trained Night N rse. Salary £50 par inr.nin 
Application, enclosing diploma and oopiee of testimonials to 
5L F. Dowling,Clerk uf Union. (See Advt.) 

Victoria Hospital. Folkestone.—Uonse Surgeon. Salary £100 per 
annnm, with board, reridence and laondiy. 

West Africa—Three Medical Offloeta Salaries offered £40 oar 
month, plue Bubsistenoe allowance, first-claaa passages, and 
outfit allowance. 

Weet Herts Infirmary, Hemel Hempetead.—House Surgeon, sin^e. 
Salary £100 per annum, with furnished rooms, board, fire. 
Ught^ washing, and attendanoa_ 

girths. 

Calbt,—O n July 20th, at Colville House, Ealing, the wife of 
Guthrie NerfUe Caley. H.D., of a son. 

LAEaroBP.—On JulyfiSih. at Weston Park, Crouch End, N., the 
wife of C. Harris Inugford, M-B.Lond., of a daughter. 




£VAKS—Bbxeeak.—O n July 23id. at St. John the Divme’s, Bich- 
mond, David Boliert Powell Evans, L.B.C.P.Lond„ M.B.C.8. 
Eng., L.8.A., to Jessie, daughter of Charles Beenham. 

UoRSFALL — Campbell.—O n July 24th, at Ho'y Trinity, Melrose, 
(Jharles Edward HonfalL M.B., Bedale, Yorkshire, to Lilias 
Marianne, daughter of Bohert Hume Campbell, ol Qlendaroel 
Argyieehire 

Stabs—Froudx.— On July 30th, at Marylebone Parish Church, 
Eweu Cartbew Stabb, F.B.aS., of 57, <2aeen Anne Street. W., 
eldest son ^ William Henry Stabb, of Ilfracombe, to Emma 
liangworthy, daughter of the late James Henry Fronde, of 
Newent, Glos. ^ 

Watts—Tassell.— On July Slst, at St. Andrew s Church, Fulham. 
Aip»«tMiAF Mlnter Watte. M.B.. B.8., of ToUthorpe House, 
Holbeaeh, Lincolnshire, son of (japtain James Samuel Watts, 
B.N.. to Graoe Evslj^ fourth oanghter of ths late Bobert 
TumU, Baq., of Bocky EUl, Maiditoue, Kent. 


HoasFALL.-O q July 23rd. at Newland House, Leamington 
Fiands HorsfaU, M.B.C.S.Eng„ L.B.aP.Bdln., aged 80 yean 



le 










158 Tif» Mbdioal PBBis. 0 BIGHT All COMMUNICATIONS.__ Aug. 14^ 1901. 


would, no doubt, have lived out bia natural life a naeful 
member of the community in which hia lot was 
cast. There are in asylums, at present, scores of 
similar apparently *' harmless lunatics, who require 
the moral support of their enrironment to protect 
them from some such fate. Hedicslsuperintenaentsof 
districts asylums are well aware that the cases which 
heretofore have been transferred from the work* ; 
houses are, by no means, as a rule " chronic harmless 
lunatics.” Chronic, indeed, they too often are: but 
very frequently full of risk to themselves and others, 
as well as advanced in disease or age, or both. 
When chronic tbeir habits are usually dirty, destruc¬ 
tive and erotic, and when pbjsically^ ill they exhibit 
the cachexia of air starvation incidental to their ' 
close confinement. Taking them all round they are, 
perhaps, on tbe whole the most troublesome, expen¬ 
sive, and most unsatisfactory, from a medical stwd- 
point, of the years admissions. They require all 
tbe control, care, and comforts that our a«ylums can 
afford. Is there any reason to believe that those 
still remaining in the workhouse wards will not 
exhibit, wherever located in tbe future, the same 
urgent conditions sooner or later P Does anyone 
with the most elementary knowledge of tbe circum¬ 
stances suppose for one instant that if tbe residual 
lunatics of any county were brought en masse to-mor* 
row to the county asylum of the district, tbe motley 
consignment of degraded humanity could be fiti 
tingly boused in a ” chronic block.” Would it not 
be the first and obvious duty of tbe superintendent 
to distribute them according to their physical and 
mental state, over tbe appropriate departments of 
his institution P Yet it is such a group it is pro¬ 
posed to place in an auxiliary ” and to maintain at 
at a cost of some 5s. 6d. per week, of which tbe 
local taxation accout is to contribute 2 b. per head. 
So far then, it would seem that the provision neces¬ 
sary for the requirements of the residual lunatics is 
bas^ on a misconception of tbeir characteristics, 
and has, moreover, b^n very much underestimated 
seeing that they in no respect differ from those of 
the same class heretofore sent to asylums, where 
they cost the maximum sum for maintenance and 
tax the full resources of those institutions. It is also 
evident, as sadly illustrated bytbeoase of J. S. that the 
comparatively small number of mild chronic cases of an 
apparently “ harmless ” character cannot be removed 
without risk from the district asylum where, moreover, 
they are for the most partwilliug helpers in the daily 
work, and so reduce the cost of paid labour. These 
chronic lunatics require the asylum environment, and 
the asylums as at present constituted require the 
assistance of this class to help in every denartment 
of labour, and so lighten the general cost. It is clear 
then, as bas been abundantly proved by tbe complete 
failure of tbe clauses of the Lunatic .^ylums (Ireland) 
Act, 1875, that transfer from asylums to workhouse 
wards should be avoided for every reason. It may be 
argued without fear of contradiction that the same 
reasons will still hold good wherever it is proposed to 
transfer apparently “harmless” chronic lunatics 
from the District Asylum to any institution of tbe 
proposed “ auxiliary type—in other words, to a few 
isolated wards grouped under the condition of work- 
house life and forming receptacles for incurables, 
many of whom have yet wit enough to read and sen¬ 
sibility enough to ^ injurious^ affected by the 
inscription writ so largely over its door—“ Abandon 
hope all ye who enter here.” So much, then, for the 
difficulties which attend the selection of cases for the 
“ auxiliaries.'’ Let ns now see bow tbe auxiliaries 
themselves are to be provided. 

In February of this year the Local Government 
Board issued a circular to the County Councils, in 
which it was pointed out to these bodies that:— 

” The following courses are now open to a County 


Council, who should consider how any action of tbeirs 
might affect both asylums and workhouses 

“ 1. To build a separate auxiliary asylum for 
chronic harmless lunatics, with a resident medical 
superintendent, and at least one assistant medical 
officer (Local Government Act, Section 84). 

“ 2. To add, subject to the Lord Lieutenant's 
direction, by the erection of buildings less elaborate 
than the original ones, a new department to an 
existing asylum, and to place it under the resident 
medical superintendent of tiiat asylum. 

“ 3. To acquire and adapt some workhouse or other 
building, either as a separate auxiliary asylum, or, 
if the Lord Lieutenant so direct, as a department of 
some existing asylum.*’ 

Since this circular was issued some six months 
ago public attention has been directed to the subject 
in tne general and medical press, and it may be 
taken as fairly representing the state of opinion 
to-day, with regard to the different courses, that No. 
1 is impracticable because of its small numbers to 
be provided for, say 4,000 spread over twenty-two dis¬ 
tricts, or 180 to each. Beyond a reduced capitation 
grant the constitution of tbe auxiliary from an 
administrative point of view would in no way differ 
from tbe existing district asylum. 

No. 2 bas been considered feasible to some extent, 
but it creates a crop of difficulties by introducing a 
second class treatment, so to speak, side by side with 
what has been already approvea—two systoms under 
the same management and one roof. 

No. 3 has found little favour, inasmuch as the cir¬ 
cular of the Local Government Board suggests that 
it would be cheaper to build new than to adapt old 
buildings. This statement has been support by 
tbe estimates received for converting workhouses 
into auxiliary asylums. Financially tbe adapted 
workhouse as an independent asylum is open to the 
same objection as No 1, and as a “ Department ” “ of 
an existing asylum ” to tbe same objection as No. 2. 

An examination of the propositions set forth in tbe 
circular when based on a toll knowledge of tbe con¬ 
ditions which practically affect the questions regard¬ 
ing the due care, proper supervision, and adequate 
treatment of the insane brings to light the following 
facts 

1. That in the words of tbe Local Government 
Board’s circular, “ humanity demands ” the removal 
of the 4 000 insane from workhouses, who must be 
provided for elsewhere. 

2. That tbe class of patient for whom auxiliaries 
are proposed cannot be conveniently, beneficially, or 
economically grouped in such institutions. 

3. That the accommodation proposed would under 
Schemes 1 and 2 be as costly, and the administration 
moreexpensive than that of existing asylums, though 
nominally established on economical lines for the 
less curable cases. 

4. That no asylum can be properly carried on at a 
minimum cost of 5 b. 6d. per head, and that the cost 
in an “ auxiliary,” either as a separate institution or 
a department, would exceed that figure, hence the 
2s. grant is inadequate. 

5. That in face of all the circumstances, the 
number and nature of the persons to be dealt with, 
the object in view, the financial asf>ect of the ques¬ 
tion—the only one, I regret to say, the public bas 
seriously considered,—tbe creation of “ auxiliaries ” 
is unjustifiable, and that tbe wisest course, in the 
ordinary country districts at least, is to increase the 
existing asylum accommodation on tbe ordinary 
lines. In large urban districts, or conjoint district^ 
other steps may perhaps be taken with advantage, 
such as boarding out, or by erecting additional 

' asylums. 

I Whether or not lunacy is on the increase is a 
moie or less problematical question we need not 

O 



ACG. 14. 1901. 


ORIGINAL COMMUNICATIONS. 


Thi Midioal Fb188. 159 


fltop to consider, since the stem fact remains that 
the need of asjlum accommodation is yearly in¬ 
creasing, and that the Act of 1898, with one stroke, 
has pnuiiically certified some 4,000 individoals of 
onsoond mind, now located in workhouses. These 
persons are collectively, and for the first time legally, 
declared to be insane. It is recognised that they are 
in urgent need of adequate care; and it is provided 
that they may be (under the special conditions 
enumerated in the different courses set forth in the 
explanatory circular of the Local Government 
B<^d) removed elsewhere. This recognition of the 
malady has been long desired; if tardy, it is 
none the less welcome, but what can be said 
of the proposed remedy, but that it is of a 
weakly palliative kind, altogether inadequate to touch 
the root of the matter, and of that class of cures 
which are proverbially worse thw the disorder 
they are applied to ameliorate. The establish¬ 
ment of sterved “ auxiliaries ” on the lines indi¬ 
cated is not the course to bring these unfor¬ 
tunates to tbmr destination; it is simply send¬ 
ing them to lie on a siding until the block is cleared 
in the main line to their proper terminns. In this 
riding they may remain for an indefinite period, 
auifering the miseries of isolation and its conse- 
qofmces, while their late companions on the journey 
are going gaily along. Enpaasant note may be taken 
of the time this new departure takes place, as it is 
verily a psychological moment in the history of Irish 
Bumbledom. For to-day we fiud boards of guardians 
discussing menus of improved dietaries, trained 
nurses are displacing “ Gamps ” and “ handy women,” 
sanitation is at last asserting its importance in all 
departments of public health; the sane epileptics 
are to find a haven in central homes; the children 
are to be removed to the more beneficial surround¬ 
ings of district schools ; the unfortunate consump¬ 
tives are at last to have pure air and an 
abundance of it in sanatoriums. The new 
broom finds plenty of work in clearing out the 
dirty comers. When the reformed house is swept 
and garnished the Societies for Bri^^htening Work- 
house Life come along with music and song to 
cheer up the dreary days of the penal imprisonment 
of abject poverty. So the removal of the chronic 
and enphemistic^ly dubbed *' harmless ” lunatic is 
necessary—the most repulsive and glaringly re- 
proachable object mnst forthwith be swept into the 
outer darkness. One is inclined to ask, how does it 
come about that now when at last the dawn appears 
roeier for the pauper that he who is the veriest 
pauper of all—one bereft of means, of health, and 
of mind—is condemned to an existence which experi- 
euce has shown could not be adequately supported in 
the past on the same provisions which it is proposed 
todoleout to tbeminthe future? In point of fact,he is 
not only to stand still, but to go down hill, when all 
his former companions cry Excelsior.’’ Herein lies 
the practical point of this new departure. The esti¬ 
mated eo$t of a lunatic in an aweiluiry ia fixed at a sum 
which haa in the paat proved absolutely in$ufficient to 
tupplyin the most meagre manner the limited wants 
of theafiiiciedpoorofaUclaaaeeinourworkhouaea. It 
must be couched also that the amount of relief 
granted to reduce local taxation is hopelessly inade¬ 
quate to appreciably lighten the hiirdeu which pro¬ 
posed “ anxUiarieB ” would, if established, throw on 
the taxpayer, that is to say, if these auxiliaries are 
to he created for the betterment of the chronic 
insane. But why create yet another class of insti¬ 
tution in this small country ali'eady weighed down 
with too many institutions of all kinds? Such a 
course objectionable from medical and financial 
standpoints, can be avoided by increasing the accom¬ 
modation of the county asylums, when t^be lunatics 
aent to them would benefit by appropriate surround¬ 


ings, and the counties benefit by the larger grant. 
To this it may be urged that the county asylums 
are in some few districts too large to ^mit with 
advantage of a greater growth; possibly too some 
few superintendents who find themselves dail^ 
beset by the worries of tbe cramped condi¬ 
tions of crowded wards may say that in¬ 
stead of an increase they desire a reduction 
in the number of the patients. Such objections 
can be easily swept aside. If a district asylum has 
reached the stage of unwieldy bulk by all means let 
it be reduced by tbe creation of a legitimate branch 
of the same constitution, and not propagated by a 
“sport” of degeneracy such as an “auxiliary’’ 
would prove to be. The superintendent who seeks 
to throw off the embarrassment of accumulated caser. 
should consider the broad question of the treatment 
of the chronic insane with a view to the general con¬ 
ditions, and not to local exigencies. It is particu¬ 
larly dangerous for those superintendents whose 
asylums in the sister countries have been raised to 
the highest possible point of excellence in ^neral 
I equipment, m tbe development of special depart¬ 
ments for scientific research and in the cultivation 
: of classical cllniques, to take a summary view of 
j the disposal of the chronics. No doubt in the fulness 
I and amplitude of their administrative powers and 
success they feel that, while the “ chronic ” still 
crowd their wards, tbe idol of perfection they 
have set up has still but feet of clay. To sucu 
superintendents it may be said : If you, having done 
all any one individual can hnmanly do for the 1,000, 
2,000, or 3,000 patients under your care, find that the 
“ chronics ” do not appreciate tbe sesthetic comforts 
of your corridors, that your laboratory shelves groan 
, with the unexplored pathological material ot a kind 
1 which offers no prospect of new or attractive work, 

I that “ the babbling of green fields ” of the dement 
does not fix with the same interest the attention 
' which your clinical class gives to the highly-seasoned 
fabrications of a delusional adolescent; if for these 
reasons you deem it desirable to be rid of tbe incubus, 
pray be mindful that the one has as full a claim on 
the public purse as the other, and that it is outside 
your province to suggest the restriction of the legiti¬ 
mate comfort of demented old age in order to indulge 
tbe more recent cases in what you admit is the border 
land of luxury. Remember also that you are rolling 
along in urban areas on tbe hub of civilisation, and 
be not unmindful of others less fortunate than 
you who have to labour along tbe rut in country 
districts. Having successfully passed the goal, 
do not forget that others have but started in tbe 
race of progress. Let not your specialty sink the 
broader spirit of humanity that alone can alleviate 
the actual living suffering which the highest micro¬ 
scopic power has, as yet, failed to locate, though its 
effects are palpable to the most unobservant.” But 
it needs no reasoning to prove to the medical 
reader how “ auxiliary ” asylums of the projected 
type are unsuited to the wants of the class ihey are 
intended to accommodate, any more than it requires 
other pi-oof, than is established by an examination of 
the financi^ aspect of the question, to show that 
such institutions are unaccepteble to over-taxed rate¬ 
payers, Still, tbe necessity for some accommodation 
remains, and the problem is bow is it to be met ? A 
section of the laity indeed have, in the profound 
ignorance of the real conditions, sought to cut the 
Gordian knot by proposing “ auxiliaries ” so-called, 
to consist of adapted buildings, supervised by a per¬ 
son of the status of a bead attendant and supported 
by “ a few vigorous women, neither squeamish or 
over-refined.” It is unnecessary to dwell on this pro¬ 
ject save to record it as, perhaps, the most astonish¬ 
ing proposition of an age, characterised by astounding 
projects, from all of which, however, it differs in the 

C C 



160 Th« Mtoioal Pbim. ORIGINAL OOMMUNIOATIUN8. Atro. U, 1901 


fact that it ia as retrograde as others are progres¬ 
sive in character. In ite simplicity lies its d^ger. 

It seems akin to the line of reasoning which a few 
Tears since made it seem clear to a certain section of 
Parisian “ souls,” that the best means to promote the 
highest spiritual feeling and to divest themselves of 
the trammels of onr too elaborate system of modem 
life, rendered it necessary that they shonld migrate 
to the woods of Normandy, where, substituting fig- 
leaves for chiffons, they should resume the unfetter^ 
simplicity of promiscuous association! Amidst 
sylvan delights they were to dig up roots for food, 
and enjoy sexual relations of so primitive a kind that 
rendered formalities unnecessary—but these are de¬ 
tails. One can readily conceive, however, that the 
details of life in an “ auxiliary ” run by those 
sturdy, coarse women, would lumish scenes no 
less novel and sensational which wontd horrify no 
one more than the ecclesiastical dignitary who, in the 
fulness of his heart, but with a want of the due 
knowledge of collateral oiroumstances, outlined a 
benevolent scheme for the benefit of his flock. 

Few legislative Acts there are that do not require 
amendment, and no Act, perhaps, dealing with the 
insane ever so urgently demanded amendment as the 
Local Government Act, 1898, where it touches the 
revision for the chronic insane. And yet a very 
ttle change may set the matter right, as it only 
needs some precautionary clauses and a little more 
liberal pecuniary treatment to make the evident 
intention of the Legislature practical and efficient. 
Let the auxiliary buildings be still provided, 
proximate to the district asylums, let the 4s 
grant be given to each patient therein, and let 
the transfer oF patients from the parent asylum, and 
the auxiliary be rendered as easy as the changes in 
the mental and physical states of the patients are 
rapid. This is not too much to ask in face of a 
decreasing sane population, an increasing insane 
community, and a lo^ taxation account bai^ on a 
standard year, when every department of the Poor- 
law service was notoriously inefficient owing to 
financial starvation. Excellent in intention, but hope¬ 
lessly weak in effect, the Act offers a temptation 
which carries with it certain punishment. The 
2s. grant will fall far short of the wants of the 
chronic lunatic if adequately provided for in an 
“ auxiliary,” and the deficiency must be drawn from 
local resources already suffering from overstrain. 
Let every certified lunatic get the benefit of the 4e. 
grant, and treatment of a rational kind in suitable 
asylum wards, and then the evil ceases to exist. The 
cure is palpable, aud should be recommended to 
those who can exercise it for the dual benefit of the 
afflicted insane and tbe hard-pressed taxpayer. The 
grant of the larger sum would be of infinitesimal 
consideration in tbe Imperial Budget, yet it would 
be for a section oi tbe community “an indemnity 
for tbe past, and a security for the future.” 


CERTAIN POINTS IN THE 

OPERATIVE TREATMENT OF 
RENAL CALCULUS, {a) 

By J. HUTCHINSON, jun., F.H.C.S., 

Sursson to tbe LoBdon Hoepit&I. 

luP&oVED methods in skiagraphy have rendered it 
possible to detect renal calculi whatever their com¬ 
position, so long as the subject is not exceptionally 
stout or tbe calculi exceptionally small. The time 
required for a successful exposure to tbe X-rays can 
be brought down to fifteen or even ten seconds, 
which maybe i-egardedas instantaneous photography. 

(a) Ahs'raot of Paper read at British Medical association 
Snnn^i Meeting, 1901. 


During this short exposure it is easy to avoid all 
blurring from respiraU^ or other movement on the 
part of the patient. Uric acid calculi give better 
results with these short exposures than with the long 
ones that have been hitherto customary. The exact 
size, number, and position of stones m tbe kidney 
can thus be determined before tbe operation, and the 
kidney subjected to the smallest aegree of injury 
during the latter. In the majority of caees 
renal calculi can best be reached through an incision 
across the back of the pelvis, though it is necessa^ 
in some cases to go through the cortex. With the 
aid of the X-rays it will be almost always poesible to 
place the incisions directly over the stone or stones. 
To bring the kidney out into the wound is sometimes 
both difficult and dangerous, and to bisect it through 
the convexity (splitting the organ) may cause senoM 
hsmorrhage, or lead to a urinary fistula. _ Provided 
the urine is f^ly aseptic, a condition which can be 
generally brought about by the previous use of mo- 
tropine, a wound made through the pelvis, whether 
sutured or not, will heal readily. If sutures aie 
used they should be of the finest silk, and should 
not penetrate the whole thickness. The X-rays 
enable very small o^culi to be detected, and they 
should be removed by operation as soon ae this is 
done, since small solitary calculi are among the most 
dangerous of alL 

Occasionally whilst the calculus is on one side 
the patient’s symptoms are referred to the other. A 
striking instance of this was narrated, in which the 
X-rays prevented a serious mistake being made. The 
evidence of skiagraphy confirms the belief 
stonee occur simultaneousiy in both kidneys m the 
proportion of about one to fifteen one-sided cases. 
This information may be of the utmost importance 
to the surgeon before operating. 

By means of the X-rays in some cases a supposed 
renal tumour or hydronephrosis may be shown to 
depend on a small impacted calculus, ^d thus 
nephrectomy be avoided. Since such reliance <an 
be placed on tbe evidence of the X-rays in skilled 
bands, it is obvious that the operation of nephro¬ 
lithotomy in the absence of a stone will become 
much less frequent than has been the case. _ 

Exploratory nephrotomy is not without risk and 
(supposing there is no calculus found) very little 
may be gmned by the operation. It is, however, 
admitted that a few cases of nephralgia are perman¬ 
ently relieved by it. 

Tbe paper contained cases illustrating the awve 
points, and technical details as to the best methods 
of skiagraphy in renal calculus. 


THE ROLE OF TOXIC ACTION 

IN THB 

PATHOGENESIS OF INSANITY, (a) 

By Dr. FORD ROBERTSON. 

His own views, he observed, were based chiefly 
upon the recorded observations. Whatever else 
mind might be, it was, in the first place, a product 
of tbe functional action of certain of the cerebral 
neurons. For the normal manifestation of this 
functional action three factors are essential, namely, 
(1) Integrity of the anatomical elements which form 
the physical basis of mind, (2) the maintenance of 
suitable nutritional conditions of these neurons, and 
(3) those sensory impulses which, commencing to 
impress the anatomical elements at an ewly period 
of life, gradually endow them with their special 
functional power and of which the almost con¬ 
tinual stimulus is required in order to call these func- 

(n) Introductory remnrka to adiicasnonnt meoiins British 
Medical Aaaaciation, 1901. | 


Auo. 14, 1901. 


ORIGINAL COMMUNICATIONS. 1*hi Midical Pams 161 


tional powers into action. Morbid mental action 
might primarily depend upon a fault on the part of 
any one of those factors. He discussed the import* 
anoe that was to be attached to a fault in the cortical 
neurons in the pathogenesis of insanity.and the parts 
played by sensory impulses and by alterations in the 
nutritional conditions There were two respects in 
which the materials brought to the neurons by the 
blood vessels might be onsuitsble for their h^thy 
nutrition. There might be a deficiency of certain 
constituents which were needed for their normal 
metabolism, or certrin substances might be present 
which were taken up by the cells and then disorder^ 
their metabolism. Any such substance was a toxim 
He enumerated the various possible non*toxic pri« 
mary etIol<^cai factors in the pathogenesis of in¬ 
sanity, and contended that, when these were fully 
taken into account, there remained a very large 
majori^ of cases of insanity in which the primary 
etiological factor was toxic action. He entered 
shortly into the question of the nature of predisposi¬ 
tion to insanity, and pointed out that it was based 
upon at least three entirely different cona¬ 
tions. By far the larger proportion of such predis¬ 
position depended not upon any condition that 
could rightly be termed degenerative, but 
merely upon one extreme of those wide though 
limited differences that individuals exhibit in the 
reactive qualities of their cortical neurons to various 
forms of toxic action. He insisted stnmgly upon 
the importance in certain cases of the indirect action 
of toxms upon nerve-cells through injury to the 
nutrient vessels. The various toxic conditions which 
tended to affect the nerve-cells might result from 
(1) exogenous toxic ^ents, (2) infections, and (3) 
auto-intoxication and auto-infection. In these re¬ 
spective categories special importance was attributed 
to alcohol, syphilis, and auto-intoxication and auto- 
infection from the gaatro-intestinal tra<^ He dealt 
esperially with the last named, and maintained that 
it had far greater importance than was generally 
believed. In his opinion various forms of toxsemia 
of gastro-intestinal origin were the chief factors in 
the path<«ene8is of a large array of acute and chronic 
diseases, including several forms of mental diseaM. 
He mentioned especially arterio-sclerosis, senile in¬ 
sanity, general paralysis, locomotor ataxia, chronic 
alcoholic insanity, dementia praoox, Mute and 
chronic mania and melancholia, idiopathic epilepsy 
(as the determining cause of the fit), and chronic 
Bright's disease. He held that the large majority of 
cases of insanity were not primarily diseases of the 
brain at all, but depended upon the action of toxins 
derived from elsewhere, which affected the functional 
activity of the cortical neurons by disordering their 
metabolism and often permanently damaging and 
even destroying many of them. He agreed with Dr. 
Mercier that “ insanity is a disease of tee whole man, 
a disease of the whole organism, which can only be 
properly understood and properly dealt with when 
so regarded.” 


SOME POINTS IN THE 

MANAGEMENT OF ECZEMA, (a) 

By HENRY WALDO, M.D., M-B.C-P., 

Pfaysiciaa to the Bristol Boral Inflmary. »nd in charge of the 
Department (or Diaeaeea of the Skiq. 

The author urged that an attempt should always 
bemade to cnreeczema. Whethent depended upon 
the action of micro-organisms, or whether this is dis¬ 
proved, as Kaposi thinks, by the fact that eczema 
may be provoked at will in any part of the skin of 
aay person by mechanical, chemical, or thermal 

(a) Abetract of paper read at Annnal Heetiog of British Medical 
AModation, 1901. 


stimuli, be considers that daily cleansing the part 
affected with the juice of bran, or starch, or boiled 
oatmeal diluted with rain-watw, should be carried 
out. 

He thinks the sound parts of the skin should 
be washed daily with soap and water, as by so doing 
the eczematous surface is much benefited, and illus¬ 
trated this by stating that if a different application 
is used for each side of the body in a symmetrical 
eruption, it must not be taken as a test of tbe relative 
value of tbe two agents, as one side always responds 
to a successful treatment of tbe other. This sympa¬ 
thetic relation of tbe two sides should be therefore 
taken into account by cleaning and polishing the 
general surface of the body which is not tbe seat of 
disease. Beadvised sootbingor stimulating applica¬ 
tions to protect tee part, and to a wet eczema he 
thinks a lotion is bettw able to come into close con¬ 
tact with the living tissues. He believes internal 
treatment is also necessary, and mentions tbe chan^ 
of opinion which has come over tbe medical world in 
regard to the relative importance of attention to the 
microbe in tuberculosis, as compared with tbe more 
important elements of the nutrition and hygienic 
condition of the patient. 

If auto-intoxioation is suspected he knows of no 
better inteetinal antiseptic than benzo-naphthol. 
which is odourless and tasteless. He thinkk all 
alcohols increase tbe itching, and should, as a rule, 
be avoided. If a microbioide is needed salicin is 
recommended. Unless diabetes is present be does 
not believe in restricting tbe diet. He does not find 
that sea air aggravates eczema in anything like the 
majority of cases. Woollen underclothing is said to 
act as an irritant in some cases, and silk, muslin, or 
linen should, he thinks, be substituted. 


THE 

IMPORTANCE OF THE X-RAYS 

AS A ME4NS FOB THE EABLT 

DIAGNOSIS OF TUBERCULOSIS, (a) 

By Dr. ESPINA T CAPO, 

Of the Boy&l Medical AcademrofHadrid. ProfesBOr of Tuberculoais 
in the ProTincial Horaital of Madrid; Inspector of Pablio 
Health, Ac., Ac. 

Mt work comprisea three parts: fint, radioscopy; 
secondly, ra«liography; and tiiirdly, the technique of 
both in relation to teberouloeia. In the first part I 
shall speak of r^tdioscopy in cases of sound and tuber¬ 
culous lungs; in the second of the use of radiography 
in the different stages of the duease, whilst in the tech¬ 
nical section I sbali refer to the best method of obtain¬ 
ing tbe best results in both. 

Badioscopt. —Radioscopy as a means of dif^nosis in 
tuberonlosis b** oooetitnted, since its appearance in the 
clinical field, one of the means in which the greatest 
hopes have l^n placed, so mnch so that since the fourth 
congress on tuberculosis held in Paris, it has been con¬ 
sidered tbe equal both of percussion, superficial and 
profound, and of auscultation. 

In fourth congress, however, we could not speak 
so affirmatively because we were not yet in possession of 
positive instanoes which would leave no room for doubt. 
To-day it is already impossible to detr^M}t from this 
potent means, admitted as such in all countries and by 
all practitioners. 

Partisan as I am of the parasitic doctrine, I will not 
treat of the radiograpbio diagnosis of open pulmonary 
tuberculosis, because the analysts of sputum, and the 
presence in it of the baciUns of Koob, affirm so p^i- 
tively the existence of tuberoulosis, that no physioian 
can detract from this method. Radioscopy, in tbe case 
of open tuberculosis, serves only as a potent means of 


(a) Abstract of paper read before the British Congress on. 
Tubercnlods. 


.Coogle 


162 Thb Mscical Prxbs. 


ORIGINAL COMMUNIOATIONS. 


AtJO. 14. 1901. 


settling the topography of the leeiona, and although this 
is Tery ixnportut, it does not deserve to fix onr atten* 
tion, bocaose we prefer to employ onr time studying 
the true use of Z^^ys in the di^cnosis of pulmonary 
tuberculosis in its first period full of doubts, and in 
which therapentioal inteiwention, being more rapid and 
convenient, is also more efficient. 

There is another question of transcendent importance, 
in which the X Bays have assisted onr investigation 
with such oleameRB, that this peculiar aspect of tbe 
question justifies onr fixing it in our attention. I refer 
to glandtfiar tuberculosis, the commencement, in many 
oases, of pulmonary tuberculosis, and in all the insepar* 
able companion of the disease. 

Apart from tbe data given by all authors in explana* 
tion of the changes of colour from which the radiosoopic 
image of the lungs suffers in tbe incipient, settled, and 
oavemons stages, we shall not refer to them, bemuse at 
this Congress we are obliged to present subjects of some 
novelty. I am going to mention, hotrever, two oiroum* 
stances, which, I l^eve, perhaps through ignorance, 
possess that peculiarity, and which we can only observe, 
especially one of them, by radioscopy. 

Badioecopy constitutes a pow^nl means of studying 
the dynamic forces. It is not possible to see by r^io- 
graphy all the functions and all the movements that 
chara^rise each function. For this reason the normal 
physiology of, for example, a joint during the different 
phenomena which constitute movement and action, can 
alone be seen on the finoroscopio screen, an impossibility 
with the radiographic plate. 

The two phenomena to which we are about to refer 
appertain to actions of an organ in a state of movement, 
and for that reason can only be observed by radioscopy. 
The first is the heart. Ever since Wells drew attention 
to tbe diagnostic value of tachycardia, all specialists 
and those who devote themselves specially to the study 
of tuberculosis, have set great store upon this datum, 
raising it to an important position in the early dia* 
gnosis of tuberculosis. One of tbe most efficient means 
of verifying this datum is by fioorosoopy. As we never 
lose sight of this diagnostical resource in onr depart¬ 
ment of tuberculosis, we can affirm, in an indubitable 
manner, that, with the finoroscopio screen, the datum of 
Wells is seen in more than 94 per cent, of oases of 
tubsrculosis with so much clearness as to remove all 
doubt on this subject. I shall, moreover, refer to a sign 
which, I think, has not been touched upon by othw 
authors* namely, that this tachycardia is not rhyth¬ 
mical. There is another sign in the heart of the tuber¬ 
culous, but we shall study it when we treat of radio¬ 
graphy. 

Tbe second example that may be taken for radioscopy, 
being essentially functional, and one which we have not 
seen referred to by any other author, app‘'are to 
our observation with as much, or even more, oooetancy 
than tachycardia. We refer to the visibility of the 
diaphragmatic excursion, both in inspiration and expira¬ 
tion, a phenomenon that, as is easily understood, can be 
appreciated neither by common means of exploration 
nor by radiography. This phenomenon, wUcb under 
normal conditions is rhythmical and symmetrical on 
b^th sides, in tuberculosis is neither rhythmical nor 
symmetricid. We have observed that in the tubercu¬ 
lous the diaphragm does not rise to the same height on 
the sick as on the healthy side, and that when the two 
lungs are affected tbe ascension is shorter on the worst 
side; in such manner, in the case of a tuberculous 
patient whose diaphragm on one side has no ascension 
or where it is very short, we deduce from thU the corres¬ 
pondingly greater impermeability of the lungs. 

Accepting also in the case of radiography of tuber¬ 
culous lungs, as much as we have relat^ respecting the 
several degrees of transparency and depth of shadows 
in the first stages, darlmess in the tract of the gan¬ 
glionic and lymphatic vessels, opacity in the congested 
lung, and very great transparency of the caverns, we 
shidl only say with regard to radiography that it is 
possible with it to discover the data, also of a certain 
novelty, in the radiogram of the tuberculous. 

In OUT remarks on tachyoddia when dealing with 
radiography, we said that the heart gives a sign easier 


of record by radiography than radioscopy. Since the 
adoption of this valnabls means of diagnons, the small 
size of tbe tuberoulons heart has attracted our atten¬ 
tion, being a true cardiac atrophy. If this, as we 
believe, is a positive indication of taberonloris, we shall 
arrive at a definitive early diagnosis with greater ease 
if we find in onr radiMOopio and radiographic explora¬ 
tions small heart, especi^y if the investigations are 
accompanied by tacbyoardia; moreover, we have an expla¬ 
nation of the relations existing between the smsJlness of 
the heart, aortic narrowness, and the frequency of tuber- 
culosis in sncb subjects, which determine the rale exist¬ 
ing among these phenomena. 

Another datum that may be observed is the peculisr 
shape of tbe intercostal spaces. In other works relative 
to ^e same matter, we have referred to the difficulty of 
performing percussion on tuberonlons patients. The 
causes of this difficnlty are two ; the first the extreme 
narrowness of the intercostal spaces, it being impossible 
to place the fingers between the riba, and the second tbe 
conical form of the tuberculous thorax. Now before the 
appearance of the B5ntgen method we could hardly 
understand these difficulties, but since the clinical adop¬ 
tion of this new system, the reasona become apjM- 
rent. In tbe ra^osoopio image ia observed a 
diepoaition of the ribs strongly resembling the 
peooliar arrangement of roof tiles, in such a manner 
that the superior rib almost touches the anterior face of 
tbe inferior rib, the intercostal space being so smsll, 
Mrticularly from the fourth rib downwards, that it ia 
difficult to place ^e finger upon whioh percussion is 
made. With radioscopy this disposition of tbe ribs is 
very clear, and fanotional phenomena corresponding 
to the diminution of the respiratory exonrsion in the 
tnberonlons impossible to diagnosis in any other manner, 
is very evident. As we see, radiography permits us to 
know data of transcendental importance in the life, in 
the fanotional, in the active, and for this reason it ia 
not possible to rescind from this reooorse in tha 
diagnosis of tnberonloais. 

Tbe trauaient nature of the radiosoopic iuu^, and 
the necessity of taking it permanently, emphasises the 
need of doaely following with radiography the datum 
described in ra^oscopy. It is true that radionaphy 
cannot give us any data of function, bat in exonange, 
with this second method, anatomical facts remain per¬ 
manently indelible, as a book ever open to study. 

Amongst the most interesting faote that we can select 
from onr experience in radiography are the deformi¬ 
ties of the bones oharacteriatio of tubercnlous thorax. 
There are in the thorax certain bones, which for their 
bearing on reepiration and also from the mnsules that 
originate from them, sue organa of transcsndentsl 
importance in the osseous respiratory apparatus. They 
fue the clavicle and the soapda. Their position, form 
and size also produce very important modifioation in 
taberoolosis. 

In taking a radiograph of a tabercnlons subject, are 
see the mo^fioations of these bones; tbe clavicle princi¬ 
pally presents an angmentation on the inflection of its 
external extremity, and resembling a hyperplasia, but 
without being sufficient to constitate an alteration of 
tbe tubercnlous epiphysis, takes the shape of the head 
of a mace. The scapulas are higher, and the internal 
and superior vortex is more elevated, swinging towards 
the centre the point and internal edge which are raised 
on account of the pecnliar disposition of the ribs and 
spinal column. 

Without enteriog into the pathological physiology of 
theso facts, which entirely depends upon the great respira- 
toryueoessities of the tuberculous,united with the reduc¬ 
tion of their respiratory field, we must remark that radio¬ 
graphy shows these pathological heteromorphics srith 
great clearness. The roof-tile disposition of the ribs, of 
which we have spoken before in speaking of radioscopy, 
can be seen in an evident and clear manner by radio¬ 
graphy. Besides these deformities of the skeleton, radio- 
(rraphy also shows ns the small size of the heart. 
B^pecting this organ radiography has achieved wonders, 
not alone in tnberonlosis, but as to its real sitoation ; 
bnt patting aside this latter fact, and oiroumscribing also 
those data whioh we can recognise in tuberoolosis by the 




Auo. 14, IdOl. 


heart, we shall mention two that have, we think, a cer¬ 
tain novelty and importance. 

The first is {^ter extension of the heart towards 
the lines of Tranbe and Friedreich on the right side 
fact showing, in onr opinion, a compensatory insuffi' 
aenoy of the tnonspid valve, and. for that reason 
ventncnlar hypertrophy on the right side: the radio-' 
graphic image of the tired heart in tuberculous persons 
thus ^uues a strong resemblance to the image of the 

. he^ of the emphysematous. The second datum 
refers to the special form of the heart of the tnbercu- 
loospersons w^ch thus quires a strong resemblance to 
the of the tired heart of emphysematous. The 
leoo^ datim refers to the special form of the heart of 
^ taberculo^ similw to the foot of a Chinese woman 
m ito left ventncnlar border, remembering the growth 
of the foot of the Chinese. Seepectmg the 

limgB the fects of the first, second, and third penods 
are so classic that we do not consider them wd^v to 
occupy your a^ntion: for our part they are simply 
oonfirmafaye of what wo rdated in the fourth oc^n- 
gress held in Paris. 

TiraHiQDB or Eapiobcopt !-To observe the wonder- 
™ phenom^ raAoaoopy under the beet conditions 
of Tinbiljty ^mplete darkness is necessary, suppress- 
^ It onta the light is produced by the Eontgen tube • 
for this purpose we have bad a special box conafcmnfewi’ 


ORIGINAij COMMUMICATIONS. 


Tbs Msoioxl Puss. 163 


' * special box constructed, 

to oono^ the hght completely, provided with a simple 
ms fthanii m adaptable to any exploration that mav be 
neoeisary. ^ 

Another trouble that must be got over is the difficulty 
of wlyug the fluoroscopic screen, which is oommonlv 
ngid ttd mounted in a frame. In this form the screen 
m tuberculous cases, only be appUed upon the 
f^um or upon the internal edge of the soapnlm It is 
mown that m rs^ographio im^es size and intensity 
deiwd UTOn the distance between the pwt under obser- 
ration and the surface of the screen, so that with rigid 
scre^it is not possible to obtain a correspondmg 
eqnshty of d^ihon and intensity over all the surface 
ud to obtain such a result it is necessary to use a 
screw mounted on oard-board in such a 
^st it can be adapted to the convexities of the thorax. 
One of our coUeasues, a very competent person in these 
matters. Doctor Eedondo, Fleet Surgeon of the Spanish 
nsiy, advisee the employment in radioscopy as a 
fa^osooopic screen of the strengthening screen whose 
unsge resembles in depth of tone the radiographic 
image, and gives as fine detail as the ordinary fluo^- 
oopic screen. 

This ^^lioation of the strengthening screen makes 
the solution of the problem easy, because it avoids hav¬ 
ing to change in the laboratory the flnorosoopio material 
^hich, as we have said before, the rigid screen is con- 
strooted. 

Tha last modification of the flnorosoopio technique is 
relative to the examination of patients that must have 
mated previously, to have obtained with more clearness 
ths eemi-lunar space of Tranbe, and to observe with 
gwrter ease the phenomenon of the diaphr^matio ex 
ratsion previously referred to. 

^lOGBAPHicAi Tbchwiqd*.—F or some time we have 
omitted as much as possible the use of strengthening 
■weens. This is not the (moment to analyse in detail 
their advantage or inconvenience. I will refer, however 
to amongst its inconveoienoes which, I think ie 
pertinent at this moment, viz., the turbid and dis- 
MBinated natore of the image. When, therefore, we 
tr^ images that require great detail, obtained in 
■objects capable of enduring the exposure—a very short 
nm^that is requir^ to-day to obtain a radiograph, 

*e refer to work without a strengthening screen in 
^to obtain a completely clean image, with richness 
of de^ especially in plenrisies and patients with but 
small caverns. 


riot- 

wiU occupy ns in this address, 

refers to the developmant of radiographic plates We 
frem^h^ nearly aU modem and antique^developers, 

acid to diaiffdo- 
<^mido.reeorcme, and from this study we 
^ve deuced the necessity of never dawSin^ 
m radiograph, jith old hquid. in 
Itortion, as much with the developing as irith 
^e fixmg a^nts; we use the diamldo - phenol 
^ sulphite of soda crystallised 

100 as a developer, and Enckel's fSi^sl hvno- 
Bolptoto to 26 per 100. With these prodnota we i£S» 

only, espei^lly m Madrid, where the purity of the 
I*^a water ( 4 ' hydrotrimetrics) permits of its em- 
pl^nwt in all photographic laboratories. 

confident of having defined 
or new; but the oaUof duty hM 

THE TREATMENT OP 
TUBERCULOSIS BY UREA, (a) 


Anothm interesting subject in radiographical tseh- 
^ito, tb^ also gives dearness to the Wge. and 
Pt " ”* details, is toe distance that should g^i st 
^eon the tube and toe plate. Without disonssing 
towy, bat confining oureelves to the oollected facts, we 
bare SQoceeded in fixing this distance at 60 centimetres 


By ARTHUR H. BUOH, F.R.O.S., 

Aarirtant Snpyeon, SBisex County Hospital 

r granted that the moat im- 

“y tuberouloeia 

immunity. Jenner first reoog- 
n^ toe imj^r^oe of the immunity of a portion of 
toe oommumty to a paitionlar disease, and eventnally 

V *•“ *»owever, tiU comparatively 
reowtly that the importwoe of his work vSswdei 

^ workers in this direction, whilst 

atodying susoeptobility and immnnity, have tended to 
be^wn m one direction, and that is the preparation of 
antitoxins, by means of the injection of whiohinto the 
hu^ body we ^ either render snoh immune to. or 
modify attack already b^nn, by the germ peculiar 
toeatodiseare. -niree antitoxins have been prepared 
from the grovrth of the different organisms conoemed. 
imder various conditions, and the result is that ^ 
chemical Butotanoes which have been injected into the 
tisroes of these to be protected are powerful alkaloids 
or tox^birains differing chemically from any oombina- 
tioM hitherto demonstrated in onr organirations. 

Now this Clare of antitoxins has so far proved of 
greater value m ^te specific fevers, snob as diphtheria, 
small-pox, typhoid and bubonic plague, than has the 
ooiwponding antitoxin in tuberculosis. But tubercu¬ 
losis differs mmany other respects from acute specific 
^e^ The former is a chronic disease, the latter acute 
The tubercle bacillus is one of the family of organisms 
which are termed infective granulomata, the latter 
belong to a oliss which produce their toxic effects in the 
body without the formation of new growth around them 
The tubercle baoillns has an exceedingly wide distribu¬ 
tion, that of toe others is, comparatively speaking, ex¬ 
tremely limited. Every one « ns has breu exposed 
reme constantly, to infection by tubercle 5 comparatively 
few have developed the disease; whereas of those who 
being unprotected either by a special antitoxin or hy a 
previous atta(*, are exposed to active infection by any 
of toe acute specific fevers, I presume it is safe to say 
that the great majority would develop such. 

In other words, by far toe greater proportion of man¬ 
kind provide a fit soU for the growth of the germs of 
acute specific fevers, whereas a amgll minority only are 
capable of harbouring and developing in their tissues 
the tubercle bacillus. The majority of us, therefore, 
possess in our systems some vito-ohemical combination 
or condition which renders os immune to any ordinary 
dose of infection by the tubercle bacillus, and it follows 
that that combination or condition must be actively 


(a) Abetraot of paper read before the Brlttah Conszesa on Tnber- 
entona. 



164 Thb UxDioAL PBsas. OBTGINA.L COMMUNICATIONS. 


Aira. 14, 1901. 


hostile to the baoUlns, for we ate all exposed to the 
infection. v . -i 

This sabetanoe, or condition, therefore, whatever it 
majr be, in contradistinction to the antitoxins, mnst be 
snoh as is neither harmful nor foreign to the human 
organism. It most probably exists in some in a greater 
degree than in others; but, in any case, if we conld in> 
duoe in the tissnes of the snsoeptible some difference in 
metabolism so that this substance or condition was in* 
troduoed into or manufactured in their systems, there 
be no manner of doubt but that we should rid the 
human race of tuberonlosis. 

It was by the observation that in his experienoe the 
gouty were particularly immune to tube^e that in* 
dnoed Dr. Harper, of Nottingham, to j^resorilM pure 
urea to the tuber^ous with a view to mcreasing^ the 
amount of urea and uric aoid in their systems, and it is 
because of the enormous importance that I believe 
attaches to tbia treatment that I am reading this 
paper. 

Dr. Harper has published two papers full of interest 
in the Lancet this year (March 9th and June 16th), in 
which he mentions many cases of phthisis which, being 
apparently incurable, have recovered. I would draw | 
attention to the fact that he was induced to try this 
treatment by the observation of the peculiar immunity 
of a small p^ of the community, namely, the gouty, to 
tuberculosis: in other words, for reasons similar to those 
which induct Jenner to try vaccination for small-pox. 
It is an extremely interesting fact to note that urea, in 
the shape of urine, has been taken from time imme¬ 
morial as a medicine, and that the natives of India are at 
present using it in this way. 

As the treatment is still on trial and in its infancy, 
the answer to the second mnst necessarily be uncertain. 
The following facts, however, will, I believe, be found to 
have a bearing on the case. Urea is one of the end pro¬ 
ducts of nitrogenous metabolism, i e., of the oxidisation 
or reduction of protoid matter, and the medium in which 
most of the nitrogen excreted from the body is carried 
away in the urine. 

Urea is formed, acoording to our latest knowledge, in 
ths spleen, lymph and secr^og glands, but principally 
by the liver. The orieinal source of the mtrt^nous 
matte’', which eventually supplies urea, is, of course, 
toe proteids consumed as foods. 

It is evidently impossible at present to understand 
precisely wh^ and how urea can act beneficially 
in tuberculosis, or what changes exactly take plaoe 
on its re*entraDoe into the body. Urea contains 
nitrogen, as do these all important proteid mattere. 
During the period of grosth and development lees 
nitrogen is eliminatcNl from the body than during 
toe decline of life. The balance of nitrogen, 
therefore, with absorptioD at one end of the scale and 
elimination at the otner, plays an important part in the 
cell activity and vito-ohemlcal oonetitntion of the 
body. If we can prove that urea splits up during the 

f irocees of absorption, and that its nitrogen is aesimi* 
atod, it can only be assimi'atod in the metabolism of 
protoplasm. We shall then have established theourions 
fact that an apparently waste product, the result of a 
process of reduction by oxidisation of protoplasm, on 
being passed through the mill, so to speak, a second 
time, assists in building up tissnes similu to those from 
whito it originally derived. The proof that urea is decom¬ 
posed in the process of absorption and assimilation, and 
that its nitrogen is wholly or in part retained in the 
body, can only be ascertained with certainty by 
ela^rate processes of analysis. With the general 
practitioner this is, as a rule, impossible, owing to lack 
of experience, time, and apparatus. But more experi¬ 
ments, including estimation of total nitrogen 
eliminated, will be necessary before definite 
statements can be made. Dr. Harper mentions in 
his piper that the urea in most cases is not 
increased. 

A short description of somecaies which I have treated 
in this way is as follows: — 

Case 1.— Man, set. 36. Was deserted as an infant, 
««m 1 ■nffATftH from tuberculous disease of left ankle and 


performed below the knee for the ankle joint disease, 
and double arthrectomy of elbows at age of ten to eleven. 
Twelve years ago lupus commenced in nostrils and 
spread with some rapidity to face and forehead. In 
spite of various treatment the disease progressed, and 
the following was condition when on Marto 28to last I 
commenced treatment with urea. One large ulcer 
oooupi^ an area, around which I will trace an 
imaginary line commencing at the centre of b^ir of 
forehead to a point half an inch above the outer end of 
each eyebrow, then inwards along the upper border of 
the eyebrows to a point above the root of the nose. The 
nasal bones had necrosed and come away, leaving a 
round hole leading into nasal cavity. Ulceratioa 
existed on both cheeks, and the left lower eyelid 
gone. From the outer edge of the ulcer on 
one cheek to a corresponding point on the other 
measured six and a half inches. In the centre of the fece 
was a bridge tissue, representing remiuns of the nose 
covered with epithelium. Below this was another irro- 
gular hole where had been the nostrils. Ulceration was 
present over the area where the upper lip had existed, 
most of this having disappeared. The edges of these 
large ulcers were very much raised, irregular nodules 
composed of chestnut-coloured apple-jeUy*Iike mattw, 
sharp cut towards toe ulcer and gradually sloping down 
tow^s healthy skin, ^me of the nodules stood three- 
sixteentbs to a quarter of an inch above the level of the 
ulcer. Inside the nose one large cavi^ existed, the 
septum, part of the etomoid and most of the turbi¬ 
nated bones having disappeared. The walls of this 
oavity were in a similar condition of ulceration to the 
external parts. The granulations over all the ulcers 
were unhealthy, and showed no signs of healing except 
at the parts most distant to the spreading edge. Here 
such attempts were very feeble. There was very much 
discharge of a thin, purulent character. Bo much col¬ 
lected in toe naso-pharynx that the patient almost 
choked every morning before he could get rid of this. 
The general condition was poor and the man most 
miserable. Treatment was l^gua on March 25th, when 
20 grs. urea t.d.8. was prescribed. By June 11th the 
nodules on temples had disappeared, and that on lip 
was disappearing. At the present time the forehead is 
practically heal^, a small sore on the lip, owing to the 
local application not suiting it, formed, and has not yet 
healed again. The local application during the whole 
treatment was not change^ nor was patient’s diet or 
way of living. Bis diet was chiefly potatoes, and had 
been for years. Hie mode of living was to keep in one 
room all day, and come out to sell papers in the evening 
Case 2.—Man, set. 80. Father died of phthisis. Nine 
years ago lupus commenced on right side of face, and 
gradually spread round to under chin, healing behind 
as it travelled, except at junction of lobule of ear with 
face. Four years ago left side of nose and face was 
attacked. The patient also developed strumous dacylit's 
in second finger of right hand four years ago, this 
eventually healed with deformity, leaving a tuberculous 
dermatitis on back of right hand. June 24to. Urea 
grs. 30, t.d.8., was prescribed. The patches were then 
all raised and nodular and covered with scales and scabs, 
under which, on removal, was the jelly-like granulation 
tissue. The most marked patch was on the left side of 
nose, as big as half-a-crown. July 2od, Very great 
improvement. Tfae'raieed areas are level at the oircum- 
ferenoes with sorrounding skin, and are lees red. Sen¬ 
sation in them has improved. The scabs are now limited 
to central part. Urea continued. JnlyOtb. The skin, 
which was stiff and hard where it wae affected, is 
getting pliable and softer. The patches of lupus 
are melting away. Patient is still under treatment 
Case 3.—A man, set. 22. Glands both groins began 
to swell a month ago. No apparent cause found. One 
gland on left, softening in centre, opened, and typical 
tnbercnlons caseons gland substance seraph ont Other 
glands enlarged, and on the right, one softened. Uiea 
grs. 80 td.s., increased gradually to grs. 40 t.d.B. The 
patient, who looked poor and thin, rapidly improved, 
smd the glands did remarkably well; tbe one tlmt was 
first scraped ont healed in three weeks, the other 


Avo. 14| 1901. THB GrEITEiR^Xi 1 £BDTCAIj COUNCIL. Thb Medical Pbms. 165 

THE GENERAL MEDICAL COUNCIL. 


«t work in three weeks. Diet and general conditions 
fairly good. 

Cabs 4. —Woman, st. 30, married. Family history 
of phthisis. Glands enlaced for fifteen years left 
ride of neck. O^hrated on four yeue ^o, and 
sigain by myself six months ago, when I removed 
glands from base of sknll to clavicle. Becnrred two 
months, ago, jnst under angle of jaw, and when pat on 
urea, there was a la^e mass of glands in this fcitnation 
pnshiTig o«t the skin and looking as if they must come 
through. After urea grs. 35 t.d.8. for six weeks, tbese 
glands have almost disappeared, and the woman is 
better in every respect. Still under treatment. Diet 
and conditions fair. 

Cass 6 .— Boy, set. 15. History of phthisis. History 
of two months pain and weakness in right elbow. The 
joint was almost fixed at a right angle, and very painfuL 
ATI the hollows were filled with typic^ soft tubmolons 
granulation tissue in the synovial membrane. Wasting 
of forearm half an inch. No history of injury. July 2o<L 
—After urea gr. xx td.a, and rest on a splint for ten 
days, patient was much improved. Could flex forearm, 
so that fingers could touch shoulder. Extension not so 
good. Pronation on arm and supination nearly perfect. 
All these movements done without pain. The swelling 
about the elbow was very much diminished. July 9tb.— 
Swelling about elbow haa disappeared altogether. Move* 
ments as before, but extension from full flexion to within 
f<»^-five degreee of full extension. Still under treat¬ 
ment. Diet and conditions fair. Urea 14 per cent. 
Average total quantity urine, 36 ozs. 

Cass 6 .—Girl, st. 18. History of phthisis on 
motheris ride. Lupus commenced two years ago in 
nosMls. Glands enlarged in both submaxillary regions 
and broke leaving ulcers. In the left nostril only the 
orifice could be seen, owing to granulations of jelly-like 
and swrilixig of the parts. There was a typical 
patch of Inpns about the left part of the upper lip and 
cheek. Joly 9th. After a month with xuaa grs. xxx. t.d.B. 
the left nostril can 1 m examined with ease and the 
septom seen to be ooonpied by a healthy granulating 
ulcer. The lupus on the lip and cheek have all faded 
away, and the tuberculous moers in the snbmaxillaiy 
regions have healed. Patient under treatment. Diet 
and general conditions poor. 

Case 7.— Patient, st. 22. Many enlarged glands 
on right side of neck, together with la^e tuber- 
ouloQS abscess nnder stemo-mastoid from the softening 
of one. The absoees was opened, washed out and 
stitched up, no drrin being u^. In six weeks’ time, 
after an average dose of 30 grs. urea three times a day, 
the whole of these enlar^d glands had entirely dis- 
appemed. There was a history of phthisis in this case, 
but diet and general omditions were v^ good. 

In all other tnberenlons cases in whidi I have given 
urea myself 1 am having, or have had, good re^ts. 
Not a single untoward symptom has arisen; on tbe con¬ 
trary, the action has evidently been in many oases that 
of a nervous tonic. 

In conclusion, I will draw attention to tbe fact that 
Dr. Harper baa already laid stress in the Lancet on the 
facts that the tubercle baeUlns in the laboratory g^ws 
best on media that are of low nitrogenous value, and 
that in the lower «.iiifnA.lii it atttmka the herbivorous 
rather thnn the oamivoroxu. 

The cow is an intereetiug animal, from this point of 
view, as it is the more often attacked by tuber- 

cnlosis any other. Here we have a huge amount 
of energy expended in procuring a sufficiency of nitrogen 
from herbs and a large loss <huly in proportion in the 
niw of milk. This process of extraction of nitrogen 
goes on far beyond the ordinary period of lactation, 
ft would seem that there may well be a relationship 
between nitrogenous absorption, assimilation, and elimi¬ 
nation, and tbe tubercle bacillus in this case. I sincerely 
hope that elaborate experiments will be made with urea 
in the near future, and that it will be widely tried in all 
forma of tuberculosis. Personally, I believe that Dr. 
Harper’s discovery will lead to a revolution in tbe treat¬ 
ment of this dise^, and that many cases which have 
been considered hopeless in the p^ will be cured in 
tile future. 


Addbxsseb bt the Candidates fob the next 
Election. 


Adkxsssss by Mr. O. Brown, Dr. J. G. GIotst, Mr. Victor 
Horsiey, Mr. Qeor^ Jackson, and Dr. 8. Woodcock were deliver^ 
before a meeting cooTened by Dr. O. Horder wbicb took place on 
August ted, by permieeion of the British Medical Association, at 
the Ladies' CoUe^'*, Cheltenham. The c^ir was occupied by Dr. 
Horder, who invited Mr. Oeorse Brown to rpeak first. 

Mr. OxoBGs BaowK said he did not r^fara tbe meetinc ss one 
that can come to any definite conclusion by way of deciding as to 
who should or should not be recommended to the constitnency as 
those who should be selected for representation. He was not pre¬ 
pared to give an account of bis stewaidship then and there, bnt 
hoped that he bad succeeded in satisfying those who bad placed 
him in that position. Under tbese circomstancea he hop^ it 
would be agreeable to tbe medical men of England and Wues to 
rive him their votes again. Having nut his hand to the plough 
he had no intention of turning back, tuongb, as a general praeti- 
tioDer,itwaa nn-ionbtediv a great tix upon one's time. He had 
opposed the Midwives Bill for tra years on the principle that he 
did not believe that a partially educated woman after three 
months education should be given a diploma or licence to 
practice midwifery, and be aliowel to use dangerous dmga 
whtch they are advised to do by those who lecture to them. 
At a meetiog at Manchester he bad said that if be remained on the 
Council for three yea^e withont something being done he sould 
resign his seat. This he had not done bccanee he found that their 
sending as direct representativee to the Council men fr'm their 
own body had a considerable effect and infinence on some important 
matters, for instance, more stringent regulations with r^ard to 
the snppreBsion of unqualified practice. Since tbe last eection 
much had been done by the Connell in prohibiting unqualified 
a'siatants, and tbe effect of that had b«w of a most satisfactory 
kind as evidenced by tbe higher salaries that wers obtained, and a 
great deal haa been accomplished also in respect of preliminary 
education, although tbe effects were not very apparent yet, bat the 
r^ulations are agree'* to which will have a mat infinence indeed 
in the fntnre admission of candidates to the medical profession. 
Beferring to the case of the late Eiogaley Hunter, he said that he 
conld not acquit himself from all blame in that matter, bnt tbe fact 
was that Mr. Hnnter'e name was dovetailed in a list of onqualifled 
men and no one knew that he possessed a qualification otherwise he 
would not have consented to his proseontion. He certainly thooght 
they ought to have had a summary of the evidence, but wen if he 
hvd applied for sneh he would have been told he wee wastinj^ the 
time of the Conocil as he bad been told before. He comphuned 
that more than once wbenhebada motion down on the paper som^ 
one popped up and moved the previous question which nnfortn- 
nstely wss iDvariably carried. That however did not occur now. 
He said that his colleague, Mr. Horsley, and himself bad worked 
very harmoniously aud happily together during the time we have 
been on the Conn^l, and if he haid the happiness snd hononr to 
again represent them on the Council he wotud have the opportu¬ 
nity of continnisg to work with him. He hoped they would send 
tIuM representatives wno would work harmoniously hand In band, 
because it weakened direct representation when one voted on one 
side and one on the other. 

Mr. A. B. Bitcbie (Manchester) asked if Mr. George Brown be- 
Ueveii it probable that the praeti- e of midwives could be restricted 
by l^islatlon, so as to make the attendance of a medical man com¬ 
pulsory in easee of confloement: also what policy did he support 
in connection with such legislation as was threatened ? 

Mr. Giobgs Bbowx ssid he would oppose t*^e present Bill (a Mo. 
He was in favour of a BUI for the better training of nurses by public 
bodies for poor people. 

Mr. A. B. BrrcHis said that Mr. Brown had not answered his 
qnestions. and Mr. B. H. Wolbtkmbolme (Manchester) wanted to 
know if M'. Brown supported the Medical Guild Scheme. To 
which Mr. Q. Bbowh replied that the scheme was on tbe Uues that 
he would support. 

Mr. J. B. WHtTAKSB (Great Yarmouth) said it would be m''re 
aatiafactory if Mr. Brown enawered Mr. Ritchie's question whether 
he believed that it was reasonable or poeeible to expect the L^ia- 
lature to pass any measure pairing every obstetric case to be 
attended by a medical practitioner. 

As Mr. George Brown did not quite understand the question in 
that direct way, thi Chairiian re^ ont the qne«lion to Mr. Brown, 
wbo said that he was sure the Legislatnre would do nothing of the 
kind. 

Dr. J. G. Glover expressed the hope that they would have at the 
next election a laiger vote of the profession than on any previons 
occasion. It will he impossible to get any real addition to direct 
representation If three-fourths of the profession stand aloof and 
left the election to groups aud small nnmbera. A verv serious blow 
was Infiictod on direct representation after the last election, when 
one of the gentlemen elected, after clamonring for a sea^, left the 
Council without even waiting to discuss the main question he was 
aopposed to understand, and for tbe solution o( which he was 
chosen. He had enjoyed their confidence for fifteen years—that is, 
for three separate quinquennial periods—and be was asking them 
once more tore-elect him. He pointed out that few members of 
the CouncU had seen more of its working; few had had a largw 
experience of ita principal committees; few knew better what the 
Council conld do and what it could not do than himself. Ihe 
Council was not perfect—it was too la^; it wanted reconstmo- 
rion, and it wantM larger powers; bnt in his opinion it bod great 
powers for good even in its present form, and he saw no immediate 
chance of It being materially altered. It bad done very much 
already and might do much more, both for the public and the pro¬ 
fession—for medical edncaii n, and for the purity and dignity of 
the medical profeesioD, which are of enormous consequence tu tbe 
public. And he believed sincerely that for those ends the presenoe 


O 



366 Thv Msdical Prcsb. THBJ GENEBAIi MEDTCAIj COUNCIIj. 


A.UO. lA. 1901. 


ou the Coandi of Moenl pnctitionen—men acqneinted with 
genenl practice, with ita problems. Its difflcnllies, its ^ierucee— 
were essentiel end would m ecceptable to the Council. ETen those 
who differed from him on the matter of the midwivee qnestion 
would allow that I hare never shirked the question, aod that I had 
consistently held that some r^ulation of midwivee' practice was 
nrgw>t]]r required, and could scarcely be bad without legislation. 
His support will only be siren to a Midwives' Bill on two or three 
veiT strict and well-deflted conditions. First, (hat the practice of 
unlloens'd midwivee be stopped and penalised; and, secondly, that 
the midwife should be required, on the occurrence of any Irregn- 
laritrorabnormalityofmother or child, to apply to a registered 
medical practitioner, thus placing her in a distinct, non-medical, 
subo^tinatepo•itlon. Hehadethlrdcondition, to which heattached 
much im^rortanoe, though be b^ not been able here, as in the 
other poiots. to get the Medical Council to agree with him—vis., 
that the local sanitary authority of each district should be required 
to pay medical men a reasonable fee (not less than a guinea) when 
appealed to by the midwife. He wuhed to abolish the eslsting 
untrained, ignorant midwife—the Sarah Qamp—believing her to be 
dangerous and deadly to-poor lying-iu women, who are entitled to 
the greatest consideration; also to abolish the unauthorised func¬ 
tion of the London Obstetrical Society in giving certificates to 
midwives. He wss no party to blaming the Society tor its 
efforts to raise the character of midwivee and to give them some 
training, and he was quite sure that the M^ieal Council would find 
itself without public support if it sought to atolish this function of 
the Society, without seeing how the function was to be sasined to 
aoms other body. The only way, and the proper way, to get rid of 
the Irregular and nuanthotised action of the London Obstetrioal 
Society would be to creates Board, acting under law, to do what it 
is doing, and for which it has in time past had the ^proval of 
the pnblic and the tacit approval of the M^cal Conncil. He felt con- 
vinced that such legialatlon would eometopoM, and that it would be 
doneindependently of tbemedical profeation if it losea the chance 
of shaping it and controlling and regulating the practice of mid- 
wives. In this matter as in some others. Mr. Brown had posed as 
the saviour of the mt d cal profession. He has a medical paper all 
tohimielf—which in the interval of elections onderwent a sort of 
hybernation, and Just before the great event, came to life again and 
demonstrated to its readers that he (the speaker) was the gieat 
sinner the Jonah—and that be (Mr. Brown).waa the man to e'ect 
torepreaent the profeaaion. Yet, during the last five yeara Mr. 
Brown bad never once in all the m idwifery diicnseions moved the 
Council to declare that it disapproved of all such attempts at 
legislation. But he led his followers to think that he was TOlng to 
do so, and that some greet cbsnge was going to occur. He (Dr. 
Olover) would warn them that such a change could occur without 
the Conncil stultifying itsslf. Hr. Brown would probably not get 
a seconder as had Imppened on a recent occasion. The midwives 
qnestion after ail was only one of a score or a hundred questions 
that have to be ci'-nsidcred by the Med ctl Council, which was 
par ezeei/eneea Council of Medical Education, and this must have 
for its basis a sound pieltmlnary education. Bebad triedtodohis 
duty as their I epresentativc on this question, and in the very first 
Seeaion after his election to the Council he bod drawn attention to 
the want of p- octiral teaching in clinical and therapeutical eubjects 
and of examinations in such subjects. Tbe defect was admitted: 
he was put on the Education Committee, and the resolution he had 
proposed had beenfruitfnl of good. Passing on to another topic 
he wd that the principle of a Conciliai ion Board had been ap¬ 
proved by a Committee of tbe Council of the British Medical 
Association, and there was reason to hope much from the applica¬ 
tion of It in tbe improvement of the position and power of the 
medical profession in relation to the great Frien^y Societies. 
The Council hod to discourage degrading and unprofessional modes 
of promoting practice- especially advertising and touting. He 
hod proposed a resolution meant to discourage these practices, 
which bad been very effective where tbe evidence of sneb practices 
and of the docto' 's knowledRo of them was sufiicient. One or two 
large insurance companies with medical aid bnslDeas had given up 
the business, and several medical officers had resigned their pos^ 
tions under this clause. Mr. Brown moved tbe Council to some¬ 
thing more drastic and did not get a seconder. Such conduct 
was of no service to the profession; it wasted the Council’s timeand 
money, and placed itln an uudignified position. Dr. Olover then 
commented on thepresentposiiion of tbereform of death certifi¬ 
cates, and deplored tbe metion between tbe Boyal Colleges and 
the Council which he hoped soon to be settled. In rega^ to tbe 
fluances of (heConncil he believed that with some reforms in tbe 
conduct of tbeir disenssions the ordinary income of the Connnil 
would still suffice to meet its expenditure, and he was therefore 
opposed to an annual tax. He defended the Council against the 
charge of inertia, observing that the changes which ore taking 

place in the profession—in its curriculum—in its education_in tbe 

pnblic estimate of it—and in the State estimate of it were enormous, 
and in some aspects serious. Heasked them to lemember that as 

K rdB the election it was not the Medical Council that was on its 
so much os direct represeutation itself. 

Mr. ViCTOK HoasLET ssid he was bo^ul that tbe meeting 
would be the precursor of many similar meetings, and that it 
would be a fixture at tbe annual meetings of the Association. With 
regM to his views on tbe midwifery question he stiil held that 
registration of existing and prospective midwives was necessary 
ud should be iiisisted on by tne Legislature. Their duty as mem- 
Mrs of the Qcneral Medical Council was to see as far as they could 
that the Oovernment did not lend their support to any measure 
whi^ did not embrace tbe *en essential points given in detsil n 
tbs Muiuim of the General Medical Council. He complained that 
although the OeneralMedical Council was practioaily a eub-depart- 
mmt of the Central Oov- rnmeat. its bead being the Pri»y Co-ncll, 
which WM preaided over by the Duke of Devonehire, the Privy 
^uned during the last ton months treatedtbeOeneral Medical 
Cotmcil with aupCTlaUve contempt. They would find all the facts 
intoeMmutes. It was ridiculous for them to consider that as a 
Bub-department of the Oovemmest they could thraugh iheir Pre- 
sident, or through anyone else, influence the Privy Conncil pri¬ 


vately. Theosly way to do it was through the voice of tbe pro¬ 
fession. He beUeveo that they would get *■*»<■ power, but in tbe 
meantime the General Medical Conncil was unable to do what it 
wished to do in the matter. He peraonmlly wie responslbte for 
endeavouring to send up a protest to the Privy Council against its 
behaviour towards them ss its sab-department. Dr. MacAlister, 
however, opposed him, and succeeded very easily in persuading the 
Council, so tut no protest was sent. Another inrtance of sneb 
contemptuous action on tbe part of tbe Privy Council oocurred in 
respect of reciprocity of practice in Italy wb<n tbe Privy C^naeil 
passed an order entiraly disregarding tbeir views as a Council 
As r^arda the work of the Council in edncaiion the matter of 
the Colleges v as really a very grave gneetion. The step taken by 
the Boyal Colleges was subvetsive of tbe present five years' enr- 
riculum and of the best interests of the meucal profession, and it 
would ruin students’ reg stration. The representatire of the Boyal 
College of Physiciana, which body wss tottering to financial rnin, 
did not hesitate to state In tbe Cjuncil, and his speech unfortu¬ 
nately made a most favourable impression on tbe Council aa a 
whole, that he was willing to rain students’ registration simply to 
carry out the wishes of hla (Allege. He waiuM them not. to enter 
into any compromise on this matter, for any yielding would lead to 
an irreparable ininry to tbe medical profesaiou. As regards pre- 
liminara professional education headway was being made in this 
matier by the Conncil itself, quite irreepective of this step taken 
by the Boyal Colleges. The question of eduratiou * as considered 
with that of the one-portal system. By tbe constitution of the 
General Medical Council it was unable to receive a scheme for the 
one-portal aystam, for the (^nncil was composed of oommerchdly 
competing bodies, and was thus really unfit to control medical 
education. He then discussed the necessity jor a Medical Act 
Amendment Bill. They had swept away the men who were bitterly 
hostile to tbe profession. It has caused hard words and some mia- 
understanding, bat the men had gone, and in their place they had 
a younger set of men, among them deans of medkal ecboolawbo 
are keenly interested in grneral medical education. These men 
are men to whom one would appeal with reason, and the outlook 
for tbe Medical Act Amendment Bill Is better. But the body of 
the Oene^ Medical Conncil oonalder that such a BUI should 
come from the British Medical Association, and he vras willing to 
accept that position. He suggeeted that they should meet them, 
that the British Medical Aseociation should go on with the work of 
the Paritamentery Bills 8ah-Committ e aod bring to the Oenenl 
Medical Connell the BUI t^t tb» asked for. lu such a Bill the 
mention of unqualified practice should take first place, but aa the 
price of the purchase of that, of course, the House of Commons will 
reqnire what we also require, that the constitution of the ConneU 

sha'l be changed, and that it should be deprived of its corporate 

Body, that is to say its commercial character, so that it shall be 
made a representstive Conncil, snd if the House of Commone 
demanded it thereebooJd be an addition of one or two more Crown 
membera. There most be a baigaiu, and they roust give something 
in return if they were togetanyUiiDgout of the House of Commons. 
He bad left his next point to the last because he believed it was a 
ever by means of which they would reform tbe Genera] Medical 
C-ounrit, viz., the question of money, which is at the bottom of 
most things. They had now got to the bottom of tbe pocket of the 
Council, and the Council was in shad way and might find it neoee- 
aary to go to the Houf* of Commans and ask for some change in 
legislation which it could put into operation in order that it may 
live. He reviewed bis action in exposing the nnsoandness of the 
Conneil's finances and said that the report propoeed ss reforms 
everything that they hsd been asking for. Among these reforms 
was the Annual Beglatration fee. He said that he waa a firm 
believer that the annual registration was a necessity in legislation. 
An annual registration fee of one pound would give tlie General 
M^icsl Council an income of £30,0i0and tbat was amply suffio ent 
for the Conncil to be really operative in the interests ol ihe public 
and the profeation. Tbe question of the annual registration fee, 
which he perfonallyconaideredanecesslty, had never been properly 
discussed, and os they looked to Manchester os usual for rmorm.so 
they looked to tbe meeting at Manebestor to have that TOint 
thoroughly threabed out eo tbat we sball know what it the voioe of 
the profeseion in the matter.' 

Mr. Ororus Jacesok (Plymouth) recalled that at n previous 
election he had polled over 4,0(X) votos, and had been asked by the 
Incorporated Practitioners* Association to come forward as a 
candidate again. In regard to the question of the midwivea be said 
they ought to try and guide legislation so tbat it shall not be regis¬ 
tration of midwives as midwivee, but rather at nurses, and I would 
say tbat all nurses should be roistered. It should be impossible 
for any womsn after just three months trainiug to be turned out as 
a midwife. He urged that district nunes should be appointed wbo 
might give lessons in elementary sanitation snd attend to ordinary 
dressings. The porulation was not increasing and one womsn in 
fifteen was said to die in her first confinement. At any rale, the 
mortality was very considerable, and ic behoved them to take more 
care of 'heir population-producing people, to take more care <rf tbe 
mothers of the country and not allow them to die in this way. and 
to take more care of the children. He suggested that the British 
Medical Association should introduce a Bill into Parliament ou the 
lines indicated on the " Medical Guild (Quarterly,” and that there 
should be a re^lar system of nones that should have two to three 
yean training uefore they were allowed to have anything to do wi^ 
nurang, as a sufficient trainisg was neceeoary so as to thoroughly 
drill the nurses in tbeir work, because, if taught only for a limitM 
time, the nurses relapsed into careless vays. He would be in 
favour of more direct reprMsntatives and of catting up tbe 
country into smaller districts. The General Medical Council 
would thus be able to promote legislation favourable to the profee- 
sicu and to tbe country at large. (Quacks, who praetised under 
the name of anrist s, ocu'ists, should m prosecuted. It would be a 
good plan if every medical man hsd to pay a small annual sum each 
year which would then enable theCouncii to act. Tbeexaminatioa 
for tbe entrance to the medical profession should be raised. Another 
important point is that a bill snon'd be introduced into Partiament 
for the better registration of deatbs, because of the enormous 






Avo. 14. 1901. 


AUSTEI A. 


Tb> Hbdical Pbxss. 167 


BBiaberof oBcartified StilUbirtbs also should be regis¬ 

tered. He could aot claim personal experience like the present 
r e w escntatieee. bat, if elect^ he wonld carry oat the dotisa as far 
tsnecoa’d. 

Da. 8. WooDCOCX, J.P. (Uancheeter), seemed doubtful whether 
or not he spoke as a candidate. He maintained that thw were 
entitled to a representatire from the north of England, and other 
ptecea than London shoold hare some share in representation. 
With regard to the midwires' qnestion he had never been in favour 
of initialing le^iatioo on thu qaeetion. He objected to self- 
tieoted men arrcqtatiiig to themeelvee the ri^bt of giving- certifi. 
cates to women, and be had assisted in elaborating a Bill In which 
two or three jgincipal things were simed at, limiting the fancti -n 
of the regiitoed nudwifery norse in a deflmte way. This ^1, 
b^ever, was to be pnt in only in order that it should not be said 
that they bad nothing to soggest. He oonsidered thaJt to inaist on 
a m^icu man being called in in every case of confinement was im- 
prsctacable. With reard to the attitud - of the present Govern, 
ment he said that wi^ all their efforts they had never been able to 
grt at the Pr sident of the Privy Council, who had invariably 
rriosed to receive a depctatlea. On the other hand, the promoters 
of the Midwives Bill had had no difflcnlty, and they were enooar- 
Sfed by him to go oo. and when a vacancy occurred cn the General 
■sdical Conncil of a Crown nominee the appointment was given to 
the man through whose efforts more than anyb^y else the first 
■ndthe worst Begistration Bill was brought forward. With regard 
to the Madkal Ooild Bill, he did not disapprove of it, but he 
santed something to be done in his lifetime. Speaking generally 
he approved of the attitude and policy of Mr. Horsley, and he 
agreea with him on this midwivee* qnestion. He was not sm- 
poiting the mcassre In tavonr of the registration of midwivee. He 
nad also taken aome put in attempting to draft a Medical Act 
Amendmenta Bill, and tnere he had snmoientiy indicated his o^nion 
ia regard to the representatives of the corporate bodies. ^Me 
tbonld be elected by the licentiates and members of those bodies. 
He thought they shoold aim at having the one-portal system. If 
the ConneU was paialyaed for funds we shoold go to Parliament 
sad get psrmteion to have an annual registration fee. He knew 
inm rthiiig of the workQfgenatalnrBctica,a»i4hnl had sofneesperi- 
enoe in pnblic life, and if the memcal profession thought he 
the sbiUty and the tact to represent them snffleienUy well he was 
pmaied to place himself at tb«ir service. 

Mr. BiTcHic said after the speeches they had heard the mid- 
sivceqneetion most be dropped out of that election. 

Mr, U. H. Bboadbeht (Manchester) said that he thought Jnst 
the opposite bcoanse it waa mosteseatial. 

The Ckajuxar then uked the candidates: Did they believe it 
prolableihat the practice of midwivetwill be reetricted by egisla- 
tiOD so es to make tbe«ttendance of a medical mao oompnlsory in 
cases of confinement, to which they answered. No. 

Dr. Qiovnn said in reply to Mr. A. Cox, of Gateshead, that he 
voted (or the piesent form of certificate issued by the London 
Obstetrical Society, and he would contione his present attitude 
nstfi some leg^ body was provided to look after that bnsinees. 

Dr.MuoaOaxBxvrooD lemarkedthat the Council had mmiA the 
Obstetrical Society alter the diploma issued to ml- wives into a 
certificate. Whet was it that led those who held certificates to go 
OB oslng the term L.O.S. That was the most important point and 
that was omitted by the ConneU. 

Hr. WoLSTESBOLitx asked Dr. Olovks if he had afforded Mr. 
Horsley sssiitanee when the Chairman of the ConneU refused Mr, 
Horslw aceem t o the documents. 

Df. Otovsa said that he did not remembr r the circumstances 
about the first resolntion dealing with the documents. The nlti- 
■ateRoolntion, however, by which the documents were accessible, 
vwmovedby him. He expl-ined that he had no other object 
than to sacore first the care of the documents, and secondly, the 
right and convenience ef members in the use of them. The 
present rseolntioa of the CouncU was drawn np by him in place of 
the first one, which, though be supported, was not quite satisfac- 

r. WoLSTSKBOUts asid the scheme of the Boyal Colleges 
npeand to rednee the medical carrioulnm to four years. Dr. 
Olover had spoken of a modtw mwndt, was that to prevent the five 
years' course being cut down to four P 

Dr. OLOvxa replied that he had no intention of disturbing the 
five yeare’ course, aud there waa not one instance in which the 
CollsfM had accepted less than a five years curriculum. They 
I nc luded in that ourricul'im one year passM at a preliminary edu* 
cational iostiintion ap,>roved by them. 

Hr. WoLSTSBHOLKE then wanted to know if Dr. Glover agreed 
to that 

Dr. Gloves said that be agreed with that till the ConneU had 
powvr to interfere with the I^al rights of the Colleges. 

Hr. WoLsrsEHOLME then demanded from Mr, Horsley whether 
he had had any difficulty in inspecting the documents of the 
Connril, whether he had been thwarted in that attempt, and 
whether Dr. Glover had properly sopported him. Also was Mr. 
Hanley in fsvonr of the modtu vivendx. 

Hr. HoasLBT; In r^ard to the first Session when the qnestion 
of the doenments came np, be saw when he made hie protest he 
m opposed by Dr. Glover so strongly that actually he could not 
obtain a fair hearing, and during the whole of that week’s work he 
wu looked npon as a kind of onteast for having endeavoured to 
disorterly interrupt the Chaim,an. That was the state of s^rs, 
bnihe carried his point at the nextSession. Headmitted tVist it was 
on Dr. Glover's motion that the documents are now open for inspec- 
tion. With regard to the modus ri ivndi with the Colleges, he thought 
that if tite matter were brought before the Courts the Courts would 
hsTS to My both rsrties were in the right, so he intended to resist 
snv attempt to spend the money of the profession in going to law in 
Ukis matter. There is no possible ntodiu viven/fi. If the Council 
ritOM to sneenmb to the Colleges, that was possible, snd nnless the 
direct reprasentsUves would a», with the voice of the profealon 
bshin d them, that the. Conncil shall adhere to its former position, a 
very grave injnry would be done to tbe medical proteesion. 

Aftersomeforaer questions and remarks, the pioceedlngs ter- 
atnatsd with a vote or thanks to the Chairman, 


JlttBtrk, 

[FBOH OTO own COBBBaPONDlNT.J 

VnBRA. Angnst 10th, 1901. 

Sakgvinal Kbswbl. 

A FABTicuLAB mania for new drugs with physical 
and chemical demonstrations has now overtaken the 
minds of the Anstrian medical world. Diagnosis av»<i 
pre^osis was formerly the chief end of all me dical 
labour in the wards with bacterial examinatioa to con¬ 
firm the prophecies, and there the case ended. Now 
tbings^have changed. In every ward you enter experi¬ 
ments are proceeding with some new drug which has 
given rise to a restlessness for novelty which is con¬ 
stantly supplied by the proprietary vendor, who is ever 
ready to act on the slightest suggestion. 

Sanguinal kiewel ia another of those hcavnut i^ pre¬ 
parations recently launched on the market as a ferri 
albominoos combination. It contains the iron in its 
native form, and represents 10 per cent, of hsemoglobin, 
44 per cent, of peptonised muscle, and 46 per uent. of 
the blood salts which Bunge affirms ia the moat import* 
ant constituent to be supplied in all cases of anamta. 

Gerber, in Prof. Nenaser's wards, has recently been 
testing tbe efficacy of sangninal kiewel in chloroein as a 
standArd test for anemia. Many experiments have been 
conducted with it in neurasthenia, rachitis, scrofula, 
nephritis, tuberonlosis, and syphilis with the greatest 
success, but in chlorosis, where Boerhave has affirmed 
that "Nihil in hoe easu plus eoTidmcit quam Chalyhio** 
has not authoritatively been put on record, which 
Gerber has endeavonre d to supply. He affirms that he 
has not attempted to interfere with the qaeetion 
. still.'.under controversy, whether iron supplies 
! a want or merely stimulates the hsmato-poetio 
apparatus, but contents himself with the physiological 
and clinical results with actual examinations of tbe 
blood. No effort was made to discover whether the 
albuminoid compound was broken np as a chloride sul¬ 
phate or nitrate, as it is now taken for established that 
the dmg is absorbed as an albnminoid. In addition to 
this sangninal krewel combines In itself the constitnents 
of the other theory that the salts of the blood are at 
fault, which is supported by the fact that manganese 
and fresh peptonised musoles, which alone is potent in 
the regeneration of nuclein, lecithin and fat are all 
present, thus increasing tbe number of the red blood 
corpuscles and amount of bsmoglobin in the sanguineous 
fluid. 

In all the cases experimented on the clinical facts, 
both objective and subjective, were excellent. The 
body weight and general appearance was improved, 
while the dyspneea and palpitation were removed in a 
very short time. 

To prove this he quotes tbe case of a young woman, 
st. 20, factory worker, who bad suffered for three years 
from chlorosis, for which she had used Bland's pill, 
ferrum, &o., with varying degrees of success. Still she 
complained of general malaise, difficulty in breathing, 
rigors, palpitation, pain at the cardiac end of the 
stomach, menses irregular, smd dyameuorrboea. 

On February 10th pil sangninal, three per day, was 
administered. Hsmoglobin, 80 per cent.; red blood 
corpuBoles, 24,80,000; colour index, 0'4; white cor-1 



168 Thx Midioal PbB88. 


THE OPERATING THEATRES. 


Auo. 14. 1901. 


puBoIes, 4^20; body weight, 62i kiloe, or 115'5 Iba.; 
poikilooytosie, microcytosis, and blood^plates. 

On March 17th the haemoglobin waa 60 per cent.; red 
blood oorposoles, 6,240,000; colour index, 06; white 
blood oorposcles, 4,800; body weight, 56^ kilos, or 
1212 Ibe. 

The second case was a honeemaid, set. 16, who for the 
last half year bad suffered from severe headache, 
difficulty in breathing, vertigo, rushing in the ears, 
constipation, and pain in the stomach. The skin and 
mucous membrane were pale; systolic murmurs over 
mitral and pulmonary areas; cardiac area diminished; 
spleen imperceptible, no fever, no albumin in urine or 
oedema anywhere. 

On February 25th 25 per cent, haemoglobin, red blood 
corpuscles, 2,287,000; colour index, 0'6; white blood 
corpuscles, 6,400; body weight, 64 kilos. After com¬ 
mencing with three pills of sanguinal it was increased to 
four pills a day on March 4tb, and on March 26th the 
hemoglobin was 46 per cent.; red blood oorpusoles' 
4,200,000; colour index, 0'6 ; white corpuscles, 5,960; 
body weight, 68 kilos, or 127 lbs.; while the blood 
corpuscle as in the former case had resxuned a normal 
appearance. 

Fifteen other cases related gave somewhat similar 
results, which speaks favourably for sanguinal krewel 
as a hsmapoetio drug. 

Hofbath Baron Wibdbbbofxb. 

Another of Vienna’s lights have ceased to bum in 
the person of Professor Wiederhofer, who has long 
enjoyed the imperial sunshine of the palace, being the 
favoured attendant and special adviser in the Imperial 
family. 

He was bom at Weyer, in £ms, Upper Austria, 1832, 
and qualified in medicine at Vienna in 1866. He com¬ 
menced as assistant under Professor Mayer, in the 
Children’s Hospital, and soon after was appointed second 
in the Vienna Orphanage. In 1862 he waa made extra¬ 
ordinary profeesor, and in 1884 ordinary professor. 

It was in 1863 he waa appointed private attendant to 
the Kaiser’s family, since which he has endeared him¬ 
self to the head of ttie monarchy in Austria. 

As teacher and examiner, Wiederhofer was respected 
as a highly-cultivated and learned authority in ptedi- 
atrios. Students and colleagues were r^^ularly found 
crowding his class-room, which was never large enough 
for the number that desired places. 

Two years ago he was seised with an apoplectic fit, 
from which be recovered, but last winter another repe¬ 
tition paralysed the centre of speech. To recover 
strength he was transferred to Ischl,where he died, under 
the solicitous care of the Kaiser and his family. 


©derating theatres. 

KING’S COLLEGE HOSPITAL. 

Excision of Lower Jaw for Sarcoma (?).—Mr. 
Careless operated on a girl, st. 21, who had been the 
subject of a large swelling of the right side of the man¬ 
dible for some months. The case had been under the 
care of Dr. Bateman, of Bichmond, and the tumour bad 
increased considerably. Dr. Bateman had previously 
made an exploratory incision demonstrating that the 
mass was mainly solid, but with bony foci scattered 
through it, and that it was exceedingly vascular. 


The mass] bad grown since that explcvaticai, bat 
not very rapidly; it was of a luod consistence, but it 
felt more like cartilage than bone, there being a slight 
“ give ” about it; the matins were very sharply 
defined, and the mass projected mainly on the outer side, 
encroaching but little on the mouth. Mr. Carless 
expressed the opinion that the tumour waa of a fibro¬ 
cystic type, or, as it has been termed by Mr. Bland- 
Sntton, an epithelial odontome. The patient having 
been anffisthetised, an inoisioa was made from the lobule 
of the ear behind the tumour mass to a point half an inch 
behind and external to the symphysis menti, practically 
running along the lower border of the jaw. Inthecentre 
this out was deepened so os to exp<Me the tumour; the 
fibres of the masseter were firmly incorporated with the 
outer wall, which was opened tbrough, exposing a 
tumour mass partly infiltrated with bone, and exceed¬ 
ingly vascular. The finger was used to break down the 
mass and define its structure and limits, and as it was 
found that the growth occupied nearly the whole of the 
vertical ramus, and also the horizontal ramus as far for¬ 
wards as the second molar, it was obvious the only way to 
deal with it was to excise this portion of the mandible. The 
cheek tissues were therefore reflected off the outer wall 
of the tumour, but the greater portion of the masseter 
had to be left attached to it The horizontal ramus 
was cleared and a section made with the saw between 
the first and second molar teeth. It was subsequently 
found that the inner aspect of the jaw had been slightly 
encroached on by the tumour in front of this line, there¬ 
fore a second section was made immediately behind 
the canine tooth. The tumour mass was then 
enucleated; this was a matter of some difficulty 
owing partly to the hsemorrhage, partly to the fact that 
the mass broke down, the outer portion of it breaking 
away with a part of the horizontal ramus, leaving 
behind a deep soft portion, which extended into the 
pterygoid region and upwards, along the temporal 
tendon as far as the great wing of the sphenoid. Both 
the ooronoid process and condyle were removed, the 
growth having encroached to within a very short di^ 
tanoe of them. The whole dissection was made with a 
very small opening in the month, really not more than 
three-quarters of an inch, as a number of the teeth on 
that side had been removed previously. The bleed¬ 
ing having been stopped, an attempt was made 
to close the wound in the mucous membrane by the 
introduction of stitches, and the external wound was 
sutured in the usual way, a drainage tube being left in. 
The tumour was as large as a good sized orange, and it 
had destroyed the greater portion of the jaw. The 
slowness of the growth and the sharp definition of its 
borders were points in favour of its being simple and not 
malignant in nature. Mr. Carlesa emphasised tiie 
desirability of not laying the buoo^ cavity more freely 
open than was possible, inasmuch as by this means it 
I was easier to prevent the wound becoming septic; 

I suturing up the mucous membranoe, he said, also had 
this object in view. Unfortunately this happy result 
was not attained as the wound subsequently became in¬ 
fected, but not seriously. 

TOTTENHAM HOSPITAL. 

I Htstbrectomt fob Mtoka.—D r. Arthur Gilxs 
I operated on a single woman, set. about 40, who had 
suffered for some time from pressure symptoms due to 
' the presence of a laige uterine myoma. Dr. Giles had 


Ava. 14. 1901. 


LEADING ARTICLES. 


Tst Mwdical Pbibs. 169 


performed an operation for myoma uteri on the patient's 
•ister three yean ago. In ^e present case the 
patient was seen about two months before the operation, 
when she oomplained of pelric pain, frequency of mic. 
turition, and menorrhagia. The last qrmptom was not, 
however, very pronounced. On examination the cavity 
of the pelvis was found ooonpied by a hard la^e Tn»m« 
which depreesed the pouch of Douglas and extended 
laterally, so that it appeared to invade both broad liga> 
ments. The cervix was drawn high up behind the pubes, 
and there was scarcely room for the examining finger in 
the v^ina between the tnmour behind and the pubes in 
front. In view of the form of the tnmour as felt through 
the vagina, and of the fact that hsamorrfaage was not a 
oonspicuouB feature in the case, it was surmised that the 
growth was mainly sub-peritoneal with lateral extensions 
into the broad ligaments. Operation was advised on 
account of the pressure exercised by the swelling. The 
patient readily agreed to operation, but desired to wait 
until the reopening of the Chelsea Hospital for Women 
where her sister’s operation had taken place. As there 
appeared to be no immediate urgency t^ was arranged. 
Some weeks later, however, she had retention of urine on 
several occasions, and it was decided to operate without 
delay. From the character of ttie growth as diagnosed a 
difficult operation was antioipated,bnt on opening the ab¬ 
domen and raising the tnmour out of the pelvis 
the operator was agre e ably surprised to find that 
the cervix and broad Ugameots were in no 
way involved, and the operation proved to be a 
simple and straightforward one, the ordinary supra¬ 
vaginal hysterectomy being performed. The mmh por¬ 
tion of the growth was the sise of a fatal head, it origi¬ 
nated from the posterior aspect of the fundus and had 
extended downwards in its growth till it had ooonpied 
practically the whole of the available space in the bue 
pelvis of the cavity of which it formed a fairly perfect 
cast. A marked flattening of the left posterior border 
indicated the position of the rectum. The body of the 
uterus was studded anteriorly with several small growths 
resembling new potatoes, but its cavity had not beoome 
involved. In the toppling over backwards of the 
tumour the cervix had become gradually drawn up 
anteriorly. The frequency of micturition and the 
subsequent retention of urine from which the patient 
suffered were readily accounted for by the anatomical 
conditions present. Dr. Giles said that there were 
three leadingindications for surgical intervention in oases 
of myoma:—1. Hsemorrht^ ; 2. Degenerative changes, 
and 3. Pressure symptoms. One or more of these might 
be pr^ent in the same case. Inthepresent instance opera¬ 
tion was undertaken on the third indication. It was evi¬ 
dent, he pointed out, that had the case beenleft alone the 
pressure effects must have been grave; those most to be 
feared would have been ohauges in the bladder and 
kidneys; pain also must necessarily have beoome very 
severe. Diagnosis of the precise condition preseot was 
practically impossible, as the pelvis was so completely 
filled npf the subperitoneal character of the growt hs 
was indeed suspected on the grounds given before the 
operation, but the important matter from the point of 
view of operative manipulation, whether or not the 
lower zone of the uterus and the broad ligaments were 
free from growth, could only be determined after the 
tumour was exposed. He called special attention to the 


characteristic oast of the pelvis formed by the tnmour, 
this, he said, was not often seen except in the case of 
cervical myomata. 


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^ht jdsbtcd fttss anb CtratUr. 

Published every Wednesday momiiis, Pnoe Sd. Pest free, Sid. 


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BALUB POPULI BUPBBHA LBX.** 


WEDNESDAY. AUGUST 14, 1901. 


THE CHOICE OF DIBECT REPRESENTA¬ 
TIVES. 

The meeting at Cheltenham last week, of which 
we pnblish a report elsewhere, brings the approach¬ 
ing election of direct representatives to the fore. 
We commend this report to the notice of our readers, 
at any rate of those who are interestod in the elec¬ 
tion of representarives for England. From it they 
may glean an idea of the present condition of medi¬ 
cal politics, and form an opinion as to the points to 
be borne in mind in voting for candidates to 
represent them on the General Medical Council 
when the present mandates have expired 
by effluxion of time. There seems to be a general 
opinion that the time has come for the infusion of 
new blood. Although there are obvious advantages 
in selecting men who are closely in touch with the 
wants and aspirations of the great mass of general 
practitioners, that is to say, men who are themselves 
general practitioners, this alone should not be deemed 
a sufficient qualification for selecrion. It is necessary 
that the direct representative should be in a position 
to command attention and respect, either in virtue of 
his professional status or by reason of bis intelligence 
and familiarity with the problems in the solution 
of which he will have to take a more or less 
prominent part Mere amiability of character 
and affability, though they may conduce to har¬ 
monious relatione with the other members of 
Council, are not qualities calculated to the effective 
discharge of the responsible duties which the direct 
representative is required to discharge. Then, too, 
the representative should be a man of superior edu¬ 
cation, in order that he may hold his own in a 
society of educated gentlemen. In so far as these 

.^.y.iized t 





170 Thb Medical FaBas LEADING ARTICLES. Ads. 14. 1901. 


qnatiiies, or the more desirable among them, are 
common to all the candidates some farther test mast 
be applied. Clearly it would not be prudent at the 
present joncture to make the much-debated mid¬ 
wives’ legislation the touchstone. There is reason to 
suppose that the general feeling in tbe profession is 
opposed to legislation in the direction of providing 
for the registration of midwires, and this feeling, no 
doubt, is mainly influenced by tbe view that to dub 
midwires women who hare received at most a very 
perfunctory training in the art is to invite, nay, to 
create, a detestable form of competition. Neverthe¬ 
less, it is well to recognise that something has to be 
done, and the most becoming, as well as the most 
tactful, attitude for medical men to adopt would be 
to use their influence to secure the introduction of 
clauses providing for adequate medical control. By 
opposing legislative proposals tooth and nail, 
without presenting alternative proposals, we should 
simply play into the hands of those who foster the 
measure, especially as the latter have the advantage 
of Government support. But there are many other 
questions before the profession which require to be 
dealt with. There is the question of Council reform, 
as to which we must require very explicit assurances 
on the part of candidates. It is idle to clamour for 
additional direct representation so long as not more I 
than a fraction of voters take the trouble to avail' 
themselves of the privilege of voting; but we do 
want the Council to take a wider view of its duties 
towards the profession and to obtain such additional 
powers as may be required to enable it to fulfil its 
functions in purifying tbe RegUter, and in suppressing 
the irregular practice of medicine. The finances of 
the Council are in a most unsatisfactory condition, 
and we are face to face with the necessity of pro¬ 
viding additional funds, possibly by the imposition 
of an annual tax on reg^tered practitioners. 'We 
agree with Mr. Horsley that such payment would in 
many ways add to the infiuence of the profession on 
the Council and of the Council on the public Lastly, 
there is the question of the standard of preliminary 
education, which continues to furnish material for 
copious discussion without making much progress. 
The time is not yet ripe for us to discuss the merits 
of the individual candidates upon whose utterances 
we shall ponder. 


“ CHRONIC HARMLESS LUNATICS.” 

The question as to bow the numerous “ chronic 
harmless lunatics,” as they are officially termed, 
which are distributed thi'ough Irish workhouses, are 
to be provided for in a manner which will satisfy 
modem humanitarian and scientific ideas is one 
which at the present moment demands solution. 
Our readeis will remember that the Irish Local 
Government Board issued a circular on February 
26ih of this year to the Irish County Councils in 
which they proposed that the latter should consider 
the following schemes, with the object of determining 
which would be the most suitable:— 

1. To build a separate Auxiliary Asylum for 


chronic harmless lunatics with a Resident Medical 
Superintendent, and at least one assistant medical 
officer. 

2. To add, subject to the Lord Lieutenant's direc¬ 
tions, by the erection of buildiogs lees elaborate than 
the original ones, a new department to an existing 
Asylum, and to place it under the Resident Medical 
Superintendent of that Asylum. 

3. To acquire and adapt some workhouse or other 
building, either as a separate Auxiliary Asylum, or, if 
the Lord Lieutenant should so direct, as a depart¬ 
ment of some existing Asylum. 

The order of merit in which these three schemes 
will be placed by those who only consider tbe well¬ 
being of the insane, and by tbe County Councils 
will probably be very different, and in this 
opposition of views lies the great danger which 
awaits all efforts to solve the question of pro¬ 
viding adequate accommodation for the chronic 
insane. If medical superintendents, and philan¬ 
thropists generally, range themselves on one side, 
and county councillors on tbe other, and if neither 
of them consider that there is any force in the aigu- 
ments of the other, then tbe County Council, who hold 
the purse strings, will carry out whatever scheme is 
cheapest. If, on the other hand, attempts are not 
to foroe the County Coundls into excessive 
expense, it will probably be found that the latter 
will agree to whatever scheme unites economy and 
efficiency. Proof of this is furnished by the action 
of the Committee of Management of the Down 
District Asylum and the County Council. In March 
last, a specif joint committee was appointed by these 
bodies to consider tbe communication of the Local 
Government Board, and this committee recommended 
the adoption of scheme three. Thereupon, the Medical 
Superintendent addressed a 'circular letter to the 
members of the Committee of Management, in which 
be pointed out the expenses which such a scheme 
would entail, and the advantages of adding new 
buildings to the existing asylum—a scheme by which 
the chronic insane “ would have the benefit of the 
exceptional surroundings of the present asylum, 
standing m grounds of 170 acres, and well equipped 
with all adjuncts required by the insane when living 
in association.” And, he stated, further, ” that the 
major portion of the outlay involved in locating the 
chronic lunatics within the asylum walls would, if his 
suggestions be adopted, go to render more efficacious 
those portions of the institution set apart for the 
acute and curable oases.” The immediate result of 
this letter was that a fresh joint committee was 
appointed by the Committee of Management and the 
County Council, and that, at a meeting held in Bel¬ 
fast on July 19th, it was decided to rescind the reso¬ 
lution formerly adopted, and unanimously resolved 
to recommend the County Council to provide for the 
i nftftwfl at present in the workhouses of the county 
by adding to the accommodation of the existing 
asylum. We congratulate the County Council on 
their decision, which in their case and in the case 
of many similarly situated asylums is at once 



Auo. 14, 1901. LEADING ARTICLES. Thi Mbdioal Prsss, 171 


tbe most snitabte and the most economical, 
la onr present nnmber we publish a paper 
bj the Resident Uedical Superintendent of tbe 
Down Coontj Asylum, Dr. H. J. Nolan. In the 
coarse of his paper Dr. Nolan elaborates his pro* 
posals for dealing with those whom he terms 
“residual lunatics.” At first, we confess, we iden* 
tified Dr. Nolan’s proposition with scheme two of the 
Local Goremment Board. This oonclnsion, howerer, 
was incoirect. Dr. Nolan’s proposition in brief 
is as fcdlowBTransfer the “chronic harmless 
lonatica ” which at present are in workhouses to the 
county asylum. Tf there is sufficient existing accom¬ 
modation for tbe purpose, so much the better; if 
not, it must be provided. If there is no room for tbe 
extension of the present asylum build an off-shoot 
to it, not as an “ auxiliary,” but as “ a legitimate 
branch of the same constitution.’’ Each “ chronic 
harmless lunatic ” is then in a position to receive— 
not the two shilling grant of the auxiliary asylum, 
but tbe four shiDing grant which is given in the case 
of tbe certified lunatic. Furthermore, the expense 
of tbe installation and maintenance of a completely 
new establishment is avoided. And, lastly, the 
“ chronic harmless lunatic ” is not condemned—* 
because be is harmless and chronic—to a worse 
existence than is tbe acute dangerous lunatic.— 
Dr. Nolan's scheme at first sight appears to be prac¬ 
tical and economical, if the difficulty of obtaining the 
full capitation grant is removed. It may be, 
that, “ the Act of 1898, with one stroke has 
practically certified some 4,000 individuals of 
unsound mind, now located in workhouses .... 
and provided that they may be removed else¬ 
where.” Is, however, this certification of a 
sufficiently practical character to carry with it tbe 
full capitation grant of four shillings instead of the , 
grant of two shillings per head which tbe Local | 
Government Act specifies? That the amount of 
the latter is absurd few will deny, but it apparently 
is fixed by the Local Government Act. Here is an 
opportunity for the Irish members of Parliament. 


WHAT IS A SANATORIUM ? 

PoBLic opinion just now is all in favour of the 
provision of additional sanatorium accommodation 
for the phthisical. This wave of opinion has a solid 
foundation because it embodies the application of 
tbe ris mtdicatriz naturae, but unless cai'efully super¬ 
vised it may lead to very undesirable results. 
Tbe present tendency is to raise a consider¬ 
able amount of money and then to build a more 
or less gigantic, and in any event very costly, 
edifice, in which the unfortunate victims of 
tuberculosis are to be aggregated. Now there 
are numerous and weighty reasons why this 
plan should be modified. Administrative control of 
an institution of this kind increases out of propor¬ 
tion to its size and, from a bacteriological point of 
view, nothing could be less desirable than the con¬ 
centration of large numbers of phthisical patients 
under one roof or on a limited area. Not only tbe 


cost of construction but also the cost of mtunten- 
anoe increases out of all proportion to the increase 
of size, mid the moral effect on the individual patient 
of living in the midst of a community of persons 
similarly affiioted, cannot fail to he the reverse of 
beneficial. If sanatoria are to be constructed by 
local authorities or by local philanthropic agencies 
in any sort of proportion to existing require¬ 
ments, a much more economical plan will have to be 
followed. It happens too that economy in this matter 
is not incompatible with efficiency; indeed, we 
greatly question whether a multitude of smaller in¬ 
stitutions would not on the whole be more beneficial 
and more easily compassed than a less number of 
more or less gigantic structures erected at an immense 
cost. The simplest form, one moreover which is 
available for many months in tbe year, is tbe camp 
sanatorium. Under intelligent management these 
could be made and kept as hygienic as tbe 
lai^r buildings; indeed, the problem of com¬ 
plying with sanitary requirements is necessarily 
much simpler when we are dealing with a 
comparatively small number of patients than 
when they are counted by hundreds. There is one 
point in respect of which, at first sight, the large 
establishments may appear to offer an advantage, 
viz., medical supervision. But Is this really as im¬ 
portant as one is apt to suppose P Except in 
advanced cases tbe general principles of treatment 
are pretty well stereotyped, and can be formulated 
at tbe time when the patient is sent to the sana¬ 
torium. Obviously such camps must be within a 
, reasonable distance of medical aid, and it might 
even be well to arrange for daily visits by a neigh¬ 
bouring practitioner who is willing to master the prin¬ 
ciples of this treatment. If a patient is so ill as to 
require close medical supervision bis place is else¬ 
where than at a sanatorium, at any rate at a sana¬ 
torium of the class under consideration. The fact 
that the open-air treatment can be made available at 
comparatively small cost is one which cannot be made 
too widely known. The number of persons actually 
suffering from pulmonary tuberculosis is enormous. 
One of the fundamental principles enunciated at the 
Congress which has just taken place was that the 
removal of consumptives belonging to tbe labour¬ 
ing classes from their insanitary surroundings 
is indispensable to any success in the endeavour 
to stem the tide of contagion. Not only is the 
patient himself placed under conditions favourable to 
recovery, but by removing him we remove a fertile 
source of infection from bis family, his neighbours, 
and from tbe district in which he resides. At the 
sanatorium he will learn enough of the nature of his 
disease to recognise and adopt the elementary pre¬ 
cautions which, if methodically carried out, prevent 
bis being a source of ooutamination. This is the 
sort of education that is required. It may be trusted 
to produce beneficent effects far and away beyond 
those of any number of lectures or sermons, and in 
the long run will secure that co-operation on tbe 
part of the entire population without which the most 
elaborate legislation must needs remain inoperative. 





172 Thi Mxdioal Psass. 


Atjo. 14. 1901. 


NOTES ON CORRENT TOPICS. ' 


on €^mrrtnt ^opicB. 

The Jenner Society. 

The report of this Society for 1899 and 1900, some* 
what tardily published, affords a very good idea of 
the results of the last vaccination legislation. There 
has been an increase in the number of vacoinaUons 
equivalent to 33'8 per cent., and the ratio of success¬ 
ful vaccinations has also undergone a marked 
increase. This latter fact suggests a doubt as to 
the genuineness of many vaccinations performed by 
private practitioners under the old regime, indeed, it 
was a matter of public notoriety that, in deference to 
the whims of parents, some practitioners were in the 
habit of complying with the letter, rather than with 
the spirit, of the law. The improvement may be attri¬ 
buted in part to restored public confidence in the pro¬ 
tective powers of vaccination as the result of the very 
thorough investigation at the hands of the Royal 
Commission, and partly also to the fact that vacci¬ 
nation has been brought to the doors of the great 
mass of indifferent people who, while they would not 
take any trouble to obtain the protection for their 
offspring, do not directly refuse compliance with 
the law. On bigoted anti-vaccinators the effect has 
been nil, except, perhaps, in that it has rendered them 
more obstinate mid irreconcileable than ever. As 
the report says, when a man commits himself to a 
position which he can neither maintain intelligently 
nor abandon without virtually confessing that 
he has blundered, he is more likely to be exas¬ 
perated than conciliated by being treated with 
magnanimity. The report deprecates the attitude 
of certain well-meaning magistrates who have 
placed difficulties in the way of the aoi 
dUant conscientious objector, and urges the 
maxim, eurtout paa trop de tele. Unquestionably 
this magisterial attitude has done something to 
mmntain the feeling of hostility to vaccination, and 
is unattended by any compensating gain to the 
community. The imposition of heavy fines on obsti¬ 
nate recalcitrants is also disadvised as enabling them 
to pose as martyrs. The public vaccinator, it is 
pointed out, is still handicapped by competition with 
practitioners who content themselves with a single 
mark, and it is urged that there should be a statu¬ 
tory definition of what constitutes successful vacci¬ 
nation, otherwise vaccination is liable to be brought 
into discredit by reason of the inadequate protection 
afforded thereby. The only other alternative is 
that vaccination shall be done exclusively by men 
not engaged in private practice. We commend this 
report to the notice of our readers on account of 
the useful information which it contains on the 
working of the Acts and on the advantages of this 
method of protection against small-pox. 

Professor Koch and His Critics. 

Opinions are divided, even in Germany, on the 
question of the identity of bovine with human tuber¬ 
culosis. Yirchow, on the one hand admits that the 
two are different, and even claims to have enter¬ 
tained this view all along, but he points out that 


the non-identity of the two diseases does not neces¬ 
sarily entaU the non-transmissibility of cattle taber- 
culosis to human beings, indeed he alleges clinical 
evidence to the contrary. He adds certain views 
which candidly do not assist in the understanding 
of the questions at issue. He warns ns, for instance, 
f^ainst considering everything formed in connec¬ 
tion with the tubercle bacillus as tubercle “ since 
there are both bacillary and non-bacillary tubercle.” 
Moreover, his opinion is that a small number of 
bacilli is not injurious, and be complains that this 
question of quantity has not been considered by bac¬ 
teriologists. Professor Elebs, on the other hand, is 
very hostile to the view that human and bovine tuber¬ 
culosis are essentially different, and he mentions a 
number of cases in which both adults and children 
have been infected by drinking the milk of tubercn~ 
lous cows. He declines to admit that Koch's views 
are conclusive. In the mean time the German 
Government has appointed a committee, of which 
Professors Virchow and Bollinger are members, to 
investigate the points in question. It is offimally 
laid down that there is at present no ground for 
modifying the precautions which are taken to pre¬ 
vent the spread of tuberculoris by milk and butter. 
It may be several years before the question of the 
difference of human and bovine tuberculosis is 
finally settled. Even on veterinary grounds dairy 
owners must still be required to sterilise their milk 
by TWARnw of heat, as otherwise there would be no 
means of preventing the spread of tuberculoeis 
among their cattle. Consumers also are strongly 
urged to continue not to use milk before it has been 
thoroughly boiled. 

An " Bminent ” Bone-setter. 

A MEDICAL contemporary has drawn attention to 
the description of a garden fete recently published 
in the Staffordahire SerUinel. The Duchess of 
Sutherland, so it is stated, looked in at the park 
where the crippled children were being entertained, 
and was accompanied by an “ eminent bone-setter,’ 
who has attended the Duchess and a number of her 
friends. As might have been expected this extrar 
ordinary proceeding has roused the local medical 
profession into arms. It is to be presumed that the 
crippled children were under the care of properly 
trained and qualified medical men. There is, pei- 
haps, no single branch of surgery that demands more 
highly specialised and experienced skill than tiiat 
of orthopeedics. So fully is that fact recognised 
by most surgeons that they will not undertake the 
treatment of these deformities, but hand them over 
to their orthopedic brethren. Tenotomy, resection 
and grafting of bones, aseptic surgery, tendon 
grafting, and a host of mechanical Appliances have 
greatly advanced the possibilities of this branch of 
surgical art. It seems incredible, under such dr- 
cumstances, that educated people should be found 
ready to trust themselves and their friends to the 
tender mercies of a man untrained in anatomy and 
surgery. The responsibility of entrusting a number 
of cripples to an unqualified charlatan is simply 

D<._, Google 



Auo. 14, 1901. 


NOTES ON CtTBRENT TOPICS. Thi Medical Peeeb. 173 


appalling, bat, if we are to beliere i^ta cru^nxrt 
Sentinel^ the Dncheee of Sutherland has not feared 
to undertake that risk. The extraordinary state of 
the law that permits the open practice of bone¬ 
setting by medically nnqaalified persons is so 
familiar that it hardly invites comment. 

Medical Portraits in Lay Journals. 

The recent manifesto by the Council of the 
British Medical Association against the publication 
of the portraits of medical men in lay newspapers has 
received an early and somewhat amnsing commen¬ 
tary. The portrait of the new President, Dr. 
Ferguson, appeared in the London Sun for the 7th 
instant, and by this time has doubtless illumined 
many other jonmalistio pages. If it be wrong for 
John Jones, a small practitioner in apiovincial back 
street, to allow an enterprising editor to reproduce 
his classic features in the local press, surely it would 
be equally an ethical offence on the part of his pro¬ 
fessional brother who happens to live in a prominent 
position and to be the leading practitioner in the town. 
It really looks as if medical ethics failed to 
realiee the fundamental principle of jnstice embodied 
in the homely proverb— “ What is sauoe for the 
gooee is sauce for the gander.’’ The consultant con¬ 
demns as an advertiser the general practitioner 
whoee name is published in connection with this or 
that medical matter in the public press; but he 
winks at notices of his own class in connection with 
boepital affairs, new cures, and a score of things in 
which laymen are closely interested. He seems in¬ 
clined to view the publication of portraits in much the 
same way. Not long ago a whole page, or there, 
abonts, was devoted in a South Wales newspaper to 
the portraiU of the honorary medical staff of the 
Cardiff Infirmary. It would be interesting to ascer¬ 
tain how the Ooxmcil of the Association propose to 
deal with wholesale offences of that nature. 

The Annnitl Dinner of the British Medical 
Aseociation. 

A COBBB8FONDSMT writesThe annual dinner of 
the British Medical Association, held this year at 
Cheltenham, will always be remembered as an occa¬ 
sion which was characterised by a series of “ dumb 
crambo’’ shows on the part of those who were set 
down on the official programme as the speakers for 
the evening. It was useless for the Chmrman, Dr. 
Ferguson, the President of the Association, to appeal 
to the andienoe for a few minutes’ quiet. The guests, 
to the number of over 400, had evidently come there 
to enjoy each other’s society and conversation; they 
did not actively object to the speakers, but they cer¬ 
tainly were not going to listen to them, and so in a 
perfect babel of loud and cheerful talking and of 
roars of laughter, together with the noise of many 
waiters moving about, a long toast list was worked 
through. A curious fact was that the inability to be 
heard did not in any way affect the length of the 
speeches. In the case of one orator every artifice 
was employed to convey to the speaker the fact that 
time was short and others were to follow, for even the 


bugler from the band was commandeered and loudly 
sounded the “ Cease fire,” but all to no purpose—the 
eloquent but unheard oration was not shortened by 
one single sentence. With the exception of the 
trouble about the inability to bear the official 
speeches the dinner went off exceptionally well, and 
moreover mmiy of those present were heatd to de¬ 
clare that it was the most enjoyable public dinner 
they had attended for a long Ume. 

Medical Guardian and Medical Officer. 

SouB time since we alluded to the complaint 
brought by the Medical Officer of the Newton 
Abbott Workhouse gainst one of the goardians, 
a medical man, on the ground that the latter in his 
official visits interfered with the treatment of the 
patients and criticised the diagnosis. A Committee of 
Inquiry was appointed, and they reported that the evi¬ 
dence was ** not sufficient to find that any intentional 
.interference had taken place.” One might have 
expected that the incident would end there, but with 
glorious inconsistency the guardians subsequently 
passed a vote of confidence in their medical officer, 
coupled with the hope that ” he would have no 
further cause to complain.” It really louks as though 
either the medical guardian or the medical officer 
would do well to resign, and it is to be regretted that 
a purely personal matter of this kind should disturb 
the harmony of the Board. On the whole our sym¬ 
pathies are with the medical officer, who is perfectly 
justified in resenting even the appearance of inter¬ 
ference with his professional functions by a fellow- 
practitioner. 

The CsusBtion of Phosphorus Necrosis. 

One of the most nsefnl addresses delivered at the 
Obeltenbam meeting of the British Medical Associa¬ 
tion was that by Mr. W. F. Dearden, of Manchester, 
on ” The Oausation of Phosphorus Necrosis.” Ac¬ 
cording to one school the fumes of the lower oxide 
of phosphorus given off from the moist phosphorus 
paste, in the course of manufacturing matches 
for use on the Continent, exercise an influence 
that is purely local. In the opinion of another 
body of thinkers the maxillary necrosis is a 
local manifestation of a general disturbance of 
the system. Mr. Dearden has very skilfully worked 
out his reasons for partially accepting both these 
views. He adopts, in fact, the commercial method 
of ” splitting the difference.” It certainly seems 
clear that the possession of carious teeth is a neces¬ 
sary factor in exciting the acute local necrosis, but 
it is equally certain that phospboiots fumes exert no 
specific action on exposed bone or periosteum. There 
must be some systematic predisposing influence 
from a primary infection of the tissues acting as a 
necessary adjunct to the local excitation. This ex¬ 
planation places the local irritation as the actual 
exciting cause in quite a secondary position. This 
contention is borne out by the comparative fre¬ 
quency of the occurrence of spontaneous fi-actures 
of the long bones in match-makers of many years ^ 
Digiiized; 




standing, and the brittle condition of the bone as- 
snredlj accounts in some degree for the low resist* 
ing power of the jaw to local inflammatory injury. 
Further, the bone of a match-maker and healthy bone 
shoW' a distinct difference in the relative proportions 
of phosphoric acid to lime, and this also is observed 
in cases of “ phossy jaw." By'the aid of the X-rays 
it can be demonstrated that bone formed in young 
people working at phosphorus processes daring the 
growing period is much denser in character than it 
would otherwise be. We quite agree with Mr. 
Bearden in his conclusion that certain changes do 
take place in bone tissue as a result of inhaling 
phosphorus fumes for long periods, and that it is 
reasonable to account for "phossy jaw” by local 
irritation through a carious tooth acting on bone 
already damaged as the result of a general infection. 

How Cheltenham was Saved from Small-pox. 

It is so usual to connect Government offices with 
red tape, delay, and muddle that when the Mayor of 
Cheltenham recently referred to the sensible manner 
in which the efforts of that city to control the well- 
known outbreak of small-pox at Gloucester were 
helped and encouraged by the Local Government 


and undergo decomposition. The advant^^ of 
having the process of carding carried out under one’s 
eye, so to speak, is that there is less risk of any por¬ 
tion of the contents being stolen or replaced by 
inferior material against which one can have no 
guarantee when it is sent to a factory. 

Action for Slander. 

A cuBious action for slander ag^st a medical 
man was tried at the Birmingham Summer Assizes 
last week, when Mr. Gray, a dentist, claimed damages 
from Dr. E. W. Welchman, J.P., for having declined 
to give chloroform for a patient of his on the ground 
that he (the plaintiff) was not a qualified dentist. 
It appears that, as a matter of fact, the plaintiff is 
' actually on the Dentitit' Register. The defendant 
in his defence pleaded that he bad received a cir¬ 
cular warning him not to assist any unqualified 
dentist, and though the plaintiff’s name was on the 
Register it was only in virtue of his having been 
in practice before 1878. The Judge put it to the 
jury that if the defendant bad acted under appre¬ 
hension of consequences in the event of the dentist 
being unregistered their verdict ought to be in his 
favour, and the jury thereupon returned a verdict 


Board his audience of medical men greeted the 
announcement with loud applause. In neighbouring 
Gloucester there were 430 deaths from small-pox 
recorded, and it was felt that immediate steps ought 
to be taken at Cheltenham, so the Mayor 
and Council snapped their fingers at precedent, 
and on their own authority made every medical man 
in the place a vaccination officer, and within a week 
or so the vaccination and re-vaccination of over 
10,000 people was carried out. Twenty-thi*ee cases 
of small-pox were imported from Gloucester into 
Cheltenham; these were duly isolated, and the Mayor 
had reason to be proud in recalling the fact that 
they bad not a single death in Cheltenham from the 
disease. The Local Government Board not only 
winked at the inejiularity, but put matters straight 
by granting certificates to the medical men as 
Government vaccination officers. 

Sanitary Bedding. 

A COBBBSPONDENT cslls attention to the curious 
indifference of English people to the quality 
and cleanliness of their bedding, at any rate of cer¬ 
tain parts thereof* notably the mattresses. He points 
out that in France even the working people aie not 
content to lie on mattresses made op of the debris of 
old woollen rags, carpets, &c. Their bedding is of 
white wool and horsehair, and at least once in two 
years the mattress is picked to pieces and carded 
by itinerant women. There is undoubtedly much 
truth in the reproach, for the practice of having 
mattresses re-made seems to be almost unknown in 
England. This may be the effect or the cause of the 
process being so costly as not to be accessible to 
persons of moderate means. The consequence is, as 
many of us know to our cost, much discomfort and, 
not improbably, injury to health, for dust and dirt 
must accumulate in the interstices of the mattress 


for the defendant, to which the Judge added costa. 

Unremunerative Honours. 

Election to the post of direct representative on 
the General Medical Council appears to be a some¬ 
what onerous distinction, judging from Mr. George 
Brown’s experience. In his speech at Ch^tenham 
be plaintively referred to the fact that his awnnaJ 
fifty cases of midwifery had dwindled down last year 
to one, and that one a gratis case, in consequence of 
the demands on his time by attendance at the 
Council at Committee meetings. This is certainly a 
serious state of affairs, for the loss can hardly be 
compensated by the five guineas per afternoon dole 
which is all that the members get. As Mr. Brown 
put it colloquially, the post is " not a very fat thing.” 
In spite of this disastrous effect on his practice, Mr. 
Brown asserts bis willingness to continue his self- 
sacrificing efforts on behalf of his professional 
brethren. It remains to be seen at the next election 
whether his brethren will consider themselves justi¬ 
fied in imposing the sacrifice upon him. 

Diachylon. 

The frequent use of diachylon as an abortifacient 
in the city of Nottingham led to the Nottingham 
Medico-Chirurgical Society calling the attention of 
the British Medical Association to the matter. The 
matter was passed on to the Pharmaceutical Society 
with the request that steps should be taken to have 
diachylon scheduled as a poison. The Pharmaceuti¬ 
cal Society appointed a special committee of the 
Coimcil to consider the desirability of extending the 
schedule to the Pharmacy Act, 1868, and the corre¬ 
spondence from the Nottingham Medico-Chirurgical 
Society has been remitted to the special committee 
referred to. The members of the medical profession 
at Nottingham are to be complimented on the very 




oogie 




Aug. 14,1901. _NOTES ON CURRBNT TOPICS. Thi Midical Pbms 175 


jodicioiis oonne they have pursued in this somewhat 
difficult condition of affairs. 

Reform in Soldiers* Dress. 

Tn dress of the soldier is one of the points that 
demands firm handling in the new era that it is not 
altogether imreaeonable to hope will ere long descend 
upon the British War Office. At present the full 
dress uniform of man j privates and of most officers 
is a survival of monumental foolishness, unfitted 
for either the arts of war or tiie purpose of peace. 
The garments are so beavj and tight fitting tha^ 
thej permit no departure from the constrained 
stifbees of the warrior standing at “attention,” to 
B 87 nothing of the fact that they are coloured so 
gaily, and loaded so heavily with metal buttons, and 
lace and other finery as to be a constant source of 
wearing anxiety to their owners. The first thing 
an officer does on returning from a full dress 
parade or other function is to revert to his loose 
patrol jacket. Indeed, it is rumoured that 
if Mr. Brodriok’s proposal that officers in future 
should wear their uniform in public were carried 
out, at least half of the present army officers would 
forthwith resign. Why, then, should these uniform 
absurdities, which are so heartily disliked in the 
army itaebf, be retained to delight the hearts of 
8 ervani>msid 8 and drill>sergeant 8 , not to mention 
army tailors ? A good beginning has been made in 
the matter of supplying many regiments with 
slouch hats. In Italy the whole of a regiment while 
manceuvring near Naples recently, was attacked by 
malaria. The Minister of War has since issued 
orders that all troops in that district are in future to 
wear veils and gloves to protect them from mosqui* 
toes. The good sense of that proceeding may well 
he commended to onr army authorities at home. 
The relation of dress to disease is a most important 
point in military administration, and one worthy of 
the highest skilled investigation and control. 

Undez^^und Bakehouse Legislation. 

The question of underground bakehouses has 
agrin come prominently before the public by reason 
of certain amendments proposed in the Factory Acts, 
which will probably have been settled in the Commons 
one way or the other within a day or two. The mHin 
proposition brought forwainl is that all underground 
or cellar bakeries shall in future be abolished, except 
in cases where the local sanitary authority grant a 
special certificate of the fitness of the premises from 
a health point of view. In practice any condition of 
the kind is likely to reduce legislation to a dead letter. 
Experience has shown that many bakers are actually 
members of vestries or conncils, and oppose any 
action agmnat their fellow-tradesmen tooth and 
oail. There is also often a strong under¬ 
current of opposition on such boards against any 
interference with trade interests. The reasons why 
undeigronnd bakehouses should be abolished are 
numerous and weighty. They affect the health not 
<mly of the producers but also of the consumers of 
bread. The whole case has been investigated by i 


Drs. Waldo and Walsh, who have published a book, 
“ Bread, Bakehouses, and Bacteria,*’ which has for 
some years been the authority upon this subject, and 
has formed the basis of all recent bakehouse legisla¬ 
tion. Their chief scientific point was the demon¬ 
stration of the fact that the ordinary loaf is not 
sterilised by baking. If non-pathogenio microbes 
survive the ordeal of the oven it is fair to assume 
that pathogenic micro-organisms will also retain 
their vitality under similar circumstances. This 
non-sterilisation of the dough in baking proves the 
absolute necessity of a perfect sanitary environment 
in the bakehouse. 

The Folly of Bolting Food. 

A PAPER read before the British Medical Asso¬ 
ciation furnishes some remarkable facts about the 
mastication of food. The author, an English prac¬ 
titioner in Yenice, says that there exists a loet reflex 
action of the throat, whereby it refuses to swallow 
food unless well chewed and mixed with saliva. After 
five or six weeks of prolonged and careful ohewiog 
of solids and prolonged insalivation of fluids, this 
reSex can be restored. The necessary condition of 
success is that both fluids and solids shall be dealt 
with in the month until they are reduced to a taste¬ 
less condition. The author says that by adopting his 
process indigestion is vanquished, the body becomes 
healthy, a far smaller quantity of food is required, 
and in one case oorpnlencj was reduced to 
an extraordinary extent. If his views be accepted 
the treatment of many maladies will be simply revo¬ 
lutionised. With the modem man quick eating has 
become a necessity, at any rate in the breakfast and 
luncheon hours. The tendency is to bolt everything 
at those meals, and to eat far too quickly even when 
there is ample time at disposal. It is clear that pro¬ 
longed mastication would render a dinner of many 
dishes impossible. It is equally clear that most of 
ns eat far more than is needful to satisfy our bodily 
requirements. That there is something to be said on 
the side of the quick eaters, however, may be gathered 
from the fact that many of them pasa long lives 
without being overtaken by the Nemesis of dyspepsia. 
Among many native tribes, moreover, and with a 
host of carnivorous animals, it is the rule to bolt food 
in rapid and wholesale fashion. 

The Public Endowment of Cancer 
Research. 

The shadows of the scientific world have long 
hinted at coming events in the curative and pre¬ 
ventive aspects of cancer. It is now pretty gene¬ 
rally believed that the dread disease in question is 
due to a parasitic organism which has gained access 
to the human body. If that be tbe case cancer is 
at once brought within the category of infeotious 
and therefore preveutible maladies. The importance 
of accurate knowledge upon these points to man¬ 
kind generally hardly be over-eetimated. One Is 
not surprised, therefore, to find an intelligent layman 
writing to the newspapers and advocating a plan 
whereby a number of endowments of £500 per annum 



176 Th* Mkdicil Pxxsi). notes. ON-CUBRBNT TOPICS. Ado. 14, 1901. 


maj be eatablisbed for the benefit of medical men who 
will undertake special inTestigation of the .dieeaM'.' 
While fnlly endorsing the Talne of this' snggMtion 
we can hardly agree with his proposed plan of 
selecting the workers from physicians and surgeons 
with a large experience of the disease, and requiring 
them to work in the cancer wards of a generaJ 
hospital. The purely clinical aspects of the disease 
have long been worked out, and the crucial problems 
of causation must be solved in the pathological and 
bacteriological laboratory. By all means let ns have 
liberal endowmmite for cancer research, but let the 
money be spent in the right direction. Any philan¬ 
thropist wishing to confer a lasting benefit upon the 
human species could hardly do better than found a 
special cancer laboratory. That would in many 
cases be a more logical and strictly philanthropic 
proceeding than the creation of pseudo-medical 
charities. 


Indiarubber Corsets. 

Thb corset, as all the world knows, is an essen¬ 
tial detail of the costume of the modem civilised 
woman. We use the term modem” advisedly, 
because early woman was free from that artificial 
aid to symmetry which has appeared upon the scene 
cmlysrithin the last hundred years or so. Thatithas 
some quality which commands the admiration of the 
fair sex is clear as daylight, otherwise it would have 
gone the way of crinoline and high waist and a 
hundred and one other absurdities of dress. The 
principle of the corset is that it supplies a “ figure ” 
built upon the unbending lines of beauty laid 
down by the dressmaking craft as the beau ideal 
of the feminine form divine. To that end 
this arUcle of dress is made practically as a cuirass 
of stiff material strengthened and stratted with slips 
of steel, whalebone, and wood. The apparatus, in 
its present stage of evolution, has gained the whole¬ 
sale contempt and detestation of all physiologists as 
an outrage upon the organs of respiration, circula¬ 
tion, and digestion. Lovely woman, however, con¬ 
temptuous of mere scientific criticism, has carried 
her fashion a step nearer breaking-point by inventing 
coieets of indiambber designed for bathing purposes. 
The idea of thus converting what should be a most 
wholesome and health-giving recreation into a field 
for exploiting various kinds of irrational dress could 
have been engendered only in the brmn of a latter* 
day fashionable woman. 

The Army Medical Service Committee. 

. Sis William Thomson, C.B., Fellow and late 
President of the Royal College of Surgeons in Ire¬ 
land, has, we understand, been offered a seat on the 
Committee appointed to inquire into the present 
state of the Army Medical Department. Even if 
Sir William Thomson is able to acc^t the invitation, 
the representation of Irish Schools on the Committee 
will still be altogether too small, when it is taken 
into consideration that the number of medical 
officers in the B.A.M.C. who hold Irish qualifications 


at present is equal to 87 per cent cff the entire 
number of officers. Sir Thomley Stoker, F.B.G.S., 
Ireland, has addressed a second letter to The Timet, 
in which he calls attention to the fact that there is 
still insufficient representation. 

Wage Limit. 

Tbb question of the wage limit is generallj 
believed to be a subject in which practitioners are 
keenly interested. It would, howevm*, seem open to 
question whether, after all, the medical profession is 
really interested in this matter. In any event, it is 
noteworthy that although all the branches of the 
British Medical Association were written to, asking 
for the opinion of their members on the wage limit 
question only nine branches replied, and the others 
are now being stirred to activity by urgent appeals 
from the cent^ authority to *' give this important 
matter their careful and early attention.” This fact 
certainly aigues in favour of the opinion that thia so- 
called burning question is in reality regarded with 
something akin to indifference by medical men in 
this country. 

Cigarette Smoking. 

Two hundred medical practitioners in Edinburg 
and Leitii have signed a memorial against oigar^te 
smoking by children, and mging that steps should 
he taken by Parliament to restrict the sale of tobacco 
in any form to lads under sixteen years of age. 
There is no difference of opinion in the profession 
as to the deleterious effects of cigarette smoking by 
the young, but we are fain to admit that l^rislative 
proUbition will be very difficult to obtain and still 
more difficult to enforce. 

A Warehouseman Vaccinator. 

A Glasgow warehouseman has recovered three 
guineas and expenses from the Glasgow Corporation 
for vaccination fees. It transpired that the plaintiff 
had been employed by the Corporation to vaccinate 
during the recent epidemic, and was promised six 
shillings a day, i.e., the same rate as that paid to 
medical students. The Glasgow corporation is 
known to be very enterprising, but this is an inno¬ 
vation of which it is difficult to approve. 

An action was tried last week at the Glamorgan 
Assizes in which a miner claimed damages from Dr. 
Ward, of Merthyr, for alleged negligent treatinent 
The plaintiff had sustained a fracture of the left 
forearm, and a false joint had resulted. Mr. Robert 
Jones, of Liverpool, was called on behalf of Dr. 
Ward, whose defence was looked after by the 
Medical Defence Union, and distinctly negatived 
any suggestion of malpraxis, and a verdict was 
returned in favour of the defendant 

Thk death is announced of Dr. Julius 8t Thomas 
Clarke, of Leicester, which took place quite suddenly 
on the 2nd inst Dr. Clarke, we may recall, was the 
victim of an assault by a lunatic last October, when 
he was shot with a pistol, the baU lodging in the 
lower part of the spine, v There is no reason, how- 

Digitized by 'O 


Ave. 14w 1901. 


COBRE8FONDEI7CB. 


Th> Msdioal Pbm. 177 


erar to think that his dea'li had any dirsct oonneo* 
licB with the injuy. 

PERSONAL. 

Ms. W. Watsox GBimx, H.B., F.R.C.S., has been 
i^pointed Ophthalmic Snrgeon to the Sussex County 
Ho^iital. 

Sonaaow-OKirxBAL T. F. O’IIwtxb, P.lf.O, will 
shortip ret ir e from the serrice on oomple^on of his 
tsBvre of his i^Kantment at Aldershot. 

Dn. C. W. Daxibls left Liverpool cm the 8 th inst., 
I 7 the 8S. ** Sekondi,* for Siem Leone, West Africa, 
to join the sixth malaxial expedition onder Majw 
Donald Sosa. 


Tax resignatioDB of Dr. Bassett Jones and Dr. Morgan, 
Honorary Surgeons of the Aberystwitb Infirmary, have 
been a ceepted at a meeting of the management comit* 
tee of the institntton. 


Bta Fbaxcis B. Cauxss, M.D., Fellow and ex-Presi¬ 
dent of the Boyal College of Physicians of Ireland, has 
been appointed one of the honorary physioians to His 
Hajssty the King in Ireland. 


Da. Fabouhabsoh, uf Lichfield, has been appointed 
Medical Offioer of Health to the Bishop Auckland Rural 
Didrict Cotucil, at a salary of £360 per annum. 
There were forty-two applicants, and the advertise 
atent stipulated for whole servicei to be devoted to 
duties of the ofBoe. 


A roBTUAiT of Dr. Thomas Young, oopied from the 
painting by Sir Thomas Lawrence, has just been pdaoed 
in the Victcwia Hall, Milverton, Somerset, with an 
iasoription in which he is described as "physidan, 
Bstnral philosopher, and master of many langnages.*' 
Dr. Young died in 1776. 

Db. Hbhbt C. Woods, C.V.O., one of the King’s Naval 
Hoaotary Physicians, «ho served in the Royal yacht 
** Victoria and Albert ” from Febmary, 1687, nntil bis 
retirement a few months ago, been appointed to a 
qiedal post at the Admiralty, and has oommencred his 
duties in Northumberland Avenne. Dr. Arthur R. 
Bankart, M.Y.O., who attended the Khedive in tbe 
"Osborne** in July last year, bas been appointed to Dr. 
Wood’s vacant poet in tbe Boyal yacht. 


€orr£B|ionbntLt. 

IWtdo Bot bold onnelveazscponsible (or tbe opinions of onr 
ecmspondents.] 

BRITISH AND COLONIAL JOUBNAL OF 
OBSTETRICS AND OYN.®COLOOY. 

Ts (be EdUcr of Thb Hbdical Pbxss and Cibculab. 

Sib,—I n yonr editorial note araended to the letters 
which appear in Tbb Medical Pebss and Cibculab 
of July 81st ^on state tbe opinion that there is room 
forsn'imMrtal’ jonmal of obstetrics andgynmoolcgy.** 
1 can confidently assnre yon that it is an “imperial ** 
lounal which the promoters aim at, and they will be 
mtisfied with nothing lees. 

"Dyto appears to be some mitapprehension in certain 
)>»teti ns to the origin of the present movement, and 


the aims and motives which have infineneed its pro¬ 
motes and supporters. It is difficult to see how any 
misunderstanding oonld arise. There never has been 
any attempt to oonoeal the incidents in the movement, 
and there can he no possible objection to a frank etate- 
ment of what has occurred. 

After conversations and oonsnltations extending over 
many months among oertain members of the North of 
Englftnd Obstetrical and Gynecological Society, an in¬ 
formal provisional oommittro was formed at tbe begin¬ 
ning of ibis year with the object of asoesrtaming the 
views of tbe specialists of the United Kingdom and of 
the Empire at la^ on tbe feasibility of eetablishin^ a 
jonmal of ohsteti^ and gynreoology worthy of being 
ranked with those of Europe and America. This com¬ 
mittee was selected aoomdmg to definite principles in 
order to obviate any misnndOTstandings anumg the 
members of tbe Society, where so many were well fitted 
to undertake tbe work in hand. It consisted, when 
complete, of all Uxe official teachers of midwifery and 
diseases of women in tiie fonr medical schools of 
the ptovinoes covered by the Society. It was felt 
Uiat we most first find ont if the gynnoo- 
logisto were strong enough to found a jonmaJ, 
aiA no ^tpeal mart be n^e in the first stage of 
the entMpnse to the hospital surgeons who to some 
extent specialise, whether or not they were members of 
the various obstrtrioal or gynmoological societies. 

I ondertook the obiet of the oorrespondesoe, and 
was assirted hy my junior oolleagnes, Drs. Arnold Lee, 
W. E. Fothergill, and Arthur Wallace. 

We were all firmly oonvinoed that the time had ooae 
for a snceo es ful enterprise of the kind, but we harboured 
00 illnsiouB. We knew it was a venture: we did not 
feeljnrtified in formulati^ a scheme: we oonld not, 
therefore, infiuenoe opinion; weooidd only try to aaoer^ 
tain it and report. Most of onr correspondents were as 
well acqnaintM with the position of Bntiab gynnoology 
as we were ourselves. 

Ont of the extensive oorrespondenoe which is now in 
my posveeai(m two facts soon became prominent: first, 
tlmt tbe gynnoologifets of provincial England, Scotland, 
and Irelud were praoticwy nnanimons mid cordially 
favonrable to the sobeme, while tbe teachers of obstetrics 
andfftyoeoology of the Colonies'and dependencies of Uie 
Empire were absolutely unanimous, and if possible more 
oordial still in their expteeetons of interest and promises 
of support—Canada, Ausbulasia, India, without b 
L aodiosan. Secondly, that the difficulties arising from 
apathy or hostility among oertain dnlee of London 
' gynnoologists were well nigh insuperable. To onr snr- 
priee many of the friends and opponents of tbe scheme 
appeared in entirely nnexpeoted quarters. There was 
not the clear line of cleavage which we anticipated 
from a more or lees intimate acquaintance with the 
contemporary history of gynecology in London. 

To those of ns in the north who know the motives 
and aspirations of tbe original promoters of the scheme 
it is startling to read that “ it is an open secret the 

J 'onrnal has been oonoeived and taken in hand mainly 
>7 those who are openly and avowedly hostile to the 
British Gynecological Society and its Journal." No 
atatemmit oonld more completely misrepresent tbe 
foots. It would be nearer the tmtii to say that the 
main obstacle in the way of smooth and rapid progress 
with the arrangements bas been the hostility of the 
most inllnential members of the British Gynasoological 
Society residing in London. Yet there are many exoep- 
tions: verbally and by letter, both directly and indirectly, 
the provisional committee has received assurances ot 
friendly interest, which will doubtless be changed to 
active support in due time. 

The objeotiona on the part of the leading men are 
natntal and obvious enough; they are bigmy credit¬ 
able to their loyalty, if not, with all resect, to their 
discrimination the signs of the times mid the r^ 
qoirements of contemporary British gynmcology. One 
of the most respeotedmid inflnential members writes 
" I have spoken to several of onr men and am 
confident that they will take no action without fully 
understanding how tbe Gynaecological Society U like'j 
to he affected by tbe movement.'* And yet many of the. 



GOBBESPONDENCK 


Auo. 14> 19aL 


178 Tub Mbdxcai. Pbbss. 


Bioet aotive nipMrtere of the new journul eobane are 

{ irovinolal or Colonial members of the British Clynsco- 
ogioal Society, and do not believe that they are acting in 
a way to prejodioe its prospects. In my humble opinion 
^6 Society will be in rae same position as other similar 
societies throughout the country which periodically 
print and distribute to the members the papers and 
contributions brought forward at the meetings, and its 
quarterly journal will not lose in the slightest. 
its value, even if many of the contributors to its 
admirable abstracts and reviews of the contem- 
Mrary literature of obstetrics and gyntecology could 
wd energy and inclination to take part in similar 
work on the new journal. Why should such parti* 
cipation be considerM incompatible with entire loyalty to 
^e British Gyncecolopeal Society P Let me a^ add 
that all the objectors and a good many apathetic oorre* 
spondentsappeutonnder-esrimate entirely the character 
and position which the promoters intend the new jouroal 
to assume. Even with moderate success it must belong 
to a different category from anything at present pub* 
lished in this country. It will be necessary to look to 
Germany for something to compare with it in scope and 
quality. No question of rivalry can arise here. The only 
emulation should be in a patriotic endeavour to ocmoen* 
taste the intellectual activity of the Empire inaoertain 
field of professional work so as to produce the iiighest 
possible result. 

Onr local provisional committee, after consideration 
of the oorrespon^nce, came without hesitation to the 
oonolusion that we must proceed with the undertaking. 
The respcmse surprised while it gratified the most san* 
gnine among ns. We deplored the sporadic apathy or 
hostility in London, but there could now be no question 
of tae experiment Mng made. 

The most natural proceeding appeared now to be the 
calling of a meeting of the friends of the scheme to take 
counsel as to the next steps. In arranging for such a 
meeting in co-operation with the moetoordial and influ¬ 
ential supporters of the scheme among the London 
ooUeagnes, it was surely natural to invite the attendance 
of those who had from the first been unequivocally 
friendly to the enterprise P The promoters could at least 
count on friendly criticism and advice intended to be 
helpfnl. Whether the meeting would consider the 
moment opportune was another matter. In the name 
of praoti<^ common sense, what useful purpose could 
have been served by the introduction of a known 
hostile element even though small in amount 
numerically P Objections such as would emanate from > 
a friendly source had been all well considered. 

The circular calling the meeting was signed by 
twenty-four representatives of British gynecology, and 
it was sent to between 180 and 140 m^ical men and 
women known chiefly as practising obstetrics and 
gynecology in the United Kingdom. The list was 
compiled from reports snpplied by the most prominent 
specialists in the various oentres of population. The 
meeting was attended by representatives from every 
part of the country, and from the point of view of the 
promoters was most snooessful and satisfactory. A 
resolution was passed unanimonsly to the effect that it 
is desirable to establish a journal of midaifery and 
diseases of women for the British Empire, and that the 
time is opportune for the undertaking. A committee 
was then appointed to give effect to this resolution. 
That committee is now at work; it him reported to an 
adjourned meeting, and it will soon be able to announce 
the results of its deliberations. 

In your note referred to yon ask, '* Who is responsible 
for the assumed privacy P*’ The privacy, Sir, is altogether 
assumption. It is a figment of your correspondent, and 
implies considerable creative power. ** Privacy " of 
meetings twioe summoned by seven score printed 
oiroulars, in association with unlimited oorrespondence 
and the most nnoonstrained conversation and gossijp! 
There has been, of course, the usual conventional official 
reticence on the part of those obisfly responsible for the 
summoning of the meeting. It would have served no 
useful purpose to have mid tiiemsdvei prematurely 
open to worry and misrepresentation from anonymons 
writers in tae medical journals. What would the 


objectors have done under the oirounutances ? If they 
had been oonscions of the support of practically tiie 
whole British Empire^ would they, knowing the unhappy 
differences among London gyneoologpst8,lmve begun the 
movement by proclaiming its inituU stages from the 
hoosetow, or have called the meeti^ by advertisemant ? 
Or could they have po8tp<aiod action cowards the fulfil¬ 
ment of the wishes of the vast majority of their col¬ 
leagues throughout the Empire until London tactions 
were reconciled P 

The committee which is makiog arrangements Iot 
bringing out the journal is, perhaps, just as representa¬ 
tive as any that could be formed so as to include the 
same proportion of men who are praotising purely as 
speclaUsts in the United Kingdom. The names will 
appear in a circular which is in course of preparati<m 
and will be issned shortly. The list of collaborators who 
will be invited to oo'Operate with the editorisd staff, and 
will inolode the names of the beet known workers both 
at home and in the distant parts of the Empire, will also 
be published in due course, but its compilation is a work 
that requires time. Inwbattbeydotheoommitteewillbe 
guided. I believe, only by the desire to make the future 
journal snooeeeful in every way. Whether the members 
reside in London or in miy other part of the kingdom 
they are infinenoed as much by a patriotic desire to see 
one of the reproaches removed from British medical 
sci en ce, and as little by jealousy of individuals or ot 
institutions, as are the men who write cordial letters in 
support of the journal scheme, with friendly wishes and 
helpfnl suggestions, from Montreal and Toronto, from 
Mmboume and Sydney, or from Calontta and Madr— , 

It would be to me a cause for deep regret if by want 
of cleatness in expressiou I should appear to say any¬ 
thing to hurt any snsceptibilitiee. That is far from my 
intention. There is surely room for all patriotic men 
scientifically interested in their profeesional work to 
join in this enterprise ? A British Empire journal will 
oertaioly be published, and it is my firm conviction that 
it will be established. It will be representative of 
British gynfficology in the fullest sense, and it will hold 
up its bead in the presence of the best that Germany or 
France, or Italy or the United States of America can 
produce. Assuming the role of prophet like your cor¬ 
respondents, who prophesy failure, 1 can confidently 
predict that it will not be so very long before some cd 
your oorrespondeots, looking back on their efforts at op¬ 
position, will be congratulating themselvee that they 
wrote anonymously. 

I am, Sir, yours truly, 

W. J, SlNCLXIB. 


Birmingham Libel Case. 

A BBTrLixiMT was announced at the Birmiogbam 
Assises, on the 6th inst., in the action brought 1^ Dr. 
Alfred Hill, the Medical Officer of Health for Birming¬ 
ham, against the BirmtnyAom Doily Gazette. The ground 
of the action was that the Gazette had imputed to the 
plaintiff responsibility for shortcomings in the housing 
of the poorer olssses. Defendants consented to judg¬ 
ment for ^250 and oosts, and withdrew the reflections 
complained of, but claimed to have acted &o*a fide. 

Another Beer Poisoning Senaatioo. 

A OBEAT sensation (says the Ntxcca^tle JoumaX) has 
been caused in Trowbridge and district by the publica¬ 
tion of the annnal report of Dr. Thomas, County Medical 
Officer of Health for Wiltshire, in which it is stated that 
last December atsenio was found in beer from a oertain 
brewery, and that in oons^uenoe a namber of persons 
suffered from arsenical poisoning through drinking such 
beer. Theattentionoftbebrewerwasoalled to thematter, 
and a sample of the gluooee used was given to Dr. 
Thomas, which also was found to contain arsenic. The 
brewer immediate^ withdrew the oontmninated 
beer from sale, and undertook to destroy the beer 
in stock. Samples of beer and gluooee afterwards 
obtained and analysed were found to be free from 
arsenic. 

The Dental Hospital of London. 

Hie Majesty thx Kiko has been graciously pleased 
to grant bis patronage to the Dental Hospital of Lon^ 


C 




Aro. 14 , 1901. 


PASS LISTS. 


Tav Hxdical Psisa. 179 


wbieb bas leoently beat rebuilt in Leioeater Square, 
London. 

Vital Stettftioa 

Th> deaths lefristered in the aeek ending August 
3rd in 86 large towna of Great Britain and Ireland corre¬ 
sponded to an annual rate of 22‘4 per 1,000 of their 
abrogate population, which is estimated at 11,463.026 
perrons in the middle of this year :— 

Birkenhead 24, Birmingham 26, Blackburn 22, Bolton 
24, Bradford 18, Brighton 17, Bri^l 13, Burnley 26, Car- 
diif 11, Croyd<m 0, Derby 21, Dublin 20, Edinburgh 17, 
Glasgow 21, Gateshead 88, Halifax 11, Huddersfield 18, 
Hull 19, Leeds 29, Leioeater 21, LivArpool 80, London 20. 
Manche^r 29, Newcastle-on-Tyne 81, Norwich 16, 
Nottingham 23, Oldham 18, Plymouth 14, Portsmouth 29, 
Preston 27, &dford 25, Sheffield 28, Sunderland 27, 
Swansea 14, West Ham 31, Wolverhampton 11. The 
highest annual death-rates per 1,000 living, as measared 
by last week’s mortality, were:—From mea^s, 2 in Edin- 
hnrgb, 7 in Qla^ow, 1*4 in Birmingham and in Sheffield, 
and 21 in West Ham and in Salford; from scarlet fever, 1 
in Edinburgh, 1 in Glasgow, 1*2 in Blsckbiim,and 1 Sin 
Preston; and from ^azrhceal diseases, 27 in Dublin, 
12 in Edinburgh, 78 in Glasgow, 61 in Newcastle-on- 
Tyse,5'3 in Snnderland, 6*4 in Hull, 6 5 in Hndderefield, 
69 in Leioeater, 7 6 in Birmingham, 8 in Birkenhead, 8*6 
in Burnley, 9*4 in Gateshead, 9 6 in Nottingham, 9 9 in 
Bolton, 10*1 in Leeds, 10*6 in Salford, 11*6 in Mantffiester, 
118 in Portsmouth, 12*4 in Sheffield, 12*8 in Liverpool, 
18*8 in Preston, and 14 in West Ham, In none of the 
large towna did the death rate from whooping-oough, 
ot from fever ” reach 1*0 per 1,000. The 69 deaths 
from diphtheria included 28 in I^ndon, 6 in Leeds, 6 
in Sbeflield, 6 in Leicester, 3 in Brighton, 3 in Cardiff, 
3 in Manchester, aod 8 in Salford. One death from 
amall-pox wes r^riatered in London, but not one in any 
other part of the United Kingdom. 

Death under Bther at I«eds. 

Ah inquest was held at Leeds a few days since on 
the body of H. Hodgson, et. 12, of Pilley Bill, Dods- 
worth, who died while underming an operation at the 
Leeds Infimaary, for a nasal <fi>sttnction. It was stated 
that the proper quantity of ether was administered, 
and after the operation bad oommenoed the boy went 
into convulsions, which lasted about twenty minutes. 
Restoratives were applied, but in vatu. The jury 
retmned the usual verdict. 

The Sale of Drugs Xfj Ksdleal Graduates. 

Tub Senate of the University of Aberdeen has 
iasned the following pronouncement Whilst it is 
admitted that the exigencies of practice in certain 
localities may sometimes render it unavoidable for a 
medical practitioner to supply to his patients the reme¬ 
dies which he prescribes, the Medical Faculty of this 
Uuivers.ty is of opinion that it is undesirable and 
detrimental to the position of medical graduates of the 
UBivernty that this custom should be followed under 
othw drcumstances; and further, it regards the rale of 
objects other than remedies by its medical graduates as, 
under all circumstances, to be strongly deprecated." 

Dublin Death-rate. 

Dubiho the thirty-one weeks ending with Saturday 
last the death rate of Dublin averaged ^*9 a 1,000. The 
nte of mortality in Loudon was ^ ; Edinburgh, 17*3; 
Puis, 18*4 ; New York, 19 per 1.000. Fifty-eight of the 
pcnons whose deaths were regUtered during the week 
were nnder five years of age (45 being infants under 
one year of age, of whom tight were nnder one month 
old). There were 28 deaths from diarrhcea, four from 
simple cholera, and four from whooping-cough. 

The Mortality of Fmreicn Cltlso. 

Ths following are the latest official returns, and re- 
pcesent the last weekly death-rate per 1,000 of several of 
the popolatums:—Calcutta 114, Bombay 47, Madras 38, 
Puis 17, Brussels 14, Amsterdam 18, Rotterdam —, The 
Hmtba —• Copenhagen 21, Stockholm 16, Christiania 22, 
St Petersburg 26, Moscow 86, Berlin —, Hamburg 20, 
Dteeden —, Keslau 88, Munich 19, Vienna 17, 
Prague 22, Buda>Pesth 18, Trieste 28, Borne 17, Turin 
(10 days) —, Venice 28, Cairo 46, Alexandria 37, 
New Tore (imfinding BrooUyn) 19, Pbilitdelphia 26. 


Royal CoUasM of Physicians and Snqrsons of Bdlnburgh, 
and Faoulty of Poystdans and Surgeons of Glasgow. 

Ths qnartsrly examinations of the above Board, held 
in Edinburgh, were oonduded on July 27th with ^e 
following results 

First Examination.—Of thirty candidates entered, ths 
following fourteen passed the examination:—Lec^ld 
H. Gill, George A. 8. Hamilton, James Murphy, Jessie 
Jean M. Morton, Henry G. 8mith, James Watson, 
Ayodeji Oyejols, Edith Boomgudt, Ernest P. Titterton, 
George H. Waugh, Robert M. Fraser, Nicholas D. 
Sweetnam, William P. Walker, and Charles 8. P. 
McDermott; and five passed in physics, four passed in 
elementary biology, sod one in t^emisiry. 

Second Examination.—Of twenty-sevur candidates 
entered, the following fourteen passM the examination: 
—Joseph van Someren Taylor (with dititinotion) 
William H. Bcaltb, Broderick E. M. Newland (with 
distinction), Richard H. Rigby, Debendranath Banerji, 
Sybil Louie Lewis, John J. Lawton, Stephen McCarthy, 
Bessie Chappie, Eileen FitxGeralA Claude E. Watte, 
Patrick Shaw,Robert D.Hirech and William E. O’Hara; 
and two passed in anatomy and one in physiology. 

Second Examination.—Of eight candidates, entered 
the following six passed the examination:—An^ew P. 
Walker, WiSiam F. Wangh, Urban Bnraton, Fergus D. 
Tourelle, John C. Grant and John Martin. 

Third Examination. — Of twenty-six candidates 
entered, the following sixteen passed the examina¬ 
tion:—Adam W. H^l, Thomas A. Meades, Leo Levi, 
Charles 6. Mscaskte, John A. Douglas, William P. 
Cowper, Thomas J. Walsh, William J. Gray, «ohn M, 
Gerety, George J. Harman, Annjnta Kellgren-Cyriax, 
Alice Esther Gilford, Peter 0. Jollie, Shavaksba P. 
Mistri, Benry Carlaw, and John O’Conror, and one 
passed in anatomy and one in materia medica. 

Final Examination. — Of eighty-fonr esmdidates 
entered, the following forty-eight passed the exami¬ 
nation and were admitted L.R.C.PE., L.RCSE. and 
L.F.P., and S.G.David Mitchell, James C. Nicholson, 
Alfred A. Beeks, Claude St. Anbyn-Fsrrer, Jss. A. ^ird, 
Frank J. Pattee, Raoul F. de Boissiece, Neil Gavin, 
Alice M. Marv^ John B. Mason, Alice D. Sibree, 
Alexander W. Frew, Beraud h'loo^ Anthony Corley, 
Barry Holden, Norman L. Stevenson, Joseph Cravrford, 
Frederic W. McCay, David G. Metheny, David L. Wil-^ 
liaiuB (with honours), Charles W. Sharp, GopalChunder 
Gbose, Michael B. Conroy, Alice E. Brown, Jennie 
Newton, Walter G. Edwards, Herbert E. J. Batty, Cecil 
R. Martin, Augustus D’Souza, Jeysing P. Modi, Thomas 
F. Okell, Henry E. Blackwo<^, Patrick W. McHugh, 
Gerald 8. Coghlan, Richard Fox, Bebramji B. Paymaster, 
Jose S. da Piedade Rodrigues, Kaikhusroo D. Cooper, 
Ebenezer Millicans, Donald McNeill Ford, Walter 
Sykes, James H. Stewart, Birjie N. Anklesatia, Herbmt 
D. Pitt, Darabshaw F. Sanjana, William P. Grellet, 
Helen M. Serjeant, end John Dunlop, and six passed in 
medicine and therapeutics, five in midwifery, and six in 
medical jarisprudenoe. 

At the Jnly sittings of the Scottish Conjoint Poard 
held in Glasgow the following candidates passed the 
respective examinations 

First Examination.—William Noble Walker, James 
Taylor (with distinction), James Alfred Asburst, Jobu 
Msenamsra, Alfred Edwin M’Dongal, Robert Jo^ston 
Crawford, Charles Conway Fitzgerald, William John 
Cogan, W. N. Alexander, Dtmiel 'Iliomas H. Crowley. 

Second Examination, Four Tears' Course.-Thomas 
Marshall Metcalfe. 

Second Examination, Five Yeare’ Course.—William 
Hiller Ramsay, David Haig, Jsmes Booth Patterson,. 
Thomas M'Master Glen, Alexander Glen, William 
Arthur Uagill, James Macarthnr, Patrick Thomas 
Doorly, Cecil James Todd. 

^ird Examinstion.—Angus MTnnes, Thomas Long- 
more Asbforth, Alexander Russell Tonng. Robert 
Calder Blyth, David Roberts Williams, Tbomu Weir 
M'Cubbin, David Christie, R. Vithal Khedkai, Alfred 
Edward Griffith, Michael David Ahem, Grace Eleanor 
Soltau mid Constance Muriel Soott, Samuel James 
Mathewso n, Fred erick Herbert Mabmly, Aithur G,. 

JackBon-rjCHU - . QI 


180 Thi Medical PB 188 .- NO TICBS TO CORRESPONDENTS. 


Ado. 14, 2901 


fioiiuB to 

Corte090nbenls, |$hort 'fjttttto, 

COEMi F OE PW T l nqniriaf a nplj in thta oolnms an par* 
tlmlarly nqiuatod to make oae of a dirttncHv* (tpnafttra or 
i<tttUU, and aroid th« piaotioo of aifninf themaelTea “ Baadar,*' 
*'Bnbaorfbar/* "Old Sabaaribar,” fto. Ifneh aonfnaion will ba 
aparad by attantion to tbli rnla. 

BapaiHTS.—Bapriata of articlaa appaartnn in tbia Joanul can be 
h«ii at a redacad ratai proridiny anthora fira notice to tbe pnb- 
liabar or printar bafota the type hea baandistribntad. Thia ehonld 
be dona whan retnmina corrected proof a. 

Oaisiau. AjtTiCLsa or LKTTsaa intended for publication ehonld 
ba written on one aide of the paper only, and mnat be anthenticatad 
with the name and addreaa of the writer, not neoeaaarflyfor publica¬ 
tion bnt aa aridenoa of identity. 

BsADDia Camb.—C loth board caaoa, yilt lettered, containing 
twanty.aiz atrinita for bolding the nnmbara of Tei Kbpical Pasaa 
AEP CiacuLAn, may now ba had at tbe office of thia Journal, 
^ioa So. 6d. Theae caaea will be found very noaful to keep each 
weekly nnmbarintaot, clean, and flat after it haa paaead through 
the poet. 

THE CHELTENHAM WATERS. 

A PiBTiEevianBD Tiaitor, on hie arriral in the town at the 
opt ning of the Aaaooiation meeting, waa driring from the railway 
etatlOD on an omnibuB, and ha aaid to the dTirer, “ What baTC yon 
got hire in thia town ? ' to which the ’bna drirer replied, ** Mineral 
watara." lha riidtor further inquired what they were good for, 
and the reply waa For the doetora.’' It waa a little difficult to 
make the dneer underatand that thia laat remark required explana¬ 
tion, hut when be bad at laatgraaped the eiaitor'aneMof enlighten* 
mant on what appeared to blm ancb a aimpla matter the 'bne driyer 
aaid, “ Why, tbe doctors preBcriba tbe watere to their patient# and 
it RiTea them rhenmatiam and gont.” 

■ TuBRRCLX.- Thetnatmcnt le not one to be recommeiwled in tbe 
abeence of tmatworthy f'aia ocnceming the nodiu oprrandi. 
Judging from the it formation at our diepoeal it would appear not 
devoid of danger to ^e patient. 

T. M.—Tea, in our Edncatlonal Hnmber, which will appear early 
inSeptrahw. 

CLXOPKia.^-Tonr letter will appear in onr next ieane. 

WHT NOT SETTLE THE QUESTION AT ONCE f 
' At tbe laat meeting of the Penge Urban Diatrict Conncil, Hr. 
Conndllor Waet aaked that the medical officer of health ehonld be 
inatrncted to give a fnll report on the qneation of the inteisoummn- 
nicahility or owerwiae of Mvine tubarcnloeis “ ao that tbe matter 
ahonid be set tied once end for aU." It aaya eometfaing for the in- 
teUlgeBoe of the Board that the anggeetion waa reoeie^ with loud 
ianahtar. In tbe meanwhile it waedecidedtoaffixnotieeaforbidding 
apittlng In tbe tramway earn, which ia poaaihiy a atep of greater 
importance than that of reporting on tbe eommanicabiJity of 
bovine tnbercnloeia. 

** Wxu., madam,” eaid tbe doctor, ” bow ia our patient thia 
morning?” HIa mind teama to be perfectly clear thia morning, 
doctor.' replied tbe tired watcher. ” He reruaea to touch any of 
Uie medidaei ChmM and Druggitl. 

Cabpipatx.—W e are unable to accede to yonr requeat at tbe pro- 
■ent Btage, Ibongb yonr aaaiatanee may be appreciated later. 

8. y. B.—Ton will find the matter haa been dealt with in onr 
iaaue for May Bth of thia year. 


Bdtlxb, Williae, M.B.Olaeg., C.M., D.P.H.. B.C.P.S.Lond., 
Medical Superintendent. leolation Hoepitnl, Willeeden. rice 
D. B Skinner, M D., rraigned. and Aeeiatant Medical Officer of 
Health to tbe Wilie^en Urban Di-trict Council. 

OopuH J. H., F.B.C.S.Edin., L B.C.P.Lond., Jerti^ing Surgeon 
undrr the Factory Acta for the Torquay District^ Devonahi^ 

Haswbll, W. C., M.B., B.8.I>urh., Certi^dng burgeon under the 
Factoiy Acta for the Flaxton Bnral Direct of the Nor^ 
Biding of York, 

HArKAiB. Nobeae, B.8., M.D.Olaag., M.B.CS.Eng., LB.C.F. 
Load.,-Extra Dispenaing Phyaiciu to the Olaaeow Boyal 
Inflrmary. 

Morfht, Dkbis, L.B.C.3.Edln,,. L.B.C-P.Edin., LP.P.Olaeg., 
Puthologiat to the Cork North Charitable Inflrmary and County 
BoapIteL - 

Fatuce, B. M.D.I>arb., M.B.C.S., LBC.P.Edin., Certifying Sur- 
geon under the Factory Acta - for the 8OTth.eaet Bolton 
Bisteict. 

Peabsov, B. Cabdbe, M.B., F.B.C.8.Edin., Surgeon to tbe 
Darlington BoapltaL 

Tdbmib, B. B., M.B., B.S.Camb., Certifying Bnigeon under the 
Factory'Act a fof tou Onndle Diatrict of Morthanta. 


^ocandts, 

Birmingham City Aaylum.—Senior Aaeiatant Medicai Officer, aleo 
Junior.' Saiariea reapectivcly £180 and £130 per annum, with 
board, apartmente, and waahing. 

Brecon Infirmary.-r-Beeident Honae Surgeon, unmarried. Sakn 
£100 per annnm, with fumiahedapartmenU, board, and attend* 
ance. 

County Mayo Inflrmary.— Bouae Surgeon and Compounder. Salary 


£109 per aanum. with apartsienta. attendanoe, waeUnr, fln. 
and wbt. Application at once to Dr. H. O'Malley Knott. 
Castl^. (SeeAdvU 

Denbighohire Infirmary, Denbigh.~Honae Sorgeon. Salary £100, 
with board, reaidenoe, and wnaUng. 

Devon Conn^ Aeylnm, Exminjter. — Third Aaewtant 

Officer. &UarT oommencingnt £I85per >nnnm,andincraMing 
at the rate of £10 rerannnm to £155, with board, reeidenoe, Ac. 

Devonahire Boepital, Buxton, Derbyshire.—AoaietaDt Honae 
Sorgeon. Salary £50 per annnm, iHth fnmlabed apnrtmecta, 
boara. and waabiog. 

EaBtem Conntiea’ Aeylnm for Idiota, Imbeoilea, and the Feeble 
Minded.—Beaident Medical Attendant, unmarried. Salary 
£100 per annnm, with fumiahed apartments, beard, ana 
wanblng. 

East Biding of Torksblre.—County Med<cnl Oiflear of Health. 
Salary at the mte of £400 per annnm, rioittg by incrcaBee of £& 
to £500 with aliowancee. Applicetiona on or Wore September 
88th to Clerk of the Coun^ ConneU, County Ball, Barm-ley. 
(See Advt.) 

FnTham Inflrmary,St. Dnnatan’a Boad. Hammeremitb,W.—Loenm 
Tenant for fo'jr weeks. £3 Ss. per week, with boa^ apart* 
manta, attendanoe, and washing. 

Emit and Canterbury Boapita].- Aoaiatant Hcnee Snigecm, nn- 
married. Salary £90 per annnm with board and lodgug. 

Lewea INspenaary and Innrmaiy and Tletoria Hospital.—B^dent 
Medical Offloer, Salary £100 per annnm, with apartments, 
board, and attendance. 

North London Hoepltal for Conanmptiou, Hampeteod.-Junior 
Beeideut If odioal Officer for six montbe. HouorWnm at rate 
of £90 per annnm. 

Nottingham Oenetal Dispensary.—Assistant Beeident Snigeon, 
unmarried. Salary £100 per annnm, increasing £10 every year, 
with fnmiabed apartmente, attendance, light, and fneL 

Owens College, Mancbeeter.—Jnnior Demoanrator ia Ptayaiology. 
Salary £100 rieiog to £150 per annnm. 

Plymouth Borough Asylum. - Aaaiataot Medical Ofltoer. unmarried. 
Salary £150 per annnm, rising to £800, with apnrtmente, board, 
and wmahiM. 

Boyal South Bants and Southampton Homltal.—Jnnior Honae 
Sorgeon for tix months. Salary at rate or £50per annum, with 
roomt, board, and waahing. Also Dispenser. Sala^ £60 per 
annum, with board, rooma and waahing. - 

Royal Surrey County Boepital, OuUdford.—Aaei-tant Honae Snr- 
geon.—Salary £75. with boa^reaidenoe, and laundry. 

StaflordKhlre Conn^ Aaylnm, Stafford.—Jnnior AsBit^t Medical 
Offloer, unmarried. Salary £150 per annum, with board, 
lodging, attendance, and waahing. 

Stamfe^ Butland, and Oenetal Inflimary.—House Surgeon. 
Salary £100 pw annum, with hoard, lodging, and waahing. 

Toxteth raxk Workhouse and Infirmary, Liverprol.—Bearideat 
Medical Officer. Salary £100 per annum, wiUi board, washing, 
and apartmeata 

West Afnea.—Three Mediosl Offieera to accompany Bailway Surrey 
^rtiee. Saiariea £40 t>er month, plus allowaooea. 

Went Ham Boepital, Stratford, E.—Junior House Surgeon, Salary 
£75 per annnm, with board, residence, Ac. 

WolverluuD^ton and Staffordihire General Uoepital.—Aanlatant 
Bouse SnrgMn. Hortorariomat tbe rate of ^5 per annum will 
be giren. Board, lodg^, and washing pp ride^ Also Amiis- 
tantHouse Physician. Honorarinmat tnerateof^Speraasnm 
will be given. Board, lodging, and washing pruvidsd. 

Wolrarhampton Eye Infirmary.—Honse Surgeon. Terms, £70 per 
annnm, rooma, board, and waahing. 


girths. 

OEDDxa.— On Angnat 5th, at Winterton, Fenyhill, oo. Dnxbam, 
tbe wife of J. W. Oeddes, M.B., C.M., of a oanghtsr. 

PxoRTE-WiLLiAEB.—On Au^t 5th, at 13, Walbeck Street, W., 
the wife of B. J. Probya*Williams, H.D.,of a daughter. 

Boer.- On August 1st, at 30. St. Mary'a Bead, Higher CrwpealL 
Mancheeter, the wife of John bust, M.KC.8., L.B.C.P., of a 
BOn. 

Swallow.—O a August find, at Taunton Honse, Clapham Bead, 
8 W., the wife of Allan J. Swallow. M.B.. B.8.,of adangbttf. 

White.— On July 26th. at Vanbrugh Park. Blackhaatb, the wife of 
Finch Vrbite, M.B.C.S., L.B.C.P.Lond., of a son. 


(IRarriages, 

CALTxaLKT—DovRT.—On July fi7tb, at St. John's, 8.E., Eraeat 
Joseph Ooodfellow Calverley, M.B., B.S.Lond., MH.C.8., 
LH.C.P.,of Claremont Honae,Folkestone, to Evel^,daughter 
of £. Dcufeh Esq., of St. John's 

DAEBTSHiax— WoBLET.— On August lit, at St. John's Cbnndi, 
Perth, W.A., Donglaa Edward Darbyshire, M.H, LJS.C.P., 
M.B.C.S.. to Florence, seoond daughter of WilUiaai Cbarlee 
Worley. L.B.C.P.. M.B.C.8., of Green Lanee, N. 

Dobalo— Bemkeb.-O n August 6th, at St. Panl'a, Wiolaton-on. 
Tyne. David Donald, LB.C.P., LH.C.S.Edio., L.F.P. A 
S-Qlaagow, to Bessie, oangbter of the late Francis T. Beoner, 
Newbiggin, Nortbomberland. 

Hat—Masoe.— On Angnat 8tb, at 8t Andrew’s Church, Deal, 
William Lealie Hay. M.B.C.S.Eng.. L.B.C.P.LDiid.. to Mary, 
daughter of tbe late Thomas Ediwd M.D., and of 

Mrs. Maaon, The Limee, DeaL 

Ltlx SsLyx. On July Slat, at Holy Trinity Church. Blackheath 
HiU, Herbert WUlougb^ Lyle. M.D.Lond., M.B.C.&, F.Z.S., 
elder eon of Thomas Lyle, M.A., to Elitabeth Ada, eldest 
daughter of James D. SeUe, of Blackhaatb Biae. 


^odthB. 

WtLEiHsOR.—On August 7th, at Barnard Oastla, Durham, after a 
very short Ulnces, Thomas Lewis WlUdnMn, M.D., of tbe 
Orange, Exmonth, in Us 7Sth year. 




VoL. CXXIII. WEDNESDAY, AUGUST 2 1, 1901. 


No. 8. 


ODriginal Crnnnrnmratiims. 

THE CAUSATION, PREVENTION, 

AND 

TREATMENT OF MISCARRIAGE. (., 

By PETEE HORBOCKS, M-D., F.R.C.P., 

Preudent of tho Obetetrica] Society of London j Obstetric PhrsicUn 
to Ooy's Hospital, London. 

1.—Causation. 

The term miscarriage is taken to inclnde prema¬ 
ture expulsion of the contents of a gravid uteinis at 
any time from conception up to the end of the sixth 
month, before the fmtus is viable. 

The term abortion is more commonly associated 
with criminal cases, and it is convenient to limit it to 
each cases. The proportion of miscarriages has 
been wtimated at about 1 in 80 from hospital 
stotistics, and at 1 in 5 from other statistics. In 
me statistical report at Guy’s it was only -1 in 182. 
These^ estimates are of but little value, owing to 
me difficulties^ in obtaining accurate information. 
In all probability if all the instances could be col¬ 
lected, and pa.rticnlarly if it were possible to include 
▼ery early miscarriages, the proportion would be 
eren greater than 1 in 5. 

Primipara are less likely to miscarry than multi¬ 
part. 

The possibility of pregnancy occurring at any 
time during an intermenstrual period wiUi a mis- 
<5arnage resulting at what would nave been the first 
miMed period is discussed, such miscarriages being 
spoken of as menstrual miscarriages. 

The majority of known early miscarriages occur 
after one period has been missed, and such cases are 
mostly criminal. 

The methods of criminal abortionists are men¬ 
tioned. 

that disturbs the attachment between 
me fcstus and the mother may cause miscarriage. 
Hence increase of the intra-abdominal pressure from 
straining is one of the prolific causes. 

These causes operate not only by separating the 
maternal and foetal parte of the placenta, and so 
fusing uterine pains, but the blood may plough up 
the foe^ parts of the placenta or the ovum, and so 
result in a cameous mole, and in later stages sti-ains 
may actually rupture the membranes and so lead to 
miscarriage. 

Shock and fright are causes, and the modue 
operandi is discussed. 

In former days operations could often be done 
without disturbing the course of gestation. This is 
even more true at the present time, though occa¬ 
sionally miscarriage results. 

Neighbo uring diseases, such as fibroid tumours in 

(») Abatnot tA paper mdat mwtiiisof Britleh Medloa! Aesooia- 
tioB, Chalteahaa, Augoet, 1901. 


the pelvis, ovarian tumours, parametritis, perime¬ 
tritis, Fallopian tube diseases, may cause mis¬ 
carriage. 

Tight lacing and great contraction of the pelvis, 
r^tal diseases, and abdominal tumours interfere 
with the natural progress of gestation. 

The role played by syphilis is discussed, and it is 
pointed out that as a rule the miscarriage is due to 
syphilis in the ovum, derived from the paternal 
element. 

If a pregnant woman acquires syphilis after she 
has conceived, the child is not svphUitic. 

Hydatidiform mole is described, and also fatty, 
calcareous, and inflammatory conditions of the 
placenta. 

^ Excessive and scanty liquor amnii and malforma¬ 
tions of the foetus. 

Deciduoma maliguum is mentioned. Imperfect 
fertility duo to extreme youth or age of one or both 
parents, or to debauchery or feebleness. 

Affections of the umbilical cord, knots, shortness 
(disturbing the placenta), longness (round neck). &c. 
Diseases of the foetus, causing its death, and so 
resulting in miscarriage. Endometritis, one of the 
commonest maternal causes of syphilis. Oatarrbal 
endometritis with hydrorrbcea gravidarum de¬ 
scribed. The ill effects pi-oduced by criminal 
abortions and by methods adopted for presenting 
conception. The effect of sea voyages, sea sidmess, 
Ac., are discussed. Also, displacements of the 
nterus, blood diseases, convulsions, chorea, placenta 
prsBvia, cancer, over-suckling, deep fissures of the 
' cervix, damage to the uterus, baths, alcohol, anses- 
thetics, habit. 

IL—Prevention, 

Avoid overstrain, shock, and fright. Operations 
not to be performed unless needful, especially 
extiaction of teeth. 

Avoid using instruments about uterus and cervix, 
and also avoid syringing. Pessaries should not be 
worn after the fourth month. 

Purging should be avoided, and enemata, 
specially with turpentine or glycerine. Constipa¬ 
tion should be avoided. Pelvic tumours may be 
pushed up into the abdomen or even removed. 
Endometritis must be cured. Cessation from coitns 
often permits of gestation progressing to term. 
Uterine displacements must oe remedied. Avoid 
tight lacing. 

Certain ecbolic drug^ must not be ^ven, such as 
ei^t, savin, digitalis and quinine, lead. 

Syphilis should he treated in both father and 
mother, and very often it is useful to give small 
quantities of mercury throughout pregnancy. 
General diseases must be treated with the appro¬ 
priate remedies. Orer suckling should be avoided. 

Trachelorrhaphy sometimes enables the ovum to 
remain in the uterus. OOg . 






l82 The Medical Pbiss. ORIGINAL COMMUNICATIONS. 


Auo. 81, 1901. 


Alcohol should not be t&ken to excess, and in 
most cases should be avoided alto^ther. 

High pyrexia from any cause ^onld be brought 
down by cold baths, Ac. 

III.— Treatment. 

a. Avoidable, h. Unavoidable, e. Incomplete. 

Best in bed and some form of opiate ^e best 
treatment. If in doubt operate and clear out the 
uterus. 

When there is serious hssmorrhage, or when os 
uteri is so large or expulsive pains so ereat and fre¬ 
quent that miscarriage is inevitable, allow it to talce 
place, and, if need be, assist it either by puncturing 
the membrane or clearing out the uterus digitally 
under an ansesthetic. 

When incomplete it is best to clear out the re> 
mainder. In some cases it is useful to pack the 
vagina with gauze. The bleeding is stopped or 
lessened, and uterine contractions are promoted, and 
later on it is much easier to deliver. 

Vaginal injection of hot lotions are recommended 
by some, but they are not very trustworthy. 

Dilators may have to be employed and ovum 
forceps and a curette, but it is better to mutilate 
the fcBCus than to damage the mother. 

Everything must be done aseptically, and if need 
be the uterine cavity must be swabbed out with 
tincture iodi or some other antiseptic. 

ASYLUMS AND ASYLUM WORK, (a) 

By OSCAR WOODS, M.D.Dub., 

Beaident Msdicsl Sapertatendest. District Asylum, Cork. 

After cordially welcoming the members of the 
Medico-Psychological Society to the southern capital 
of Ireland, and Imanking them for the high favour 
conferred on him by his election as President for the 
ensuing year, he said as this is the first meeting 
of the association in the Twentieth Century, 1 
think that a short resume of what has b^n 
done for the insane, more especially in Ireland, 
during the century just closed would not be out of 
lace, and afterwards I wish to point out what 1 
ope will be effected early in the present one. The 
census report for 1851 stated that the first steps 
taken to provide for the lunatic poor in Ireland was 
in 1728, when the Lord Mayor of Dublin, Sir William 
Fownes, caused cells to be erected in the workhouse 
for the reception of lunatics. The Act 11 and 12 
George III (1772) was subsequently passed, enabling 
some provision to be made in workhouses for luna¬ 
tics, but the first legislative enactment specially 
directed for the support of the insane appears to 
have been 27 George III., c. 39, which enabled grand 
jurors to present for the support of insane persons, 
and to provide wards for their reception in the 
county infirmaries. This Act was, however, little 
availed of. St. Patrick Hospital (Swift’s) was 
founded in 1745, and at the openin|i; of the 19th 
Century the only otherprovision exisringfor the care 
of the insane in Ireland was two institutions, known 
as Houses of Industry, one in Dublin, opened in 1772, 
the other in Cork, in 1787. the latter being the latter, 
giving accommodation for 425 patients, and ad¬ 
mitting in the first twenty years of its existence 
3,443 patients. The present Richmond Asylum, 
opened in 1815, grew out of the House of ^dustry in 
Dublin. In 1817 a committee was appointed to 
report on the state of the pauper lunatic in Ireland. 
It reported: The common mode of treating the in¬ 
sane was when a strong young man is thus affected 


(a) Presldeatlal Address delivered at the Sixtieth Annaal 
Heetint of the Medico-Psycbolosicsl Association [of Oimt 
Britaia aad Ireland, held at Qaeen’s College, Cork, July 8Sth and 
b.lSOl. 


the only way they have to manage him is 
by making a bole in the floor of the cabin, 
not high enough for the person to stand in, 
with a crib over him to prevent bis getting out; the 
hole is about four feet deep. They give the wretched 
being his food in it, and then he generally dies.*' 
The friends did their beat; the State had done 
nothing. The mode of treating the lunatics of this 
time was by confining them in wooden cells specially 
constructed for coufiuement and coercion. HniiMm 
writing about this time, says that most people be¬ 
lieved in moon-madness, or, as described by the 
Irish, “Geal taigh cachet.” Such then was the 
condition of the insane at the beginning of the last 
century. In 1817 nine asylnms were ordered to be 
built, providing accommodation for 980 patients, at 
a cost of £204,000. In 1821 an Act was passed, 
enabling the Lord Lieutenant to direct any number 
of asylums to be built for such districts as should 
seem expedient, and when more than one county was 
included the asylum should be sufficient to contain 
not less than 100 or more than 150, but when only 
provided for one county a number of not less than 
50. It was not till the 8 and 9 Victoria, o. 107, 
was passed that this legislation was repealed. The 
earlier asylums built were therefore ml too smaU, 
and from that day to the present the Irish asylums 
have year after year been reported as overcrowded, 
notwithstanding that asylums have from time to time 
been built,and tbeoldsrones enlarged. Atthepreeent 
date there are 23 asylums, accommodating over 
17,000 patients, and nearly all are overcrowded. 

I exbuct the following information from the 
report of the inspectors of lunatics ; it is, however, 
arranged somewhat differently in order to show the 
num^r of lunatics and idiots at large in each censns 
return. In 1851 the lunatics and |idiots in a^lums 
were 3,436; Innatics at large in workhonse and 
prison, 1,840; idiots ditto, 4,704; total not in asylnms, 
6,544. In 1901 the number of lunatics and idiots in 
asylums was 16,822 ; lunatics at large in workhouse 
and prison, 4,041. The number of idiots and lunatics 
at lai^, as returned in the last census is not yet 
available, but I have reason to believe it is not much, 
if at all, reduced. These figures show that there is 
still an ample margin for a large increase in the 
registrable insane without any increase in the occur¬ 
ring insanity. As a rule, ^1 non-medical writers 
assert that lunacy is much on the increase, and one 
sapient statistician has calculated that in 400 years 
the sane people would be insufficient in numbers to 
put the insane safely under lock and key. However, 
the figures given above are such as to cause us to 
think seriously, and endeavour to suggest a 
remedy. If we deal with the registers in¬ 
sane alone, we find the following figures for 
the United Kingdom :--1859 : Ireland^ 6,7^; 
England, 36,762; Scotland, 6,072. 1900: Ireland, 
20,863; England, 106,611; ScoHand, 15,663, or one 
registered insane person to the sane population in 
the following proportion:— 1859 — Ireland, 600 ; 
England, 535; Gotland, 505. 1900—Ireland, 213; 
England, 301; Scotland, 281. Thus, while in 1859 
Ireland was the sanest portion of the United King¬ 
dom, at the present time it has much the lanrest 
proportion of insane, having increased from 1 in 600 
m 1859 to 1 in 213 of the same population in 1900. 
The population in 1859 was estimated at 5,861,711; 
by the last censns return just issued it bad been re¬ 
duced to 4,456,546. This was lai^Iy accounted for 
by emigration to the United States, which conntry 
was glad to have our fittest and best, but took good 
care to return those who did not prove themsdvee 
mentally and physically sound, sending home those 
who showed the slightest symptoms of msanify, even 
after years of residence there. 

It is very doubtful whether the latest attempt to 



Aco. 21, 1901. ORIGINAL COMMUNICATIONS. Thb Midioal Pbub. 183 

deal with the chronic insane in this country will Ireland it is almost unknown for a man to select a 
bare good results. The Local Government Act of wife outside his own circumscribed valley or neigh- 
1898 , S^tion 76, made special provision for the care of bourhood, and this dislike to bring in new blood had 
the chronic and incorrectly-called harmless insane, very evil results. In some districts almost all the 
bat only provided a rate in aid of 28. per head people have the same name, and another has to be 
per week. This amount was, I am sure, fixed added on to distinguish the families. I do not 
onder a misconception, as the cost of 3s. 6d. think it would be impossible to take steps, both 
per head mentioned in the Act, evidently re- medically and legislatively to arrest to some extent 
ferred only to cost for food incurred in many heredity. This was a matter of vital importance if 
of the workhouses. A little agitation on the part of they were to retain their present position among 
the Irish members could, 1 am sure, have this other nations, and of absolute necessity to the pros- 
increas^ to 4s., and even if the local taxation perity of the country. Typhus, fever, small pox, 
account should fall short, which is possible, no diphtheria, had been almost stamped out by sanitary 
Government conld refuse to contribute the full quota precautions. Typhoid fever and other diseases are 
to eecnre proper care for Irish lunatics. This pro- largely prevented by inoculation. Why, then, 
vision of 2^. m the Act was evidently provided in should not every possible step be taken to prevent 
drier to better the condition of the unfortunate the mostpitiable, the mo8t6xpen8ive,andtoanation 
j jiBartft in the workhouses, who are admitted by all the most degenerating of all diseases P It might be 
to be very inadequately provided for, but if the grant declared illegal to discharge any man or woman 
is not increased it will uever be thought advisable to from an asylum during the procreative period of 
transfer patients from existing asylums where a rate life unless perfectly recovered. Marriages of dis* 
in aid of 4e. per head per week is contributed to charged patient ought not only to be discouraged, 
another institution where only 28. would be received, but under certain circumstances prevented by law, 
even though it would be necessary to add inexpen- and practising physicians ought to ^ more sJive to 
uve buildings to all the existing asylums. It is tbe danger of the neurotic, and those predisposed to 
manifestly nnjust to force on tbe County Councils insanity, contracting unsuitable marriages. Many 
the responsibility of providing for all tbe msane, and would say they could not interfere with the lilwrty 
to lower the rate in aid per head from 4s. per week of tbe subject, and that restrictions of this Idnd were 
to 2s. for all in so-called auxiliary asylums. out of tbe question, but if this evil was not antici- 

It is unnecessary here to argue the important pated and d^t with more acutely than at present 
and much-vexed question as to whether primary insanity must go on increasing, 
insanity is on tbe increase or not; bat as the number 2. The necessity for early rieatment has nut been 
of rostered insane is increasing and has to be sufficiently recognised either by the pusHc or by 
provided for, every effort should made to arrest law; nearly 50 per cent, of the insane are kept at 
if possible the progress of the disease. There is a home until they become a source of danger, thereby 
marked difference in tbe type of insanity in considerably lessening the prospect of their recovery, 
Ireland and in Great Britain, for while a large and acting as a means of propagating insanity and 
number of the patients admitted into tbe asylums of transmitting disease. I tbiuk it will be accepted 
this country are acutely maniacal, there is much less that 45 per cent, of those admitted to asylums may 
general paralysis ana epilepsy. Tbe prominent be classed as incurable ; many of them rendered so 
causes oi general paralysis— syphilis, bard living, because they have not sooner been put under treat- 
and intemperance—are much less potent in Ireland ment, the friends looking on asylums as prisons, 
fliaTi elsewhere. Syphilis, which is so frequently the and believing patients cannot be sent in until they 
cause of general paralysis, is rare in this countiy, commit some indictable act, and except in very acute 
while in England and Scotland it is, at least in cases keeping them at home till they become dan- 
some districts, very common. Then tbe life led by gerous to themselves and those about them, 
the agricultural classes in Ireland is altogether 3. A greater effort should be made to deal with 
different to the anxious, exacting, and toilsome life premonitory symptoms, to watch those with hei'edi- 
led by tbe lower classes in England and Scotland, tary predisposition at the critical periods of hfe, and 
especially in the cities and mining districts j and establish hospitals throughout the country, where 
slcoholic stimulants, which, no doubt, contribute neurotic patients of all kinds could V e treated. It 
largely to this disease, are consumed in a very should not be necessary to wait till certificates can 
different way in the two countries. 1 can recollect be signed. Many asylums In England are now open- 
no case of general paralysis ever coming under my ing out-door departments; if this could be carried 
notice in Ireland of an agricultural labourer who had out I believe tbe loss of many valuable lives by 
not at some time been out of his own country, suicide would be prevented, and tbe actual number 
Sildiers, sailors, and occasionally members of the coming under certificates would be lessened. Greater 
constabnlary force are mainly tbe sufferers. Unless provision should also be made in all asylums for tbe 
these reasons also account for tbe small proportion separation and treatment of curable patients. I do 
of epilepsy in Ireland I can give no explanation, not think any patients regarding whom there is a 
The transmission of insanity by heredity is of possibility of cure should be allowed into a ward 
importance, and we should aim at prevention in with chronic patients, but should be separated in 
the near future by arresting heredity and en- small wards, according to their mental condition, 
courafHng in every way early treatment. Attention and placed in charge of fully-trained nurses 
should also be devoted to providing hospitals for the in the proportion of at least one to dve. A great step 
treatment of the curable patients and villas for in advance has been made in the recently constructed 
phthisical patients, and promoting pathological English and Scottish asylums, but I hope before 
research. long every asylum admitting acute cases will have its 

1. Tbe danger of transmitting insanity might be detached hospital for curable patients, very much on 
greatly lessened by more judicious marriages. 1 the lines planned for East Sussex, and so lucidly ex- 
coold trive yon case after case of the patients who plained to us last year by Dr. Hayes Newington. I 
have been more than once in an asylum entering presume it will be admitted that in tbe majority of 
into marriage shortly after dischar^. Of course, asylums not more than 5 per cent, of the population 
such cases were almost bound to break down again, are curable, and for them money ought to m spent 
and tn propagate children defective from hirtb, or ungrudgingly. It is difficult to treat properly acute 
who would develop insanity at some important epoch mental cases, many of them of the must nervous 
of life. In some districts in the south and west of emperament, in the wards of a chronic asylum, but 

iGgie 



184 The Medical Pkbss. 


ORIGINAL OOMMUNTOATIONS. 


Auo. 21. 1901. 


leas expensive buildings than most of tbe English 
modern asylums would, I think, suffice for the care of 
many of our demented patients. 

4. When we find that the death-rate from phthisis 
varies from 17 to 40 per cent, in asylums, it is rurely 
necessary that more active steps were taken to arrest 
a disease which is now generally recognised, with 
proper precautions, to be preventible; no doubt the 
insane are specially prone to it, and it is very difficult 
of detection without the careful observation of both 
physicians and nurses, but with early recognition, 
complete isolation in suitable villas with a maximum 
of sunlight and open air, and a thorough disinfection 
and destruction of all bacilli, much might be done 
to stamp out a disease infectious and, in a well- 
orsanis^ institution, largely preventible. 

5. Pathological work will, I trust, take its proper 
place in asylums, and the good example shown by 
the London County Council and Scotland be followed 
in other districts. At present an effort is being 
made to legalise the appointment of a pathologist 
for the Irish Asylums, and will, I hope, bear fruit at 
an earlr date. The Chief Fecretary. in reply to a 
deputation that waited on him recently,acknowledged 
the necessity; with his sympathy and aid I hope the 
difficulty will soon be got over, and that the various 
asylum committees will quickly co-operate and 
appoint men of the fullest experience to carry out a 
work of vast benefit, not only to tbe present, but to 
future generations, and to tbe nation at large. 

But these recommendations mean money, much 
can be done in England and Scotland that cannot 
be attempted in Ii-eland, and it may not be out of 
palace here to quote a sentence from the report- of Dr. 
Corwin, Superintendent of the Warren Asylum, 
U.S.A., who not long ago visited this country, and, 
referring to Irish Asylums, wrote: " It is earnestly 
and sincerely to be hoped that tbe English Govern¬ 
ment which has the control and direction of all 
matters concerning the expenditure for such institu¬ 
tion in Ireland will awaken to the urgent necessities 
of the situation, and extend a helping hand and a 

g enerous support to the most dependent of its people 
y the provision for more extended moans for their 
relief and maintenance.” 

Although tbe English Government has not the 
control and direction of matters concerning the 
expenditure, I fear much must remain undone till 
more liberal aid is given by the Government for the 
insane poor. Lunatics have a special claim on the 
State. Why should not the example which has been 
set with such good results by the American Govern¬ 
ment be followed, and asylums be supported alto¬ 
gether out of State funds P 
This change was inaugurated in the United States 
on October 1st, 1893. What are the results, and what 
was almost tbe first recommendation of tbe Com¬ 
mission ? “That all State hospitals which are not 
already provided with suitable facilities for 
epecialisea individual treatment of recoverable cases, 
provision be made for tbe erection and equipment 
of small hospitals, sufficient to accommodate about 
twenty-five patients, with their attendant nurses, 
one building for either sex, and that these buildings 
be supplied with everything in tbe way of structural 
arrangements, and medical appliances and equip¬ 
ment, that may be regarded as necessary to ensure 
to their inmates the highest degree of medical skill 
and treatment.” TbeState Commissionalsomadepro- 
vision for the pathological research of the most com¬ 
plete kind recognising that tbe pathology of insanity 
18 not definitely established, and of tbe great advan¬ 
tage that medical science, and through it the general 
public, would derive from a correct knowledge of this 
subject, which might be applied not only to the cure, 
but also to tbe prevention of mental disease, the 
Commission feels that the importance of this recom. 


mendation can scarcely be overstated. Now what 
is tbe result of this important change? Dr. Wise, 
Fresidentof the State Commission in Lunacy, giving 
his experience of five years’ working, states that the 
State Care Act “will ever stand as a monument of 
the progressive spirit of our commonwealth.” He 
quotes one superintendent who was opposed to the 
change, but who now writes, “ In all that pertains to 
tbe care and treatment of tbe insane, whether it be 
in structural provision, equipment, a high standard 
of repair, nursing and personal attendance of 
patients, tbe medical service and scientific inquiry 
and observation, tbe personal liberty and diversion 
of patients, and all that tends towards their cure, 
contentment, and comfort, the quality, tbe prepara¬ 
tion of food; to tbe physiological curative needs of 
the insane, the clothing of the patients, and in all 
other things this hospital has progressively and 
steadily advanced its standard under the present 
system, and I truly believe this applies to all tbe 
other hospitals in the department of insanity.” 

Testimony such as this is abundant, and while 
there is a unanimity of opinion that the standard of 
improvement has been raised by 50 per cent., it has 
been effected at a redaction of tbe cost of more than 
20 per cent. Dr. Wise is so enamoured of the good 
done that he concludes bis pamphlet in tbe following 
words: “Like planting and cultivating will produce an 
equally rich harvest in all institutional work for 
charity, reform, and correction.” This is indeed re¬ 
markable, and veiy strong testimony, and ought not 
lightly to be setaside; we live to learn, and in apeor 
country such as this. State aid cannot be too liber¬ 
ally dealt out to the most affiicted of all God’s 
creatures. Whatever legislation decides as to tbe 
future of the insane, we must not forget that we have 
committed to our charge those unable to assist them¬ 
selves. We are in all cases their guardians and 
guides, let us then endeavour to do our duty so that 
it may be said of us as Shakespeare said of tbe 
faithful servant 

“ 0 good old man, how well in thee appears 
The constant service of tbe antique world. 

When service sweat for duty not for meed. 

Thou art not for the fashion of the times 
When none will sweat but for promotion.” 


THE USE OF DRUGS 

IN 

PULMONARY TUBERCULOSIS, (a) 

By W. B. HUGGARD, M.A., M.D., F.B.C.P., 

Daroa Platt, Biritterland. 

In regard to tbe use of drugs in pulmonary tuber¬ 
culosis there is much difference of opinion among 
medical men. By some physicians drugs are con¬ 
sidered either nseless or harmful; by others one drug 
or method of treatment is considered the treatment. 
Creosote, cinnamate of soda, arsenic, formaldebyd, 
and various other drugs have each their devoted 
adherents, who regard their pet remedy almost as a 
specific. A large number of medical men, while not 
discarding drugs altogether, employ them only for 
the relief of urgent symptoms. 

All these views are, in my opinion, too narrow; 
some over-estimating the power of drugs, and others 
over-estimatiog their limitations. From another 
standpoint, also, the foregoing views are too narrow. 
The great variety in tbe clinical forms of phthisis is 
dropped out of sight; and tbe same line of treat¬ 
ment in regard to remedies is sometimes adopted 
without sufficiently precise reference to the case in 
hand. 

(a) Pap«r re»d before British Confrees un Tuberculosis, July, 

1001 . 



Auo. 21, 1901. 


ORIGINAL COMMUNICATIONS. 


Ths Mbdical Pbbbs. 185 


The object of this paper is to point out some of the 
adrantages that may be gained by the judicions use, 
and some of the erik that arise from the injndioious 
or indiscriminate employment of drugs in pulmonary 
tuberculosis. The brotd principles will abo be indi¬ 
cated which determine my own selection of remedies 
aocording to the variety of the case. The subject is 
one in which the comparison of individual experience 
is of the greatest value in extending onr knowledge, 
and in putting it on a firmer basis. 

The nrst point to be made clear is that up to the 
present no specific has been foimd for tuberculosis. 
Not merely so; but there is no drug that is 
useful in all cases. Nevertbeless there are various 
drugs that favourably influence the courae of some 
varieties of the disease always provided that they 
are well tolerated by the patient, and that they do not 
cause any disturbance of appetite, digestion, or 
assimilation. Time does not permit even a hasty 
review of all the drugs useful in phthisis. The 
various conditions only that indicate or contra¬ 
indicate one remedy rather than another will be 
rapidly considered. 

what medicines have we at our disposal ? Drugs 
may favourably influence the course of the disease— 
I. By improving tbe general health; as, for example, 
arsenic, quinine, strychnine, lime, phosphorus prepa¬ 
rations. 2. By increasing the local resistance of tbe 
affected tissues, as creosote and its derivatives, salicyl 
preparations, and counter irritants. 3. By modifying 
the quantity or character of tbe cecretions, as the 
balsams, the terebintbinates, tbe essential oils, mor¬ 
phine and apomorpbine, and inhalations, e8p>ecially 
of formaldebyd. 4. By controlling systems that re¬ 
act ^judicially on the patient. Among these are— 
(a) Digestive ailments. (6) Excessive or needless 
cough, which shakes and exhausts tbe patient, causes 
fever, or prevents sleep, (c) Scanty expectoration 
and retention of secretions, (d) Fever, which spoils 
appetite, and prostrates tbe patient. 5. By re¬ 
moving complications, such as syphilis. 

In tbe choice of remedies the points to be con¬ 
sidered are not the same as guide us in diagnosis or 
in prognosis. The first and most important point 
to recognise is, that treatment by medicines must be 
altogether subordinate to general hygienic manage¬ 
ment—good food and fresh air with rest and exercise, 
aocording to t he individual needs of the patient. 

Tbe first and most important point in treatment 
is to consider tbe state oi the digestive system. If 
the stomach or digestion is ont of order drug treat¬ 
ment is, as a rule, inadvisable, except in so far as it 
may aid in restoring tbe digestive functions to a 
normal state, or in removing some condition that 
tends to prelong the digestive ailment. For example, 
appetite and digestion not uncommonly improve 
with the artificial reduction of temperature, or with 
tbe control of excessive cough. In such cases we 
must feel our way cantiously and be guided tenta- 
tivriy by the resets. The most important indica¬ 
tion then is to get the stomach and bowels ioto 
proper working order. Nothing goes right so long 
as the digestion is wrong. 

Temperature is the next most important guide to 
treatment. Pyrexia will in a large proportion of 
cases yield to absolute rest, bodily and mental, com¬ 
bined with life in the fresh air. In many cases, 
however, a return to a normal level of temperature 
can be hastened by the administration of small doses 
of pbenacetin—one to three grains—in combination 
witn quinine and salol and sometimes arsenic. Taken 
in this way pbenacetin seems to have rather a tonic 
than a prejudicial effect on tbe heart and on tbe gene¬ 
ral heal^, and may without hesitation be continued 
for months if need be. My experience of other anti¬ 
pyretics, save for occasional use, has not been so 
fivr arable, with the exception perhaps of salipyrin. 


Arsenic, quinine, and salicyl preparations greatly 
diminish, in my opinion, tbe tendency to recurrent 
attacks of subacute inflammatoir character and 
^ose recurrent febrile attacks without any change 
in the physical signs which aie eo marked a feature 
in a large number of patients suffering from pulmo¬ 
nary tuMrculosis. These recurrent febrile attacks 
are no doubt of very various origin, tubercle as a 
rule rendering tbe organism highly sensitive to in¬ 
fluences that cause pyrexia. The dregs I have men¬ 
tioned seem to me to diminish this sensitiveness to 
febrile reaction. In doing so they accomplish some¬ 
thing more than the avoidance of a temporary draw¬ 
back or inconvenience. In tuberculosis, more than 
in any other disease, slight drawbacks are apt to 
provoke further prejudicial effects, and each morbid 
condition tends to become chronic. In averting 
slight drawbacks, therefore, we avoid great dangers 
which might completely alter the conrse of tbe 
disease. Tbe disease is one in which pre-eminently 
anything short of the best is bad. 

Next to pyrexia, as a guide to treatment, I would 
place a marked tendency to hsemoptysis. Creosote 
and guaiacol increase, in my opinion, tbe liability to 
pulmonary btemorrbage—as well, in fact, as to pul¬ 
monary inflammation—and should be avoided where 
such a disposition is present. The lime salts, the 
lerebintbinates, and the balsams have, I believe, on 
tbe contrary a somewhat restraining influence, as baa 
also morphine in minute doses. 

The treatment of excessive cough requires much 
judgment. A closely allied object of treatment is 
the modification and, as a rule, the diminution of 
bronchial and pulmonary secretion—the “ drying up 
of tbe lungs.’’ A certain amount of cough is in a 
large num^r of cases indispensable, and has a salu¬ 
tary influence. The problem is to secure the removal 
of the pulmonary and bronchial secretions with the 
least amount of virulence, exertion, or fatigue for the 
patient. Sometimes the secretions are extremely 
abundant, sometimes too scanty. Tbe balsams and 
tbe terebintbinates and tar for the most poit diminish 
bronchial secretion, and tbe terebintbinates commonly 
render it at tbe same time less tenacious and easier 
to get up. Minnie doses of morphine—from one 
hundred and twentieth to one sixtieth of a grain of 
any of its salts—diminish secretion, but as a rule 
render it more tenacious. Anomorphine in small 
doses—one-twentieth to one-sixteenth of a grain of 
the hydrochlorate—loosens the secretion without 
making it much more abundant. The recently 
introduced morphine derivatives, heroin and dionin, 
greatly diminish cough, and to some slight extent 
dimmish expectoration, while they are free from the 
drawbacks that morphine has, of rendering the 
secretion viscous and difficult to get up. They are 
also practically devoid of constipating effect, and 
they do not upset tbe digestion. For the last two or 
three years they have almost altogether replaced in 
my practice tbe phosphate of codeine, which has 
fewer drawbacks than nas morphine for the relief of 
excessive cough. 

Tbe most vuuable agent that I am as yet acquainted 
with for modifying the bronchial and pulmonary 
secretions is the vapour of formaldebyd. For tbe 
last three years I ^ve used this dreg extensively, 
and with more and more satisfactory results. When 
steadily used it generally causes the secretions to be 
less purulent and more mucous, at the same time 
diminishiug tbe amount and rendering expectoration 
easier. Where the use of the drug h^ b^n steadily 
persisted in for months, tubercle bacilli have, as a 
rule, also become less numerous, and in some old 
cases even have disappeared. The mode of employ¬ 
ment reqtures a little care. The best way, in my 
opinion, to use formaldebyd is by means of a muzzle 
inhaler. The strength of the solution should at first 

J> 



186 Thk Mdioal Pbbbs. ORTGINAL COMMUNICATIONS. Aco 21,1901. 


Dot be more tban two or three per cent, in rectified 
apirits of the ordinary forty per cent, aolntion. The 
addition of some essential oils renders the inhalation 
oite i^reeable. Only from five to ten minims at 
rst should be put on the inhaler, and this quantity 
should be renewed every fifteeen or twenty minutes, 
the entire time of inhalation beint; from two to four 
hours a day. The strength may be gradually in¬ 
creased up to 6 or 8 per cent., and sometimes even to 
doable tnat amount. If cough is very irri* 
tab’e, chloroform may be added to the inb^tion. 
From independent observations I am strongly of 
opinion that chloroform, apart from its soothing in¬ 
fluence on the cough, has in some cases a beneficial 
influence on the disease. It must, however, be used 
with judgment. I have known it seemingly give rise 
to pyrexia, by causing retention of secretion. The 
inbmation of formaldebyd on the contrary tends con¬ 
siderably to diminish pyrexia due to the absorption 
of toxins. Formaldebyd has another advantage. If 
not too strong, it diminishes irritability in the 
pharynx and larynx. It is, however, very irritating 
to the eyes and nose, and for this reason should t« 
used only with an oral inhaler, or if the Burney Yeo 
oro-nasal inhaler is employed, it should be placed 
below the nose. 

According to my experience syphilis is a complica¬ 
tion of pulmonary tuberculosis in a much larger pro¬ 
portion of cases than is usually thought. In such 
cases I consider the treatment of the syphilis to be of 
the tirst importance. Small doses of the percbloride 
of mercury have then, instead of a depressing, a re¬ 
markably tonic influence. Intra-muscular injections 
of mercurial salts, though more strikingly beneficial, 
have as a rule the drawback of being excessively 
painful. To this rule, however, huile griee or mer¬ 
curial ointment, rubbed up with sterilised oil, is an 
exception. The iodide of ethyl inhalation is per¬ 
haps the least objectionable, while not the least 
efficacious mode of giving iodine. It may be com¬ 
bined with the formaldebvd inhalation. 

To sum up, then, my line of treatment is deter¬ 
mined, in the first instwce, by the digestive system, 
by the general health, and by the state of nutrition. 

If digestion is bad the only drugs indicated are 
such as will restore it to a normu condition. If 
digestion is good, the general condition satisfactory, 
and the patient improving, I refrain from using 
drugs unless some definte indication is present. 
Among the most important indications for 
drugs ar*- persistent afternoon pyrexia in spite 
of absolute rest out of doors; a tendency 
to recurrent febrile attacks or to slight inflamma¬ 
tory attacks. This tendency is usually combined 
with impaired nutiition and with a low state of 
general health. In these conditions arsenic, stryob- 
nine, quinine, and salol are among the most useful 
tonics. Active softening, excessive cough, over¬ 
abundant expectoration, and, more rarely, scanty 
expectoration, expectoration of extremely purulent 
or nummular character, require attention; and the 
drugs useful for these conditions generally seem to 
me to have a favourable influence on the course of 
the disease in addition to the temporary relief from 
discomfort they may afford. Among such drugs 
are formaldebyd vapour, creosote and its derivatives, 
except the carbonate of guaiacol, which has generally 
seemed to me to be inert, terpin hydrate, oil of 
cinnamon, myrtol, the balsams, and the lime salts. 
In sluggish chronic softening, counter-irritation by 
iodine or by small flying blisters is of the greatest 
nee. When an old sy^Uitic taint is present its 
removal should be our first care. 

The short time at my disposal does not permit a 
detailed examination of the points I have Drought 
forward, and my remarks are rather to be con- 
eidered in the light of heads for discussion than as 


even a partial exposition of the subject What I 
have said may, however, I trust, be sufficient to 
induce others to bring forward their experienoe on 
the same lines. 


INOCULATION AS A PREVENTIVE 
AGAINST TYPHOID FEVER, (a) 

By HENRY M. CULLINAN, L.R.C.P., L.R.C.S.I., 
L.M.Rotunda Hospital., 

Senior Aatiitaot Medical OfBcer. BlchmoDd District Asrlum, 
Dabiin. 

Ik venturing to write on the subject of preventive 
inoculation asainst typhoid fever—a measure of 
treatment which, so far, is on its trial, and which 
can hardly be said to have been yet adopted by the 
medical profession—I should like to preface my 
remarks by stating that, in presenting the result of 
my experiences gained in the inoculation of over 
five hundred female patients in the Richmond 
Asylum during the recent epidemic of enteric fever, 
I lay no claim to have made a discovery, and it is 
possible that, bad my opportunities for ^ting the 
efficacy of this treatment fallen into other bands, 
more interesting results might have been forth¬ 
coming. At the same time I have considered that 
the conclusions to be drawn from the occurrence of 
this epidemic in the Richmond are interesting, and 
justify me in placing before you the result of my 
observations, principally in the hope that any dis¬ 
cussion which my remarks may give rise to will be of 
practical utility, and draw from those present sug- 
gestions which may guide us in the preventive 
treatment of this disease. 

The epidemic referred to occurred in the Asylum 
last year, extending over some five months, and was 
of considerable severity. There bad been cases of 
enteric with long intervals between each for about a 
year, but in August last the number of cases began 
to assume the proportions of an epidemic. When 
eighteen cases had occurred within three weeks it 
became evident that a serious state of affaire existed, 
and Br. Conolly Norman, Medical Superintendent, 
obtained from Professor Wright, of Netley, a supply 
of lymph, which he has introduced for inoculation or 
vaccination against enteric fever. On receipt of this 
I commenced operations, and inoculated in rapid suc¬ 
cession 807 female patients, inoculating each patient 
once only with | c.c. of the serum, commencing on 
September 6th and finishing on October 3rd. 1 had 
then operated on all the patients who lived and slept 
in the portions of the Asylum which were cdd- 
sidered infected areas. It was suggested to me by 
some enthusiastic medical friends that I should vac¬ 
cinate only one-half of the patients in each ward, in 
order to see if the other half would contract the 
disease, but I did not feel justified in adopting this 
course, however interesting the i-esult might have 
been; on tbe contrary, the cases were becoming so 
numerous that our only anxiety was to inoculate 
everybody as rapidly as possible. However, unin¬ 
tentionally, I did, in fact, experiment, inasmuch as 
we did not inoculate any of tbe nurses, and 
it will be observed that in proportion to 
their numbers our staff suffered much more 
severely than the patients; also, having completed 
the inoculation of these patients, compris^ in 
certain wards, and numbering, as stated, 307, 
the operations were stopped, and it was not until 
November 5tb, when it was found that the wards 
which bad not been gone over, and which bad been 
looked on as immune, began to contribute casee, and 
severe cases, to tbe number attached, that I again 


(a) Bead before the Section of State Medlcioe of tbe Bojal 
Academ} of Medicine, Ireland, April 26th, 1901. 


Avq. 21, 1901. ORTGIITAIj communications. Thb Mssioaii Pabsb. 187 


«tarted and ioocalated the remaining patients in the 
hoQse, bj which I mean all those of 55 jears and 
Qoder that age. 

The most interesting and important point in these 
experimenta is, of conrse, to determine whether the 
raccination confers anj immunity against typhoid 
ferer. I bare come to the conclusion that it 'sof the 
almost valne in this respect, and I hope I am not 
incorrect in forming that opinion, deduced as it is 
from the records kept of the dates in which cases 
occurred and the very important and practical fact 
that out of a total of 511 patients inoculated only 
seren contracted the disease, and almost all of these 
were, in my opinion, in the incubation stage when 
inoculated. As already mentioned, eighteen cases 
had occurred when the raccination was commenced 
on September 6th. Of these, ten were patients and 
eight were nurses. Owing to want of hospital ac¬ 
commodation we were able to operate on only forty 
patients at a time, and as these were kept three 
or four days in bed it took some time to go over 
them alL 

While the inoculation was in progress—that is, 
from September 6th to October 3rd—nine fresh cases 
oecrned, of which only three had been operated 
upon. Of these three there is no doubt that one was 
actually in the early stages of the disease at the time 
of inoculation, as, owing to an oversight, her tem- 
penture was not previously taken, but was found to 
M 101^ immediately after the operation, remaining 
high and at once assuming the characteristic curve 
of enteric fever. Case No. 2 was found to have 
normal temperature, and was apparently in good 
health before inoculation. The temperature rose 
after the operation, but instead of coming down in a 
few days, pereistently remained high and assumed 
enteric features almost at once, and, as immunity is 
aid not to be conferred until from three to five days 
have elapsed after inoculation, I think it may be con- 
eluded that she would have contracted the disease in 
any case. The third case was inoculated on Septem¬ 
ber 22nd, and on the 24tb was quite well apparently, 
hot on the 28th was found to have a temperature of 
100*^, and a couple of doubtful rose spots. On the 
SOtb there was a typical crop of spots, and the case 
from that out was a severe one, complicated later on 
by double pneumonia, from which, however, she re¬ 
covered. and has since left the Asylum. 

I would not place this case definitely among those 
snSering from prodromal signs at the time of inocu¬ 
lation, but allowing three or four days to the serum 
to confer immunity, and as the spots began to appear 
six days after the operation, 1 think we may fairly 
refrain from blaming the lymph. A girl who had 
been inoculated on October 3rd, having left hospital 
three days after vaccination, was attacked very 
severely on October 15th. She was found on this 
date to have a crop of spots. This patient, I regret 
to say, died. It must be remembered that in an 
asylam patients are frequently walking about with a 
high temperature and severe symptoms unknown to 
the medical staff and without complaint; and it is 
only when they get very ill that they are noticed to 
be BO. Accordingly, it is difficult to determine when 
this patient began to be the subject of enteric fever. 

On November 5tb, owing to several cases having 
occurred among patients not inoculated, I resumed 
operations, and vaccinated 204 females, making a 
total of 5ll. 1 am much indebted to my recent col- 
leagae, Dr. William Starkey, for bis assistance in 
inoculating a considerable number of these patients. 

On November 14th a patient who bad been inocu¬ 
lated on September 22nd—nearly eight weeks pre- 
rionsly—and bad been quite well in the interra], was 
found to have a most profuse crop of spots. This is 
w example of a case in which the serum failed to do 
its work, and it also exemplifies tbo fact that lunatics 


will often walk abont with a severe disease attacking 
them, seemingly in normal bodily health, as this 
woman only complained of feeling ill when she 
actually exhibited the spots in great numbers. 
Another patient, inoculated on November 12th, was 
verv ill after the operation, and continued so with a 
high tem^ratnre. On the 20tb she had a crop of 
spots, having had all the appearance of typhola in 
tne interval. This may, I think, be considered a case 
in which the patient was sickening for the at 

the time of inoculation. 

Another woman, abont fifty years of age, operated 
upon on November 5th, and getting over the effects 
in three days, was found on November 17th with a 
temperature of 101°, and had a very severe attack, 
followed by a I'elapse, from whi(5h she nearly died. I 
consider that on this occasion the serum acted detri¬ 
mentally, and probably accentuated the severity of 
the attack. 

In order to prove the efficacy of serum inocula¬ 
tion as a preventive measure it is necessary to show 
that those treated were living at the time within an 
infected area. This was undoubtedly the case in the 
Richmond, as, although tbo place was thoroughly 
overhauled by the Public Health Authorities, and a 
new system of drainage laid down with great promp¬ 
titude, cases continued to occur with persistent 
regularity, mostly among the staff—a total of seven¬ 
teen nurses being attacked, of which nine contracted 
the disease after the inoculation of patients com¬ 
menced, none of the nurses having been operated 
on. Twenty-eight inmates were attacked during 
the inoculation process, of whom only seven had 
been operated upon—showing that during this period 
thirty-seven cases had occurred, proving conclu¬ 
sively that the source of infection still existed. The 
last case which occurred was a girl admitted abont 
five weeks when she was attacked, a fact which adds 
we^ht to this statement. 

‘I^e question might be asked, Would these patients 
who were inoculated and escaped tbe disease have 
contracted it had they not been inoculated P This, 
of course, I am not in a position to answer, and it 
would, I think, be quite impossible to ascertain. The 
fact remains that they were inoculated and did 
es^pe. 

W^ith respect to the constitutional disturbance 
following inocnlation it did not prove in any of the 
cases in my experience to be of great severity. In 
every case, almoet, the temperature rose within a 
couple of hours, in some few instances reaching 103° 
and 104° the day of operation, while 101° and 102° 
were common heights for it to attain. It usually 
fluctuated for a couple of days, coming down gradu¬ 
ally from the maximum, and being generally 
normal on the third day. In every case operated on 
four-hour temperature records were kept. Except 
in tbe cases already specially mentioned tbe patients 
were able to be up and about on the fourth day. Tbe 
principal symptom was headache, from which eighty- 
five suffered, some of them very severely. Yomiting 
or retching occurred in sixty-three cases, loss of 
appetite and refusal of food in thirty-three, diarrhoea 
' in two. rather severe prostration in three; four com- 

E lained of abdominal pain, while stifiuess in tbe 
ack and soreness over the seat of inoculation 
occurred in nine and twenty-two cases respectively. 
Tbe last symptom—soreness in the flank, wnere each 
patient was vaccinated—was not in any case accom¬ 
panied by local manifestation beyond slight redness 
of the part, with some swelling. 

I should have liked to have been able to compile a 
table in which the agglutinative action of the blood 
serum of each patient on the bacilli before and after 
inoculation was shown, but unfortunately tbe rapidity 
with which cases occurred created something of the 
nature of a panic, added to whidi, coming on during 

C 


Auo. 21, 1901. 


188 Thi Msdical Pbs86. ORIGII^AIj COMMUNICATIONS. 


the vacation season, we were handicapped as regards 
medical assistance, for which reasons the inocula¬ 
tions were performed as quicklj as possible withont 
first examining the blood, except in a certain number 
of cases, not very large. On examining the reaction 
of tbe serum in these cases, I found that in every in¬ 
stance there was a certain amount of clumping of 
bacilli, in some much more than others, but in no 
case did I find tbe remarkably thick clumping 
which is shown in the blood of patients actually 
suffering from enteric. I believe that tbe fact of 
our patients only having been inoculated once 
contributed to this lessening of the Widal reaction, as 
Dr. Wright recommends a second inoculation about 
twelve davs after tbe first, but. as already stated, we 
were unable to carry this out. Although from a 
pathological point of view this omission to inoculate 
a second time is unfortunate, I think it proves clini¬ 
cally more conclusively the usefulness of the lymph, 
as there is no doubt our patients were exposed to 
infection during the entire period of the process. 

I append a ^ort table showing tbe ages of those 
attacked, distinguishing those inoculated and those 
not inoculated; also tbe ages of all who were inocu¬ 
lated, whether attacked with the diseaseornot. Tbe 
result, in brief, shows that of a total of 655 who were 
liable to be attacked fifty-four contracted the disease 
— i.e , 8 24 per cent. Of the 511 patients inoculated 
seven, that is 136 per cent., were attacked after tbe 
operation. Forty-seven cases occurred, not having 
been previously inoculated, that is 7'16 per cent of 
the total liable to infection. 


Ape- 

16 

tO' 

80 

20 

to 

26 

25 

te 

30 

30 

to 

35 

35 

fo 

40 

40'45 
to to 
45^ 50 

50 

to 

55l 

I TotaL 


Inoculated .' 

9 

35 

107 

83 

149 

5948, 

21 

511 

Contracted disease ... 
(previonslj inocul’t'd) 

- 

2 

] 

3 

— 

1 


1 

(1-36) 1 

1 

» 54 

extracted disease ... 
(not previously inocu; 
lated) .1 

1 

16 

6 

6 

8 

7 

2 

1 

(7.fe)) 


In connection with this table I should point 
out that I have made no distinction m it 
between tbe nurses and tbe inmates who were 
attacked. In looking at these two classes of 
patients separately it must be allowed that tbe 
insane are more liable to be attacked than the 
sane by a disease like enteric; their mode of life and 
general environment, taken together with their 
mental disability, render them peculiarly susceptible 
to any disease which is rife. Judging the results of 
the inoculation from this point of view (and this 
should not be overlooked in arriving at a decision) 
we find that 17 out of 114 nurses, or 14*9 per 
cent., were attacked, none of the nurses having been 
operated upon; while 37 inmates out of a possible 
541 liable to attack, or 6'83 per cent., were 
the subjects of enteric. That is to say, more than 
double tbe percentage of sane and robust people, 
none of whom were inoculated, were attacked, as 
compared with tbe percentage attacked among 
the inoculated, all of whom were, owing to their 
insanity, more likely to suffer from physical ailments. 

In conclusion, I should be sorry to make any 
dogmatic statements as to the absolutely preventive 
action or otherwise of inoculation against typhoid 
fever. If one can credit the results as evidenced 
among the soldiers in South Africa, enormous 
numbers of whom were vaccinated, it would appear 
to have been somewhat of a failure. There may 
have been circumstances in their case which militated 
against tbe success of the procedure. 1 cannot help 
thinking that it was of use in the epidemic in the 


Richmond, but I shall be glad to hear tbe remarks 
of more experienced physicians than myself, who, 
though they probably have not had on opportunity 
of testing the lymph to tbe same extent as 1 have, 
can bring clearer views than mine to bear on the 
question. 


JariB OlUttiral ICecturcB. 

MEDICAL TREATMENT 

OP 

CANCER OF THE STOMACH. 

By CHARLES ROBIN, MD., 

Professor of Clliiical Medicine, tJDiTeisUjr of Paris. 

[EEPOBTBD by OTJB PARIS COEBE8PONDBNT.] 

[Fob First Articlb See Medical Press asd Circolar, 

July 24tb, 1901, pege 8.j 

I WILL complete to-day tbe medical treatment of 
cancer of the stomach by the consideration of 
remedies which relieve tbe symptoms and prolong 
the existence of tbe patients. 

These remedies are directed either to tbe pre¬ 
dominating symptoms or to the accidents which are 
apt to occur in tbe course of tbe malady. Tbe 
symptom which immediately attracts the attention 
of the medical attendant to the existence of cancer, 
especially in elderly patients, especially if at the 
same time they are pale and emaciated, is anorexia 
or loss of appetite. 

This anorexia soon merges into a positive diegiat 
for food, and it is a most distressing symptom. If 
we know how to avail ourselves of tbe various means 
at our disposal we may be almost sure of stimnlating 
the appetite of these unfortunate patients. As the 
I'emedies employed for this purpose are extiemely 
numerous and vary greatly in respect of their nature 
and effects, I will divide tbe symptoms into three 
groups, having regsrd to their intensity, viz.:—Slight 
anorexia, pronounced anorexia, and total anorexia. 

In the first series the first agent I employ iagwutia 
amaram info8ion,andit is onUiewboIeavery success¬ 
ful treatment. If at the end of a week the appetite 
has not returned I have recourse to menganie, or water 
clover, which, like gentian, is usually employed in 
tbe form of a maceration. I prefer giving it in 
the form of wine; one drachm of mengante in a 
pint of boiling claret, and allowed to infuse twenty 
minutes. It is then strained and left to cooL Tbe 
patient takes balf a tumbler of tbe preparation 
Mfore meals. If neither of these remedies gives 
satisfaction, I order tincture of nux vomica. In 
pronounced anorexia I give, a quarter of an boor 
before meals, a cachet containing five grains of 
chloride of ammonium, two grains of Dover’s 
powder, five gprains of bicarbonate of soda, and a 
quarter of a grain of powdered nux vomica. 

In grave cases of anorexia remarkable results may 
be obtained by two new drugs, on which I read a 
paper recently before the Therapeutical .Society, viz., 
persulphate of soda and metavanadate of soda. Tbe 
first is given according to tbe following formula 
Persulphate of soda, xv grs.; 

Water, 5v. 

A teaspoonful before the two principal meals. 

Each teaspoonful contains two grains of the salt, 
a dose which should not be excelled. As soon as 
the appetite returns the treatment should be sus¬ 
pended, otherwise, as Hirtz pointed out, a painful 
and distressing sensation of hunger is created. The 
persulphate given under these conditions succeeds in 
two-thirds of the cases. 

Metavanadate of soda is even more active, and 
should be substituted for the preceding when, after 

■ooge 



Auo. 21, 1901. 


G B B M A N T. 


ThI MsOICAI. PbB88. 189 


eight days the desired result has not been obtained. 
It mast not be for|;fotten that it is a powerful tonic, 
and requires to be administered with prudence. The 
dose should not exceed one*fiftieth part of a grain, 
given twice a day. 

Metavanadate of soda, 1 gr.; 

Water, 5*. 

A teaspoonful represents one>fiftieth part of a 
g^rain; two daily before meals. 

By one or other of these means we shall probably 
aucceed in restoring the appetite to the patients. 
But this is not all; the patient must be able to digest 
vrfaat be eats. These patients secrete little or no 
hydrochloric acid, consequently the judicious exhi¬ 
bition of pepsine and hydrochloric acid is calculated 
'to give satisfactory results. 1 employ a solution of 
hydroch loric acid ( 2 - 1 , 000 ) of which the patient 
t^es a wineglassfnl in sips daring the meal. 1 ineist 
on this detail, which, however insignificant, has its 
importance; in fact, we must endeavour to repro¬ 
duce as exactly as possible the conditions of natural 
digestion. Now, we know that hydrochloric acid is 
not secreted all at once but gradually, as the food is 
being digested, consequentlv the liquid must be 
inboducM into the stomach progressively and not 
in one dose at the end of the meal. The same 
rule applies to pepsine. It is my practice to give 
daring the meal from three to five of the following 
cachets:—Pepsine, 6 grs.; maltine, 2 grs. As a 
general rule, pepsine is prescribed in too small quan¬ 
tities, for we must remember that under normal con -1 
ditions the stomach secretes enormous quantities of 
pepsine; consequently, we ought always to give from 
twenty grmns to a drachm of pepsine and two or 
three pms of pancreatine. The patient then should 
take in sips during the repast a wineglassful of hydro* 
•chloric acid ( 2 * 1 ,^X)), and four or five cachets, con¬ 
taining each ten grains of pepsine and two grains of 
maltine, and at the end of tne meal two or three 
pills containing two grains of pancreatine. 

If the artificial digestion is accompanied by 
irregtdar fermentations provoking pain, this sym¬ 
ptom must be treated according to its nature. Wnen 
the fermentation is lactic, 1 prescribe fluoride of 
ammonium, 5 grs.; water, 31 . Of this solution the 
patient will take a tablespoonful during the meal, or 
we may g^ve a cachet containing iodide of sulphur, 
2 grs. Such is the treatment of anorexia, dyspep¬ 
sia, and gastric fermentations in patients suffering 
from cancer of the stomach. There is another 
^mptom, more frequently met with, however, in 
gastric ulcer, which will require your attention and 
that is p^. The following mixture will be found 
useful in such cases *. 

Cocaine'! •, 

Lime water, ^v. 

A dessertspoonful to be taken when the pain 


supervenes. 

1 have also been in the habit of prescribing 
instead of the mixture a cachet as follows: 

Lactose, xv gr.; 

Calcined magnesia, xxx. gr.; 

Subnit. of bismuth | 


' aa xij gr. 


Prepared chalk 
Codeine, | gr.; 

Bicarb, of soda, xv gr. 

I must not omit to call your attention to a not un- 
frequent accident, viz., bsmorrbage. Naturally, 
hmmorrhage has not the same importance in cancer 
as in ulcer of the stomach, bat it must be borne in 
mind that frequent coffee-ground vomiting exhausts 
the patient and must be treated. Against this we 
may prescribe: 

Tartaric acid, 5 to 10 grmns; 


Powdered opium, ^ ; 

Calcined magnesia, u grs. 


For one cachet: one to be taken before each meal. 
If this does nob succeed, which is rare, you can try 
against the vomiting; 

Picrotoxine, ) 1 

MorphU, ! 

Sulphate of atropine, grain; 

Brgotine, xx grs.; 

Cherry laurel water, 3iij. 

Five or six drops about ten minutes before eating. 

If, however, no treatment succeeds, solid food must 
be suppressed, and the patient confined to milk diet. 

Such are the indications and the rules for the 
medical treatment of '*ancer, and the results will be 
found to be to a certain extent satisfactory. Out of 
twenty-five patients thus treated, ten increased in 
weight, and their lives were prolonged by several 
months; the average was 422 days. 

Before closing I must say a few words in regard to 
the suigical treatment of cancer of the stomach, 
which comprises pylorectomy on the one band and 
gastro-enterostomy on the other. As regards the 
results of these two operations, it would appear from 
statistics that the improvement obtained m the con¬ 
dition of the patient is often greater than that from 
medical treatment; life is also more prolonged, the 
average being 507 days. Consequently each time 
that it is possible to diagnose cancer of the stomach 
at an early stage you will advise pylorectomy. As to 
gastro-enterostomy, which consists in establishing a 
communication between the stomach and the int^- 
tine, the results are less favourable, the improvement 
for the patient being more transitory, and toe average 
gain in the patient being only 209 ^ys. 


Sennaitp. 

[Fbok Oub Own Cobrbspondint.] 

BiaLta, Anaut 17tb, 190L 

At the Free Society of Surgeons Hr. Sonnenburg first 
of all alluded in suitable terms to the loss the Society 
bad just sustained in the death of its honoured member. 
Hr. Langenbooh, after which Hr. H. Oppeinheim related 
a case of 

Tumoub op teb Spinal Cobd. 

The patient was a gentleman, st. 40, who first con¬ 
sulted him in September last, complaining of pains in 
the left hypochondrinm oorreeponding to the region 
supplied by the seventh and eighth dorsal nerves. The 
pains had been present for two and a half years, and in 
spite of all known remedies had steadily got worse. 
The patient’s bearing was stiff, there was no kind of 
deformity observable in the spine, and no tenderness on 
pressure. On examination it struck the speaker that 
the patient’s umbilicus was drawn a little to the right, 
the muscles of the left side appeared to be flabbier 
than the right, but itwas difficnlt to be certain as the 
patient was fat. The moscles on the left did not react 
to faradisation, and the reflex on that side was absent, 
whilst it was distinctly marked on the right. A tomonr 
was snspected on account of the duration and intensity 
of the symptoms, but as there was a possibility of a 
developing spondylitis a corset was applied. When the 
patient was again seen the symptoms bad become 
I worse. He could still walk, but there was weakness of 
the legs. There was now thermo-smassthesia of the 
right leg, as well as diminished sensibility in the pain- 
fnl parts. Extension treatment was now begnn, under 
which symptoms of pressure rapidly developed. 

On November 12th there was complete peraplegia. 



190 Ths Hbdical Psib8. 


A U 8 T B X A . 


On the right the teosoiy asd on the left the motor 
symptom most marked. There was retention of nrine, 
girdle pain, and spasm in the lower extremities, and 
further a slight swelling of the soft parts in the region 
of the serenth and eight costo^rertebral articnlations. 

On November 17th the canal was chiselled and a 
tnmonr fonnd at the level of the sixth vertebra and 
shelled out. It had grown from behind and poshed the 
cord on one side. The longest diameter of the tnmonr 
wasS'Sctm. It wasamyxoma with partisd myxomatons 
degeneration. The after oonrse was at first favourable. 
The girdle pain ceased in twenty-four hours. In four 
days the nrine was passed spontaneously, sensibility and 
motor power improved. Some days later, however, fever 
of an intermitting character developed, and the patient 
died on the eighteenth day of ascending meningitis. 
The cord showed a very slight constriction, but tbe 
microscope revealed ascending degeneration and diffuse 
disease at the site of tbe compression. 

Hr. Sonnenburg made some technical observations, 
and thought the unsuccessful termination of the case 
was due to the temporary resection. He had the im~ 
pression that the vertebral arches acted as foreign 
bodies and irritated the wound, whereby the outflow of 
spinal fluid was impeded. He would advise that the 
resection should not be temporary, that the first dressing 
should be kept on a long time, and that only the upper 
layers should be changed as soon as they were soaked 
through. 

Hr. Israel bad brought a case of chiselling of the 
spinal canal through, although meningitis did come on. 
and he attributed the good result to not making the 
resection temporary. It was a case of complete 
paralysis from fracture of the vertebral column. On 
opening the canal he fonnd a large quantity of fluid 
above the oompression, but none below it. A lamella 
of bone was found to be the cause of the compression- 
This was removed, and during the process of removal 
the dura was tom. For a week things went on well, 
and then symptoms of meningitis set in, with a good 
deal of purulent discharge from tbe dural sac. The 
dressing was renewed as often as it got soaked through, 
and this he thought essential, and tbe child pulled 
through. The paralysis was not relieved. 

Hr. Sonnenburg discussed the subject of 
Afpxndicitis AMD Tbauha 
from a medico-legal point of view. Whether an injury 
could set up appendicitis had been decided by Bramann 
to the effect that it might if the appendix harboured a 
coprolite. Tbe speaker, on the contrary, believed that 
trauma could excite inflammation only when the 
process was previously altered in structure. 

The following case was very instructive:—A woman, 
who had had pains off and on for a long time had 
violent pains after a slight injury. This recurred 
several times, and after two years and a half led to ex¬ 
tirpation of the appendix. Nemr the tip of this were 
found some coprolites, the mucous membrane in a state 
of catarrhal inflammation, and fixed by adhesions. 
These adhesions were caused by hscmorrhage following 
the injury. It was remarkable that when a trauma 
occurred where perityphlitis was present, the result did 
not correspond in severity to that of the injury. Pre¬ 
vious disease of the process was necessary for trauma 
to set np peritonitis.) 


Ado. 21, 1901. 

Hr. V. Bei^mannn confirmed the .views of the pr^ 
vlons speaker. 

Hr. Uuhssun spoke on the 

Diffxbemtial Diaonosib bbtwxxm AppKKmcms ami> 
Typhoid. 

A man was taken suddenly with obstructioD, vomit¬ 
ing, and abdominal pain, and after temporary iminove- 
ment was sent into hospital. The sensorium was then 
free, temp. 38 2, pulse 88. Tbe abdomen was soft, 
but slightly resistent in tbe ileo-cmcal region. No splenic 
tumour and no roseola. In a few hours the symptome 
became so much worse that gangrene of tbe appendix 
was suspected and laparotomy performed. The omen¬ 
tum was attached to the appendix, and a piece of the 
csBcal wall had slipped between the adhesions. The 
wall of the bowel was thinner at this spot, tbe re¬ 
mainder of the csecnm swollen. The mesenteric glands 
were also swollen. The adhesions were separated. 
A week after tbe laparotomy roseola and splenic 
tumour made their appearance, but neither bacterio¬ 
logical nor chemical test showed evidence of typhoid 
until the tenth day, when Purtkowski's test gave a 
positive result. 

Hr. Sonnenburg related a case of 

fAcUTB GANaBBHODS ApPBNDICITIS IN A GbAVIDA. 

Vomiting, pain, and distension set in in a woman five 
months pregnant. Sesistance was found in the right 
side independent of the uterus. Laparotomy was per¬ 
formed, and tbe appendix was found gangrenous at tbe 
tip; stinking pus behind the uterus. The appendix 
was removed, the abscess emptied, and recovery took 
place, with abortion following some weeks later. 


JluBtria. 


[PBOM ODB OWN COBBSSPOMDBHT.J 


ViKRSA, Aogast 17tb, 1901, 
Fobxion Bodies in the Thboat. 

Spiba, of Cracow, in his review of Polish work, relates 
a number of interesting cases. The first, a female, was 
admitted to hospital nnder Dndrewica, with a peculiar 
history. While at a meal she swallowed some bread 
which gave her sharp pain. Shortly after she began to 
vomit, which rather increased tbe pain when endeavour¬ 
ing to swallow, more particnlarly on the left side which 
was tender to pressure, tbe pain being increased with 
coughing, which was accompanied with hoarseness. A 
week later there was blood in the sputum and saliva. 

After this, a careful exploration of the larynx was 
made, with special attention to the seat of pain. The 
internal surface of tbe larynx was greatly swollen, more 
particularly the left side, and left false vocal cord. 
Between the Santorini and Wrisberg cartilH^es on the 
left side, just over the prooessna vocalis, was observed 
a gray coloured point which tnmed out to be the head 
of a pin. Cocain ewaa applied to the inner rarfaoe of 
the larynx to bring down the swelling. A later exam¬ 
ination revealed a red line below the vocal cord, indicat¬ 
ing the presence of a foreign body. With the aasist- 
ance of a pair of long forceps the head of the pin was 
seonred and extracted, being 32 m.m. long, or I'S 
inch. The point of the pin, which was evidently- 
swallowed with the bread, seems to have been lying 
free in the trachea, which would increase the pain in 
vomiting. 


Diuiiized by 


Googic 


Auo. 21, 1901. 


THE OPERATING THEATRES._ Th. M.dicai. Pbsbb. 191 


PsiVABT IkPLAMCATION OF TH* MaSTOID PbOCXSS. 

Hmni Mi, of Wanav, infoms a* that, according to 
hi* experience, very fe» primary eases of periostitis of 
the mastoid process go on to suppuration. All that do 
ooonr are of a traumatic origin, altbongh he has had 
one that arose from erysipelas. All the cases he has 
met with have ended in resolution or thickening of the 
periosteum arising from severe exposure to cold, syphilis, 
or rheuma ti s m . A number of the so-called primary 
penostites are in realify secondary to ostitis media ex- 


other oases they were present forty times; in thirty oases, 
eighteen times; and in twenty-one oases every one. 
The coloured patches are not to be found on the con¬ 
junctiva or nasal membrane,|ooly on the tongue, and this 
is oharacterieed as the measle tongue. It is more evanes¬ 
cent than the scarlet fever tongue. 

KING’S COLLEGE HOSPITAL. 


^ inflammation of the soft tissues in the imme¬ 
diate neighbourhood. 

A primary periostitis of the mastoid procees may be 
^**8®®**^ by a hard, painful, well-deftned swelling over 
the process, while the skin, soft tissues, aural, passive, 
tympanum, and middle ear, are found to be perfectly 
healthy. 

According to Heiman, primary inflammation is a very 
rare oconrrenoe,although Politser affirms that this in the 
mastoid process is not uncommonly met with. Injury, 
cold, and syph ilitic origins usually commence the trouble, 
the inflamma tion of the periosteum in the cavnm tym- 
pui extending later to the mastoid process. It may 
easily he understood from this argument that primary 
mastoiditis is more theoretical than clinically practical, 
and, furthermore, when we ars told by Heiman, whose 
wealth of experience is extensive, that he has not mtt 
with a single genuine case, we must infer that it is a 
Tery rare occnrrence. 

Washing th* Phabtnx and Labtnx. 

He'yng is a Arm believer in the gargle, but the 
patient mnst be taught with small quantities at first to 
take it well back by inclinations of the head and allow¬ 
ing it to return by the nasal passage. The fluid should 
be cold at first and warm after. Ice mnst not be 
administered becairse of the danger of introdncing 
nucrobes into an already morbid passage. Three or fonr 
onnees of the gargle shonld be used for five minntes at 
a time to be of any service, this acts on the mncons 
membrane as hydropathy to the skin. As a prophy¬ 
lactic it is indisputable when epidemics of scarlet fever, 
diphtheria, angina, &c., are prevalent. 

There are many cases where this form of treatment 
is contra-indicated, such as post-diphtherial paralysis of 
the soft structures gloeso and labiopharyngeal, and re¬ 
current paralysis, perforation of the hard or soft tissues, 
perichondritis, Ac., Ac., where the patient has no control 
over the fluid and where the spray is useful. He 
divides the medicaments into antiseptics, antispas- 
modics and narcotics, adstringentia, and resolventia. 
Of the antiseptics the best is a sublimate solution of 1 
in 2,500; next comes salicylate and boracic, 1 in 200, 
and thymol, 1 in 1,500. 

Zawsdzki baa recently been experimenting with 
insoluble powders and gargling with metbyline blue or 
washing ont the powders with simple water. His 
results were that the pharynx was never reached with a 
gargle, the tonsils sometimes, and the mouth always. 

Koplik’s bPOTS IN Mxaslks. 

Strz^bicke draws attention to the di^nostio import¬ 
ance of ** Svor" or patobee on the tongue, ot which 
Filatow first drew attention, and which recently has 
been confirmed by Koplik, whoee name they now bear. In 
the late epidemic of measles in Tula eighty-four ont of 
every 100 had well marked Koplik patches; in fifty-nine 


Kxkoval of a Tuhoub from tbs Brain.— Mr. 
Lsntbai. Chsatls operated on a woman, et. 84, who 
had been admitted under Dr. Aldren Turner. The 
patient had suffered from fits for five years; she had 
also complaiued of headache. Beoently they had in¬ 
creased in frequency and wore accompanied by left 
hemiplegia. They always began by slight twitohinga 
of the angle of the month on the left side, spreading 
from thence to the rest of the face and to the left side 
of the body, and then the convulsion became general— 
evidently a typical case of Jacksonian epilepsy. 0 ptio neu¬ 
ritis bad been lately rapidly developing. There was some 
pain on thumb pressure over the right Bolandio r^ion- 
These symptoms led Dr. Turner to believe there was a 
cerebral tumour, probably of simple nature and situated 
in the lower part of the right Bolandio r^on, and the 
following operation was undertaken for the removal of 
the growth;—A flap was turned down exposing the 
right side of the vertex of the skull by means 
of a curved incision beginning behind the external 
angular process, extending to the middle line at 
tbe top of the skull, and ending at the external 
occipital protuberance. This flap was turned 
down and then wrapped in cyanide gauze wrung out in 
1 in 2,000 warm percbloride of mercury solution. The 
pericranium was then reflected, aad a trephine inserted 
at a point where the fissure of Bolando joins the Sylvian 
fissure; a circular piece of bone was removed, and the 
trephine hole enlarged by means of bone forceps. The 
dura mater looked opsque and white towards the region 
of the frontal lobe. This appearance of tbe dura mater 
caused the operative procedures to be extended towards 
' the frontal lob^s, and necessitated turning down another 
flap of skin from the frontal region. Upon incising the 
dura mater after removing more of the frontal bone the 
underlying brain was incised and the finger inserted. 
No abuormal condition could be detected, therefore 
tbe right Bolandio region was more thoroughly ex¬ 
plored by removing more bone. These procedures 
demonstrated a tumour, the surface of which was flat, 
hard, and superficial. It had a somewhat pearl-like 
appearance, its edge being abrnptiy demarcated from the 
surrounding convolutions. It measured two inches in 
its longest diameter (which was in a longitudinal 
direction), and about one inch and a half in its widest 
diameter. The dura mater was very slightly adherent 
t) it. Upon reflection of the dors mater the encapsuled 
tumour was easily separated from the surrounding 
cerebral convolutions. lu doing this the right latera 
ventricle was opened, and cerebro-spinal fluid escaped. 
Only one arterial branch required ligature, bleeding 
from other parts being easily arrested by applying the 
blunt end of a needle at dull red heat. The opening 
juto the lateral ventricle was not sutured as the oonvo- 
Intious fell so naturally into apposition; the dura mater 
was sewn up, the skin sutured, and tbe wound dressed 



192 Ta> Mbdical Fbem 


LEADING ARTICLES. 


in the ordinary w»y. Mr. Cheatle said the enojees 
of the operation had depended entirely on the acooraoy 
of the dia^OBie originally mede by Dr. Torner. The 
first symptoms that suggested the presence of a 
tnmonr were the left hemiplegia, the optic neuritis, the 
pain on thumb pressure over right aide of the head, and 
the fits. The fact of these last beginning at the left angle 
of the mouth and then becoming general pointed to the 
tumour being in the right lower Solandio r^on. Mr. 
Cheatle remarked that the tnmonr from the slowness 
of its growth and its encapsnlatirn was probably 
benign, bnt that if it were sarcoma it was in all likeli* 
hood not of a malignant form, and he thought that the 
simple removal of the growth nithont any portion of 
the surrounding convolutions would be all that was 
necessary towards the idtimate cure of the patient. 

It is satisfactory to state that a week after operation the 
woman is doing well, all her former symptoms having 
completely disappeared. There has been no rise of 
temperature. 

CANCER HOSPITAL. 

Ihguinal Colotout fob Cabcinoua 'Rxcurbing 
AFTXB EzCI6IO^ OF BtCTOH AMD YaOIMA. — Mr. 

Cbabuxs Btall operated on a woman, set. 46, who had 
been admitted into the hospital complaining of painful 
and difficult defeecation. Two years ago she was taken 
into the ssune institution suffering from malignant dis¬ 
ease, implicating the lower rectum and the posterior 
v^nalwall: the diseased parts were then removed by 
the dorsal incision, sacrificing the coccyx; healthy 
rectnm was brought down to form the posterior vicinal 
wall, smd the new anus was placed beneath the sacrum. 
From this the patient made an excellent recovery, ttnd 
was discharged from hospital; she had kept well until 
recently. She now oomplaius of great difficulty in 
passing a motion, which is accompanied by great 
straining and much pain. Tbere is a copious and con. 
stant disobarge of muons, with considerable loes of 
flesh. On examination the anal orifice was found to be 
atenosed from cicatricial contraction, and on introducing 
the finger a lai^ new growth could be felt on the right 
aide blocking the lumen of the bowel without any 
apparent deetmetion of mucous membrane. The 
vi^ina seemed practically normal, but in the pos¬ 
terior onl-de>8ao could be felt the new growth 
which was implicating the rectnm. Colotomy was 
considered a necessity owing to the obstmotion. Bight 
inguinal colotomy was performed, the muscle fibres 
of the abdominal wall being separated and not divided. 
The sigmoid loop was drawn out, and a spur fixed in 
position by double sutures through the mesentery and 
abdominal wall, a single suture at either end of the 
wound securing the longitudinal muscu'ar band. The 
bowel was not opened at the time of operation. Mr. 
Byall remarked that tbere was no necessity to stitch 
the peritoneum all round toe incision to the bowel, as 
sfarong adhesions took place even in a few hours, and 
the bowel could be opened with perfect safety if there 
was any distension; bnt patients, he said, are generally 
able to wait for two days before this is done. At the 
end of a week the stitches would be removed and the 
spur cut off level with the skin, after which a colotomy 
plug would be worn. He said tibat the reemdesoenoe 
of the original disease was a disappointment, as the 
patient had kept well for nearly two year^ and he drew 


Ano. 21, 1901, 

attention to the posterior vaginal wall which bad been 
formed of the rectum at the first operation, sad which 
felt like a normal vaginal wall. 


BeOISTEBED fob FBAMBlIKSIOir Abboad. 

Jflcbital fwfiB anb Circnlar. 

Fubllahsd erery Wednesday morning, PrieeSd. Peat tree, 6td. 

ADYBBTISBIfBlITS. 

fOB OvB IBBBBTIOB Whole Psgs, £5 Os. Od.; Half Page, 
£a lOa. Od,; Qnarter Page, £l 6e.; One^eightli, ISs. 6d. 

Fob a Sbbucs or iHsaanoiisWhole Page, thirteen insertlona 
{ weekly, fortnightly, or monthly), at £3 10s. Od.; tweoty^ix 
insertions (weekly or fortnightly) at £S 8a. Od.; fifty-two 
inaertiona (weekly) at £S eaoh. Half Page, thirteen imwithina 
at S6a.: twenty-aix at SSa.: fifty-two inaertiona at 80a. eaeh: 
Qnarter-page, thirteen inaertiona at 18a. twenty-alz iiiSMtlmis 
at 16a.: flfty-two insertions at ISa each. 

Small annonneementa of Practices, Asaiatanoiee.Vacanc i ea, Books, 
Ao.—Seven lines or under, 4a. per insertion; 6d. par line 
beyond. 


Jdtbual PresB atib Circular. 


8ALU8 POPULI SUPRBMA LBX.*’ 


WEDNESDAY. AUGUST 21, 1901. 


SCHOOL BOARDS AND SANITATION. 

The announcement of a change in the terms of 
the appointment of the medical officer of the School 
Board of London affords a fitting opportnnitj for 
discussing the general relations that exist between 
educational bodies of that kind and sanitary admini¬ 
stration. The immediate cause of the retirement of 
Dr. W. B. Smith from the London Board is that he 
could not ^i^ee with the condition attached to a rise 
in salary, namely, that he should '* hold no other 
appointment except that now held by him as Pro¬ 
fessor at King's College.” The merits of that par¬ 
ticular demand we do not propose to discuss here, 
but content ourselves with the remark that the 
magnitude and importanoe of the interests 
involved seem sufficiently great to require the whole 
time and energies of any single officer. But apart 
from that issue there are varioiu important points 
that will repay consideratiem. The work of the 
medical officer may be divided into the care of the 
health of teachers on the one band, and of that 
of the children on the other. Candidates for 
teaching are properly required to come up to a fair 
physical standard, which is usually determined by 
the Board medical officer, who may or may not be 
required to attend the teaching staff medically dux ing 
illness. The main part of his function, however, 
is preventive, that is to say, he has to look after the 
proper construction and sanitary environment of the 
school buildings, and to adopt measures with a view 
to prevent the spread of infectious diseases. In 
approaching this subject it should be borne in mind 
that the school board system is comparatively 
modem, so that the development of any sound system 
of sanitary supervision would naturally require years 
Diuiiized by 'OO^ C 


ino. 21. 1901. 


LEADING ARTICLES. 


Thk Mbdioal Pbcss. 193 


experienoe. It is clear that the brioging together 
of itfge nambers of children, especially in the 
crowded centres of popnlation, at once mnltiplies 
greatlythe chances of propagation of communicable 
diaeases. Most public health authorities are agreed 
that the disastrous spread of diphtheria in recent 
jears has been mainly due to the aggregation of 
children in board schools. Whether that be the case 
or not, it may fairly be asked what steps have been 
taken by the London School Board to exclude 
scholars suffering from sore throat. The medical 
officer of health may be unsparing of h's energies in 
eradicating diphtheria from his district, but bis efforts 
may be checkmated by the counteracting induence 
irithin bis boundaries of certain board schools, where 
medical supervision is lax or altogethe'^ absent. 
This conflict of central and local health authorities 
is to be deprecated, as the board school is only too 
apt to fall to the ground between the two stools. 
We have always maintained that the district sani' 
tary authority should have absolute control over the 
scholars so far as infectious disease is concerned, and 
over the sanitation of school buildings. The Salva* 
tion Army night shelters were shown to be a danger 
to the public health, and only after years of legisla¬ 
tion were brought under the control of the local 
authority. The board schools of London have for a 
long time past been an acknowledged danger to 
pnblio health, bat they still remain under 
a central medical administration that apparently 
hu never quite realised its responsibilities in the way 
of guardianship of the physical welfare of the 
•cbolars. The case of ringworm abundantly illus- 
tntee that retrograde position. The disease pre- 
rails to an enormous extent in the board schools of 
Zicmdon, but we have yet to learn that any steps have 
been taken by the Medical Department of the Board 
either to era^cate or exclude the malady. There can 
be no doubt whatever that ringworm is spread to a 
degree that is well-nigh incalculable by the agency 
of the board schools. That fact can be testified to by 
all who have any experience of spemal hospitals for 
diseases of the skin or of skin departments at the 
general hospitals. So far from attempting to exclude 
children suffering from ringworm, the officers of the 
Board seek by every means in their power to bring 
pressure upon parents to send such children to 
school. A crop of prosecutions is directed weekly 
agunst those responsible for sufferers of that class. 
It is open to question whether under a carefully 
supervised medical system it would be possible for 
children suffering from this obstinate, troublesome, 
and costly complaint to attend schooL Then, 
again, there should be some systematic method 
of excludiog all doubtful cases of sore throat, to 
saj nothing of granular lids and other infectious 
disorders. On the whole, it seems likely that nothing 
short of systematic daily medical inspection would 
suffice to maintain a high preventive standard. If 
the London School Board do not see their way to 
adopt a system of that kind it is to be hoped that, 
in their readjustment of the medical side of their 


administration, they will at least take steps to 
remedy some of the grosser defects to which we 
have called attention. To maintain the wholesome- 
ness of school buildings, and to exclude as far 
as possible the invasion of communicable dis¬ 
eases, is not the least important part of the duties of 
a school board, more especially in dealing with the 
population of the richest and largest city in the 
world. 


GASTROECTASIS OF CHILDHOOD. 

Evert physician, at some time or other in bis 
practice, meets with gastroectasis in the adult. Its 
diagnosis is comparatively easy. He has the his¬ 
tory, the well-known symptoms, and his principal 
concern is the treatment. But when the disease 
occurs, as it does sometimes, in children, particularly 
in strumous ones, where the dyspeptic troubles 
are not easily traced to a state of gastroec- 
tssis, the diseas.} is likely to be overlooked. 
Few medical writers on children’s diseases 
refer to it. withal the proneness of children 
to dyspepsia from getting unwholesome food 
ehould put us on our guard and make us look for 
such. We are apt to foi^t that the disease is not 
always attended with either pain, closure of the 
pyloric orifice, or cancer. That it may occur sud¬ 
denly and cause death in a few days without giving 
rise to any of the usual symptoms of the disease, 
even in an adult, is shown by the case of Watson 
and Bright, in which the patient died on 
the eleventh day of her illness, and the cause 
of death was only rec<^nised at the examina¬ 
tion of the body, although the stomach reached to 
the pubis and had given way in several places. 
Malnutrition and nerve innervation are more power¬ 
ful factors in producing gastroectasis than pyloric 
narrowing; and snob conditions are the outcome of 
dyspepsia, particularly in city-reared children. We are 
inclined to think that the disease would be seen to be 
more often noted if the cause of death in childhood 
were more frequently verified by post-mortem exami¬ 
nation. In childhood vomiting is not so frequent as 
a symptom of the disease as it is in the adult, simply 
because the malnutrition of the muacolar walls leaves 
them incapable of throwing out its contents. When 
the effort to vomit is made it nsually eods 
in partiallr expelling the contents through the 
patulous pylorus, the child utters a faint cry and 
falls back exhausted. The belly is tympanitic, the 
tongue coated, the bowels irregular, often purged, 
the stools being liquid, with an acid, sour, foetid 
smell, and the breath according to the stage of the 
dyspepsia may give off the smell of acetone, butyric 
acid, caproic acid, or sulphiiretted hydrogen. If the 
child is stripped and placed on its back tbe epigas¬ 
trium will be seen to rise or rather be jerked for¬ 
ward, from time to time as the over - dis¬ 
tended stomach tries to empty itself into the duo¬ 
denum. The wasted little body offers no difficulties 
in the examination, and the incessant feeble cry of 
pain which soothing syrups and carminatives fail to 
DitJiiized by 



194 Thi M.D1CAL Pbum. notes ON CUKKBNT TOPICS. 


Axjo. 21. 1901. 


stop, tells bow much the child suffers. The condi¬ 
tion now rapidly runs from bad to worse, for as the 
digestiTe fiinction is more and more disordered, the 
natural stimulus of normally digested chyme is 
wanting, and the pyloric sphincter irritated by the 
decomposed stomach contents contracts; the con¬ 
tents remain bottled up in the viscus which they 
enlarge by distension, and the fungi, the germs of 
which were swallowed in the food, now finding 
a suitable menstruum for their growth, react 
injurio'isly on the mucous membrane. The 
difference between gastroectasis and dyspepsia 
is more one of degree than of quality; the condi¬ 
tions tiiat produce dyspepsia will, if persistent 
produce gastroectasis. In every case the food must 
be such as the child can digest, and the environment 
of the child must be such as promotes its general 
health, and great care must be taken to ensure a 
complete convalescence after the acute diseases of 
childhood. We find that in the recorded cases the 
history of one went back to an attack of small-poz; 
in a second case the tardy convalescence from 
typhoid fever was blamed; in a third, ansmia. 
But the most interesting of these is M. Leven's case 
(Soc. Anat.) of a child nine years old, whose stomach 
reached to the pelvis and seemed to occupy the whole 
belly; the child was tuberculous, got an attack of 
pleurisy, from which she died, and the post-mortem 
examination revealed the gastroectasis, which bad 
been unsuspected for years. Two things conspired 
to produce the disease in this case, to wit, the 
aniemia, and marasmus of the tuberculosis, and the 
mechanical pressure of the swollen lymphatic glands 
which surrounded the pylorus, and were found in the 
course of the gastro-duodenal artery and the hepatic. 
To increase the difficulty of diagnosis the disease may 
beclosely simulated by congenital stenosis of portions 
of the alimentary canal as Brinton taught at the 
beginning of the Nineteenth Century. The lesion 
usually manifests itself soon after the child com¬ 
mences to get solid food —when it may be mistaken 
for intussusception or hernia. In a recent case the 
little patient, a girl two yeara old, had the principal 
symptoms of gastroectasis, and yet the post-mortem 
examination revealed a congenital narrowing of the 
ileum near its middle, and enormous distension of 
the jejunum and upper half of the ileum. 


on Current Copies. 

The Eyelid Symptoms in Exophthalmic 
Qoitre. 

Thebe are two peculiarities of the movements 
of the eyelids met with in connection with Graves’ 
disease to which more or less diagnostic importance 
is attached. Under ordinary circumstances the 
upper eyelid follows the movement of the globe 
when this is turned downwards, but in the subjects 
of this disease the eyelid lags behind or descends 
by jerks. This is known as Von Graefe's sign. It 
is to be noted that the upward movement of the lid 
does not usually present any peculiarity. Stellwag's 


sign, first described by him in 1869, though it had 
previously he noticed hy White-Cooperand Dalrymple. 
consists in a retraction of the lids, thus increasing the 
dimensions of the palpebral fissure through which the 
sclerotic may be visible all around the sclero-comeal 
margin. This retraction is most marked in the 
upper lid, though the lower lid also participates in 
the process. Both these signs exist quite indepen¬ 
dently of the exophthalmos, indeed they tend to 
become less marked in proportion as the proptoeis 
becomes more evident. It must be noted also that 
even in cases of extreme retraction the I'ds, in the 
absence of a mechanical obstacle due to the promi¬ 
nence of the globes, can always be closed by a 
voluntary effort, only the unconscious movements 
being thus affected. It is difficult to estimate the 
diagnostic value of these eyelid symptoms in the 
absence of trustworthy statistics as to their fre* 
quency and duration. When present they are 
probably very significant of the malady, but their 
absence by no means negatives its existence. 
The origin of these signs is as yet imperfectly under¬ 
stood, bnt they have been attributed to changes in 
the oculomotor nuclei, a view which is supported by 
the comparative frequency in exophthalmic goitre of 
paresis of the external ocular muscles, especially of 
the internal recti. 

Mirror Writing. 

The so-called mirror writing is the normal spon¬ 
taneous effort to write with the left hand cf a person 
accustomed to write with the right hand. This 
tendency applies equally to all movements acquired 
by the right hand. Without any special education 
the left hand reflects as in a mirror the gesture of 
its right fellow, so that we are driven to the conclu¬ 
sion that there has been a process of unconscious 
education of the left extremity pari passu with that 
of the right member, in other words that the train¬ 
ing of the centre for the right hand has been reflected 
en miroir on the cortical centre for the other limb. 
It has been suggested that this fact should be 
turned to account in the case of persons who are 
deprived of the use of the right hand by encouraging 
them to adopt the plan of mirror writing with the 
left^and in preference to the tedious acquisition of 
the ability to simulate right-handed writing. It is 
asserted, moreover, that this tiaining has for effect 
to favour the functional reintegratiun of the damaged 
centre on the other side. It is interesting to note 
that the readiness with which persons write en. 
miroir with the loft hand is in direct proportion to 
the extent to which they have trained the right hand. 
Persons of defective education, in whom the tracing 
of each letter entails a distinct effort of the will, are 
incapable of writing with the left hand, even en 
miroir, whereas those accustomed to write with 
fluency adopt this alternative with comparative ease. 

A NUMBER of children were poisoned at Bukin- 
field last week from eating laburnum seeds, but tbe 
prompt administration of emetics proved successful 
in averting a fatal resulLT 

Ui'. iizeo O ^ 



Apq. 21, 1901. 


NOTES ON GUaBENT TOPIOS. 'ru Msdioal PaHS. 195 


What are the Marks of a Bite? 

Thi question of bow a wound has been inflicted is 
often a crncial point in medico-legal cases. The 
nstare of the injniy often affords satisfactory evi¬ 
dence as to ttie way in which it has been caused, as, 
for instance, when grains of powder are embedded 
around the entry-perforation of a bullet. At a 
glance it is possible, as a rule, to say whether or not 
the damage has been caused by a bite. The double 
semi-circular row of lacerations may be aptly com¬ 
pared to the indented marks left by an attempted 
bite from a bard, grren apple. That there are 
foUacies about circumstantial evidence of the kind, 
however, is made abundantly clear by a recent police- 
court case in London. Two medical men attached to 
1 general hospital testified that the injuries sustained 
bj a woman were due to a bite. The chief point 
wis the indented wounds were on both the back and 
the palm of the band, and could have been caused 
^7 pressure on both surfaces alike. Had the 
wounds been caused by a blow with a jagged instru- 
nieut, or a stick studded with spikes or nails, only 
(me surface would have been indented. On the other 
side a medi<^ man swore positively that the wound 
was not dne to a bite. While he admitted that the 
(Darks were something like teeth-marks in their 
grouping, yet from their position the teeth could 
not have cansed them unless the assailant had the 
whole hand in his mouth, because of the position of 
the convexity of the arc. Moreover, the two series 
of marks did not correspond. No answer to these 
objections was forthcoming from the first-mentioned 
witnesses, and the magistiate came to the conclu¬ 
sion that an assault bad been committed, without 
passing an opinion upon the conflicting medical 
testimony. 

The College of Safe Medicine. 

The attention of the Apothecaries’ Society may 
be called to a certain J. C. Purdue, who figured last 
week at a Limehouse inquest. A baby taken to and 
treated b; that person subsequently died of pneu¬ 
monia. Tbe bottle of medicine given to deceased was 
labelled “ J. C. Purdue.F.C.S.M., London. Safe Medi¬ 
cine. Member of tbo Magnetic and Botanic Scb(x>l 
of Safe Medicine, London. Founded 1893. Advice 
gratis drily.” In answer to the coroner, Mr. Wynne 
Baxter, Purdue stated that be was a " registered 
herbalist,” and he explained that he made that state¬ 
ment on the strength of his name appearing in ” Kelli’s 
Director;.” From bis own admission it appears that 
he has been carrying on his nefarious occupation 
in the same neighbourhood during the past ten 
jesrs, and has figured in no less than five inquests. 
With such a record of public experience it is 
nothing short of a social scsandal that piratical prac¬ 
tices of this kind should be permitted to continue 

after year. In the course of his evidence 
Pnrduo allnded several times to a Dr. Meadows, 
and when questioned as to why he did so replied 
that if anyone took a child to that gentleman and 
■rid he had been to Purdue he would say ” If he 


(^an’t do you any good, I can’t.” We should be- 
lotb to believe that any duly qualified practitioner of' 
medicine countenanced in any way quackery so dis¬ 
graceful as that of tbe College of Safe Medicine. 
We prefer to think that the bringing in of the 
medical man’s name was simply a part of the tissue- 
of chicmnery and bluff that form the stock in trade- 
of men of Purdue’s stamp. 


Holiday Funds and Sick Children. 

A SERIOUS defect in the working administration of 
a country holiday fund was disclosed last week in a 
London inquest. From tbe evidence it appears that 
a boy was sent home from a village in Huntingdon¬ 
shire practically in a dying condition. On the 
journey he was unable to speak, and the railway 
guard gave him water several times. He was suffer¬ 
ing from peritonitis, and subsequently died while^ 
undergoing an operation at hospital. Tbe woman 
under whose care he bad been placed stated that he- 
had been ill for three days, and she sat up with him 
the night before bis depai-ture for London. She 
had not called in medieval assistance, and bad 
received no instructions as to what she should 
do in case of illness. Tbe secretary of the- 
socie^ produced a copy of rules, one of which pro¬ 
vided that if a child fell ill the country visitor 
should be informed at once. In this particular case- 
he knew nothing of the woman with whom the boy 
bad been lodged, as bis dealings were with a woman 
of another name. This evidence points to laxity in 
an important matter affecting the safety of the 
children committed to tbe care of the Fund. The 
movement which affords town children a few days’ 
holiday in the country is so altogether admirable 
that it would be a great pity were its usefulness 
curtailed by an oversight which appears to be one of 
administration rather than of organisation. 


Adrenal Therapeutica. 

The employment of adrenal extract bids fair to 
become a very important therapeutical departure. 
Experience has shown that the gland is possessed of 
very active physiological properties as a cardiac 
stimulant, and hsmostatic and contemporaneous 
medicml literature affords ample evidence of its value- 
in various directions. We alluded some weeks since- 
to the possibility of remedying the non-(M3agulability 
of tbe blood wbich is the characteristic feature of 
tbe condition known as hsemopbilia by the adminis¬ 
tration of the extract, and it has been successfully 
employed to combat uterine hsemorrbage. Its effi¬ 
cacy in arrestiog epistaxis is really remarkable, andl 
for this purpose it is best applied on a swab or by 
means of a spray. It has been stated to have a 
marked effect in promoting uterine contraction, but 
this apparently does not obtain when given in thera¬ 
peutical doses, for a case was recently published in 
which the extract was given to a pregnant woman 
to check bleeding from the nose and gnms without 
any undesirable effect on gestation which went to 
full term, although some five ounces of tbe solution 

Diuiiized by ' . i ooge 



NOTES ON CURRENT TOPICS. 


Auo. 21, 1901. 


196 Th« M«pica.l Pb«m. 

of adrenal was given during the last three weeks of 
pregnancy. 

Medical Research in Ireland. 

The question of medical research has been brought 
actively before Parliament during the last week of 
the Session, and in one direction with a most satis¬ 
factory result. On August 8th, Mr. William John¬ 
ston asked the Chief Secretary to the Lord-Lieutenant 
of Ireland whether, having regard to his reply to the 
■deputation which waited on him in Dublin concerning 
a proposal to establish a pathological laboratory 
devoted to research in connection with insanity for 
the asylums of the'coimtry, he could introduce a 
clause into the Local Government (Ireland) Amend¬ 
ment Bill empowering county councils to contribute 
towards the support of such a central laboratory for 
the study of mental pathology. Mr. Wyndham re¬ 
plied : “ Such a clause could not be inserted in the 
Local Government Act Amending Bill, but it would 
be germane to the Lunacy Bill now before the House. 
I earnestly hope to be able to introduce an amend¬ 
ment of this character into the latter Bill.” 
It is most satisfactory to be able to record that on 
August 14th, on the motion of Mr. Wyndham, the 
following clause was inserted in the Lunacy (Ire¬ 
land) Bill, viz:—“ The committees for any two or 
more disdnct asylums may agree to unite in provid¬ 
ing and maintaining a laboratory for pathological 
research in connection with insanity and nervous 
diseases, and may defray the expenses incurred in 
pursuance of an agreement under this section by 
eontributions from the funds at their disposal for 
fhe maintenance of the respective asylums.” The 
fact that this clause was inserted in the bill without 
nny opposition, shows that it is probable that advan¬ 
tage will be taken of it; indeed, we understand that 
many County Councils have been deterred in the 
past from devoting a portion of their funds to such 
an object solely by the fact that it was not in their 
legal powers to do so. We trust, however, that 
before any two or three asylums rush into a scheme 
for starting a conjoint laboratory, they will first unite 
with the other asylums in discussing the possibility 
and advantages of a grand central laboratory for the 
whole of Ireland. 


Typhoid Fever in Belfast. 

The recently published minutes of the Public 
Health Committee of Belfast gave a serious picture 
•of the extent and lethal character of the present 
epidemic of typhoid in that city. The Medical 
Officer of Health, Dr. Whitaker, tells in plain figures 
the gi'owth of the epidemic which is very alarming. 
During the past month 306 cases of typhoid fever 
were notified, and the disease from being localised 
has come to prevail all over the city. Two 
things appear to account for the epidemic: 
the bad water supply and the deficient sewage 
a,rrangements for this rapidly growing and 
great city. The inhabitants are now fully alive to 
the evil, and with commendable energy the Public 


Health Committee are taking steps to remedy tiie 
faulty sanitation, and get a pure water supply. And 
notone minute too soon, for it is an opprobrium to 
find that 167 deaths from such a preventive disease 
as typhoid fever took place there during last month. 
It is a difficult matter to ensure efficient sanitary 
arrangements in the large number of artisans' dwell¬ 
ings that the city contains, and to not unduly inter¬ 
fere with the necessary growth of such houses which 
the ever-increasing population of the city demands. 
A new water supply bus now become a necessity, 
and altogether the condition is one calling for imme¬ 
diate treatment by some well considered scheme of 
sanitation. The citizens will have to face a heavy 
outlay. Belfast can be made a healthy city, as 
Hamburg has been made, and we have every con¬ 
fidence that the public spirit of its citizens will be 
found equal to the task. 

The Late Small-pox Epidemic in Glasgow. 

Glasgow has now a clean bill of health so far as 
smaL-pox is concerced, the last two cases of that 
disease having been dismissed from Belvidere Hos¬ 
pital a week ago. Tbe total number of cases has been 
1,850, and of these 230 proved fatal. In connection 
with the late epidemic a nseful object lesson bas 
been taught the citizens of that large commercial 
city, as well as all other large centres of popolation, 
of the efficacy of re-vaccination in stamping out a 
loathsome and fatal disease. Free vaccination still 
obtains in Glasgow, and should be so in all large 
cities whether small-pox does or does not prevail. 
Dr. Chalmers, the Medical Officer of Health, is 
expected to issue a special report on the late epidemic 
which will be of a very interesting and instructive 
character. The accounts for re-vaccination have 
just been paid by tbe Corporation. In one instance 
a medical man received a cheque for over £300. 
Several accounts were over £200, and a number were 
over £100. The total cost has been considerable, 
but it is generally conceded that the money has 
been advantageously spent. 

Government Grants for Scientific 
Investigation. 

In the House of Commons last week, Mr. Field 
asked tbe Chief Secretary for Ireland (1) whether he 
was aware that the Eoglish Local Government Board 
had at its disposal a yearly grant of funds for the 
purpose of promoting scientific investigation; and 
(2) seeing that the Irish Local Government Board 
had not at its disposal any sum for a similar purpose, 
would he recommend the placing of tbe Irish Local 
Government Board in this respect on the same foot- 
j ing as tbe>imilar Board in England P Mr. Wyndham 
I replied that the vote for the Enelisb Local Govern¬ 
ment Board contained provision of a sum of money 
for " auxiliary scientific investigations” in connection 
with the medical department of the Board. He was 
at the time inquiring as to the special objects with 
which this money is voted; nntil be received 
information on this point be was unable to 

DitJiiized by' -vH C 


Aue. 21. 1901. 


NOTES ON CuARENT TOPICS. Thi Msdical Pbbbs. 197 

replj to the saggestion in the second paragraph, clouding uf the lens, or whether it would require the 
We fancy that many boards of guardians would like presence of a purulent disease of the adjacent carities. 
to determine at the expense of the State what mini* The formation of cataract in such cases would bsTe to 
mum amount of food per diem it is possible for a be looked upon as being due to infection, or in some 
Poor-law medical oificer to live upon, with the object cases it would appear necessary that there should 
of thus reaching the irreducible minimum of salary exist in addition some acute febrile trouble iuTaria- 


for the post. But apart from such purely philan¬ 
thropic inquiries there are many useful problems to 
the solTing of which money at the disposal of the 
Local Government Board could be devoted. En 
passant, if the English Local Gk>Temment Board has 
a yearly grant at its disposal, would it not be spent 
very suitably in solving the question of the relation¬ 
ship of bovine and human tuberculosis ? 

Sea-Sicknees and its Prevention. 

Thb question of sea-sickness will weigh heavily 
upon the mind of many a traveller during the present 
holiday season. This is the age of exhibitions, so we 
are often told, but surely there was never a more 
curious excuse for an “ Exposition ’’ than that of sea¬ 
sickness preventives, to be held next month at 
Ostend. The number of drugs vaunted for the pre¬ 
vention and the cure of that malady are legion, but 
for all that the surgeon on board ship still lacks a 
specific for his distressed patients, although he may 
afford a little relief here and there by carefully- 
selected remedies. Of mechanical cures there have 
been not a few launched by ingenious inventors upon 
this troubled sea of mal de mer, but the sea-sickness 
still continues in unabated flood. It is somewhat 
strange that the real inwardness of this familiar and 
distressing stomachic upheaval still remains one of 
the unravelled mysteries of the medical world. 
Perhaps the most plausible theory of causation is 
that which attributes it to the disturbance of the 
localising and balancing function exercised by the 
delicate semicircular canals of the inner ear. In the 
name of sea-sick humanity we wish hearty success to 
the Ostend Exhibition. 

The Connection of Nasal Disease with 
Cataract. 

Thb importance of nasal diseases with regard to 
cataract is a subject which has up till now only 
been slightly touched upon. Professor Zieni, of 
Bantzig, says in the August number of the Journal of 
Laryngology, Bkinology, and Otology that it may be 
assumed that by correct treatment of disease of the 
nose, not so much by bloodless galvano-cauterisa- 
tion, especially of the middle turbinal, but by the 
witiidrawai of blood from the nose, by the removal 
attended with loss of blood, of obstructive swellings 
or polypi, by syringing of the nose, by counter-irrita¬ 
tions in the post-auricular space, and last but not least 
by the removal of febrile processes, the further 
development of cataract will straightway be pre¬ 
vented. Granting the assumption that the develop¬ 
ment of a cataract can be brought about by 
obstructed purulent disease of the nose as by other 
foctors such as diabetes, &c., it would have to be 
farther established whether the obstruction in the 
nose by itself would be able to accomplish the 


bly connected with diseases of the nose, notably, 
for example, influenza. A striking illustration of 
the possible significance of febrile diseases in the 
etiology of cataract is to be found in the frequency 
of opacities of the crystalline lens in countries 
where febrile infectious diseases are of an endemic 
character, such a tract of marshy woodland for 
instance, as the Sunderbunds,” and also the district 
of Galicia. Much, no doubt, could be written on 
this theme, and perhaps, in the course of time, we 
shall live to see *'Ophthalmology” added to the 
sonorous title of Journal of Laryngology, Rbino- 
ogy, and Otology. 

Summer Diarrhosa. 

In many parts of the United Kingdom the scourge 
of summer diarrhoea is playing havoc among the 
infantile town population. In Manchester, for 
instance, last week's returns gave no less than 115 
deaths from that malady out of a total of 316 deaths 
from all causes, aud of the 115 diarrhoea deaths 95 
took place under twelve months of age. In the same 
town the mortality from the epidemic in question 
reached 192 in the previous week. At the neighbour¬ 
ing township of Salford the returns for last week 
showed fifty deaths due to summer diarrhosa. 
Urmston, a residential suburb in the neighbourhood, 
presented a striking, not to say a startling, contrast, 
by having no deaths at all, either from diarrhoea or 
any other cause. As things stand at present the 
recurrent prevalence of epidemic diarrhcsa is one of 
the gravest problems that demand the attention of 
public health administrators. Much has been learnt 
as to the bacteriology of town environment and also 
of the disease itself as it affects the human alimen¬ 
tary canal. For all that an immense field of research 
remains comparatively unexplored in the domain of 
comparative pathology. It seems likely that the 
key to the position lies in the direction indicated in 
the Milroy Lectures of 1899, namely, in the relation 
of town dust charged with bowel bacteria of the 
horse to the specific contamination of air, food, and 
dwellings. 

Ankylostoma Embryos. 

In 1898 the fact was published by Dr. Looss that 
ankylostoma embryos can enter the skin of the 
human being, chiefly by the hair follicles. Dr. Looss 
happened on this discovery quite by accident. While 
engaged at laboratoiy work at the Cairo Medical 
School a di-op of pure culture of ankylostoma embryos 
fell on to bis hand. He examined the drop a 
few minutes later, and to his surprise be dis¬ 
covered numerous empty sheaths of embryos, 
the embryos having evidently penetrated the 
skin. The effect was to cause an inflamma¬ 
tion at the spot where the embiyos entered. 
Digitized bv 



198 Ths Msdioal Fbbss. N^OTBS 01^ OUaBBNT TOPICS. Auo. SI. 1901. 


ollowed bj ankyloatoma infeobion, as sbown bj tbe 
faeces, with tbe usoal symptoms of intense anaemia 
and extreme debility. Subsequent obsenration de< 
monstrated the fact that the embryos enter the skin 
by the hair follicles and push their way towards the 
hair papillae, at which spot they pierce the surround¬ 
ing tissue of tbe true skin. These riews were 
received with hostile criticism in 1898, but Professor 
-Sandwitb, of Cairo, brought the matter up again 
at the last meeting of tbe British Medical 
Association, and remarked on tbe importance 
of tbe discovery in relation to other parasitic 
diseases. He was supported by Col. Giles, who, how¬ 
ever, drew attention to tbe difficulty of explaining 
the method of infecting the intestine by embryos 
introduced through the hair follicles. Dr. Patrick 
Manson discussed the matter impartially, and sug¬ 
gested as an efficient test that the experiments 
should be repeated in a country where the chance of 
previous infection was practicaDy impossible. Dr. 
Manson’s opinion that tbe embryo sought tbe hair 
follicle simply for the purposes of shelter will not, 
we think, find universal acceptance. 

Dysentery in Asylums for the Insane. 

In a lecture recently delivered by Dr. Washboum 
at Guy’s Hospital on the subject of dysentery, he re¬ 
ferred incidentally to the points of relationship 
between the dysentery of camps and that which 
occurs in epidemic form among the insane confined 
in asylums. This serious matter of dysentery in tbe 
asylums for tbe insane under the London County 
Council has been most exhaustively dealt with 
by Drs. Mott and Durham in their report 
presented to the Asylums Committee. Tbe 
report shows that there was distinct evidence of 
spread of infection from bed to bed owing to the 
dirty habits of the patients, tbe imperfect arrange¬ 
ments as to personal cleanliness of patients and 
cleansing and disinfecting of their bedding, and the 
serious overcrowding of the dormitories. From the 
description given there can be little doubt that 
this asylum dysentery is identical with the camp . 
dysentery of the South African campaign; there 
is the same type of fever and similar sym¬ 
ptoms. Moreover, according to Dr. Washboum, 
the post-mortem appearances are identical with 
this exception—that acute cases sometimes die 
before ulceration has occurred, a condition which 
he had not observed in South Africa. It has been 
held that the cases described by Dr. Hale White 
under the names of simple colitis and ulcerative 
colitis were really sporadic cases of the dysentery 
reported on by Drs. Mott and Durham to the 
Asylums Committee of the London County Council 
The conclusions to be drawn seem absolutely clear, 
that this disease is ascribable to insanitary condi¬ 
tions, that it is infective, and that it can be pre¬ 
vented to a certain extent at the war, and to a very 
large extent indeed in institutions where we have a 
right to expect that tbe greatest care should be 
exercised to protect the helpless inmates against 


infective maladies arising from overcrowding and 
dirt. 

Operation under Accidental Hypnosis. 

Though operations on patients under hypnotic in¬ 
fluence is no new thing, it certainly has not happened 
to many medical men to repair a vesico-v^inal fis¬ 
tula with tbe patient under complete ansesthesia 
obtained accidentally and without premeditation- 
Tbe facts are given in tbe St. Pavl Medical Journal 
for May, and it is explained that the patient was of a 
yielding nature, and implicitly obeyed any iostmc- 
tions. The parts in the neighbourhood of the field of 
operation were infiltrated with a 2 per cent, solution 
of cocaine, and the woman was told she would have 
no pain and must keep absolutely quiet. She 
obeyed so thoroughly that it was quite forgotten for 
some time that the operation was being conducted 
without a general ansesthetic. In the course of the 
proceeding the practitioner had occasion to make 
some remark to the patient, when it was noticed 
she made no answer; she was on examination found 
to be sleeping soundly, with normal colour, pulse, 
and respiration. On being awakened she complained 
of feeling sleepy, and sank back into a sound slumber 
on a few passes being made over her face. She sud¬ 
denly woke as the last suture was inserted, and left 
the consulting-room after tbe operation still com¬ 
plaining of sleepiness. 

The Forerunners of Tuberculosis in 
Synovial Sacs. 

The examination of a number of tuberculous 
joints reveals a considerable thickening of the walls 
of the vessels of the synovial membranes. This, 
however, is only apparent, for the thickening is 
really the result of diapedesis o! white cells fol¬ 
lowed by a deposit of fibres and organisation of con¬ 
nective tissue forming a sheath round the vessel. 
This sheath enclasping tbe walls of the vessels re¬ 
duces their elasticity and affords an explanation of 
tbe tendency to bleed that characterises tuberculous 
synovial membranes. Dr. Dieterichs, who describes 
methods of investigation in Vratch, believes that the 
circulatory disturbance and the formation of tbe 
connective tissue sheaths are the forerunners of 
tuberculosis in these tissues. 

Disseinination of Disease by the Secre¬ 
tions of the Mouth and Respiratory 
Tract. 

In the coughing of phthisical patients, even in 
hospitals where every possible attention is given to 
hygienic matters—ventilation, light, and the proper 
disinfection of sputum—we may possibly find an 
explanation of the fact that patients in the early 
stages of the disease often do so badly. By an 
ingenious mask {Neto Tor1t Medical Journal, July 
27tb, 1901) holding a microscopic slide in front 
of tbe mouth evidence has been collected to show 
that the secretions of the mouth and respiratoiy 
bact are atomised aud given off in the form 
of s rav in both health land disease. There can 

Diuiii^ed by - ' lC_ 



Adq. 21, l9ol._ NOTKb ON CURRByT TOPTOS. Th* Midical Pbsbs. 199 


be no objection raised to tbe conclnsion that diseases 
affecting tbe month and respiratory tract are spread 
in this manner, as for example diphtheria, scarlet 
fever, and pertnssis. Proof is thus afforded of one 
means by which clothing on which a patient has 
coughed may serve to convey disease from honse to 
bouse, and of the danger of infection to man from 
the salivary spray of horses, cows, dogs, and cats 
snffering from certain maladies. 

Alleged Hospitcd Neglect. 

A cOBOKxa’s jury last week passed a censure upon 
the authorities of St. Thomas's Hospital The facts of 
the case, as disclosed at an inquest in the City of 
liondon Court, showed that a woman of 49 was ad¬ 
mitted to the hospital after taking a pennyworth of 
salts of lemon. She was discharged from St. Thomas’s 
a week later, and removed in the cnstody of the police 
to tbe Sonthwark Police Court, whence she was re¬ 
manded to Holloway Gaol. On arrival at the prison 
she was immediately removed to the infirmary, 
where she died three days later. Medical evidence 
showed death to be dne to acute broncho-pneumonia 
and Bright’s disease. There can be little doubt that 
most unfortunately tbe woman was sent from tbe 
hospital in an unfit condition. From one report we 
gather that the patient was discharged by the house 
physician without a proper physical examination, and 
that tbe urine was untested during the whole stay at 
St Thomas’s. It is to be hoped that the authorities 
will take steps to prevent the recurrence of such an 
untoward affair in future. The duties of a house phy¬ 
sician are harassing and responsible in tbe extreme, 
and it would be preferable to leave the dischai^ of 
patients to the care of tbe police to a medical officer 
with more leisure and experience at his command. 

The Toxicity of Camphor. 

Cakphob lis such a popular drug that its com¬ 
parative toxicity is very apt to be lost sight of. 
That it is a poison is proved by the death 
of a child at Huddersfield after swallowing two 
drachms of camphorated oil, equal to about thirty | 
grains of the drug. Dr. Murrell, in his admirable 
little work, “ What to Do in Cases of Poisoning,’* 
states that though camphor often gives rise to 
alarming symptoms, it rarely proves fatal. The 
lethal effects are apparently somewhat uncertain, 
this being due no doubt to its slight solubility, which 
gives time for tbe adoption of remedial measures. 

Testevin’s Sign. 

Th* diagnostic sign which is generally known by 
the name of Testevin has been lately the subject of 
patient investigation by Modena, of Pavia, wbo has 
lately published the record of his observations. Tbe 
sign of Testevin is sought for in urine in tbe 
following manner:—After removing any albumin, 
if present, a specimen of the child’s urine is 
slightly acidified, some ether is added, and 
the mixture well shaken. In a more or less short 
period of time a small pellet described as having 
the appearance of collodion is found to float on the 


surface of the fluid. It is stated that tbe substance 
varies in regard to thickness, consistence, and adhe¬ 
siveness. It is accepted by many as a characterisdo 
sign of infection during the incubation of acute and 
chronic infectious diseaf es, and the more pronounced 
is this peculiar reaction the greater is supposed to be 
the severity of the infection. Modena has found it in 
cases of infectious diseases, but does not consider that 
it is of any value from the point of view of diagnosis 
or prognosis. 

A Mixed Metaphor. 

A WBiTEB in the Homing Leader in the course of 
an eloquent article upon tbe war, made use of some 
dental metaphors which show considerable confusion 
as to the scope and meaning of certain operations 
connected with dental sui^ry. “ Some day,” he 
says, “ we suppose truth will out, but it is a very 
tedious process, extracted like the filling of a double 
tooth under the shadow of persistent criticism, and 
even then one cannot he sure that the whole is in the 
gnp of the pincers.” Filling and extraction, it may 
be pointed out, are two entirely different processes* 
and both are carried out undsr the fullest light 
obtainable. In the writer’s mind, however, the 
dental profession is probably associated with the 
grip of the forceps to an extent over and above 
every other aspect of that learned craft. 

Amyloid Disease in Horses TtriTnnniH*^^ 

against Diphtheria. 

EzPBBiMENTAii study of amyloid degeneration 
found in horses during the process of immunisation 
shows a diffuse visceral amyloid degeneration, espe¬ 
cially of the liver, with hepatic and intraperitoneal 
hremorrhages due to rupture of the liver and fatty 
degeneration of parenchymatous organs. In the 
opinion of the investigator, Dr. Zenoni, the horse 
should be carefully watched for the development of 
symptoms of amyloid disease, which are shown 
clinically by exhaustion, want of appetite, loss of 
flesh, and rapidly increasing anssmia. Unless the 
injections of toxin are suspended forthwith the 
animal becomes jaundiced, fever supervenes, prostra¬ 
tion becomes marked, and finally collapse is followed 
by death. 

Hooh versm Alimentary Tuberculosis. 

Thebe is satisfactory evidence, not only in this 
but also in most other countries, that the precau¬ 
tions at present in force to prevent tbe sale of the 
flesh and milk of tuberculous animals are not to be 
abandoned in deference to Professor Hoch’s recent 
utterances; indeed, the manner in which these views 
were brought forward has given rise in more than 
one influential quarter to the expression of very 
strong opinions. We note with satisfaction that 
the gieat dairy companies will continue their efforts 
to secure the freedom from disease-producing 
organisms of their milk, and we may take it for 
granted that local sanitary authorities will not fail 
to apply the powers vested in them with the same 
object in view. 

Digitized by Google 


COBBBSPONDENCE. 


Auo. 21. 1901. 


200 Tm M«DicAL PB»ae . 

The Sterilisation of Milk. 

Feabs have been expressed lest farmers and dmry- 
men should become careless in view of the facilities 
for preserving milk afforded by the process of steri¬ 
lisation. Although this fear is hardly likely to be 
realised it cannot be too strongly impressed on pro¬ 
ducers and consumers alike that boiling does not 
confer upon stale milk the dietetic properties of 
fresh milk. True it kilts all living organisms, but it 
does not rid the milk of the products of bacterial 
activity to which many of the ill-effects of stale milk 
on the young are due. A milk which has been 
boiled at a stage of bacterial activity is very apt to 
set up acute gastro-intestinal disturbance, and is 
from every point of view an undesirable article of 
food. To be of value the process of sterilisation 
must be carried out very soon after the milk is 
withdrawn, and thenceforth special precautions are 
necessary to prevent its becoming contaminated from 
the outside. 


The Growth of the Hair ia the Insane. 

A Fbeitch alienist has remarked by a comparison 
of the growth of the hair in normal and insane 
women that the growth of the hair is much more 
pronounced in the latter than in the former, and the 
phenomenon is specially well marked in the victims 
of senile dementia and general paralysis. He even 
goes so far as to i*egard a profuse growth of hair as 
an indication of physical degeneration, due, in all 
probility, to functional disturbance of the thyroid 
gland or the ovary. 

The Sanitary Institute. 

The next Cong^ss and Exhibition of the Institute 
will be held in the city of Manchester in the second 
week of September, 1902, under the presidency of the 
Bight. Hon. the Earl Egerton of Tatton. 

The little town of Baunds, in Northamptonshire, 
is suffering from a serious outbreak of typhoid fever. 
The Medical Officer reports that seventy-five cases 
of typhoid have occurred in a fortnight, most 
of them being of a very serious character, and trace¬ 
able to a well supplying 200 families, which had been 
polluted by storm water. 

PERSONAL. 

Db. Bobbbt Wxlsh BaANTawAiT* has been appointed 
Inspector of State Inebriate Bef ormatories, a post which 
is likely to be more or lees a sinecure for some years to 
come, judging from the progress accomplished so far in 
providing these much-needed retreats. 

Dr. Edmukd Gwtns has been presented with a pair 
of silver candelabra and a silver bowl by the medical 
practitioners of Hampstead, on the occasion of his re¬ 
tirement from the post of Medical Officership of Health. 
The presentation was made by Dr. Ford Anderson. Dr. 
Gwynn was also presented with a set of four silver 
bowls by Professor Stokes on behalf of his colleagues on 
the Hampstead Borongb ConnoU. 


Camb., was elected Assistant Medical Officer to the Port 
of Liverpool on the Ist inst. by the port sanitary 
aothority. Dr. Hanna studied at Glasgow, Cambridge, 
and Berlin. These studies were supplemented by an 
experience of three years on plague dnty in India, and 
in the investigation of tropical diseases at the Govern¬ 
ment Research Laboratory, Bombay. 

Db. W. Tatlob, Chief of the Army Medical Depart¬ 
ment in India, who bM now been appointed to the 
headquarters of the Royal Army Medical Department in 
London, will not take over the duties for some six weeks- 
Surgeon-General Taylor, directiy he joins the Head¬ 
quarters Staff at Victoria Street, will be chiefly engaged 
in carrying out the fnitber reorganisation of the 
R.A.M.C. 

A OBBAT ovation was accorded on Friday night at 
Manchester, when thirty men of the Manchester Volnn- 
leer Medical Staff Corps returned to the city from the 
seat of war in South Africa, after an absence of twenty 
months. The crowd was so great and the enthusiasm 
BO demonstrative that they had the greatest difficulty in 
reaching headquarters, where the officer ommanding 
the corps (Surgeon-Colonel Coates) subsequently ad¬ 
dressed a few words of welcome to them. 

Db. Paul Gabnault, of Paris, has suddenly lei^rt 
into world-wide fame by his offer to teet upon himself 
Dr. Koch's theory of the non-transmisBion of bovine 
tnberonlosis to human beings. He has written 
to the German Professor offering to undergo inocnla- 
tion with bovine tuberculous material. Dr. Gar- 
nault states that he ia forty-one years of age. that 
he weighs over 100 kilograms, that his height is I'd! 
metres, that his health is perfect, and that he has no 
children. 


(Kfftrwponbcnce. 


[We do not hold onraelveateeponsible for the opinions onz 
oorreapondents.] 

THE DIFFICULTY OF DIAGNOSIS IN 
INFECTIOUS DISEASES. 

To the Editor of The Medical Fbbbb and Cibculab. 

Sib,— The highly speculative conditions to which 
medical men ate exposed in the diagnosis of disease 
subject to notiflcation, and the responsibility, both 
moral and legal, thereby incnrred, render the qnesti<m 
of more or lees considerable moment. The difficult is 
no doubt intensified among tboee practitioners wboee 
lot has oast them among a nest of the less opnlrat 
classes whose circomstanoea are such that nothing 
save dire necessity or anxiety prompts them to 
seek medical advice until the appearances may 
seem to them to indicate gravity. Hence in many 
of these oases the landmarks to diagnosis in any rash, 
&c., which may or may not have app»red, have become 
and the practitioner is often driven to the 
wildest conjecture as to the original nature of the 
disease. Taking the law, however, as we find it there 
can be no doubt as to the advisability of granting con¬ 
siderable latitude towards medical practitioners in their 
discretionary ability and onerons duties with r^ard to 
notification. I have heard it stated, and this on 
authority too, that medical men in &e pr^ent day 
notify rashly, and the officials, therefore, should act with 
extreme caution before applying any oppressive 
measures in attempting to uphold the law in the event 
j of any supposed breach, otherwise ttie procedure would 


Diuiiized by 


Google 


Db. William Hanna, M.A., M.B., R.U.I., D.P.H. 



Awe. 21,1901. 


CORRESPONDENCE. 


Thx Midical Pb> 88. 20l 


tend to stimnlate timid members of the profession to 
carry on notification to an extreme degree which, as 1 
bare jost stated, has already been suggested on 
antbority. 

Betnming to the point concerning the diffion'ty of 
notification I may mention a few cases within my own 
knowledge. On one occasion a domestic servant whom 
I attended came to the honse on the day following, and 
appeared to be suffering from chicken-pox. Although 
the case as I thought was anything but typical, never- 
tfa^ess it flashed across me that it might be one of 
small-pox, however, there happened to be little or no 
constitutional disturbance, and as there was a fair sprink- 
lisg of rash on the face 1 concluded that the general 
state of health was inconsistent with an attack of small¬ 
pox seeing there was, as I have siud, some amount of rash. 
The maid, however, was sent home and a local practi¬ 
tioner called in, as also another, presumably in consul¬ 
tation, both of whom notified the disease as small-pox. 
Feeling reasonably certain that a mistake had been 
made, 1 called on the medical officer of health and 
likewise at the ambulance station, and through the 
courtesy of the official at the latter department, I was 
inform^ by letter that the case had been retnmed in a 
few days chicken-pox. 

On another occasion quite recently I was fetched to 
Eee a child suffering from throat affe^ion, and as there 
appeared some herpetic eruption on the Ups I believed 
the case to be catarrhal, and calling the following 
day thongiit the same. On the third day, how¬ 
ever, 1 was surprised to find the child at play 
in the garden, and on examining the throat on this 
occasion a tongh-looking piece of membrane appeared 
on the tonsil, which I oonclnded was diphtheria, and ex¬ 
plained the necessity of notification, but the husband 
not being at home I suggested for satisfaction calling in 
another local medical man; whereupon the mother 
remarked to me in a confidential tone that her husband 
wa9 "a fuimy man,” after which she went on to explain 
that the husband had actually taken the child to the 
snrgery of another practitioner during my attendance, 
and tlmt he pronounced it cold, probably from the same 
reason as I, riz., the herpetic etnption. As, however, 
opinion was set against opinion, I suggested striking 
the balance by calling in another, bnt on the arrival 
of the hnsbrad home the same medical man was 
consulted, and on this occasion he notified diphtheria. 
A point of interest seems to me to consist in this, viz., 
thrt supposing the medical man in question had had no 
opportunity of seeing the case the second time a prima 
fade suspicion of non-nutification might present itself, 
and ifideed a prosecution took place, and was referred to 
in jour oolnmns, in one point analogous to thir.^insomnch 
that ia both they were taken for examination to a snr- 
?«7. 

On yet another occasion, and this recently too, a child 
WBS taught to me apparently suffering from scarlet 
fever—at least the rash was identical—sore throat, and 
the fwntest, if any, catarrhal symptoms, but fortunately 
notification was delayed, and in three days’ time it 
turned out an unmistakable case of measles. 

I have mentioned these instances merely to iUnstrate 
the difficulties involved in notification, difficulties, too, 
which may not be so readily appreciated by those in 
high placM. How far notification may have decreased 
mortaUty, or to what extent isolation has rednced the 
number of infections diseases, is a problem perhaps not 
easily solved, as the evidence is complex, but with re¬ 
gard to isolation it would apMar that if any disease of 
an infections type invade a bouse, iu the majority of 
cases other mem Mrs of the honsehold seem to contract it 

Every medical vnim in a populated district must be 
aware of the fact how freqnentiy infections diseases are 
broDgfat to the honse, and we may thereby infer that if 
notification and isolation are what they purport to be 
or anticipate, and of the importance that they appear 
to naerit, the sooner the system of allowing dm^i^ to 
prescribe be stopped the better for the pnblio interest, 
otherwise the ^ects of the Act most, to a greater or 
Isas degree, be nnlUfled, because we may be certain that 
a percental of mild infections cases escape detection 


tbrongb filing within the meshes of their nets and doe 
to their direct or indirect prescribing. 

I am. Sir, years truly, 

Clsmxmt H. Sbbs, M.B.C.8., LB.C.P.Edin. 

E-S.—1 most mention that in the case of diphtheria 
referred to above other members of the honsehold were 
notified, and an infant died, but not under my care. 

"LATENT CEEVICAL FEACTUBE.” 

To the Editor of The Medical Pbebs amd Ciboxilab. 

Sib, —"Will you please say for the satisfaction of yonr 
readers. How conld force snfficient to break the trans¬ 
verse process of the fourth cervical vertebra be applied 
BO as to leave no external mark P 

Conld Buob a fracture result from muscular force ? 

What is Simon’s definition of a " latent” fracture ? 

How many such fractures are on record P 
I am. Sir, yonrs truly, 

Clbofas. 

[From the pablisbed report of the post-mortem exami¬ 
nation evidence of subentaneona extravasation of blood 
led to the examination of the posterior cervical 
region. A fracture of a transverse process of the 
fourth cervical vertebra ia not likely to resnlt from mus- 
colar action. Lidell’s definition is as follows:—"In the 
examples of so-called latent fracture of the vertebree the 
spinal cord is not at all affected by concussion, nor by 
contusion, nor is it compressed by displaced bone, nor 
by extravasated blood.” We have not Simon’s definition 
before ne. To asceitsin the number of recorded *' latent'' 
fractures of the spine would involve a tedious and 
laborione investigation.—E d.] 

THE PEOPOSED BEITISH AND COLONIAL 
JOURNAL OP OBSTETEHIS AND GTNAICOLOQT. 
To the Editor of The Medical Pbbss abd Circplab. 

Sib,— In a somewhat lengthy letter. Dr. Sinclair 
seems to me to miss the one point which was necessary. 
There is undoubtedly a feeling that the British 
Oynsecological Society has been thrown over in favour 
of the Obstetrical Society, and I would suggest that Dr, 
Sinclair shonld let ns know how many Fulows of the 
Qynsecol^cal and bow many of the Obstetrical 
Society were invited to the preliminary meeting, 
noting at the same time how many Fellows of eadi 
society asked practice in London. By doing this 
Dr. Sinclair will at once show bow things stand, and if 
he does not do it, I, for one, will draw my own conclu¬ 
sions. 

In a letter of three lines Dr. Sinclair can settle the 
relation of the proposed jonmal to the two societies. 

I am. Sir, yonrs truly, 

Skene Ebith. 

London, Angnst 20th, 1901. 


Mb. Pbbeoinb Pubvib has sent a donation of ^1,000 
to the Royal Free Hospital, London. 

Mbssbb. T. B. Shaw, M.B., P. T. Nicholls, A. T. 
Oailton, M.B., and G. S. Davidge have been gazetted 
snigeons to bis Majesty’s fleet, with seniority, of 
Angnst lOtb. 


Boyal Army Medical Corps. 

Subobon-Capt. C. Dalton, embarked at Liverpool on 
Saturday last for Sierra Leone. A draft of 100 men 
embark^ at Sonthampton on the lOthinst., on the s.s. 
Canada, for Sonth Africa. Surgeon-Major G. Take 
joined at Woolwich on the 10th inst. Lieut. Davies and 
Lieut. A. W. Gibson have been posted to thv Cambridge 
Hospital at Aldershot for doty. Surgeon-Major Dodd 
has aasnmed temporary chai^ of the Connanghc Eos* 
pital at Aldershot during the absence of lAeut-Ccl 
Wilson. 

D , - . _30gk 



202 Tbs Msdical Pbbbb. 


LITERATURE. 


Avq- 21. 1901. 


^ptcrature. 

SENN’S “PATHOLOGY AND SUBGICAL TREAT¬ 
MENT OF TUMOURS.” (a) 

Tbs second edition of Professor Senn'B book on “ The 
Pathology and Snrgical Treatment of Tnmoars ” forms 
a Bubstantial volnme. The illnstrations are very 
nnmeroos and, on the whole, well selected. Many of 
those representing histological details are excellent. A 
very liberal nse has been made of italios in emphasising 
important points in treatment and in the definition of 
terms. The Bnocessfnl sorgio^ treatment of tumonrs 
depends, probably more than other branches of operative 
surgery, on the resonrcefnlness of the surgeon rather 
thsm on the remembrance of any formulated rules. In 
the book before us the operations described are those 
which have been found most generally useful, or which 
serve to illustrate some great principle in operative 
surgery. The general medical reader is not confused 
by an exhaustive desoiiptive list of operations. 

The direction is given in italios on page 406 that 
“ the removal of a snbontaneons lipoma must be done 
under strict aseptic precautions,” and special reasons 
for this are then given. The inference is only too 
likely to be drawn from snch statements that in opera¬ 
tions on other forms of tumour in which these special 
anatomical conditions are not present atrict asepsis is 
not necessary or essential, Praotioe based on suoh a 
belief must result, sooner or later, in what would be 
considered lamentable results. 

Multiple false neuromata and moUnsoum fibrosum 
are reg^ed as synonymoiu terms. Even allowing that 
molluscnm fibrosum be connected with, or even dhectly 
the result of changes in the nerves of the skin - and this 
seems to be as yet non-proven, it is almost indiapen- 
sable for the clear understanding of their clinical 
features that the two conditions should be distinctly 
marked off from one another. It will be pretty generally 
conceded that cUnieaXly the two conditions are distinct, 
consequently it seems undesirable to place them so closely 
together as Professor Senn does. We have noticed confu¬ 
sion in other American textbooks in the desoriptiona of 
false neuromata and molluscnm fibrosum. The terms ma- 
croglossia and maorooheilia are restricted to lymphan¬ 
gioma of the tongue and lips. It is well to thus limit 
the applicability of these otherwise indefioite terms. 

OPPENHEIM'S NERVOUS SYSTEM. (6) 

Wb have here not a first appearance, but a well- 
known and well-established work, now in its second 
edition, of which it may be well to give some fuller 
detail than usual of the scope, purpose, and style. 
The anther’s main idea is to block it at the out¬ 
set into two main parts, viz., the general part and 
the special part. In the general part, of course, the 
subject is opened op in general terms, the reader is led 
through the simpler and broader pathways of knowledge 
of the subject ae they first present tbem^vee. and from 
the point of view of height and breadth has the general 
differentiation of the great nervous system at an advan¬ 
tage. Methods and modes of examination may be said 
to comprise the first part of the work, and here 
undoubtedly there is more to be said than appears on 
the surface. The author lays stress on the importance 
of methodi -al detail, in the methods of examination, of 
the beginner; but he does not think the experienced 
examiner requires a fixed order of examinaiion. We 
join issue here, for the success of our young physicians 
IS due to the fact that they are still methodical, and the 
failure of older men, who now lag in the paths of research, 
is due to the fact that “the gold coast” is too attractive, 
and time to a busy consultant means money. Of course, 
we make exceptions to this statement. We agree with 
the author that the question of heredity should find a 

(a) “ The Pstholf^ and Suivical Treatment of Tumoure.” Bj 
W. Sena, M.D., Ph.D., LL D., Profeaaor of Surcerr, ChlcaM Polj- 
clinic, Bneh MMkal Collwe, ao. SeMnd Sdloon, Beviaea. Sto. 
Pp. 718. Illnitrated bj 4^ angraTinxs and 12 fnll-paBe plates in 
coloora. Philadelphia i W. B.Baunden. 1900. 

(&) ** Diseases of the NerroniSrflteo.'' Br H. Oppenbeim, U.D. 
Philadelphia and London: J. P. Lippineott and Co. 


first and important place; bnt sometimes this up 

a long time, and the consultant trusts to his experience 
to pass it by. We believe this is a great mistake. The 
author is rather hurried in dealmg with the anamnesis, 
and he sums up the most important inherited 
diseases without any discrimination. A thorough 
and sound descriptive article on the evolution 
of the neurons wonld be most instructive and 
valuable, aod full of suggestiou for practical usee. 
It is cot enongb to tell ns that “ morbid inclinations to 
suicide, alcoholism, Ac., indicate a neuropatbio diathesis.” 
There is too much begging of the question here. Agaio, 
much more might be said of the disessee which predis¬ 
pose to nervous affections, and certainly the statement 
regarding consanguineous marriages is a very meagre 
one. It requires a chapter to itself. It is not usual for 
writers on diseases of toe nervous system to insist that 
a knowledge of psychiatry must always accompany, if 
not precede, that of neurology. In this country such 
a statement is nsnally oonspionons by its abseooe. It 
is, nevertheless, a sound expression of opinion, and 
applies to the whole gamut of disease as well. The 
author goes very fully into the question of the stigmata 
of degeneration, the skull, ear, teeth, paltto, Ac., bnt 
verv wisely makes this reservation, that “too much im¬ 
portance should not, however, be given them, as almost 
all may occur in perfectly normal individnids.” The 
general symptomatology of the musonlar system receives 
a very considerable share of attention, bnt more 
explanatory references are needed. The minute mus¬ 
cular system of face, eyes, tongue, larynx, Ac., is here 
fully treated of. We come now to the second or 
special part, which is mainly taken up with spinal, 
brain, and peripheral diseases, and practically 
occupies the chief portion of the book. The ana¬ 
tomical description, especially microscopic, of the 
spinal cord, is very gO(M, and, of coarse, much of it 
is repetition; bnt that is unavoidable. What the 
student and practitioner will most appreciate is the 
fresh light which is thrown upon fanction, espeoialiy 
the reflexes. Beginning with the system diseases of the 
spical cord, we find locomotor ataxit beads the list. 
We find also here, as elsewhere, that the author is by 
no means redundant in bis descriptions, and that littie 
space covers a good deal of matter. On the subject of 
treatment Oppenheim is more communicative than 
some others. He evidently has something to say worth 
taking note of, and he is evidently more hopeful of 
resulto in the early treatment of this wretched disease. 
Into descriptions of neuritis and multiple neuritis the 
author enters with much detail and discrimination, bnt 
on tbe subject of craft paralysis wetbink be might have 
said more. On introdneing the section of diseases of 
the bnun, a brief anatomical description is given. A 
brief, bnt fairly satisfactory, reference is made of the 
localisation of function, but though with some slight 
equipment to introduce the clinical description the 
reader is referred to other and fuller details, so as not 
to over-write this book. Tbe general phenomena of 
' cerebral disease are here claraed under two beads 
(a) tboee representing organic disease, (6) those repre¬ 
senting functional disease. Into these, here and else¬ 
where, the author enters with great care, and this part 
of the work will be found most interesting and prac¬ 
tical. The method adopted here is very good. Undw 
the title of local symptoms, Oppenheim tre ats first of 
symptoms of irritation, b^inning with the cortical 
motor zone, and treating of localised spasms, including 
Jacksonian epilepsy. From symptoms of irritation be 
passes on to paralysts, bnt here, though he is on practi¬ 
cally the same ground, the author is not explicit, and 
does not distinguish plainly. Space forbids ns to linger 
here longer, bnt we commend all this to the reader, 
especially the section on speech defects, which is not toe 
long. A long series of excellent oh^ters appear on the 
diseases of the meninges, tbe brain substance, Ac., and 
here, as elsewbore, it might be expected tiiat more 
might be written. Tbe well-read and experience 
student and practitioner, however, will read aod know 
' between the lines much more than (appears on the sur¬ 
face. He will find here much valuable help, especially 




Aco. 21. lOUl 


LTTEBA.TURE. 


Thi Mbdical Pbisb. 203 


ID the differentiftl di^noeie of mauy difficult and 
obecnre bnia diseases. Comiog Dear a close the author 
ia Section TV. takes up the neuroses. A brief introduc¬ 
tion on the term Neuroees would have been useful. The 
term is much read; its definition is not clear, nor are 
its limits well understood. Here he plunges right away 
into hysteria. Why ? We know not; but we do know 
that we beard of hysteria long before we ever heard of 
“ The Neuroses." We are not even clear yet as to how 
much of so-called hysteria is neurosis, and how much is 
not. As regards the proportion of women and men 
relatively affected, we agree with the author that the 
figUTM Briquet must be modified. Ibis section from 
its Continental origin is sure to have something new for 
many of our readers, and we would specially direct 
attention to hypnotism, neurasthenia, phobias, The 
remaining sections, dealing with diseases of the sympa¬ 
thetic nervons system, angionenrceee and enpno- 
neuroaes, and wi'h nenro-tozemiae are very important, 
but rather short. The illustrations are very appropriate, 
and altogether the work ia well worthy of a pl^ in 
Snglish medical literature. 


IiEFTWICH^S INDEX OF SYMPTOMS, (o) 

Thx idea underlying this little work ia ingenious, and 
we may infer from the fact that it has reached a second 
effition that the author's scheme has met with a favour- 
•Ue reception. The contents are divided into the main 
eb^>ters. one of symptoms ascertained by interrogation 
and another of symptoms discoverable by physical 
Bzsmination. The method is the same throughout; 
DBder the head of a particular symptom is given a list 
of the various conditions or diseases to one or other 
of which it may be doe. In practice this leads 
to some mthtt startling rapprochtmentt. For in- 
itmce, under ** sleeplessness " we get as poesible causes 
collapse of lungs and triobinosis, while under night 
tenors” we have mucous disease (?) and frights. Some 
of the references excite enrpriee, for example, 
“bulimia” is associated with exophthalmic goitre, 
iodism, and 'whooping-oongh, while anorexia is described 
t8 possibly due to cancer of liver or stomach, cystitis, 
tnpyema, &c. Beally we fiul to see what possible 
SHutanoe such references can afford in arriving at a 
diagnosis. Of conrse all the lists are not equally wide 
of ^ mark, and herein lies the value of the work. 
The more special the symptom the greater the value of 
the list which it precedes. The book oonclndee with a 
tueful little chapter on methods of diagnosis for the use 
of clinical clerks, Ac, and it is illustrated by seven 
figures. We can quite believe that the work has 
entailed upon the author a large amount of patient 
work, we only fear that the result may not be found 
eommensnrate with the labour and energy devoted to it. 

GOODSALL’S ANUS AND EEOTUM. (6) 

This book commences with an excellent chapter, folly 
iSustrated, on the anatomy of the parte; the second 
cbspter ia on general diagnosis, and gives some very 
prs^cal suggestions for questioning and also for 
estmining the patient. The ohipter on abscess comes 
next, and opens the way for rae one on ano-rectal 
fistula, which is not only profusely illustrated but 
oaistitutes in itself an ezbanstive treatise on the 
sid»}eot, occupying 81 pp. Becto-nrethral, recto-vesical, 
sad recto-vaginal flatus are more lightly dealt with, 
but sinus over the sacrum, a condition the literatnre on 
which, the anchors point out, is very limited, is more 
fully entered into, some illnstiative and illustrated cases 
beiog given which much enhance the authors' explana¬ 
tion. The description, position, stiology, symptoms, 
diagnoris, and tr^tment of anal fissure is next given, 
logger with a graphic account of the two principal 
opeiationa for its relief. The last chapter is devoted to 


(a) ** An bidez of 87 inptoma u n Cine to Dingnoaifl.” Bv Ba]ph 
W jailing ton M D. , late Aaaiatnnt Phyaician to too East 

I«odon GhBdrea'a Hospital. 2nd Edition. London: Smith. Eldar, 
and Co. 1901. 

W “ IHaaasaa of iha Anna and Bectuin.” By D. H. Qoodaall, 
F.Ea 8 .. and W. Emeat KUee, r.B.C.S. (in Two Parta). Part I. 
Pp. Sll. Loudon : Longmans, Qrasn, and Co. 


external and internal piles. With regard to the latter 
the authors have a very strong preference for ligatnre 
(Salmon's operations), and give their reasons for 
objecting to the other seven methods of operation. 
Altogether this first volume, though containing 
nothing particularly new, is well worthy of pemsal, if 
only for the very graphic iUastrations, and we look 
forward writh pleasure to the advent of Part II. 


GANT’S MOCK-NURSES. (a) 

Th> second edition of Mr. Gant’s book is supple¬ 
mented by an interesting anto-memoir of the anthor, 
which takes the reader back to the beginning of Isst 
century, with reminisoences of Eastbourne, Hastings, 
and St. Leonards, then merely villages, next on to the 
Crimean War, with glimpses of Baladava, Inkermaa, 
Scutari, Ac., culled from Mr. Gant's experiences when 
acting as one of the civil snrgeons to the troops, and 
finally to the author’s long oonnection with the Royal 
Free Hospital and the evolution of that institution into 
(he practical medical school for women. A review of 
the first part of the book has already appeared in oar 
columns. 


BICHAT'S GENERAL ANATOMY. (6) 

This is the first fssoiculos of the re-edition of Bichat’s 
work—a work of positive philosophy—and conforms to 
the spelling, pnnctnation, Ac., of the 1801 edition. The 
plan of the work is to consider by itoelf each of the 
single systems which by their different oombinations 
form the human organism; the base of this plan is 
anatomical, but the details it embraces belong also to 
medicine and physiology. The several dootrinee pat 
forward are oppos^ to these of Boerhaave, and differ 
from those of Stahl and bis followers. After some 
general considerations the author deals with the oellnlar 
system, with the nervons system, and with the vascular 
system, all of the subjeots beiog treated in a philoeo- 
pbical manner and the whole fasoioolos is interesting as 
an abstmse study. 


MANSELL MOULLIN’S WHEN TO OPERATE IN 
INFLAMMATION OF THE APPENDIX, (c) 
Tbssb four lectures, which were originally published 
in, and reprinted from, the Clinical Journal, and which 
have been revised and partially rewritten for the present 
edition, oan be read with advantage by every medical 
man. Mr. Mansell Monllin is evidently an advocate for 
operation in nearly all oases of inflammation of the ap¬ 
pendix, and his reasons are so straightforward and his 
arguments so convincing that his words should go a 
long way towards converting those who are more in 
favour of expectant treatment. 


HALLS’ DISEASES OF THE NOSE AND 
THE OAT. (d) 

Wb have read this book with great pleasure. The 
style is clear and concise, and the descriptions aro 
graphic. The information is up-to-date; the volnme 
oontains more than eoongh for general practitioners 
familiar with the use of the laryngoscope; and it may be 
described as an excellent text-book for students 
beginning the study of the subjeot. 

We heartily endorse the oondemnation of the removal 
of the inferior turbinated bone by the spokosbave ; an 
operation of which we were among the first to disapprove, 
as likely to be followed by tronblee worse and lees easily 
treated than the condition for which it was proposed. 


(а) “ Mock-Nnnes of theLstest Fashion, with a Short Uemoir of 
the Author.” By Frederick James Gant, F R.C S. Pp. 2S3. Second 
Edition. London : Bailliere, Tindall, and Cox. 

(б) “ Anatomie Oin^rale Appliqnto i la Phyaiologie et k la 
HMecine.'* Xavier Biohat. Fremidre Partie, O. Stelnheil, 
Faria 

(e) ” When to Operete in Inflammation of the Appendix.’* Br 
C. Hansell kEonllln, M.D., F.B.C.S. Second Edition. Pp. 38. 
John Bale, Bone, and Danieleson. 

(<i) *' Diaeaaea of the Noee and Throat.” By H. de Havilland 
Ball.M.D., F.B.C.F^ and Herbert Tilley Lewis, M.D., L«»d. 
F.B.C.8. London: H. K. Lewis. 



204 Thk Msdical PBisb. 


LITERATURE. 


Avo. 21. 1901. 


not to speak of tbe danger from hemorrh^ during and 
immediately after its performance. 

We are glad to see that the “ head down ” position for 
remoTal of adenoids U here adTocated. So far as we are 
aware, all the deaths from this operation have occurred 
during its performance with the patient in the upright 
position, either from syncope, from chloroform, or from 
drowning by blood. ‘Ihese dangers are obriated, or 
rednced to a minimum, by the*'head down” position, 
and we have no doubt that this method will beat the 
older one ont of the fleld. 

There is little in the work for adverse criticism. The 
statement at p. 142, that “ the sense of smell is at least 
twice as acute in man as in woman,” does not accord with 
our experience. 

THE THERMAL WATERS OF BITH. (a) 

This small book not only gives an account of Bath 
and the development of its now splendid bathing 
establishments, but also gives much information on the 
use of massage, with or without the waters, that will 
be found very useful by a large class of invalids. The 
author claims, and we think quite correctly, that the 
Bath waters, aided by judicious massage, can do quite 
as much good in cases of dilated heart as can be aocom- 
plished by the Nauheim treatment The observations, 
at page 29, on this subject are well worth study. 

In his concluding chapters the author does not shirk 
statistics. In rheumatoid arthritis he gives 5 per cent, 
as cured and 80 7 relieved. Mo one knowin^t anything 
of the complaint will think such results unfavourable. 
Of cases of true gout treated 18'9 were cured and 607 
relieved. 

The appendix which closes the book affords informa¬ 
tion as to charges and fees for the baths. Though 
small and of very moderate cost the book is very full 
of interest and instruction, and everyone contemplating 
a visit to Bath will do well to get a copy, and wW Bnd 
the perusal well repay him. 


TUBBY'S INTRA-ABDOMINAL SUPPURATION. (6) 
This little book comprises seven clinical lectures de^ 
livered at the Weetmiubter Hospital, of which four are 
devoted to Appendicitis, one to Sub-draphragmatio 
Abscess, one to Pelvic Suppuration and Tuberculous 
Peritonitis, and one to General Peritonitis. The four 
lectures on Appendicitis are very practical. They in* 
elude: Anatomy, Pathology. Bacteriology, .Etiology, 
Symptoms, Signs, Complications, Seqnelse, Di^^osis, 
ProgDosis, Treatment, and should prove especially use¬ 
ful to students who eventually take a country practice. 
The next lecture on Sub-drapi^agmatio Abscess is well 
worthy of perusal, the symptoms and signs bring very 
clearly given, particularly those in connection with an 
abacess of this kind caused by perforation of the 
stomach. The last two lectures are fully up to the 
mark of the first five, and Mr. Tubby is to be congratu¬ 
lated on having placed before the profession in book 
form so much instructive matter. 


ALLCHIN'S MEDICINE.—PART II. (c) 

Pabt n. of this important manual sustains the opinion 
expressed on the appearance of tbe first part, namely, 
that it contains a large amount of valuable work. It 
continues tbe description of the general diseases, and 
includes those caused by parasite, by poisons intro¬ 
duced into the body, primary perversions of general 
nutrition and diseases of the blood. Under ** Opium ” 
washing out the stomach is advised only when 
the dose has been taken into that organ. Surely, 
it is nowadays recognised that morphia, if in- 


a) " The Thermsl Waters of Bath.” Gilbert A. Bannatyae, 
.D.. M.B.C.F., Bosorary Physician to the Boyal Mineral Water 
Hospital, Bath. Bristol; John Writrht and C%. London : Simp- 
kin. Manh«li, Hamilton, Kent, and Co., Ltd. 

(b) "Clinical Lectnree onthe Varions Forms of Intra-Abdominal 
SnppnrmtioD.'' By A. H. Tobby, F.B.C.8, Pp. 91. Medical Pub. 
Company, Limited 

e ^'A Manual of Medicine.” By W. AUcliin. M.D.Lond., 
C.P., Senior Phratcian and Lectorer on Clinical Medicine. 
WestminsterBoepital, ftc.,ftc. PartH. London: MacmUlanand 
Co. I9C0. Prloe 7s. 6d. 


jeoted hypodermically, is rapidly excreted by the 
stomach. In directing that tbe patient should be 
kept walking to and fro, it would be well to point ont 
that this plw of treatment has not unfreqaently killed 
the patient by sheer exhaustion. The danger of relapse 
in theee oases is very properly insisted upon, but no 
mention is made of tue necessity of emptying the bladdw 
by means of a catheter. On p. 66 we notice *' morphia” 
and ” morphine ” on tbe same p^e. Under phosphorus 
we find no mention of Stockman's classical work ou 
"phossy jaw.” It is correctly stated that codeia 
has no advantage over morphia in the treatment 
of diabetes mellitus, but it might be added that 
codeia has the groat disadvantage, especially in 
hospital praotioe, of oostiag more than twice as much 
as morphia. Most of the articles contain good matter 
well arranged, although at times tbe information is of 
a somewhat elementary nature. So far as our criticisms 
are concerned they mainly deal with minor points of 
omission. For instance, no mention is made of the 
value either of belladonna or ergot in diabetes 
mellitus. Under hsemophilia it is surprising to note 
that a systematic manual of this importance does not 
mention the name of Dr. Wickham L^g, in spite of tbe 
fact that his treatise on the maU^y published in 
1872 was regarded as the standard work on the subject. 
Even as recently as 1898 he contributed ao article on 
the subject to Clifford AUbntt’s System of Medicine. 
The articles on diseases of the blood have been entrusted 
to a writer who is now a Commissioner of Lunacy. The 
subject, however, has been ably dealt with, and is illus¬ 
trated with some extremely l^ntifal coloured plates, 
and we are glad to note that the writer does not think 
it necessary to call a red oorpiuole an erythrocyte. No 
mention is made of tbe Tallerman superheated air 
treatment in tbe otherwise extremely able article upon 
gout. Under rheumatoid arthritis the topical applica¬ 
tion of dry air heated to 250*’ F. or 30(^ F. is men¬ 
tioned only to be dismissed curtly by Dr. Dawson with 
the remark that it is doubtful if it has any curative 
action. Dr. Allchin, who writes the article on ebrooio 
rheumatism, says that dry heat will ” sometimee effect 
most satisfactory results. ” It seems almost incredible 
that such an attitude should be taken in a modem 
manual of medicine with regard to so powerful a 
therapeutic agency in gouty, rheumatic, and allied 
conditions as that affor^d by tbe Tallerman super¬ 
heated air-treatment. On the whole ^eedicor’s labc^ous 
and responsible task has been well and conscientiously 
performed. Both he and the publishers may be con¬ 
gratulated upon the general excellence of their produc¬ 
tion, which should be in the hands of all practising 
physicians. 


HUNTER’S ORAL SEPSIS, (a) 

This is the reprint of an article which appeared in 
The Practitioner of December, 19U0, and is published in 
this separate form ** in the hope that it mav serve to 
draw ^ditional attention to a source of disease ex¬ 
tremely prevalent and meet egregiously overlooked.” 

In the first place attention is diiected to the local 
effects of oral sepsis as affecting the mouth, jaws, tonsils, 
and pharynx; and then Dr. Hunter points ont that in¬ 
fective disease of the mouth is not tbe "mere question 
of the presence of an organism, however pathogenic, but 
a question of dose and resistance.” This is tbe keynote 
of the book. Aooordiog to the bacteriological invertiga- 
tiuns of Miller, Galippe, and Vignal, Jung, and more 
recently Professor Arkovy of Bndapest, it is shown that 
the bacillus gangrenes pulpeswaa preeent in 9&’3 per cent, 
of cases of dentu caries; the staphylococcus pyogene 
aureus in 34*8 per cent., and the streptococcus pyogenes 
in 23'2 per cent., Ac., do. 

Now, without doubt, as Dr. Hunter points ont, if such 
pus organisms are constantly being swallowed there 
must result what he terms a septic gastritis. And this 
in addition to the indigestion set up by tbe swallowing 
of imperfectly masticated food (owing to the bad teeth). 

(a) “Oral Sepsis as a Canse ot Disease.” Bj WilUam Huntvr, 
M.D., F.B.C.P. London. Paris. New York, and Mribome: 
Cassell and Companx, Limited. 1901. Pp. iv. and SO. 



PASS LISTS. 


Auo. 21. 1901. 


Thk Mxdical PbS88. 205 


Partioniare are given of six casee, all enffering from 
three main symptoms, viz., salivation, gastric discom¬ 
fort. gastric catarrh, all of which were oared when 
either the ill-fitting septic plates were regularly and 
properly cleaned or perhaps a few old stumps removed. 

^garding the more general effeote— toxic effects—of 
oral sepsis Di. Hunter tabulatee five varieties, viz., 
fover, septic rashes, purpuric hemorrhages and bleed¬ 
ing from the gums, profonnd septicemia, and toxic 
neuritis. 

Though Dr. Hunter brings forward some seven oases 
in support of bis view that such conditions, as are men¬ 
tioned above, result from the oonstant swallowing of 
pus organisms due to oral sepsis, still the present 
reviewer would advance the opinion that a much larger 
number of easee must pass under observation before oral 
sepeis is shown to he the definite and absolute cause of 
such conditions. Undoubtedly, Dr. Hunter has done 
well in putting prominently ^fore the busy general 
practitioner a pocsible cause of many obscure gastric 
disturbances, which is as easily observed as it is 
generally overlooked. 

To the dental profession the book should be of great 
interest and sound a loud note of waming. For, as Dr. 
Hunter points out, patients suffering from oral sepsis, 
who visit their dentist on the urgent entreaties of their 
physician, often are sent iMwk to the latter in as bad a 
state as when they went away. 

©bituarg. 

SUBGEON-GEHEEAL CHABLES BICHABD 
PBANCI8. 

Wx regret to have to announce the death of an old 
frimid of the Mxdicai, Pbiss and Cibculab in the 
person of SuigeoQ-General Charles Richard Francis, of 
the Indian Army (retired), who died at his residence, 
41, Spencer Park, S.W., in his eighty-first year. 
Between 1844 and 1875 the deceased officer filled 
numerous civil and military appointments in India’ 
having at one time occupied the position of Principal 
and Professor of Medicine at the Medical Collie at 
Calcutta, and Physician to the College Hospital. He 
was also Examiner in Medicine and Obstetncs to the 
University of Calcutta. Towaide the close of his Indian 
career he held socoeesively the posts of Secretary to the 
Surgeon-General, Depnty Snrgeon-General, and offici- 
dating Surgeon-General with the Government of India. 
In 1853 he was appointed by the Government to investi¬ 
gate, in coujonotion with Ih. Frank Pearson, the nature 
of the mahamnrree, which was r^ng as an epidemic in 
the bill districts of Knmaon and Gtorhwal. Drs. 
Francis and Pearson succeeded in demonstrating the 
identity of this disease with ‘'bubonic plague,' and 
their investigations proved the basis of a vadnable 
report thereon. Dr. Francis devoted much time and 
eusTgy to the study of snake* and snake poison, with 
the view of dif covering an antidote. He was a prolific 
writer, and was at one time editor of the Indian 
Htdical Gcuet*e. 

^cbital 

?mecntlott of a Medical Man nnder the Sale of Food and 
Drags Acta. 

In the Dublin Police Court, on Angust 9th, before 
Mr. Wall, K.C. ; Mr. J. C. Me Walter, Ii.B.C.SI., 
lf.P.S.I., trading as J. I«cnard and Co., pharmacists, 
was sommoned nnder the Sale of Food and Drugs Acte 
for haring, on Jane 26th last, sold to Inspector Bow- 
some, a Corporation official, a quantity of spirit of nitrons 
ether which wM sot of the natnre, substance, and 
quality of the article demanded. Ihe quantity pnr- 
^ased was six ounces. Sir Charles Cameron, City 
Chemist, certified that thv article contained only 0 4 per 
cent of ethyl nitrite, whd*eas it should have contained 
at least 1‘76 per cent. Mr. A. F. Blood, E.C., appeared 
for the defecoe. Inspector Bowsome proved the pnr. 


chase of the ding, and Sir Charles Cameron’s certificate 
was snbmitted. Mr. Blood drew attention to the fact 
that in the bottle in which the Corporation spedoien of 
the drag was contained there was only a small quantity 
of the liquid left, and he snbmitted that so small a 
quantity could not be analysed as required by the Act 
of Parliament. Any deterioration which had taken place 
occurred after the drug left defendant’s branch establish¬ 
ment at Great Britain Street,where it had been procured. 
Dr. Ashe deposed that the componnd in questiou was of a 
very unstable nature, and should besecuied in a coloured 
and stoppered bottle. It was really a gas dissolved in 
spirit, and the bottle in which the specimen now was 
contained was a most improper reoeptacle therefor. The 
magistrate was understo^ to say that anyone who had 
to do with whisky knew the importance of keepiog it in 
stoppered bottles. Theoonnectionwasnotappsrent.tnt 
the several scientific experts present assented to the 
proposition. Professor C. B. C. Tichbome, M.P.S.I., 
gave evidence that the spirit of nitrous ether was very 
volatile and was extremely subject to the action of light 
and air. He did not consider that the sample produced 
was in a proper bottle. It was agreed eventually that 
the liquid in the bottle should be sent to Somerset House 
for analysis, and the case was adjonmed pending the 
reenlt. 

Harmful Headache Powdno. 

At the UlverstoD County Court on Aug. I8th', Jeannie 
and Willis SbiUitoe sued W. B. Hird, a grocer, for £60 
damages for a fortnight’s illness suffered by the female 
plaint after taking one of Proctor’s headache powders 
sold by the defendant. The medical evidence was very 
uonflioting. One medical man stated that the powders 
contained 6i to 7} grains of antipyrise, and the British 
Pbarmaoopoeia prescribed the ordinary dose as from 1 to- 
3 grains. On the other hand. Dr, Anderson asserted that 
in most headache cases a dose of 4 to 14 grains could he- 
given safely. His Honour held that the negligent sale 
of a drug had been proved, and gave jadgment for plain¬ 
tiffs for £21. 

Tlie Manchester Msdlcal OoUd- 

Tbx following resolutions were nnanimonsly passetf 
at the last meeting of the Medical Guild, Manchester, 
on July 26tb, as follows: - 1. That iu the opinion of the 
Medical Guild, seeing that vaccination is made com¬ 
pulsory in the interest of public health, the parent or 
guardian of a child shonld have the right to select any 
registered medi<^ practitioner, who is willing to do so, 
to perform the vaccination, and that the cost of the 
same shonld be defrayed by the State at a fixed rate. 2. 
That, in the event of the foregoing resolution being 
passeA the Council be requested to consider what steps 
can ^ taken to inflnence future legislation on the snh- 
ject. 

|)A0S ^0t0. 

Army Medical School. Netley. 

SueoBOKB on probation snccessfnl at both the London 
and Netley Examinations. Prizes are awarded for 
marks gained in the special snbjecte taught at the 
Army Medical School. The final positions are deter¬ 
mined by the marks gained in London added to those 
gained at Netley, and the combined numbers are 
shown:— 

F. W. Lambelle ... 6,289 M. C. Beatty ... 3,947 

L.J.S. Cahill ... 4,703 J. B Welland ... 8,686 

W, C. Stevenson* ... 4,166 H. W. Long ... 8,386 

* GainedDe Chanmont Prize in Hygiene. 

List of sargeons on probation recommended for com¬ 
missions in the Boyal Army Meiical Corps at the close 
of the 82nd session. These gentlemen were nominated 
to the Army Medical School:— 


T. F. Bitohie 

2,106 

H. Rogers ... 

... 1,688 

A. W. Sampey .. 

1,786 

W. J. 8. Harvey 

... 1,606 

T.J. Potter 

1,778 

W. Davis ... 

... 1,670 

A. J. Williamson.. 

1,761 

J. C. Hastings 

... 1,42C 

E. V. Aylen. 

1,681 

D- O’Donoghne 

... 1,390 

oogi 


c 






206 Thi Midtcal Presb. NOTIOBS TO CORRBSPOITDBNTS. 


Ano. 21, 1901 


flatlets to 

CotreoponbentB, Short 4ft. 

iV* CouiBrovDRVTB reqoiriiiE * in thii oolnma are par* 
Iralarly reqaected to nuke noe of a dtiMncMo* tionaturt or 
nitiMls, and aroid tho praotioa of aifning themselTea '* Bonder,*' 
" Bnbaoribar,'' **01d Sabaotibar," Ao. Vnoh oonfoaion will be 
spared bj attention to tbia rule. 

BcraiKTS.—Beprinta of articles appearintr in this Joamal can be 
had at a reduced rate, providin? authors ^ire notice to the pub* 
lisher or printer before the type has been distributed. Tbia ehould 
be done when retnminv corrected proofs. 

Obioisai, Abticles or liSTTaas intended for publication ibould 
be written on one aide of the paper onl/, and must be authenticated 
with the name and addrees of the writer, not necoewirily for publica¬ 
tion, bat as evidence of identity. 

BKAOUfo Caaxa,—Cloth board caaee, gilt lettered, eontainin? 
twenty-six atrinffs for holding the numbers of Tkb Ubpical Pbxbs 
atrn Cibcplab, may now be had at the office of tbia journal, 
price 2s. 6d. These cases will be found very naeful to keep each 
weekly numberintoct, clean, and flat after it bae passed through 
the post. 

VicTOB.—The qnotaUon is from Addison, and runs as follows 
" A wealthy physician who can help a poor mui and will not 
withont a fee has a leas sense of humanity thanapoor man who kills 
a rich man to supply his necessities." 

B.A.M.G-~The time is past, lot na hope, when an Army medical 
officer is *' to be seen and not heard." We shall be Tcry pleMed to 
conkider any carefully thought out suggestions on the reform of the 
Betrice. alrhough frankly it appears to ns that the subject has been 
well threshed out already. 

M. B.—If the skiagram wasmadeat jroor request, and paid forby 
yon, the ropyright, we imagine, ia yours. In any event it would be 
a giOBs breach of commercial etiquette for the operator to make 
public nee thereof without previously obtaining yonr oonsent. 

J. H. C. (Salford). • ICany thanks for letter. We should like to 
see the matter taken up as you euggest, and we think the case 
merits ths attention of the Iriah HedToal Aseoslntion. 

Dr. H. S. C.—The decision of the arbitrator has only jnst been 

g ven. It is in effect that the pastarrangemeotbetween theCounty 
inncil and the borough for proridiog accommodation for pauper 
lunatics should cease, and that a new arrangement be made under 
section 844 of the Lunacy Act, 1800. 

Dr. J. B. W. (Vienna).—The gentleman addreesed is away on 
holiday, but returns this week, when your communication will re¬ 
ceive attention. 

Dr. J. C. T.—Comrannioation is marked for next number; proof 
will be sent you in due course. 

JUBTHEN AND MUBDEBS. 

D.C.L. (Brighton). -L The number of Jurymen at a coroner's in 
quest may be anything between twelve aod twenty-three. Anyone, 
should necessity arise, may be summoned from the street to act as 
uryman. 2. Tec. The late Dr. Bond was engaged professionally 
or many years in nearly all the great mnrder trws. He owed his 
first appearance in criminal work to his post as Surgeon to the 
Detective Departmentof the Metropolitan Police. His first notable 
achievement was the discovery in the brain of the woman murdered 
by Wainwrigbt of three bullets that had been overlooked in a pre- 
vIouB post-mortem. Among other medico-legal emsea he was pre- 
minently engaged in the Cunp mnrder, the mysterious Jack the 
Bipper murders, and also the Lefroy, Lamson, and Nell Cieam 
oases. His uncle acted as a surgeon to the London, Brlehton. and 
South Coast Bailway, aod under him Dr. Bond is said to have 
Boqnlred hla first experiences of surgery by attending a railway 
accident at Bishopetoke. 

F. G. WiLLiAMSOR (Cnmberland).~We have ascertainrd that the 
writer of the medical notes to eorreepondente in the Sunday news, 
paper you mention is a qualified medical man, bat the only body 
likely to take up the matter is the Medical Defence Unicn. The 
General Medical Connell would, probably, take no cognisance of an 
offence of this kind nnlese formally brought to its notice. 


,|L))7onrtnunts. 

AaTBoa, BicHAan, M.D.Edin., Honorary Assistant Saiweoa, to the 
liar and Throat Department of the Sydney Hospital. 

Barices, E. W.. L.K.<).C.P.Irel.. L F.F.S.Olasg.. District Medical 
Officer to the Liverpool Union, vice Dr. Caldwell, resigned. 

OoLLon, Bowlaxd W.. M.B.C.8.. L BC.P., Assistant Anesthetist 
to the Hospital for Sick Chil^n, Great Ormond Street, W.C. 

Coulter, B. J., M.B., F.B.C-S.IreL, Ophthalmic Surgeon to the 
Newport and Monmouthshire Hospital, vice B W. Qowring, 
M.D., resigned. 

CuBTis, H. J., B.S.Lond., F.B.C.S.Eng., Assistant Snrgeon to the 
Boyal Hospital for Children and Women, Waterloo Brid^ 
Boad. 

Die, B. H., M.B^ B.S.Dnrh., Junior House Physician to the Boyal 
Infirmary, Newcastle-on-Tyne 

Obbsswell, D. a., M.D.Oxoo., Permanent Head of the Department 
of Public Health, Victoria. 

Bbslof, j. W., M.B., B.S.Dnrh., House Suiyeon to the Boyal In¬ 
firmary, Newcastle-on-Tyne. 


Orkebod. Hekbt LAWBKifCE. M.D.,B.Oh. B.U.I., L.BC.P.Lond., 
M.B.C.S., Medical Officer to the Shirehrmpton Isolation Hos¬ 
pital. 

PoBTEa. A. E., M.D.. D.P.H Cantab , Asxistsnt Medioal Officer of 
Health for the Citv of Leeds. 

BoE, B. W. E., L.B.C P.. L.B.C.S.Irel., Medical Officer for No. 2 
District of the Ongar Union. 


9acaitdt0. 

Balmullet Union.—Medical Officer. Salary £130 per annuin, ud 
£10 peryearas Medical Officer of Health, together with regUte- 
tion and vaccination fees. Immediate appUcatirm, aec rmnanied 
by diplomas and testimoniils, tr E. N. Flynn. Clerk of Union. 
(See Advt.). 

Birmingham Workhouse Infirmary.—Assistant Besident Medical 
Officer. Salary £100 per annum, with apartments, istiona, 
coals gas, laundry, and attendance. 

Bradford Children's Hospital. House Surgeon. Salary £100, with 
board, reeidenoe, and washing. 

' Bradford Royal lafirmary.—Dispensary Surgeon, unmarried. Salary 
£100 per annum, with board and re-idence. Also JoniorHoose 
Snrgeon, nnmanded. Salary £S0 per annum, with board and 
reridence. 

County Asylum, Lancaster.—Ass'stant Medical Officer, unmarried. 
Salary £150, increasing to £800, with apartments, board, wash¬ 
ing. and attendance. 

Eastern Connties' Asylum for Idiots, Imbeciles, and the Feeble 
Minded, Ciolchester.—Besident M^cal Attendant, nnmarried. 
Salary £100 per annum, with fnrniah^ apartments, beard, sad 
washing. 

East Biding of Yorkshire.—County Medical Officer of Health. 
Salary at rate of £400 per annum, rising to £5C0 peraonnin, with 
allowaccss. (See Advt.) 

Great Northern Central Hospital, London. - Vacaneiee for Honae 
Physician, Salary £60 per annum: Junior House Physician, 
Salary £30. Board, residence and waabing provided in eaeh 
ca^e. Also Junior Honae Sn^^eon, Salary £30, with brard, 
reaidenoe, and washing; and a non-reeident Assistant House 
Snrgeon. with Salary at rate of £30 per annum, and partial 
board. Full particnlars of these vacancies will be found in onr 
advertisement coinmna. 

Johanneehurg.—Medical Officer of Health, Salary £1500 per 
annum. 

Northampton General Infirmary.—House Physieieo. unmuried. 
SalarT£100 per annum, with apartments, board, attendance, and 
washing. 

Salop Infirmary, Shrewsbury. - House Surgeon. Salary £100 per 
annum, with board, washing, and residenoe. 

Scarborough, Borough of.—Medical Officer of Health. Salary £32$ 
per annum, riling to £375 per annum. 

Stamford Rutland, and General Infirmary.—House Smyeoa. 
SalaiT £100 per annum, with board, lodging, and wuhinr. 

Suffolk (Mneral Hospital, Bury St. Edmunds.-House Snzyeon. 
Salary £100, with board, lodging, and washing. 

Township of MMCtaeater Workhouse CrumpMlL—Janior Besident 
Asstitaot Medical officer. Salary £110 per annum, with apart¬ 
ments, fire, Ueht, washing, and attendance- 

university of Glasgow.—Examiner for Degrees in Medicine and 
Science, with special reference to Physics. Salary £30. 

VicterU Hospital, Folkeatone.-Honae ouigeon. Siriary£l(» pet 
annum, with board, reaidenoe, and laundry. 


#trth£. 

GooaoR,—On Ang^t 9th, at Linden Honae Cheadle Cheshire, the 
wife of John H, Godson, H. R., B.S.Cwb., of a daughter. 

Gaxax.—On August 17th. at 8, West Hill, Sydenham, the wife of H. 
Melville Green, M.D., of a daughter. 

Haweibs.— On August 5tb. at London Street, Beading^, the wife of 
Francis Henry Hawkins, M.D.£din., M.B.C.P.Lond., of a 
daughter. 

Newbolt.— Od August IBth, at 48, Catherine Street, Liverpool, the 
wife of George Palmeriton Newbolt, M.B., F.B.C.S., of a son. 

Scott.—O n August 13th, at Hurstpierpoint, Sussex, the wife of 
William John Scott, L.B.C.P.I., of a son. 

Waohobv —On August 19th, at 6, (^lenluce Boad, Blackbeatb, the 
wife of J. W. Waghom, L.B.dP., B.N., of a daughter. 


4lto:tage0. 

Hatcr—Packs. —On August 14th, at St. Andrew’s Church, Wflm* 
cote, Stratford-on-Avon, Herbert Linooln Hatch, MB., ot 
Johannesburg, to Maud EUaabeth, elder daughter of the la'e 
Charles Lewis Packe, Esq., of Harefield, Middlesex, and of Mrs. 
Jmcefix, of Wilmcote V’carage 


Bell.—O n August 16th, at 1a, Cavendish Bosd. St. John's Wool, 
London. Alfred James Beil, M.B.C.8.Eng.. LH.C.F., aged Si. 

BouLTsa.—On August 7th, at Farqnhar Boad, Upper Norwood, 
Samuel John Boulter, M.B.C.S., L.S.A.. aged years. 

Brown.— On August 16th, at Clatenve Bosii^ Sonthsea, Fleet- 
Surgeon William Brown, B.N., agel5Si. 

Fbakcib.—O n August lOtb, at Spencer Park, in his Slst yesr, 
Charles Bichard Francis, M.B. bond. 

SwETE.— On August 0tb, at Castle HUl, Fishguard, Pembrokeshire, 
Horace Lawton Swete, L.B.C.F.I«nd., J.P, eldest tnrvirisf 
son of Homes Swete, M.D., ot Weston-super-Mare tad Dnn- 
marklyn, co. Cork. 

.G^ie 


m$ andi 



VoL. CXXIII. WEDNESDAY, AUGUST 2 8, 1901, 


No. 9. 


(Original CoimramicationB. 

SOME OBSERVATIONS ON THE 

ETIOLOGY AND PROPHYLAXIS 

OF 

ENTERIC FEVER IN SOUTH 
AFRICA, 

MORE ESPECIALLY THE COLONIE3 OF 
NATAL AND THE TRANSVAAL. 

By E. BLAKB-KNOX, B.A., M.D., B.Ch., B.AO. 

(UniT. DubL), L.M., 

FmwiT Awt. to Lootorer in Pathology and Bacteriologr, Trinity 
CoUcge, Dnblin; Lientesant, Boyal Army Medical Coipa. 

Of the prevaUiog >iiecanoB met with daring my xeoent 
tear ^ a^re eerrioe in South Africa, by far the most 
moininent in ite sererity and medical importance has 
been typhoid or enteric fever. Statementa as regards 
the of thia fever and its prevalence in respect 

to South Africa, more especially the colonies of Natal 
and the Transvaal before the commenoement of hos> 
tilitiee which I have had access to, do not in all cases 
hold tme when contrasted with the conditions nnder 
which these countries have been placed while in a state 
of war. 

Before the war enteric was said to be very prevalent^ 
sspedally in the high lands. It was epidemic during 
the Znlo war, at Utrecht, and after the last Boer war at 
Newcastle, Pietermaritzbnrg, and Ladysmith, while 
garrison stations hare always suffered year after year. 
Febmary, March, and April are said to be the months 
of great^t prevalence ; thoee of November, December, 
sad January ranking next. The civil popnlations and 
nitivee were said to suffer severely, so that towns and 
kraals were to be regarded as euspicions foci. 

During this war, previous to embarkation, each officer 
of the Royal Army Medical Corps was famished with a 
sienmrandam prepared with elaborate tronble by the 
Medical Department of the War Office, and having 
lefereime to the probable diseases to be met with in 
Sooth Africa, and suggestions as to the prophylactic and 
othermeasoree most snitable to be obwrved. In this, 
i^orandum it was pointed out that the streams and 
rivers were constantly polluted by adjoining habitations 
sad also by the carcases of dead animals, and that an 
equally potent oanse was the n^lect of conservancy 
arrangements and the oonetant pollntion of soil that is 
tsking place. One of the chief sources of infection in 
camping CTOonds being ^e nrine of people who are 
soffering Mm, or who have suffered from, enteric fever. 
It was l^d down that the best prophylatio measures for 
medical officers to follow was to see that in all oamps, 
especially standing camps, an intelligent and daily 
use of disinfectants be followed, that sanitary snper* 
vision of the strictest possible nature should be adopted 
on ti>e following lines. That in addition to the usual 
precautions required in oonnection with water supplies, 
such as boiling and filtration, the daily use of disinfeo* 
tanto in all latrines, urine tabs, soakage pits, &c., 


becomes essential. For this purpose quiokiime was 
recommended as the beet material to be used. It was 
to be added in the form of freebly prepared milk of lime 
(one port hydrate of lime to eight parts of water), the 
quantity to be added to nrine tubs, soakage pits, latrines, 
& 0 ., should be, roughly, in the proportion of one part 
milk of lime to twenty parte of the contents of buckets, 
raoeptaoles, pits, &c. 

The milk of lime was to be sprinkled freely on the snr* 
face of the soil in the neigh^urhood of katrines, and 
wherever snrfaoe pollntion was likely to tak» place. 
Another im^rtant point was the protection of food from 
the contamination of flies or fmcal dost. Kitchen refuse 
was never to be allowed to accnmnlate, hot was to be 
immediately bnmt, and wherever flies appeared to con* 
gregate it was to be taken as an indication that refuse 
or other oi^fanio matter was present, and that steps-were 
to be taken to use strong disinfectants to destroy if pos¬ 
sible the flies breeding there. 

Many other valnable suggestions, which time and 
space will not allow me to ennmerate, were laid down in 
this memorandnm, so that in this partionlar campaign it 
was endeavoured to move a step in advance of previous 
campaigns in the methods of obtaining, above all things, 
a pore water supply for the troops; the second precantion 
advised by the M^cal Department to the War Office 
was the provision of a filter snitable for troops on the 
more. Many of the so-called sterilising filters nsed in 
previons campaigns have been next to nseless; they get 
ont of order, the candles break, they get coated with 
mud, they are heavy and ^ffionlt to carry abont, and 
generally, as experience has shown (for example, in the 
Ashantee campaign), they were left at the bam ss use¬ 
less. The Medical Department, on oarefnl consideration, 
recommended the adoption of the Berkfield filter. 
This filter was tried for the first time at the Salisbury 
Plain mincenvres of 1899, and though open to some 
objections for field service was by far the beet filter in 
the market. This Berkfield filter was designed to filter 
thirty-four pints in ten minntee, and was sufficiently 
light to carry with troops. One was to be snpplied to 
every unit of 100 men, and was snppoaed to be able to 
be brought into operation whenever a pool or any water 
which might be a source of water supply daring the 
march was found. It was supposed to fitter water at a 
snffioiently rapid rate to give each man of a unit of 
100 men a fair quantity of drinking water within thirty 
minutes or hour of the halt. 


But having the defects common to sterilising filters 
for troops on the march, it cannot be worked perpetually, 
the candle gets digged, and the more clogged it gets 
the more difficult it is to work, and it was to rest with 
the men themselves to organise a method of passing this 
filter from man to man and keeping it cleaned. 

The third prophylactic measure I will mention advised 
by the Medical Department, which, although as yet in 
ito infancy, was that of vaccination of the troops by an 
anti-typhoid vaccine prepared in the laboratory of Fro- 
feesor Wright at the Army Medical School at Netley. 

The principles upon which this anti-typhoid inocnla- 
tion is based by him are as follows:—First, laboratory 
experiments have clearly proved that rmiwiAlw inoculated 
with dead onltnres of ^hoid bacilli have a greater 

Dig;:ized ; 


t 



208 Th* Midioal Phiss. OBIGINAIj COMMUNICATIONS. Auo. 28, 1901. 


power of reaiBtin^ infection from livinff ^^hoid bacilli 
a.TiiTw>lii not inoonlated. It may be inferred that 
thia rnle will hold with man from tlie fact that 
the anti-traboid inocolationa induce in man precisely 
the same blood changes which they induce in animals. 
Secondly, the blood changes whi^ occur in man by 
anti-typhoid inoculation are preoiscdy the same as ooonr 
in him by an actual attaw of t^hoid fever. The 
importance of thin last bet beco m es apparent when it 
is considered that the insusceptibility gainst further 
attack, which supervenes upon an aot^ attack of 
typhoid fever, is almost certainly dependent upon the 
ooonrrenoe of the Macular blood changes wmch are 
here in question, while at Netley I had the oppor^ 
tunity of seeins the preparation of this serum and 
personal demonstrations on the means of inoculation. 

The vaccines are prepared from sterilised typhoid 
ottltuiee grown either on agar>^ar or nutrient broths 
of various compositions, the strength of each vaccine is 
ascertained in the laboratory by inoculation on animals, 
and a small quantity - of antiseptic is added to it to 
provide against all possibility of contamination. It is 
then put up for use in either sealed glass capsules for 
one or two vaccinations, or in glass botUee covered with 
paraffined indiambber caps, containing enough serum 
for occasions when a number of inoculations are to be 
made at onoe. The vaccine is sterilised in these bottles 
before it is sent out. Vaccinations against enteric not 
being compulsory in the Army, it was suggested to the 
various medical officers to o2dl for volunteers among 
the offioers and men of the units going out to the war; 
some were inoonlated before going out, others on board 
the tramsports, and some in South Africa. Leotures 
were given in which the medical ofSoers explained in as 
concise and familiar terms as possible the objects and 
expectations of inoculation. A call was then made for 
volunteers, their names taken, and inoculation made in 
batches, a careful record was entered of each man with 
his age, number, and name of his regiment. While on 
passage out in H.M.T. Dilvara I made a number of 
inoculations chiefly among the officers and men of the 
Boyal lAncaster regiment and 11th Brigade Bearer 
Company in oonjuncrion with Captain Tyache, B.A.H.C., 
following the usual methods as laid down by Professor 
Wright. The men were taken in batches of flve, the 
flank of each being the site chosen for injection, on 
account of the looeenees of the subcutaneous tissue here, 
and also from the fact that owing to a certain amount 
of pain and effusion whitdi follows inoculation, it is 
always better to choose a site which lies on a more or 
less protected part from friction or joint movement. 
The skin having been first made surgically clean, the 
serum was injected from a hypodermic syringe which 
had been sterilised in oil at a temperature of 140° C.« 
160° C. 

A thick fold of skin is then pinched up between the 
finger and thumb, and the neeiue paesod down well into 
the subcutaneous tissues in the centre of this fold, after 
the necessary amotmt has been injected the needle 
being gently withdrawn, the track left by the needle in 
the skin should be gently squeezed from without in* 
wards. This last proceeding I think most important, as 
from the fact of the needle being a large one I have 
several times noticed a reflux of the serum down the 
track of the needle, either at its wi^drawal or even 
some time after. Such a reflux as this oocarring might 
easilv be overlooked and the case roistered as inocn* 
tated, and snob a subject contracting enteric fever some 
time in the future and perhaps dying would bias the 
opioion of some people as regards the advantages of 
inoculation. 

The clinical signs and symptoms which result from 
anti-typhoid vacoinatiou are subject to considerable 
individual variations, and can be divided into constitu¬ 
tional and locaL Of the former, most oases manifest 
some degree of malaise, and some even faintness or 
vomitieg; some few show definite rigor. This symptom 
generally comes on from four to six hours after inocu¬ 
lation. Temperature is seldom below 101° F., and may 
rise to 103° F., but mnerally subsides within twenty- 
four hours. The loosd symptoms are much the same in 


all cases—local effusions at the site o! inoculation, heat, 
redness, swelling, pain—but all pass away within forty- 
eight honra. Most of my oases I did at lOin the morning ; 
all turned up for their mid-day meal, some feeling a 
little stiff in the side, about 25 per cent, were abs e nt 
from their evening meal at 6 p m., and those who were 
present were decidedly sore and stiff. The absentees, on 
going to inspect them, were found lying up in their 
bunks, their chief complaint being that they were too 
stiff to TOt up. Of several hundred cases vaccinated in 
no case did any suffering occur after forty-eight hours 
from the time of inoculation. Professor Wright has 
pointed out in his memorandum issued on the suject of 
vaccination the importance of the considerable additional 
protection derived from a repetition of the inoculation at 
a later date not earlier than eight or ten days from the 
first injection. This I was unable to carry out owing to 
more men coming forward for inoculation fchM was 
expected. Finally I inoculated myself, and though 
somewhat sick and sore for nearly forty-eight hours, I 
was able to continue my routine duties and eat my 
meals. 

Having now briefly discussed the main precautions 
laid down before the war by the Medical Departinent, I 
shall endeavour to add my own personal obse^ationa on 
the fruits home by the same during the campaign. My 
observations are limited to the period oommencing 
December. 1899, and terminating February, 1901, and the 
ground covered may be taken as fairly typical, as I have 
been in all four colonies. 1 will first de^ with the sub¬ 
ject of inoculation. That inoculation has been a snooeas 
I have no doubt, but this will be a subject that will re¬ 
quire lengthy stetistical reports which cannot be com¬ 
pleted until the termination of hostilities, for many of 
the cases entered in the army returns as enteric, and 
many other cases entered as other kinds of fever, 
will have to be looked into, for it moat be remembered 
that many obscure fever cases have been diagnosed as 
enteric in persons who have been previously inoon¬ 
lated. And it must be kept in view that Widal's 
reaction, when obtained in a person who ha? been pre- 
viously inoculated, does not in any way confirm the 
diagnosis of typhoid whitii may have been arrived at by 
ordinary clinical methods. And much lees does it con¬ 
clusively prove the oorrectnees of such diagnosis. In 
view of the difficulty which has often arisen u 
di^noeing enteric in inoculated people, it must be tiie 
reduction of actual typhoid mortality that must be 
taken and not the reduction of the presumed oases 
typhoid itself among inoonlated persons. With this 
view I have always made it a point toosucefnlly examine 
all enteric oases in hospital which had been previously 
inoculated. From the evidence I have collect^ I am cl 
opinion that the following results will be found true in 
the vast majority of such oases:— 

First, tbrt inoculated cases as a rule run a mild 
course, and such complications as high fever, bntnor- 
rhage, and perforation rarely ooonr. t.e., that there is a 
very great increase of baotmiotdal power in properly 
ittooulsted men. 

Secondly, that severe oases of enteric occurring among 
inoculated men will always leave a history of no dis¬ 
tress at the time of inoculation, pointing to the likeli¬ 
hood of the vactine not taking. None of the cases I 
either inoonlated myself or saw inoculated have died 
from enteric to my knowledge, and none of these cases 
to my knowledge have been inoonlated a second time. 

Passing from the subject of inoculation to the water 
question we oome to what is really the crux the whole 
question of our heavy mortality lists in South Africa 
The water available for drinking in that country, south 
of the Pretoria-Delagoa line, is distinctly bad, having 
one ever present ingredient, namely, mud. In the 
Lydenburg district, north of this line, the water we met 
with was pure and of a crystalline spaiklenqy, and 
wholesome where not poisoned, as I have found it on 
several occasions, with the ferro-oyamide of potassinffl 
used in the mines. The water, which had to M used by 
tbe Natal Field Force in its twelve months* journeying, 
had to be drawn from sources previously occupied and 
contaminated by the Boers. It bad to be drawn either 




Ado. 28, 1901. OKTGINAL GOMMU{7ICATTONS. Tn M>dioal Pams. 


(rom Bmsll riroN or pens, tha latter baiag marshy 
pools, and was always of a dirty brown ooloor. The 
amount of mud in this water was always enormous, 
even when the water was drawn from a riser the sise of 
the Tugela. Hud nerer at anytime being a favourable 
adjuuot to the food of man, he not being a snotorial 
animal, and acting as an irritant to the intestinal tract, 
prodttoes an acute gastro-intestinal inflammation which 
always results in diarrhcea. An acute g^ro-intestinal 
inflammation produoeed by muddy water is accompanied 
by 

1. Catarrh of mucous membrane. 

2. Congestion of the vessels. 

3. Spasmodic contraction of the muscular coats of 
the gut. 

4. Development of gas in the interior from the decom¬ 
posing matter in the water. 

Catarrh of the mucous membrane is very apt to 
spread to the orifice of the common bile duct, and 
may canse a catarrhal jaundice; this accounting for 
tiie many caeee of jaundice which have occurred. 
Congeetions of the vessels, eapeoially those of the 
rec tu m, when associated with diarrhcea, tenesmus, 
and flatus, often tends to hsmorrhage; this is 
materially assisted by the conditions under which a 
soldier is placed while on the march ; he prooraatioateB 
the act of defecation until the last minute, as at least 
two belte and othfr impedimenta have to be taken off, 
and this, followed by a hurried evacuation, results in a 
bloody and mucous stool of very much the same appear¬ 
ance as that found in dysentery. Acute gastro-intos- 
tinal inflammation easily tends to become chronic; this 
is especially manifest and aggravated in troops on 
preserved field rations and biscuit. When the chronic 
stage is reached the condition of affairs is most grave. 
From faulty digestive power the patient emaoiatM and 
becomes mnoh debilitated, and the condition of the 
mucoos membrane of the inteetines is such that a most 
sniteble nidos is presented to the germs of enteric or 
dysentery should they be present in any further water 
drank. Should such a patient become infected and 
should he not report sick, as i4 often the cue, especially 
during fighting (for daring such times “ Tommy ” won't 
report sick unless he is really " very sick "), let ns see 
what happens. The patient defteoatee in the nearest 
donga; in a bot climate the stool rapidly dries, and is 
either blown about by the wind or wash^ by the first 
heavy rain into the nearest water supply, ready to infect 
tee next comer who draws water from it. So these 
disoswon spread. 

Daring the dark days of the three months preceding 
the relief of Ladysmith, ^ water question added itself 
to the numerous difficulties that (General Buller and the 
Natal Field Force had to contend with. Until the 
Tugela wae crossed uo available water was fit for 
dru^iog at either Chievely or Frere; it had to be 
brought by train in specially constructed tracks and 
carried thence in tanks on ox wagons to the troops and 
dealt out sparingly. 

At Spion Kop it was the lack of any kind of water, 
in combinatit n with the untenable nature of the position, 
that led to the evacuation of the hill. Even when the 
Tngela wae reached the water of that river wae contami¬ 
nate by corpses and dead animals, and was of a deep 
brown colour from the amount of mud it contained, 
Berkfield filters, or. in fact, any artificial filters were 
soon found to be useless. They became clogged after a 
few pints had passed throi^'h, and could not be used 
Fuel wae so noanty that it tcwk the troops all their time 
to find that necessary for cooking purposes. Fires could 
not always be lighted owing to the close proximity of 
the enemy, as any smoke rising above a hill crest was 
■ore to dnw shell fire. During the foarteen days pre¬ 
ceding the battle of Pieter’s Hill the entire army were 
hudd^ together in a valley through which the Tugela 
nn. Putrefied corpses of horses, cattle, and men con¬ 
taminated every donga leading to the river, as well as 
the river itself. The Boers h^ also been camping in 
ttiis nound for the previous three months. Torrents of 
lain fell daily, washing all kinds of contamination into 
the river, which at that time was then our only water 
■apply. 


The sewerage and offal of fever-stricken Ladysmith 
and Intombi Hospital passed by means of the Klip 
Hiver also into the Tugela. 

Such a condition of affairs gave tee medical officers 
of the Natal Field under Colonel Sir Thomas Qallwey 
their utmost to cope with, in addition to their already 
heavy work attending the wounded. It had to be 
done, and it wae done, and yet no epidemic of enteric of 
any proportion oocnrred. 

When Ladysmith was relieved on February 28th, 
1900. it was found that the garrison of that unfortunate 
town had suffered severely from the water question, and 
had it not been for the p'ompt sanitary action taken by 
the medical officers at the commencement of the siege 
a still greater amount of sickness would have occurred. 
As it was, 1.700 soldiers contracted enteric out of a force 
of 12.000, and about 1,800 contracted dysentery. The 
only Bonrce of water supply in Ladysmith was the Klip 
Eiver, the water of which was of pea-sonp consistency, 
due to the suspension of lat^e quantities of red mud. 
Major Weeoott, B.A.M.C., who acted as special sanitary 
officer doriDg this period, in his report on the analysis of 
the water available there, reports that the water 
from the Klip Biver, though notoriously sus¬ 
picious in qu^ity, only oon^ned one grain per 
gallon of chlorine, indicating an almost entire 
absence of organic matter, thos contrasting very favour¬ 
ably with that from a crystal stream ou which he was 
called to report near the gorge of Ladysmith, which 
contained fourteen grains per gallon, and that from a 
well in Intombi Sprint, which contained twelve grains 
per gallon, both of which, of course, were unfit for drink¬ 
ing purpoees. As, however, the small extent of animal 
contamination was no indication of the abeence of the 
typhoid poison, the water of the KUp river was 8terili<ed 
l^ore the drinking by filtration through Berkfield 
filters. The mud was precipitated by alum, as long as it 
lasted, but on Deoembw 19th all the available alum was 
nsed, and another plan of clearing the water previons to 
filtration was adopted, which proved to to a great 
improvement on the previous prooees. Five open hogs¬ 
heads were sank in river at different levels, with 
the result that there was a constant sopply at all watmr 
levels of perfectly clear water; this was pnmped by the 
fire-engine into tanks on the bank of the river, of a total 
capacity of 6,000 gallons. Two water-carts made con* 
stut journeys to the filters, which by working day and 
night gave a daily supply of 1,600 gallons, which was 
ample for drinking purposee. Each nnit also drew 
from the tanks one gallon per head of clear water 
for drinking purposes. In connection with the 
influence of water supply on the causation of enteric, 
Major Westoott noted that when the men in Ladysmith 
were supplied with filtered water there wae a distinct 
drop in the admissions for dysentery, while those for 
enteric fever oontinned to increase. 

On thearrivad of Geoeral Boiler’s army in Ladysmith 
it was manifestly impoesible from a sanitary point of 
view to qnaitsr hie troops in the town, and he broke 
his force np into brigades and stationed them within a 
convenient radios; some were placed on the line of the 
Tusela, others at Sunday Biver, Smith's orosBing, Acton 
Homes and Elands Laagte. It wiis to the last-named 
plaoe the 6th Division, to which I was attached, was 
posted. 

The water at Elands Laagte being anything bnt 
good, and the heidth of the trrope not being as satisfac¬ 
tory as might be wished after their exposure and pre¬ 
carious living for the last few months, I was asked by the 
General commanding the 11th Brigade to nnderteke 
special duties with regard to water supplies and geoeral 
sanitary work in the camp, and to fornieh him with a 
detailed list of snggestioDS dealing with there matters. 
After enumerating many of the points I have men¬ 
tioned in this paper, I suggMted the following reme¬ 
dies :— 

1. Diarrhcea. —That any soldiers suffering from diar- 
rhma should in every case report sick as early as possi¬ 
ble and come np for imme^te medical treatment, as 
sneh cases, with proper thenpentio and dietetic treat¬ 
ment, are easily cu^ in the early stages, whereas 
the difficulty of cniative treatment is greatly increased 

0 


210 Th> Msdioal Pbus. 


ORIGINAL COMMUNICATIONS. 


Auo. 28, 1901. 


ahonld the ailment be allowed to go on untreated, eren 
for a few days. The dietetic t^tment oonBiated in 
Bubatituting a milk, cornflour, and soup diet, instead of 
the ordinary meat, bread, and vegetable diet in a stand¬ 
ing camp. 

2. Waitr .—All water supplies to be daily inepeoted 
and marked by distinguishing flags. That three separate 
and distinct water supplies were to be reoogoUnd. «ator 
for human drinki"g and food purposes water for animals 
and water for washing, that sentries were to be posted 
over each of tht'se to see that no interchange was to 
take place between the n«es each pool was allotted to 
That all water used for human drinking purposes was 
first to be cleared of mud by either precipitation by 
alum, ten grains to the gallon, or passed through 
meoh^inal strainers; for this purpose I advised that 
dean empty barrels, of which we hsd suflSeient number, 
be utiliseid. One barrel to be sawed in half in such a 
way as to form two tubs, each tub was to have a foot 
square cut out of the bottom, and the aperture covered 
by a number of layers of fine linen or khaki, this tub 
strainer was then to be placed over another complete 
barrel which received the strained water, and the water 
finally drawn off by a tap below came out clear. This 
water was now to be passed through a Berkfield filter 
through which it now easily ran, and it was finally to 
be boiled if possible. Cleansing of water carts and the 
men’s water bottles with permanganate of potash at 
intervals was also recommended. 

3. Diapo$al of Refute .—Scriot orders were to be en¬ 
forced as to men using only the recognised latrines and 
urine tubs, and the proper disinfection of the same with 
chloride of lime. All kitchen refuse, including pre¬ 
served meat tin cans, were to be deposited in pita dug 
for the purpose, and to be burnt. All animal refuse 
was to Im reaioved some distance out of camo before 
8 a.m. daily, and to be burnt when dry. All dead 
animals were to be taken some miles out of camp and 
buried at least under three feet of soil. As number* of 
dry foetid carcases of horses lay ab'^ut the battle-field 
of Elands Laagte from General White’s engagement 
in the previoiu year, the most effectual method of 
destroying them was found to be burning. 

4. InomXation .—Recommendation of inoculation to 
all, especially young soldiers, with anti-typhoid serum, 
is advisable Hajor-General Wynne did ^1 in his power 
to assist the medical officers in their sanitary duties. He 
embodied the suggestions I have enumerated in camp 
orders, and paid d^ly visits of inspection to the various 
camps. 

On May 12th I was appointed to Lord Dun- 
donald's cavalry brigade, and with this 1 remained for 
the following six months. This brigadeoon<istod chiefly 
of colonial troops; it comprised “A” ^ttery Soy^ 
Horse Artillery. Strathoona's Horse, South African 
Light Borse, I’homeycroft’s Mounted Infantrv, Bethnne's 
Mounted Infantry. Stewart's Mounted Infantry. As it 
will be of interest to contrast the health of these irregular 
cavalry with the infantry I had been the previous six 
months with, I will first give an outline of the com¬ 
position of each of these regiments. "A” Battery, 
B.H A., consis ed of men who bad been for some time 
in India at Umbvlla. Mont of them had bad malaria at 
some time or other. The South African Light Horse, as 
well as Thomycroft's and Betbune’s Mounted Infant^, 
were all enlisted in South Africa and comprised men of 
remarkable wiry physique, but of very varitble ages. 
Al'hongb a large proportion of them were Africanders 
either by birth or adoption, many of the men came from 
other colonies. 'I'his was particularly marked in the 
South African Light Horse, a uumbw of whom were 
Australians. Stewart’s Mounted Infantry consisted of 
mounted troops drawn from a number of our regular 
infantry regiments. Stratnoona's Horse was a regiment 
of Canadians of particularly good build and physique. 
They were all big men and drawn from the north¬ 
western districts of Canada. 

During General Bnller’e continuous advance through 
Northern Natal into the Orange Biver Colony, and 
finally through the Eastern Transvaal, Lord Dun- 
donald’s Brigade acted as the advance gxiard of 
Hie army and did all the scouting. We were 


also lesponsihle for the selection of water supply 
and camps and the sanitary conditions of the 
same which was necessary for the preservation of 
thw health of the main army when it came up. 
Colonel W. B. Allin, B.A.M.C., Principal Medical Officer 
of the Natal Field Force, is to be congratulated on 
the results of his labours in this direction, f->r no camp 
for the main army was selected without his first making 
a thorough investigation of its water supply and other 
hygienic surroundings, this added to the amount 
attention paid to the food and blankets of the men, 
although hampering General Bnller with additional 
transport (he carried 1,603 medical diets with the Natal 
Field Force after the line wav left in the great advance 
north), such things greatly helped in reduction of sick¬ 
ness in the Natal Field Force; the statistics of which 
will very favourably contrast with any other field f<woe 
or any other campaign onr troops have been in. 1 was 
with the cavalry for more than six months, and was 
agreeably sarprised at the very small amount of siok- 
cess in Lord Dundonald’s Brigade. At the same time 
it must be remembered that any comparison between 
cavalry and infantry iu a campaign in the matter of 
health and admissions to hospital is hardly fair. The 
mounted mau naturally does not suffer so much from 
fatigue and thirst as does the foot soldier, who madly 
rushes to drink any water, no matter bow muddy, he 
meetd with on the march, stirring up the mud aud thus 
still farther polluting the water in his endeavours to 
fill his water-bottle. The hardened infantry reservist 
bears a favourable comparison with the infantry recruit 
in this respect on the march. While the former 
by experience has learned that he can march easier 
and perspire least if he keeps from water daring a 
march, and whom yon may see at a halt cool and refresh 
himself by merely rinsing bis mouth with water, and 
not swallowing it; whereas the recruit hugs his srater 
bottle as his most cherished poesession, he fiiU it at 
every paddle he can get to, and empties it with the 
same avidity as an infant does its feeding bottle. The 
reentt of oontinuons water drinking to the recruit is 
much discomfort, heavy sweating, and exhaustion, and 
these are the m<*n who fall out on a march and fill up 
the ambulance wagons. From what I have seen I would 
be almost tempted to cake the water bottle away from 
the reomit on foreign service. Another, and perhaps 
the best, explanation as to why this Colonial Brigads 
contrast^ so favonrably with the infantry was that so 
many of the men in it, being South Africans, had 
become inured to the climate and muddy water through 
long r«>8idenoe in the coantry. or had been used to 
country life in some of ourool»n<ee. Another explana¬ 
tion might be the fact of mounted men constantly 
moving from one camp to another. 

There is little further of intotest to rdato on the 
water question until General BuUer advanced north of 
Lydenburg. Here, while acting as advance Sanitary 
Officer of the Force, 1 had reason there to condemn 
certain water supplies in several places, as they had 
been poisoned by cyanide of potassium. Lord Boberts 
bad previous to this drawn the attention of the medical 
officers of bis force to this possibility ooourring in the ad¬ 
vance through the enemy’s oountry. But I am not snre 
if any water was found Miaoued on his side. The tests 
I employed were the ord^inary ones, a ferric salt giving 
a blux precipitate with ferrnoyauide of potassium. The 
precipitate iusolnble m dilate hydrochloric acid and 
decomposed by a solntioo of causCio soda; cyanide of 
potassium also renders water alkaline. The Iwge amount 
of iron naturally existing in the water of the Lydenbe^ 
district made the poisoning of ranning water extremely 
difficult. In concla*ion I would like to remark, notwith¬ 
standing the fact that a sanitary officer has been con¬ 
demned by Lord Wolseley as a useless eucumbranoe in 
time of war, I think the campaign in Natal has clearly 
proved that, with the oo-opnration of the general stsff 
aud the principal medical officer in the first place in 
selection of campe, feeding, and clothing, and secondly, 
what is even more importimt, the co-operation of regi¬ 
mental commanding officers with their regimental 
medical officers, has proved the value of the present 
system. This oonld no doubt be perfected by the 

C 




Auo. 28. 1901. _ORiaiNAL COMMUNICATIONS. Thi Mw>ioal Pbisb. 211 


lUotmeiit of one or two medical offioere to the staff of 
the principal medical officer of a field force, which officers 
wonid be made responsible for dailjr sanitary inspection 
cf all standing camps, camping groonds and hospitals, 
and oondoot water awysie, report on food and clothing, 
and do medical and snrgical Te8ea<t^h work. They could 
roport direct to the Prin^pal Medval Offi'erouiketpo* and 
aasist him, not only in sanitary matters, but be arail- 
able in timM of tu^ency. 

BaysssNos. 

** Sanitary Notes, Climate, Diseases, Ac., of Natal and 
Transraal.*' War Office. 1899. 

“ Vaccination against Typhoid Ferer,'’ Brit. Med. 
JouTu., January 80th, 1897, Mav 16th, 1897, February 
5tb, 1698, Lonut. March 6th, 1897. Professor A E. 
Wright. M.D., “ Berkfield Filters.’* “ Theory and Frao- 
tioe of Hygiene,’* Hotter and Firth. “ Minutes of 
Eridenoe, with Appendix and Report of the Boyal Corn- 
mission on South African Hospitals.” 


THE THERAPEUTIC AND DIAGNOSTIC 
VALUE OP TUBERCULIN IN HUMAN 
TUBERCULOSIS, (o) 

By G. A. HERON, M.D., F.B.U.P., 

Pbrsiou to the City of London Hoapital for Diseues of the Chest. 

Ik the autumn of 1890 there took place in Berlin 
one of the moet remarkable eTcnte that mark epochs 
in the history of medical science. The announce* 
mentof anewmethod of treating tuberculosis by the 
man who shared with Lister and Pasteur the honour 
of baring done moet for the adrancement of scieotific 
medicine and the consequent lessening of human 
suffering. With much enthusiasm, and with high 
hopes of its future usefulness, tuberoalin was received 
in the autumn of 189‘). Before the end of the fol> 
lowing spring the remedy bad to a very great extent 
fallen into disuse, and was damned as loudly as It 
had erer been welcomed. The outcry against the 
use of tuberculin—for it was nothiug less than this 
—had for its chief cause the condemnation of its use 
by another distinguished German, Vircbow. The 
patriarch of present day pathologists said that, in 
bis opinion, the use of tu^rculin was fraught with 
danger to the patient. His reason for maHng this 
statement was ^at be bad seen in the bodies of con- 
snoipdves, wbo in life had been treated with the old 
tuberculin, evidence which convinced him that the 
drug caused destruction of the tissues around tuber¬ 
culous centres, and so set free the bacillus to do its 
work upon healthy tissues. Virchow maintained 
that, h^ the remedy not been used, the bacillus 
might have rested, harmless, encapauled, as we 
know it often is, by tissues that have undergone 
an indurative process, and become fibrous. Now 
this statement of bis views by a man so justly famous 
as Virchow at once attracted attention. There is, I 
think, no doubt that this expression of opinion 
greatly tended to deter men from using tuberculin, 
and to prejudice the medical profession everywhere 
a,)^aiD8t ita use. And so tuberculin was both made 
and unmade in Germany! 

Of Virchow’s objections to the employment of 
tuberculin lean only say that, in my oospital ex¬ 
perience of its action, there has been observed no 
evidence of resulting spread of disease to seemingly 
healthy organs, or to neighbouring tissues. The 
arerage stay in hospital of the first thirty-five cases 
treated with old tuMreulin by me extended to sixty 
one days. There was, therefore, sufficient time in 
which to observe whether or not, in these cases, there 
was to be obtained clinical evidence in support of 
Virchow's views. In no case was this evidence found. 


(a) Abotroot of Paper read before the Dritiah Congresa on 
Tabercoloaia, July, 1901. 


and it was often searched for by other physimans 
besides those officially present in the wards. 

It may be worth while to refer in this connection 
to a case treated by me with the new tuberculin in 
hospital, and selected for that treatment because the 
patient was certainly slowly dying of extensive and 
advanced tuberculosis of rath lungs. Dr. Perkins, 
wbo is one of the honorary secretaries of this section 
of the Congress, and was then pathologist to the 
City of London Hospital, performed the post-mortem 
examination. He made special search for the 
presence in the viscera of centres of probable fresh 
tuberculous infection, but found none. This patient 
received twenty-six injections of new tuberculin in 
forty-two days, and the doses ran from mg. up 
to 2*5 mg. 

Koch bad. in the plainest words, and on several 
occasions, stated that cure of tuberculosis when it 
affected the lungs could be reasonably looked for, 
with the help of tuberculin, exclusively in those cases 
where only a small portion of one lung was infected 
to a slight extent, and where, of course, there was no 
evidence of excavation of lung tissue. He also said it 
would be reasonable to hope for a cure when onlpr a 
small portion of each lung was diseased, there being 
no evidence of excavation Any departure fiom these 
types of cases in the direction of inctvase of the 
extent of tbe disease, lessened by so much, in Koch’s 
opinion, tbe chances of a care; although even in 
more advanced cases amelioration of symptoms was, 
he believed, likely to result from tbe use of the 
remedy. Now hospital experience taught me that 
it is seldom we have there an opportunity of treat¬ 
ing these early cases. Therefore it is not common 
to find in hospital the cases in which cure of the 
disease can be reasonably expected. So far as mj 
experience of private practice goes, I must say the 
majority of cases in which I have been asked to 
advise as to the use of tuberculin have been too far 
advanced in tuberculosis to permit of high hopes for 
the best result of the treatment being obtainable. 
But when in unsuitable cases the use of tuberculin 
produces no good result, blame should not rest on 
the remedy. 

In my <minion, tuberculin has fallen into discredit: 
1. By ita frequent use in unsuitable cases. 2. By ita 
administration in too large doses. 3. By neglect of 
tbe rule that a dose of it should never be given until 
the patient's temperature has been normal for the 
previous twenty-four hours at least. 4 By neglect 
of the rule that the dose of tuberculin should never be 
increased, but, on the contrary, sbculd be diminished, 
when its administration has b^n followed by a rise 
of temperature. 5. By the prejudice raised against 
the remedy, among both doctors and patients, 
because of the severity of the symptoms which not 
seldom follow upon its use. 

In consequence of a long illness, which, until a 
fortnight ago, unfitted me for work, I was obliged 
to relinquisD tbe treatment of the cases I bad begim 
to observe for tbe purposes of this discussion. 
Therefore, I am unable to prasent to you tbe new 
work which it was my earnest wish and intention to 
have submitted to you to-day, and I can deal only 
with work I have already published. Since the end 
of 1890, fifty-seven cases have been treated with 
tuberculin by me at the City of London Hospital for 
Diseases of the Chest. Fifty-one of these were ex¬ 
amples of tuberculosis of the lungs, and six of lupus 
vulgaris. Of these, five of tbe lupus cases and 
twenty-seven of the others were treated with old 
tuberculin. One case of lupus und twenty-four cases 
of tuberculosis of tbe lung were treated with the new 
tuberculin. At the end of the year 1900 seventeen of 
the fifty-one cases of lung ffisease bad been lost 
sight of, praciicaUy from the time they left hos«I 


212 Tn Msdioai Psxbs. 


OBIGINAli COMMUKIOATlOJflS. 


Ava . 28, 1901. 


pitaJ. Sixteen of the Temaining tbirt^-fonr were 
then known to be well, and earning their living. I 
ask jon to bear with me while I tench upon a few of 
the more important features—as 1 deem them—of 
these cases. 

Whether oonsumptives leave a hospital well or ill 
is a veiy small matter compared with the answer to 
the reallj important question: How many of these 
people are able to work for their living, and for how 
long a time did they continue to gain their liveli* 
hoodP I think the return to useful life of sixteen 
out of thirty>four cases of tuberculosis of the lungs 
is not altogether an unsatisfactory result of treat* 
ment, and this result was obtained with the help of 
tuberculin. According to our information at the 
hospital, ten of these sixteen cases of recovery are 
known to have remained well and able to work for 
seven years, three for over three years, and three 
for nearly two years. Other patients remained able 
to work for periods varying from a few months to 
eighteen months, but as they are known to have 
broken down in health they are not included among 
these sixteen cases of apparent recovery. 

Thirty*two of these fifty-one cases left hospital in 
1891. Seven years afterwards—in June, 1898—the 
information concerning these cases, obtained, for the 
most part, by the assistant medical staff and nurses 
of the hospital, was as follows:—Eight of them 
were dead, ten were well, one relapsed in 1897, having 
remained well until the autumn of that year, thirteen 
were lost eight of very soon after they had left 
hospital. 

l^ese patients were all treated by the old tuber¬ 
culin, and their cases are dealt with in some detail 
in a paper I contributed to Vol. XIV. of the 
Transactions of the Medical Society of London. 

In addition to these thirty-two cases, five cases of 
lupus vulgaris were then treated by the old tuber- 
ctilin. These cases all did remarkably well op to a 
certain point, and then, at longer or at shorter inter¬ 
vals, suffered relapse. In one of the five a relapse 
did not set in until more than a year after she left 
hospital, and she would not return for treatment 
because she said she could notafford to give the time 
necessaiy for this purpose. 

Some of these cases of lupus vulgaris relapsed 
while under the infiuence of tuberculin, It is certain 
that at this period of the history of tuberculin cases 
of lupus received unnecessarily high doses of the 
drug. When relapse took place in, for example, 
three of tbese cases, one of them had gained 10 lbs. 
in weight, and was taking 400 mg. doses of tuber¬ 
culin ; the second was taking lOW mcr. doses, and 
had gained 10 lbs. in weight; the third bad gained 
181 Ihs. in weight and was taking doses of 1000 mg. 
These large doses were given once in a week or a 
fortnight, and were in these cases not followed by 
high temperature, nor by other symptoms due to the 
action of the diotg. The patients had been re¬ 
spectively 124, 128, and 135 days in hospital, and 
had received in that time the first-named 50, and the 
other two 59 hypodermic injections of old tuber¬ 
culin. It seems to me difficult to believe that these 
large doses could have exercised any material influ¬ 
ence in the direction of favouring any tendency to 
relapse. The evils said to result from tuberculin are 
ascribed to its violent effects upon the tissues, by 
which, during severe reactions, infection of neigh¬ 
bouring healthy tissue is, according to Vuebow's 
observations, apt to happen. But in these cates 
there were certeinly no reactions when large doses 
of tuberculin were given, beyond slight redness round 
the site of the lupoid patches. There were no head¬ 
aches, no rigors, no high temperatures; and yet, 
in these circumstances, a relapse did take place, 
and while the drug was being administered. If the 


tubercle bacilli were let loose into the tissues, near 
the patches of lupus, as a result of severe reaettons 
early in the treatment of these patients, then the 
drug should, one may reasonably urge, have had 
ample opportunity to exercise a beneficial influence, 
owing to the administration of the very large doees, 
which were not followed by reactions worth noticing. 
Certainly, in all but one of my lupus cases, tuber¬ 
culin seemed, after a certain time, to lose its power 
for good. I confess 1 have never been able to under¬ 
stand why, in cases which had improved so much, 
certainly because of treatment by tnwrculin, relapse 
should have occurred while the treatment was In 
full use. 

Since March, 1897, I have used only the new 
tuberculin. During that year ten eases were co 
treated in hospital. Two of these cases died. One 
of them was the man whose case I have already 
spoken of as having been selected because he was 
certainly dying. The other eight cases of this year 
were m^e up of seven examples of tuberculosis of 
the lung, and one of lupus vulgaris. They all did 
very well, and, without exception, left hospital, 
urging as their sole reason for leaving their fitness 
for work andtbeirwish to resume work. In Decem¬ 
ber, 1900, three years after treatment, the following 
was the result of the use of tuberculin in these ten 
cases:—Two were dead, both of them recognised as 
being hopeless cases from the first; three were well 
and supporting themselves by their work; three 
were lost sight of; one remained well until lately, 
and returned to hospital a few weeks because of a 
recurrence of disease. 

In 1899, ten patients, five men and five women, 
were treated in the wards with the new tuberculin. 
Of these five women two are known to be still in good 
health. One of the two is a domestic servant, the 
other is a shorthand writer and typist. Two other 
women are reported to have broken down in health. 
The fifth has not been heard of since ^e left the 
hospitul. 

Of the men, one continued well for more than a 
year after treatment, but appears to have recently 
bad a relapse. He worked as a hawker, and so sup- 

E orted himself. Another seems now to be as well as 
e was when he left the hospital, and is said to be 
able to work. The third died November 16th, 1900; 
the cause of death was not stated to us, but he was 
carried from his work, and two months afterwards 
died in his bed. Probably he died from a relapse. 
The fourth was reported to be very ill a year ago. 
The fifth is working as a photographer's assistant, 
but be says he had spitting of blood two months 
ago. 

In Hrause’s record of his six years’ experience of 
Xoch's method of treatment of tuberculosis, be 
states that of twenty-seven of these cases twelve are 
well, thirteen improved in health, one in stat. qw, 
one is worse. It is, of course, not possible on an 
occasion like this to go into details at any length; 
but some authors have more or less emphatically dis¬ 
sented from the outcry raised against the use of 
tnherculin, e.g., Hansen, of Bergen, Osier, Gmtscb, 
McCall Anderson, Petruschky, Spengler, and others. 
Those of ns who have dissociated ourselves from the 
ou'cry against tuberculin, have all expressed tbe 
view that in cases of tuberculosis, whicn fall within 
the limitation laid down in 1890 by Eocb, great 
benefit to the patient is sure to follow upon a proper 
use of tuberculin, and very often there is complete 
disappearance of all symptoms of activity of the 
disease. 

Responsible opinion is nnanimons in its recogni¬ 
tion of tbe worse than uselessness of any attempt 
to treat with tuberculin tuberculosis that is compli¬ 
cated with other inflammation. These mixed in- 


Avo. 28, 1901. 


OBIGINAL COMMUNICATIONS. Thb Midioal Prsu. 218 


factions, as tbej are called, were not recog^sed in 
1890, and it is only within the last few years that 
their great importaoce as complications of tuber- 
ooloeis, whether of the lungs, of the skin, or of 
any other tissue, has been clearly apprehended. I 
Is there good ground for the belief that tuber-! 
culin, when properly used, is dangerous in any 
degree to the patient P From my own experience 
—and I am responsible for over 2,000 injectioos of 
it—I am strongly of the opinion that it is, at least, as 
safe for the patient as is any other very potent drug. 

What, then, is the diagnostic value of tuberculin P 
That it produces its cbaracteristio reaction wherever | 
tuberculosis is present, there can be no doubt. That 
it larelv fails to react where there is tuberculosis is so 
true, that cases in which failure is recorded may 
safely be neglected. In my own experience of this 
nse of it I have never seen any evil consequences 
follow its adminstration. It produces no evil effects 
in such cases as disease of the larynx, nor in kidney 
disease with albuminuria and gl^dular tube-casts, 
nor in disease of the bladder, nor, so far as I know, in 
any condition of disease, whether tuberculous or not. 
As an illustration of the practical usefulness of tuber¬ 
culin as a test in cases always difficult and often 
impossible of diagnosis by ordinary methods, 
I would refer to the excellent work done in this 
direction by Dr. Eric France, of the London County 
Asylum, Glaybury. His object was to ascertain, with 
certainty, who among the insane inmates of the 
asylum had tuberculosis. For this purpose he 
tested fifty-6ve of his patients with tuberculin. 
Characteristic reactions occurred in forty-five of 
these cases. Thirty-four of them eventually died, 
and twenty-nine of these thirty-four were submitted 
to post-mortem examination, with the result that,ai 
Dr. France says, “ Active tubercle was found in every 
case.” Ten of the fifty-five patients did not react. 
Five of those died, and post-mortem, says Dr. France, 
“Notrace of tutercle found in any; five still alive 
and healthy.” Here is his expression of opinion on 
this matter in his own words: “ I injected seventy- 
five cases with tuberculin, and, personally, I am 
satisfied, not only with the accuracy of its diagnostic 
power, but also with its entire barmlessness, both in 
the tuberculous and in the non-tuberculous.” 

We know that the best, I had almost said the only, 
chance of cure of the consumptive is to treat him in 
the earliest days of his illness. It is a fact, that by 
no other means cati we so early diagnose tuberculosis 
in men as we can by the help of tuberculin. It is 
also a fact, that we can do this with safety to the 
patient Had tuberculin served no other good nur- 
pose than this, it would have deserved our oest 
attention, our high appreciation. I am sure the day 
is not distant when the discovery of tuberculin will 
be ranked among the most valued of the many gifte 
mankind already owes to Robert Koch. 

ALCOHOL AND TUBERCULOSIS. 

By JOHN C. THOROWGOOD, M.D., 
F.R.C.P.Lond., 

ComtUng Poyiiciu to tbe Citv of Loadoo Hospital for Diseases 
of the Cheat, Victoria Park, Ac. 

Having read the article by Dr. Kelynack on the 
above-named subject, in your issue of August 7th, I 
should like to make a few remarks on tbe same. 

Speaking from experience at tbe City of London 
Ho^ital for Diseases of the Chest, and elsewhere, 
fuj conviction is that the moderate use of alcohol in 
some form or other is helpful in most cases of chronic 
pulmonary tubercn’osis. I have observed excellent 
eSects in checking diarrhma to follow on the steady 
use of a rather rough claret as drink with meat food. 

It the food be of a milky or farinaceous character 


then brandy or whisky may answer better. As a role, 
however, I try and avoid spirit drinking, as when 
once started the patient is very apt to exceed his 
proper allowance. 

Thus 1 have known a man who was told to take 
mm and milk every morning go on increasing his 
dose of rum till he told me be took half a tumberfnl 
of rum filled up with milk as his regular breakfast. 
Under this regimen his liver attaint a prodigious 
size and the progress of bis disease was much 
hastened. I only saw him onoe, but soon learned 
he had died. 

Tbe doctor, when allowing spirits, must fix the 
patient down to a certain daily allowance with a very 
strong hand. 

When there is brnmoptysis all forms of alcohol 
should be decidedly withheld. 

A good single stout of the Romford Brewery I 
have found u safe and acceptable drink with many 
patients. This stoutis not beady,is really digestible 
and nutritions, and does not, like ale, cause cough. 

Alcohol appears to conduce to tbe development of 
fibroid phthisis, and so may bring about the arrest 
of the disease in its more serious form. I gather 
that this was the belief of the late Sir Andrew 
Clark, for I remember the case of a young chemist 
whom Sir Andrew was kind enough to see with me, 
and who was seriously ill with pulmonary tubercu¬ 
losis. 

The case was most unpromising, and the only 
suggestion made to me was to allow plenty m 
alcohol in bis diet in the somewhat forlorn hope 
that this might cause the disease to take on the 
fibroid form, and so life woold be prolonged. 

Gouty people, whose nutrient tendencies are 
rather to fibroid change of tissue, seem to me very 
i-arely to suffer from tuberculosis. 

In one very well marked case of a man who was 
rapidly going in the lungs, a sea voyage and most 
geoerous living quite arrested the mischief, while 
true gout took its place, tbe patient becoming robust 
and plethoric. 

Any one who wishes to get the resnlie of some 
valuable experience on tbe effect of alcohol in tuber¬ 
culosis will do well to peruse the remarks of Dr. 
Thomas Harris, of Manchester, as they are recorded 
at page 95 of Dr. Ransome’s work on the ” Treatment 
of Phthisis.” 

Tbe subject is one on which one might enlarge, 
but I mean this paper to be short and practical. 
Theoretical objections to alcohol as checking oxida¬ 
tion and so forth I do not consider. I dare say 
chemists and physiclogists could make out serious 
theoretical objections to tbe use of tea and coffee, 
and, used in excess, we know both these beverages 
may do much harm to stomach and nervous system. 

TONSILLOTOMY RASH, {a) 

By WYATT WINGRAVE, M.D.Lond., 

Physician and Patholoifist. Central London Throat and Ear 
HcspitaL 

The occurrence of a skin eruption following 
operations, often referred to as “ surgical I'ash,” is 
familiar to all of us, but its association with tbe 
removal of tonsils and adenoids is perhaps not so 
widely recognised that a few notes may be of 
interest. 

^cent experience of several instances prompted a 
reference to my hospital and private records which 
has revealed thirty-four cases in the course of seven 
years. Although relatively to the large number of 
operations this is but a small percentage, I feel from 


(a) Paper read at the Twenty.tliird Annual Coogrssa of 
the American Laryngologrical Aaaoctation, held at New Haren, 
Conn., 1901. 


D, 


Google 




Auo. 28, 1901. 


214 Th* Mkdical Pbibb. OBTGINALj COMMUNICATTOITP. 


recent experience that they represent but a portion 
only of those actually occurring, and that a thorough 
and eyatematic inquiry would afford evidence of 
greater prevalence. 

It is the custom at our hospital for all patients 
who are operated on in the extern department to 
attend, after a weeVa interval, for examination; and 
in several instances the parent has reported that the 
child was kept at home because it bad a rash which 
was thought to be “something catching.” Subse¬ 
quent investigation, however, in most cases proved 
its innocence of apecidcity. In other cases the rash . 
was still visible on the patient and unattended by . 
constitutional symptoms. 

Of the thirty-four cases, three which were in- 
atients proved to be scarlet fever, while one 
eveloped diphtheria. The remainder were simple 
non-specific cases. 

Character of i/asA.—The eruption generally ap¬ 
peal's on the second or third day, either papular, 
roaeolar, or erythematous in type. It most fre¬ 
quently attacks neck, cheat, and abdomen, sometimes 
extending to face and extremities. The earliest ap- 

{ >earance noted is on the day following operation; the 
atest one is on the sixth day. Its duration is 
generally two or three days, but may extend to five 
days. After reaching its maximum intensity, it 
rapidly disapprars without desquamation, but is 
sometimes associated with intense itching. 

It may occur at any age—-the youngest was four¬ 
teen months and the oldest twenty-three years. 

With regard to sex, excluding the specific cases, 
twenty were females and ten were males. 

As a rule there is but slight constitutional disturb¬ 
ance and the child does not appear to be any the 
worse. In those cases which I was able personally to 
investigate the temperature was increased 1^ to 2^ F. 

Although the incidence of so innocent a complica¬ 
tion in our most common operation may not be 
u^amiliar to many of us, I am not aware of any 
published references having been made to the sub¬ 
ject. It is, however a matter of some importance, 
since foreknowledge will help our diagnosis and 
prevent any undue precipitancy in forming the 
g^ver estimate of its nature. 

The occurrence of scarlet fever in three cases and 
diphtheria in one has, however, an important prac¬ 
tice bearing inasmuch as the remov^ of actively 
inflamed tonsils is advocated by many surgeons, (a) 
There are distinct advantages in this practice, 
since the prominence of an inflamed tonsil affords 
facilities to the guillotine, which disappears on sub¬ 
sidence of the inflammation, and there do not appear 
to be any Berious disadvantages. In the absence of 
any ansesthetio the operation may certainly be more 
painful, but it most effectually relieves the temporary 
angina and the removal is thorough. It may happen 
that tonsillotomy may be undei^ken in the early 
stage of recognised or unrecognised scarlet fever, 
dipntheria, or other specific fever, and it is main¬ 
tained by many eminent specialists that not only is 
no additional risk involved, but that it is an ex¬ 
pedient course to take. (6) This may be so if the 
tonsils alone are removed, but one may reasonably 
doubt the expediency when a large crop of adenoids 
requires removal in addition, since the formation of 
so extensive a denuded surface is not unattended 
with risk. 

The incidence of a rash upon any solution in con¬ 
tinuity of tissue, operative or accidental, is well 
known and has been well discussed, but there are a 
few points associated with this particular operation 
which may throw some light upon its pathology. 

(a) LeuDox Browne: Dieeeees of tbe Nose end Throat. Fifth 
EdtUon. P. 346. 

(b) Lennox Browne: Diseases of the Nose and Throat. Fifth 
Edition. P. 523. 


Examination of the blood during the week follow¬ 
ing the operation has, with few exceptions, afforded 
me evidence of an increase in number of the mono¬ 
nuclear white corpuscles. This leucocytosis, which 
rarely lasts beyond the tenth day, rray be more than 
coincidental, yet it is hardly surprising after so great 
a disturbance of lymphoid structures. The removal 
of tonsils and adenoids affords a very large area for 
absorption of toxic matter. 

The rash may also be interpreted as one of drug 
intolerance, since most of the cases were taking the 
usual mixture of sodium salicylate and pota^um 
bromide. 

Whatever its pathology may be, the knowledge that 
a rash not infrequently follows tonsillotomy, and 
that it is not necessarily specific, may be reassuring 
to practitioners experiencing the phenomenon for the 
first time. 

Since this note was presented eight fui'ther cases 
have been observed and are included in the numbers 
here given. 

MULTIPLE PAPILLOMATA OF 
LARYNX, {a) 

By N. 0. HARING, M.B.Lond, &c.. 

Senior Aseiatast Pbyeidon to tbe Uonnhester Hoajdtal for 
Conanmption and Dleesaea of tbe Throat. 

Description — The growth occurs in pinkish 
masses, sessile or shortly pedunculated, affecting the 
anterior portions of the larynx by preference, bat 
in many cases arising from tbe whole surfaee 
Most serious are the cases where there is much sub¬ 
glottic growth. 

Ind&nce .—It forms a large percentage of the 
growths of the larynx in children up to tbe age of 
puberty, but is not common in adults. As pertuss 
in all laiyngeal growths the male is more liable 
than the female. 

Pathology .—Microscopically tbe growth is seen to 
consist of proliferated epithelium with but HtUe 
fibrous structure, and may closely simnlate epi¬ 
thelioma. There is no infiltration of tbe contiguous 
parts. The distinction from a malignant growth, 
which is difficult in a p. m. specimen, may be almost 
impossible clinically, as one has to demonstrate that 
tbe epithelial cells do not extend below the border 
line between tbe laryngeal epitbeliiun and connected 
tissue. 

Etiology .—There is usually no history of ante¬ 
cedent chronic laryngeal disease, nor of any family 
predisposition. It may appear congenitally. There 
is strong reason to beneve that this growth is 
analogous to warts on the skin, and especially so in 
its doubtful relations with epithelioma. 

SyrnfUmt. — The ordinary ones of latyngea) 
growth, unless p eces of tbe growth are expelled 
during cough, the diagnosis can only be made by 
obtaining a view. In children wbera ordinary 
laryngoscopy may be difficult or impossible, I have 
found tbe direct view into the larynx, by means of 
Koi'stein’s or Escht’s tongue depressor, with or 
without an ancestbetic, almost invaluable. 

In children there is little fear of malignancy, but 
in adults it is necessary to note carefully that there 
is no fixation of any part of the larynx before tbe 
possibility of malignancy can be dismissed. 

Trea^menf.—Recurrence is almost certain unless 
tbe removal is complete. This endolaryngeal Vest¬ 
ment is rarely successful. 

Brushing the growth over with phenol sulpho- 
rieinate, which renders tbe growth friablo, is a uwul 
adjunct to endo'aryngeal manipulation. __ 

a Abitroct of Paper read at the Annool Meeting of the Brttub 
leal Aseociatioxi, Section of LoiTngologr, Cheltenhux, 
Aug^, 1901, 

t 



Tn Mscioal Puss. 215 



Tracheotomy is often necessary to relieve the 
dyspncea, and in some cases is sufficient to cause 
spontaneous evolution of the growth. For radical 
treatment I have found thyrotomy most satisfactory. 
In order to pr^erve the voice it is imperative to 
divide the thyroid cartilage in the middle line and to 
avoid cutting the vocal cords. Spraying with extract 
capsule much reduces the btemorrhage. 
The growth is best removed with curved scissors, the 
places of origin freely curetted and cauterised by 
the application of solid chromic acid fused on a 
probe. Absolute thoroughness of removal is neces* 
sary, or recurrence is certain. 

c^rancc. 

[PBOM OUB OWN COBBkSPONDlNT.] 

PiUiis.Aaf^t 26th, 1901. 

Th* FbBNCH CoNORESS on GTN.aCOl,OQT. 

The French ^rational Periodical Congress of Gynssco- 
logy, Obstetrics, and Psediatrics will assemble for its 
third meeting at Nantes on September 23-30, under the 
general presidency of Dr. Sevestre, of Paris, who will 
also preside over the Section of Pediatrics. Dr. Segond, 
of Pans, will be President of the Section of Gynecology, 
and Professor Queirel, of Marseilles, of that of 
Obstetrics. The questions to be considered in the Sec¬ 
tion of Gynecology are; (1) Congenital anteflexion of 
the uterus as a cause of stezility, and its treatment; 
(2) causes favouring ectopic gestation? (8) dystocia 
due to fibroids. In the Section of Obstetrics the pro¬ 
gramme is; (1) Bupture of the uterus; (2) inversion of 
the uterus; (8) the fate of prematurely born children . 
( 4 ) the uncontrollable vomiting of pregnancy? (6) 
radiographic measurement of the pelvis. In the Sec¬ 
tion of Pediatrics the following questions will be dis¬ 
cussed: (1) Arthritism in children; (2) meningitic 
manifestations in the course of digestive infections in 
childhood ? (3) intermittent albominoria in the child ? 
( 4 ) the defence of childhood (pneri-cnltnre, suckling 
weaning) ? (6) conservative methods in the treatment 
of local tabercnlosis ? (6) scoliosis, its treatment by 
kinesitherapy (movement core). 

ftfcmang. 

[Fbom Oob Own Cobbbspondxnt.) 

Bsbli 5. AnglUt 24tb, 1901. 

Special Inbtbuction in Balneoloot. 

Fob the benefit and further instruction of physicians 
anew departure in the teaching of physical therapentios 
has been taken in Baden-Baden. The Grand Ducal 
Government has arranged a ten days’ course of lectures 
and practical demonstrations—at the nominal fee of ten 
shillings, to defray casual expenses—in the munificently 
arranged bathing establishments of that town. 

Professor Erb and Professor Bosenbusob, of Heidelberg, 
will hold introductory lectures, the former on “The 
Balneological, Physical, and Dietetical Treatment of 
Nervous Diseases,” the latter on “ Mineral Springs from 
a Geological Point of View.” Further lectures and 
practical demonstrations will be held by Dr. Frey 
(Baden-Baden), “ Hydrotherapentics, their Method and 
Practical Use”; Dr. Gilbert (Bsden-Badeo),“Dietetical 
Treatment and Dietetics in Balneo-therapy ” ? Dr. Neu¬ 
mann IBaden-Baden), “Hygiene in Bathing Places”; 

Digitized by Google 


216 Thv Msdical l^Bsss. 


GERMANY. 


Avo. 28, 1901. 


Br. Obkiroher (Baden*Baden), (1) “The Mineral Springs, 
their Use and Indications, inclndiog the New Methods 
of Inhalation," (2) "Ma<sage, Meobano*therapeatics”; 
Br. Boessler (Baden-Baden), " The Chemical Aspect of 
Mineral Springs, with special reference to Mineral 
Products, and to the Medical Explanation of the 
Analysis of Mineral Waters." 

The coursee will commence on October 14th, and those 
wishing to take part should send in their names to 
Br. Gilbert, Baden-Baden, on or before October let. 

The Archi'v. /. Oyn., H. 102, has an article on 
PUBRPKBAL NstraiTIS 

by Br. Mattiesen, Leipsia This disease, according to 
Mobino, is a paralysis in the region of the median or 
ulnar nerve, coming on after a normal childbed, in 
which both sensation and motor power are affected, and 
especially in the hand most used. The affection com¬ 
mences in childbed sometimes earlier, sometimes later, 
and after a varying period, always ends in recovery. 
The lower extremitiee also may be affected, but to a 
lesser degree. According to later observation, however, 
this form of paralysis does not exclusively adhere to 
this type. Paralysis affecting the larynx and pharynx, 
the optic nerve, paralyeis of the facial and sciatica 
have also been described. 

The tstiology is not known, and treatment in conse¬ 
quence is quite empirical. Prophylaxis also can scarcely 
be considered, as the gravidity itself is supposed to be 
the cause. The maintenance of the renal function is 
considered to be one without influence. Alcohol is to 
be avoided. The usual anti-neuralgics and anti- 
rheumatics are useful, and also aotipyrlne, given, not by 
the month, but subcutaneously. Sodium salicylate acta 
favourably in the febrile stages, and also on the sub¬ 
jective symptoms. Aspirin may be given to relieve 
pain. The diaphoresis caused by the salycin preparation 
certainly has a benefloial effect in assisting to eliminate 
the toxin. 

The Munch, iftd. Wvih. an article by Prof. Kehn, 
Halberstadt, on 

Thb Mobtalitt of Opebations fob Gall-btokbb. 

According to the writer the mortality is small so long 
as the pathological changes are not too extensive and 
not too far advanced, but it is larger when the affection 
is complicated by carcinoma or purulent cholangitis. So 
long as the calculi are limited to the gall-bladder and 
cystic duct the mortality will not be much above 2 or 3 
per cent. If the stones are still in the oholedochus the 
mortality will be higher (4 or 6 percent.}, but so long as 
there is no diffuse purulent disease operation need not 
be considered dangerous. The prognosis is, however, 
just tiie opposite when the infection reaches high into 
the bile passages, and when carcinoma is a complication. 
Simultaneous operation on the stomach and intestines 
raise the mortality to a possible 20 per cent, if malig¬ 
nant disease is present. If the pancreas is diseased the 
mortality will depend on the possibility of curing it. The 
mortality after gall-stone operation will not be further 
reduced until the cases are brought to the surgeoc 
earlier, and the frequent temporary improvements 
brought about by treatment in Carlsbad and Neuenahn 
are a bar to this, as hopes are thereby raised and opera¬ 
tive treatment deferred. The experienced operator has 
a great advantage over the best physician, as the latter 
rarely has the opportunity for visual and manual instruc¬ 


tion afforded by operation or autopsy. Internal treatment 
has been but little advanced by advanoes in knowledge. 
Now, as before, operations s^e nearly always performed 
too late. In the cases Been by the writer the indications 
for operation have nearly always been empysema, in¬ 
flammatory hydrof«, frequently recurring colic, chronio 
closure of the choledoohus, adhesive processes, with 
ectasia of the stomach and pylorus, ^o. With these 
conditions the pathological changes in the bile passages 
will have been advanced. In the case of malignant 
complioatioD, also, the cpportunity for sufficiently early 
operation will only be exceptionally afforded to the 
snrgeon, and in a certain proportion of cases neither 
the physician nor the snrgeon will be able to do any¬ 
thing. 

The KKh. Therap. Woeh. has an article on 

Tbb Mbdical Tbbatkbnt of Pbbittfhlitis, 
by Professor Bourget. The professor is opposed to the 
idea that the onset of perityphlitis is always suddeo. 
On the contrary it may be taken for granted that all 
affected by the disease have snffered from affections 
of the bowels and stomach, and that these affections 
have almoet always begun in the stomach, passed on to 
the bowels, and that the symptoms have lasted months, 
and even years, before the osecum or appendix has 
shown signs of disease. But it sometimes happens that 
a slight chill to the feet during difficult digestion will 
set up pain symptoms. The prophylactic treatment 
of the disease comes, therefore, to the front, and here 
the flrst attention must be paid to the diet and 
avoidance of constipation. The ‘'candidate" for peri¬ 
typhlitis should have a mixed diet, in which flesh meat 
plays but a small part, whilst vegetables, cooked fruits, 
and farinaoeons foods should form the chief. The fear 
that fruit seeds would get into the appendix is a 
groundless one, for the woody seed baa a favourable in¬ 
fluence on the mucous surface of the intestine, as 
mncine is formed which faciltates the onward move¬ 
ment of the intestinal contents. The hyperacidity of 
the stomach must be corrected. This may be done by 
giving milk gruel or an alkali at the acme of gastric 
digestion. Baring intestinal digestion the lower ex¬ 
tremities must be kept warm, either by movement or 
by suitable clothing. The bowels should be opened every 
day. Saline laxstivee are useful - a dessert-spoonful of 
Carlsbad salts in the morning in warm water. It is 
better, however, to give a large allowance of cooked 
fruit with breakfast, and if this is not sufficient one or 
two castor oil capsules after it. Intestinal irrigation is 
also ns^ul. Very cold drinks must be avoided even at 
meals The author also recommends gymnastic exercises, 
particnlarly an auto-massage, consisting in flexing 
the thigh upon the abdomen when lying on the back, 
the hands being locked below the koee. This move¬ 
ment should be practiced four times a day, ten to 
twenty movements each time. On actual onset of 
symptoms the author advises a treatment based on 
disinfection of the stomach and duodenum, and washing 
out of the large intestine. When an attack comes on 
the patient is ,pat on a liquid diet; 15 to 20 grm i. 
of castor oil are given daily with 1 gr. of ealacetol. 
If gastric symptoms predominate the stomach is washed 
ont with a 1 per cent, solution of sod. bicarb. When 
the large intestine is washed out it must be done care¬ 
fully and so as. to avoid pain. Icbtbyol is always 

DlUiu^. lOOg C 





Aco. 28. 1901. 


BUDAPEST. 


Ths Hvdical PbM8. 217 


used for this in » solution of 4 per thonsand. He also 
vses olive oil oontainiog 1 per oent. menthol thymol in 
methyl salii^late. After the first two washings the 
whole fluid is removed; after the third part may be 
retained. The washings are repeated night and mom* 
lag. Fonltioes are applied over the right iliao foesa, 
and if the swelling is hard and resistent five or six 
leeches. After the second or third day saline laxatives 
take the place of the castor oil: sod. bicarb., sod. 
pbcsph. anhyd., sod. snlpb. anhyd., ana five grms., aq. 
■destill. 1000 grms.; 160 grms. to be given each day in 
three or font portions. 

Uunna. 

Anxnst 23Td, 1901. 

THE EFFECT ABROAD OP PROF. KOCH'S 
LONDON ORATION ON TUBERCULOSIS. 

[lITTBB VBOX J. B. WOLFX, K.D., r.B.as.XD., lati of 
OLASOOW.] 

Wb are here in vacation, nearly all the professors are 
oot of town; some of them will retnm by the end of 
this month and others at the beginning of October to 
resume their clinics. Meantime, the lectures are de* 
livered by their assistants to many English and 
American stndents who are working in the various 
special subjects—eye, ear, throat, skin—in the bacte- 
riol(^cal and Pasteur institutes. Some of these assis* 
tants are model teachers, who use their large clinical 
material to the best advantage. These are generally 
■considered as the dog-days in Vienna, but the weather 
has been pleasant—the thermometer has not risen above 
70^ to 80'=’ F. in the shade, and the heat is tempered by 
refreshing showers, making it pleasant for work and 
outdoor exercise. 

Professional opinion here, with regard to Koch's 
oration at the London Tuberculosis Congress, is partly 
unfavourable and iiartly eyuipathetic. His position is 
not considered enviable. About twenty years ago he 
prematurely announced a cure for phthisis by bis 
tutetcnlin, which Virchow unmercifully proved to 
aggravate the disease by breaking up local tubercles 
and disseminating them over the whole syatem, Veteri- 
Bsry surgeons, nevertheless, have adopted tuberculin 
as a means of diagnosis in cattle: first, in dairy cows 
when ailing, or in suspects only, but they have gradn* 
sUy extended the sphere of their operations to the 
whole bovine race, whether ailing or not. These prac* 
tices have been carried on without Koch’s authority or 
aanotion. Now, after the lapse of so many years, the 
master pronounces the performances as a flat mistake. 
This pronouncement has caused great disappointment, 
stpecisUy among bis veterinary disnples, and the Pro- 
fttsor runs fresh danger, like Actaon, of being tom by 
hiiown doga In the opinion of some, Koch ought to 
have first broached the subject at local societies before 
brisgiag it up in that great avsembly—it was too great 
s shock to bis followers. But he had no alternative; 
the prsctices founded upon bis teaching have assumed 
sQch colossal dimensions, the great interests of man¬ 
kind are so much involved that he was bound to give 
his new views the most impressive form. I was think¬ 
ing of poor Macbeth’s moral philosophy: 

“-that we but teach 

Bloody instmctions, which, being taught, return 
To plague the inventor.” 


The excitement caused by Koch’s oration has served 
the cause truth by inducing the German Government 
to appoint a Commission to examine the whole tnberon- 
loeis question, Virchow being one of the commissioners. 
In bis address to the Clinical Society of Berlin Virchow 
says“ At that Commission I shall endeavour to estab¬ 
lish the difference between pathological and bacterio¬ 
logical tuberculosis. Bacteriologists regard every¬ 
thing as tubercnlons in which tuberculous bacilli are 
found. 'Wbeu a section of a wart is put under the 
microscope and a bacillus is found they take it 
for granted that there must be millions behind 
and call it tuberculous, whilst I call only those 
things tuberculous which ate composed of cells — 
organisms grown out of the body. Tuberculous bacilli 
alone do not constitute tuberculosis.” There will be the 
Korypb&e of scientists at that Commission working 
together to find a sure basis for therapeutics. Koch’s 
labours are not lost to mankind. Whether the bacillus 
alone or in oonjnnotion with Virchow's pathological cell 
or by their discovery of a new ingredient in tuberculosis 
they are sure to arrive at it at last. Lister commenced 
his labours with carbolic patty, spray, and faith. He 
developed his system gradually and patiently until now, 
when Lord Lister is considered the greatest benefactor 
of suffering humanity by all nations. Nowadays we are 
in too great a burry for immediate cures. 


glubdptet. 

[FBOM DB. AUOLF BBDdB.J 

August 20th, 1901. 

At the recent meeting of the Nagyvurad Medical 
and Pharmacological Society, Dr. R^v^ss, Vilmos, demon¬ 
strated a pathological preparation originating from a 
patient who had suffered from 

Spiral Affbctior. 

The patient, set. 36, was admitted to the hospital on 
August 6th, 1900. He complained that he had pre¬ 
viously been very weak, and he was therefore unable 
to walk. Hie condition subsequently improved, but at 
the beginning of 1901 he again became gradually 
weaker, and since May had been confined to bed, having 
neither strength nor wish to sit up nor to get up, and 
in his lumbar rvgion he complained of marked numb¬ 
ness. Along the ^inal cord there was slight pain on 
prsfsure; tactile sensibility was diminished below the 
first thoracic vertebra from the level of the nipple, and 
there was total analgesia involving tbe lower extremi¬ 
ties. He did not feel a pin prick, but after some delay 
he noticed pressure with a finger. Cutaneous sensation, 
i e., tactile sensibility, was watting over both knees and 
over tbe lower third of the thighs. Tbe heat-sense, too, 
was greatly reduced; he mistook at the outset tbe sensa¬ 
tion of heat and cold, and he noticed more gradually 
the change from cold warmth. 

On the upper part of the trunk and over tbe limbs 
tbe tactile beat and pain sensations were normal. 
Knee reflexes were increased ; in the muscles were 
seen fibrillar twitcbings. On tbe lower part of tbe right 
leg the muscles became atrophied, and he alleges tbe 
malleolar joint has since his childhood been always rigid. 
The left lower extremity is not atrophied; on both limbs 
passive movements give rise to spasmodic contractions. 
There was no disturbance of tbe functions of tbe bladder 



218 Tub Mbdical Pbbsb. 


THE OPERA.TTNG THEATRES. 


or reetam. la the course of the later months serioas 
contractions presented themseWes in the lower limbs, 
besides obstinate constipation and bladder symptoms. 
At the height of the nipple severe zonary pains; on 
the trochanters were seen the effects of decnbitns. 
Under the whole course of observation no alteration 
occnrred in the thoracic organs, bnt ocly a tickling 
congh, with moderate expectoration of a catarrhal cha¬ 
racter. 

The autopsy showed the following; When the spinal 
canal was opened, the dura mater was deeply bathed in 
pns in the region of the fourth and fifth ribs, which 
passed through the adjacent intervertebral openings 
into the thoracic cavity, communicating with the latter. 
The openings were covered with caseous masses, which 
were already softened and decomposed. The dura 
mater of the cord was greatly thickeoed at this place; 
it was very bypersemic, and was infiltrated with tuber¬ 
culous material. The spinal cord, owing to compres¬ 
sion, had become flattened, pale, and aneemic, and when 
cut across the margins of the medulla spinalis turned 
outwards. The right Inng was flrmly adherent to the 
parietal pleura ; when separating it a large cavity was 
seen extending over all the three lobes which communi¬ 
cated throngb the intervertebral openings witii the spinal 
canaL The anterior surface of the lung was sound, with 
emphysematous isles; the left lung was fonnd to be quite 
healthy. On the ground of these conditions the author 
was justified in supposing tiiat he had to deal with a 
primary pachymeningitis externa, the cause of which 
was tuberculous caries of the vertebree. The myelitis 
was of secondary occurrence. The pus passing towards 
the thoracic cavity caused the decomposing process in 
the right lung. 

It is yet a matter of question to decide whether the 
pachymeningitis externa may be a primary or a 
secondary disease. In most cases it is a secondary 
factor, bnt in the present oa$e be had no doubt that it 
was of primary occurrence. This is proved by the fact 
that neither on the admission of the patient to the 
hospital nor later on did the signs of more severe 
alterations in the longs show themselves. The slow 
process commenced between the narrow walls of the 
spinal canal, broke through from thence the interver¬ 
tebral opening, and penetrated first to the thoracic 
cavity, then into tbe firmly adherent lungs. Tranbe 
also fonnd that in similar oases the primary disease was 
the pachymeningitis externa, which subsequently ex¬ 
tended into the dorsal muscles. 

At the time of the patient’s admission the diagnosis 
of Dr. B4 t£bz was syringomyelia, on the ground of 
several symptoms, and even the farther progress of the 
case seemed t.> strengthen this diagnosis. However, 
the autopsy failed to authenticate it. 

Sabcoua of thb Chokoid. 

Dr. Waldmann, C^la, brought forward apatient whose 
disease he calls sarcoma ohoroidem. 

The patient, a mao, wt. 24, about eight weeks before 
noticed that he did not see absolntely with his right eye. 
On examining the eye Dr. Waldmann found the cornea 
intact, and also the ooDjnnotiva, bnt the anterior cham¬ 
ber was deeper than normal. The conjunctiva was in¬ 
jected in one place only. By focal lighting he noticed 
at one part of the pupil a brownish-red growth, and 
when the light had been thrown on this spot there 


Apo. 28. 1901 

appeared a reflection. The other part of the pupil 
remained black. 

The diseased eye will be enucleated, and after per¬ 
forming this operation Dr. Waldmann will demonstrate 
the preparation of the pathological eye, and he will 
again return to this subject. 

Dr- Edelmann, Menyhert, read a paper on 
Melina Nbonatorpu. 

The patient was a baby, five days old, well built, 
and seemingly quite healthy. On the day when first 
seen it vomited after having been suckled, and the 
vomited milk was mixed with blood. This repeatedly 
occurred on the same day, and the infant sometimes 
brought up mere blood, the colour of which was bright 
red. The fseces were dark-coloured from the altered 
blood in the bowels. On the following day, i.e., on the 
sixth day of the baby’s lifetime. Dr. Edelmann saw 
symptoms of trismus. From this cause the baby was 
unable to suckle, although it took food given in a 
spoon. Death occnrred on this day. 

In this case sudden bleeding had set in. The blood 
was derived from the stomach and from the bowel. This 
bleeding itself was really not a disease, but rather a par¬ 
tial symptom of a disease. The fundamental malady 
must evidently' have been some constitutional disease, 
as, for instance, sypbilis, sepsis, hscmophilia. On the 
other hand it might also have been a local disease of the 
stomach or bowel arising either from trauma or from a 
disturbance of the circulation, for instance, by an ulcer 
or an erosion. This case may be put down to tbe first 
group although he could not elicit any farther parti¬ 
culars from tbe patents of the child. 

The interest of this case is in the fact that this 
disease is relatively very uncommon. Among 700-1.000 
parturitions it occurred only in one case (Bunge). The 
bleeding commences a few hours after delivery, most 
frequently on the second day, bnt rarely on the fourth 
or later days (in onr case on the fifth day). Fifty to 
sixty per cent, of cases end fatally, mostly owing to 
the severe hemorrhage. 

I (IDptrating 


GREAT NOBTHEEN HOSPITAL. 

Ofxsatiok fob Renal Calculi. —Mr. Pbvton 
Bbalb operated on a woman, st. about 26, whose history 
was as follows: Ten years previously she had suffered 
from considerable pain in the left lumbar region and 
had passed blood in the urine at intervals; tbe pain 
had continued with greater or less severity till the 
present time, but no blood had been passed for at least 
six years. Tbe patient was extremely spare, and had 
been admitted under the care of Dr. Beevor, who asked 
Mr. Beale to see her with a view of determining the 
nature of the pain. The abdomen was therefore care- 
folly examined, at first without an anmathetio, and both 
kidneys were easily felt, in fact every visoos in the 
abdomen could be quite easily made out, a circumstance 
which Hr. Beale said must be regarded as quite excep¬ 
tional. Although each kidney was carefully examined 
no calculus could be felt, but the left kidney wm dis¬ 
tinctly larger than the right. On another occasion the 
abdomen was examined under an anseathetic, but aa 
the operating theatre was occupied at the time the 
examination was conducted in the ward, the patient 


Dicjiii.£ecl by 


Google 



Auo. 28, 1901. 


LEADING ARTICLES. 


Tbs Mbdioal Pbbss. 219 


Iring on a bed with a spring mattress. Under these cir- 
omnstanoea no calculi coald|be detected, although the 
whole oatline of the left kidnej was easily made oat. 
A few days later a shiagram of the abdomen was taken, 
and this showed two or three dark patches, each abont 
the size of a filbert, occapying the position of the left 
kidney; no each dark patches were Tisible in the region 
of the right kidney. The patient then went oat, bat the 
pain in the left loin still persisted, so she was again 
admitted, and Mr. Beale determined to cat down apon 
and explore the left kidney. t_The patient was brought 
into the theatre, anesthetised, and placed on the 
operating table, the surface of which oonsints of per¬ 
forated zinc, i,«., a bard, fairly level surface; upon 
palpating the left kidney the presence of numer- 
ooa calculi in it was at once detected beyond 
all doubt, for they were felt grating against 
one another without the slightest difficulty. The 
kidney was then exposed from the loin, and about 
a dozen hard calculi of all shapes and sizes 
were easily removed with forceps and scoop. The wound 
in the kidney was sutuied, and the edges of the incision 
in the loin were brought together, with the exception 
of a eiuall portion at the lower extremity, about one 
inch in length, in which a gauze drain was placed. Hr. 
Beale said that there was a very interesting moral in 
this case, and that was never to examine the abdomen 
unless the patient was lying on a hard flat surface. In 
the present instanoe he bad been obliged to examine 
the patient in bed on the first two occasions, and he 
had not been satisfied with the procedure, as he had 
before met with cases in which renal calculi were only 
detected on palpating the abdomen* when the patient 
was lying on a hard flat table. The skiagram, be 
pointed out, was a help in that it showed some abnor¬ 
mality in the region of the left kidney, but the mana go 
shown was quite indistinct as r^^ards shape. Even after 
the incision had healed up he expected the patient to 
return wiQi a smus at the seat of the wound through 
which urine would pass. He considered it advisable to 
lemove the remains of the kidney at a subsequent 
operation, and not at the time the calculi were taken 
away, as if both were done at once shock was generally 
very severe, moreover, be thought that it was easier to 
make sure of removing the whole of the damaged 
kidney structure at a later date, because as the whole 
organ shrinks up its extent is more easily determined. 

Unne came through the wound for abont a week only 
subsequently to the operation, and the patient was dis¬ 
charged to a convalescent home three weeks later, the 
wound having quite healed. 


A Lady Dentist Fined. 

A PB 08 BCVTX 0 M of Bome interest to the dental pro¬ 
fession has jnst taken place in London. Two brothers, 
named Eskell-Paget, converted their basiness into a 
limited liability company. One of them withdrew and 
entered into a covenant not to practice within a certain 
ladioe of the original place of businees. That condition 
he broke, and was restrained from carrying on practice 
by an interim injunction. His wife then carried on the 
hnsiuess as the ** Eskell-Paget Dental Company,” and 
wasnmmoned for unlawfully using adescription imply¬ 
ing that she was registered under the Dentists' Act and 
wts qualified to practise dentistry. The magistrate 
convicted, and inflicted a fine of £6, with £3 Ss. costs, 
with leave to carry the case to a higher court. 


Beoistebed rOB rBANSXissioi) Abroad. 

(IRcbtal aitb Cxrntlm:. 

Fnblisbed ererj WednesdRj monusf. Prim Sd. Pest tree, 6td. 

advbbusbmemtb. 

For Osx IssBRTiOR:—Whole Pa^, AO Oe. Od.; Halt Page, 
AS 10a. Od.: Qaerter Page, At Sa,; One-eighth, ISa. Sd. 

For a Bsriro or Ibbbrtioss Whole Page, thirteen inMrtlona 
(weekly, fortnightly, or monthly), at AS 10a. Od.; twenty-six 
insotiona (weekly or fortnightly) at AS 3a. Od.; flfty-two 
insertiona (weekly) at AS each. Half Page, thirteen insertioue 
at 3&a. i twenty-aiz at SSa.: flfty-two insartionB at SOe. eaoh: 
Qoarter-page, thirteen inaertiona at 18a. twenty-slz iuacaHona 
at ISa.: flfty-two inaertiona at l.Si each. 

Small annonneemeuta of Practloea, Asalatanoies.Vaeanciea, Booka, 
fto.—Seven Usee or under, 4a, per inaertion; 6d. per line 
beyond. 


ddebual anb Circular. 

'* 8ALD6 POPDLI 8UPRSMA LBX.’* 


WEDNESDAY, AUGUST 28. 1901. 


THE DANGERS OF THE STREETS. 

Thebe are certain aspects of social life to which 
the attention of the medical profession is specially 
drawn. Among them may be mentioned the death- 
toll of human lives that is annually exacted by 
vehicular accidents in the streets of the great towns 
of the United Kingdom. In London alone the 
number of persons thus killed mounts to the dimen¬ 
sions of a small army. Yet it may be doubted 
whether the citizens of that vast metropolis, busied 
as they are with mnltifarioua and absorbing 
pursuits, realise with anything like exactitude the 
appalling extent of the mischief that is being done 
in their highways. The recent death of a 
prominent official has brought the subject promin¬ 
ently under public notice. In that particular case 
the cause of death was determined by a coroner’s 
jury to have been purely accidental, but it may be 
hoped that the wider question thus raised, namely, 
the dangers of street traffic, may not be allowed to 
escape without full journalistic discussion. To a 
great extent the medical profession is concerned, for 
most of the cases of injury and death resulting from 
street accidents come under their notice as hospital 
residents, coroners, or private practitioners. Medical 
men are in a position to furnish a vast amount of evi¬ 
dence in this important matter, and to set forth in 
its true proportions a public danger which we ven¬ 
ture to regard to no small extent as preventible. Dan¬ 
ger to pedestrians may clearly arise from a variety 
of causes, which may be either due to their own acts, 
or to those of drivers, or to the instrumentality 
of pure accident Personal defects of sight, 
hearing, or bodily health account for a certain num¬ 
ber of street injuries. Recklessness on the part of 
foot passengers is, in many instances, the main con¬ 
tributing factor. Runaway horses have to be 
reckoned with, as well as collisions between vehicles 
and the modem developments of cycles and motor 
Dig,..zedi [L 



220 Thi Hbdicu F&ms 


LEADING ABTICLES. 


Auo. 28. 1901. 


cars faave given rise to their own peculiar dangers. | 
After allowing for the unavoidable margin of acci¬ 
dents, however, there remains a certain proportion 
due to the incompetence, carelessness, or recklessness 
of drivers. The police have done their best hj a system 
of registration to regulate those in charge of 
vehicles, but it may be doubted if offences on 
the part of licensees are not too readily 
condoned by restoration of the badge. The 
root of the evil appears to be a fixed belief on 
the part of drivers that the road belongs to them, 
and that all they have to do is to shout to a pedes¬ 
trian without attempting to stop. In a great majo¬ 
rity of vehicle accidents to wayfarers, we believe that 
the mishap has been brought about by the absurd 
theory in question. It has been pointed out by a 
judge that drivers were mistaken in holding that 
opinion, and that the foot passenger has an 
equal right to the roadway as well as to the 
footway. We firmly believe that a vast better¬ 
ing of the conditions of street traffic could 
be quickly secured if magistrates and coroners 
would insist upon the rights of pedestrians 
in all cases of injury or death from street vehicles 
brought under their official notice. The police, also, 
would be able to bring a great deal of pressure upon 
drivers by way of inducing them to recognise the 
real law of the road. New dangers are being added 
to the streets by the development of cycle and motor 
car and tramway traffic. These facts are being con¬ 
stantly impressed upon medical men, not only on 
account of accidents, but because they themselves 
travel upon the King's highway more perhaps 
than any other' section of the community. As 
regards both cycles and motor cars there can be 
little doubt that they should be legibly numbered, 
and that in case of an accident the police should 
have the power of detaining the owner until his 
identification has been established. As things go the 
rider or driver may knock down and maim, or even 
kill a pedestrian, and, by giving a false name and ad¬ 
dress evade further responsibility. That state of 
things amounts to nothing short of a public scandal 
and its amendment claims early legislative attention. 
Meanwhile it is a matter of philosophic interest to 
note how the increase of material prosperity swells 
the figures of the annual mortality from street acci¬ 
dents. At the same time it is clearly the duty of 
those responsible for the safety of His Majesty’s 
lieges to see that the loss of life and limb from that 
source be reduced to the lowest limit of the unavoid¬ 
able margin. 

HOSPITAL ABUSE. 

The Forty-third Report of the Board of Superin¬ 
tendence of Dublin Hospitals for the year 1900-1901 
has just been issued as a Parliamentary Blue Book. 
Among many important and intei'esting details of, 
and comments on, hospital management generally, 
one comment seems to us worthy of special attention, 
inasmuch as it touches upon a matter of extreme prac¬ 
tical importance. Whilst we recognise that under 


existing circumstiraoes it is not possible to exclude 
patients who are not, in a financial sense, legitimate 
objects of charity, we feel that discrimination should 
be exercised to ensure that the funds provided for 
charitable relief should not be spent on persons who 
are competent to pay for such advantages.” The 
question Low to prevent the abuse of hospital 
charity is one which presses for an answer, which is 
most difficult to answer, and which at the same time 
has been most persistently neglected by those whose 
duty it is to find a suitable answer, viz., hospital 
boards. The latter bodies are elected to ad¬ 
minister the funds of an institution— funds which 
have been provided by a charitable but care¬ 
less public for a definite object. In the 
administration of these funds, the guiding prin¬ 
ciples should be efficiently to relieve the greatest 
amount of suffering with the maximum amount of 
economy that efficiency will permit, and to see that 
funds collected in the name of charity are expended 
in the furtherance of charity. All hospital boards, 
we believe, fully recognise the first of these propo¬ 
sitions—a principle important and true if followed in 
such a manner that the second principle is not at the 
same time abandoned. Unfortunately, there is a wide¬ 
spread tendency to consider that the first principle 
stands pi'C'eminent, that it is the only principle to 
be followed in the management of a hospital, and 
that the amount of support which a hospital de¬ 
serves is in proportion to the number of patients 
which it relieves. We doubt if a hospital governor ever 
asks himself or his colleagues whether the long list of 
many hundreds or thousands of patients relieved in 
the course of a year represents the same number of 
necessitous persons treated by charity for the sake 
of charity, or whether it does not represent a large 
proportion of charity expended on persons who are 
not fit recipients of charity. Hospital governors, 
if taxed with the indiscriminate bestowal of hospital 
relief, answer that they have opened pay wards into 
which such patients as can afford to pay are admitted. 
This is true, but what does it mean ? It means that 
the governors have shifted the responsibility for the 
bestowal of charity from themselves on to the 
medical staff. That, in other words, they have said 
to the patient ” You are not an object for charitable 
assistance, you must pay for your board and lodging, 
my servants—the medical staff—will then bestow 
their charity upon you, and prescribe for you, or 
operate upon you free of charge.” And the medical 
staff, by the rules of the hospital, are compelled to do 
so. “ If they do not,’’ says the Board, “there are 
other medical men anxious to do so in order to 
obtain opportunities for gaining experience.” We 
do not want to convey that hospital boards act 
thus out of mere disregard for the interests of 
the staff, or out of carelessness in the discharge of 
their duties. There are few hospital governors who 
act from either of these motives. The real difficulty 
in the way of reform is that the governors are, in 
most cases, men whose time is fully occupied by their 
private duties, and who have not got the necessary 

Diu. OOg c 



Aoa. 28, 1901. 


LEADING ARTICLES. 


Tbs Mbdioal Fbbss. 221 


Idsore to devote to tbe solving of the problem of bos- ' 
pital abase. Moreover, hospital governors do not, as a 
class, appreciate tbe barm which is done bj tbe injudi- 
donsbestowal of charity,or tbe in jnstice andbardship 
which sncb a bestowal inflicts on struggling general 
practitioners. If they appreciated these points we 
believe that reform would follow. If a body of 
men undertake the disposal of funds which have 
been collected for the relief of the necessitous, 
it is their direct duty to ascertmn that these funds 
are not used for the relief of the fraudulent. If this 
end cannot be obtained by indirect means, such as 
the posting up of notices intimating those who are 
eligible for the relief afforded by the hospital, tbe 
antborisation of the medical staff to refrain from 
treating patients who are manifestly nnsuited for 
hospital relief, &c., it should be obtained by the 
direct means of appointing an official to inquire 
into the circumstances of new patients. This is 
not the difficult or impossible task that it is 
usually represented to be. Much can be done to 
effect reform by tbe mere process of keeping a book 
in which the name of the patient, occupation, abode, 
wages, number of children, and so forth are entered. 
Such a book will readily show cases which are mani¬ 
festly subjects for charitable assistance, cases which 
are manifestly not subjects for charitable assistance, 
and those which are doubtful. If there is any doubt 
as to tbe status of a patient, it should be the duty of 
a special official to make further inquiry. Some 
paUents will undoubtedly tell falsehoods. Tbe 
number will not be great, and after a few have been 
detected tbe number will be still smaller. It 
may be said that little good would result from 
such a course. With this opinion we do not agree. 
At present notbine is done, with tbe result that tbe 
out-patient departments of hospitals are thronged 
with patients who are unsnited for medical charitable 
relief, who come there believing, or affecting to be¬ 
lieve, that they are entitled to receive it, and who are 
grossly insulted if they are regarded as recipients of 
charity. Some solution must be found for the pro¬ 
blem of hospital abuse. It is unfair in tbe extreme, 
in fact it ieimmoral, to compela medical man toper- 
form acts in hie public capacity of hospital physician 
or surgeon which he would not perform in his private 
capacity - acts which have the effect of depriving of 
tbe means of livelihood a possibly necessitous pro¬ 
fessional brother. And when all circumstances are 
taken into account, what ehe do the boards of many 
hospitals compel their staff to do P 


NAPHTHALINE POISONING? 

In the first two decades of the Nineteenth Cen¬ 
tury tbe name aromatic compounds ’’ was given to 
a small group of naturally occurring bodies possess¬ 
ing an aromatic smell and taste. For in those days 
^ physical properties and not the chemical com- 
pomtion guided tbe nomenclature. It fortunately 
happened that the name was snitable, for it was 
found that in addition to certain analogies in their 
outward properties they were connected by close 


chemical ties. In 1832 Liebeg and Wohler’s paper 
on the radical of benzoic acid, benzoyl, appeared. The 
discoveries of other bases soon followed. Berthelot 
found that if acetylene be heated to a temperature 
sufficiently high a considerable quantity of benzine is 
produced. At the same tic&e styrolene, naphthaline, 
and other hydrocarbons are produced. In 1838 
Pelletier and Walker drew attention to the oppor¬ 
tunities afforded in preparing trade chemicals for 
studying new bodies. Tbe by-products of coal-gas 
yielded naphthaline to Kidd. In 1873 Markownakow 
and Pylobin found a peculiar group of hydrocarbons 
in Caucasian petroleum, to which they gave the 
name of naphthenes. Naphthaline is now obtained 
almost altogether from crude petroleum, distilling 
over at a temperature ranging between 180 
degs. to 220 dejss., from which it crystallises 
on cooling. It forms colourless, shining, leafy 
crystals of peculiar odour and burning taste. 
It dissolves readily in alcohol, ether, chloroform,, 
carbon disulphide, benzine, and fixed and volatile 
oils. From Cohn’s physiological experiments, in 
1894, it was considered that tbe chemical was com¬ 
pletely destroyed in the body of dogs, and from the 
known properties of the drug it was recommended 
as a vermicide in oases of tape-worm, tbe dose being 
twenty grains dissolved in castor oil. In such doses, 
though often repeated for days, no toxic effects were- 
produced. As an ointment it has been applied in 
the proportion of one part in eight without even 
producing a rash; withal even pure naphthaline bas> 
been known to produce toxic effects. Bossboch’a 
patient suffered from cyanosis of tbe lips and cheeks, 
twitching of the muscles, and black-coloured urine- 
from taking ninety grains; it has also produced 
strangury, and in at least one case its external uso 
was followed by toxic symptoms. In 1896 it was, 
however, replaced by napbtbalour, of similar 
chemical composition, though differing greatly in its 
physical characteristics. It is said to be harmless, 
and is recommended for all forms of skin diBeaBeB» 
bums, ulcers, and even rheumatic pains. A solu¬ 
tion of one of these chemicals was recently used 
by a Mr. Malian, of Dublin, in tbe preparation 
of a non-poisonous sheep-dip or disinfectant. To 
show that the compound was not poisonous the 
deceased was in tbe habit of drinking some of it. 
Probably the solution was pi*epared with methyl 
alcohol; be that as it may, the unfortunate man 
drank a quantity of tbe mixture and died from the 
effects a short time since, and a coroner’s jury 
found a verdict in accordance with tbe evidence. 
Thera was no necropsy, neither was there any report 
of the symptoms from which the man suffered, nor 
any chemical examination of tbe contents of the 
stomach. Tbe medical attendant was not to blame 
for not giving tbe symptoms, for be was not 
called in until some fifteen hours bad elapsed from 
tbe time of swallowing the disinfectant. We incline 
to tbe view that the death resulted from the agents 
used to dissolve the naphthaline, and not from the 
hydro-carbon itself. And we regret that no poet- 

30 ' 


222 The Mbdioai. Pkiss. 


NOTES ON ODBaBNT TOPICS. 


Apq. 28, 1901. 


mortfem was ordered. It would bare been interest¬ 
ing to know the condition of the mncous membrane 
of the alimentarj canal and of the nrlnary apparatus; 
nor can we understand why an analysis of the 
contents of the stomach was not made. There is no 
suspicion of foul play, but tbe circumstances called 
for an analysis if only to ascertain the cause of death, 
a function of the coroner’s court that does not a 
little to safeguard the lives of His Majesty’s lieges. 


Jlotw 0it Current topics. 

Suicide at a Kent County Asylum. 

An inquest was held last week upon tbe body of 
an inmate of Harming Asylum, Kent, when it was 
proved that deceased committed suicide by hanging. 
Tbe evidence revealed the fact that there was only 
one attendant in charge of a ward in which were 
forty-four patients, sevetal of them with suicidal 
tendencies. The jury expressed an opinion that 
there should be at least two attendants in the 
ward. If tbe state of affairs be as alleged there 
can be little doubt that a most serious flaw 
has been disclosed in tbe administration of 
tbe institution in question. Harming Heath 
Asylnm, it may be said, is the larger of the two 
county asylums of Kent, and has some 1,638 beds. 
An explanation may be forthcoming for leaving the 
ward to tbe care of a single attendant, perhaps on 
the score of the sudden illness or holiday absence of 
the staff. In any case, however, provision should be 
made for emergencies of tbe kind. It is hardly 
credible that a county asylum of first magnitude 
should entrust a ward with “ forty-four patients, 
some of them suicidal,'’ to the care of one man. The 
Lunacy Commissioners will doubtless hold an ex¬ 
haustive inquiry into tbe matter, and may be con¬ 
fidently expected to make any administrative 
changes that may be necessary to the future safe¬ 
guarding of the inmates of tbe Harming Heath 
Asylum. 


Verminous Police Cells. 

Public attention has been called to the existence 
of swarms of parasites in one of tbe London gaols. 
In several instances prisoners under remand have 
obtained bail on tbe ground that life in tbe prison 
was a prolonged torture on account of the vermin 
with which tbe cells were infested. There seems to 
have been no attempt on the part of the gaol 
officia's to contradict the assertion of what con¬ 
stitutes an exceeding grave defect in administra¬ 
tion. There can be no excuse for the existence 
of such a state of affairs, for clearly prison 
cells can be kept absolutely free of vermin by 
a proper system of cleanliness in combination 
with such modem sanitary measures as disinfection 
and tbe use cd antiseptics. The police exact a high 
standard in the ease of common lodging-houses, and 
prosecute the owners when vermin are found in tbe 
beds. Is it any more difficult to keep a police cell 
clean than the room of a lodging-house P Of the 


two most people would say the chances were greatly 
in favour of the police cell, with its special 
construction, its absence of overcrowding, and 
the official eervice and capital at command. 
The fact is that the whole of our prison sjrgtem 
wants overhauling from one end to the other. A 
commission of inquiry should have medical and 
sanitary experts who would consider every item of 
environment, food, clothing, exercise, sanitary andper- 
Bonal cleanliness, and all other things from a scientific 
and humanitarian point of view. Tbe treatment of 
many persons locked up for the night in police cells 
demands minnte inquiry as to the warmth of cell, 
coverings of prisoner, food given, and supervision 
exercised. In some instances the treatment of 
prisoners locked op from Saturday to Monday in 
the way of food and exposure is enough to bring on 
serious physical disease, that is to say, if the report 
of some of these unfortunate persons on coming to 
hoapital later in tbe day may be believed. 

Broken Bibs Overlooked in Hospital. 

A CURIOUS incident was revealed at a London 
inquest last week. A woman slipped on the pave¬ 
ment one night and fell against the handle of a 
costermonger's barrow. Three days later she applied 
for medical assistance at tbe 'Western General 
Dispensary, where, it was stated in evidence, she 
eaid she bad a sore throat and bad fallen and injured 
herself. Her chest, however, was not examined, 
and next day she went to St. Mary's Hospital, 
where she was treated by the house surgeon for 
“ laryngitis.” Two days after the last visit a 
private practitioner who was called to deceased 
found her suffering from pneumonia, the result of 
five fractured ribs on the left side. She died from 
syncope on the following day. Tbe jury expressed 
an opinion that a more carefnl examination of the 
patient would have revealed tbe existence of the 
fractured ribs. The history of a blow would naturally 
lead a medical man to examine the chest carefully, 
hut it is only fair to say that the physician at the 
Dispensary denies that the deceased complained of 
anything beyond the sore throat. The Coroner, Dr. 
Danford Thomas, very properly pointed out that in a 
case of the kind it was essential to bandage the chest. 
Tbe fact is to be regretted that so serious an injury 
should have escaped detection by the medical 
officers of two London medical charities. An occur¬ 
rence of this nature suggests tbe need of a revision of 
administrative methods. 


The Chigoe- 

SiR Hbnet Colvilb tells a tale of a man who 
was tried befoi’e him on the charge of murdering his 
wife. The prisoner fully admitted his guilt, but 
explained the killing of the unfortunate woman by 
stating she was infested with the chigoe. The 
chigoe, or jigger flea, causes cyst-like formations 
that can be seen immediately under the skin looking 
like little fibrous swellings as large as a pea. Their 
removal must be complete, otherwise an ulcer ensues 
DitJiiized by C 


Atro. 28, 1901. 


NOTES ON CURRENT TOPICS. Thx Medicai Pmm. 223 


which may canse a considerable amount of distress. 
The natire home of the chigoe is Pouth America, 
hot it appears to hare been recently introduced into 
Africa, where, on tbe West Coast, its wonderful 
power of multipljring rapidly and trarelling far has 
soon caused its presence to become a matter of com 
meat. Emin Pasha’s expedition is further credited 
with having spread this pest in the continent of 
Africa, and Sir Henry Colvile, describing 
its progress in Uganda, says that it has 
maimed whole populations. He foresaw that 
the jigger would reach tbe Eastern coast, 
and it is probable that before long India and Arabia 
will be invaded by the insect. It is like a small flea 
in appearance, and curiously enough jumps in the 
same manner as the flea. It ciin live and breed in 
countless numbers in sandy soil. For an hour or two 
after it has made its way into tbe skin of tbe foot no 
particular irritation is felt, but in a short time 
excruciating pain is complained of, and the only 
means of obtaining relief is to promptly extract the 
intruder, and this must be done most efficaciously 
and thoroughly. According to Dr. Moffat, an im¬ 
portant part of the work of missionaries at the pre¬ 
sent time consists in imparting to tbe natives the 
necessary knowledge of how to effect in a proper 
manner tbe removal of the chigoe when it has gained 
an entrance through the epidermis. 

Prophylaxis of Blindness. 

The great frequency of ophthalmia neonatorum 
in Palis, and the frequency with which it is followed 
by loss of sight of one or both eyes, has latterly en¬ 
gaged the attention of the French Government. The 
initiative in tbe matter was taken by Senator Dr. 
Fedebidon, who brought before the Senate tbe de¬ 
sirability of asking tbe Academy of Medicine of Paris 
to issue instructions to the midwives of tbe districts 
of the city to bathe and daily wash tbe eyes of tbe 
newly-bom children with a weak solution of per¬ 
manganate vf potassium. Tbe Academy of Medicine 
recognising that they had no power to enforce com¬ 
pliance with their instructions to the midwives, sug¬ 
gested that the following rules be adopted by the 
executive:—(1) That there be distributed in each 
district, with tbe certificate of birth, a paper giving 
tbe causes, symptoms, and dangers of ophthalmia of 
the newly-bom. (2) To ensure that all cases of tbe 
disease are duly notified by midwives and doctors. 
(3) That in all maternity hospitals, there shall be 
an ophthalmic surgeon, whose duty it shall be to treat 
the ophthalmia of the newly-bom, and to instruct 
students and midwives in the treatmentof the disease. 
These are admirable suggestions in their way, but is 
the last one necessary ? From what we ourselves 
have seen of the disease, or perhaps it would be more 
correct to say from what we have not seen of tbe 
disease, it is well proven to our satisfaction that if 
the precautions and prophylactic treatment laid 
down by Crede are followed in maternity hospitals 
there will be no ophthalmia neonatorum. This mode 
of treatment is as simple as it is efficacious, and 


though it may sound well to be able to say that an 
ophthalmic surgeon is attached to a maternity hos¬ 
pital, still there is more chance of good resulting to 
a greater number of infants if the regular c fficers of 
the hospital make it their business to instruct the 
charge nurses in their duty in these cases. It will 
thus be far more thoroughly brought home to the 
midwives that the prevention of ophthalmia presents 
no difficulties which they cannot overcome them¬ 
selves. 

Pathological Iiyiog and Dreaming. 

It is well-known that in hysteria a form of reverie 
may occur in which the patient imagines the dream 
in such a vivid and real manner that it henceforth 
becomes as a matter of fact to ber. This morbid 
state may result in false witness being given, and the 
term “pathological lying’’ has been applied to it. 
Professor Pick, of Prague, has pnblisbed a curious 
study of some patients under bis care who suffered 
from day dreams which were so distinctly pathologi¬ 
cal in their character that tbe patients themselves 
recognised their psychiatrical significance, and sought 
medical advice to rid themselves of tbe domination 
of a succession of dream pictures. The practical 
side of the question is shown in the incapacity of 
these patients to follow their usual vocations in 
consequence of these day-dreams causing a reaction 
in various ways, such as talking aloud and gesticu¬ 
lating. This is one of those studies of psychiatry 
which is liable to excite tbe ridicule of the thought¬ 
less, but the practical effect of these day-dreams is 
by no means a laughing matter to the unfortunate 
sufferer. 

Medical Advertising under the Pharaohs. 

The King Sahura, who lived 3,500 years before 
Christ, wished to record his gratitude to bis doctor 
because he had “made his nostrils well,’’ and for 
that purpose he caused an inscription to be engraved 
on a tablet in which he wished him long life and 
happiness. The inscription shows further that the 
Hinij’s physician appreciated the pecuniary benefits 
of publicity, for at tbe doctor's own suggestion to 
his royal master tbe tablet, or in plain English the 
advertisement, was placed in a conspicuous position 
in tbe waiting room of the regal palace, and it is to 
be hoped that tbe worthy practitioner reaped tbe 
benefit be deserved, not only for his successful 
treatment but also for his evident business capacity. 
Dr. J. Wright in tbe Laryngoaeope has written an 
entertaining article on the subject, which those 
interested will do well to consult. 

The Saddleworth System of Medici 
Relief. 

The Saddleworth Guardians have instituted a 
system by means of which poor persons can obtain 
medical relief from any doctor they may desire to 
consult residing in that neighbourhood. Mr. Colin 
Campbell, of Saddleworth, has explained the method 
fully in an article he has written in the organ of the 
Manchester Medical Guild, the Medical Guild 
Digiiized ; ^ 



^24 Ths Hxdical Pksm. 


NOTES ON CUBEENT TOPICS. 


AtJO. 28, 1901. 


Quarterly, under the heading of “ Parieb Doctor and 
Outdoor Uedioal Belief.” The method is Bimplicitj 
iteelf: The Saddlewortb Gnardians appoint every 
registered practitioner in the district who may so 
wish to he a district medical officer, and in this 
manner the ordinary contract medical officer's work is 
avoided, and much nnnecessary professional friction 
is done away with to the advant^e alike of patients 
and practitioners. 

Pruritus and Lyxaphadenoma. 

The connection of pmritus with lympbadenoma 
is not mentioned in the majority of onr textbooks 
on medicine, but the fact that this complication is 
something more than a mere coincidence has been 
emphasised by Dr. W. Cottle and Dr. Lee Dickin¬ 
son, in a communication published in a contemporary 
describing three cases of pruritus associated with 
lympbadenoma. The importance of the subject lies 
in the fact that pmritus in lympbadenoma is of 
serious prognostic import, and in instances which 
otherwise do not appear beyond recovery this com¬ 
plication, particularly if accompanied by pigmenta¬ 
tion of the skin, is of grave significance. In the 
casee described the rapid course of the malady fully 
bore out the prognostic gravity of the pmritus. 

The Parisian Medical School. 

The falling-off in the nnmber of foreign stndents 
attending medical classes in Paris has incited the 
Municipal Council of the city to take steps to increase 
the facilities for medical teaching and make the 
school more attractive. In a series of articles in 
L’Eclair, M. Daussett, President of the Council, 
shows that during the past twenty y ears the French 
schools of medicine are being gradually deserted by 
foreign students, who now seek instm stion in Yienna 
and Berlin. To stay this stream of foreigners from 
Berlin and direct them to Paris it is proposed that a 
“ Municipal Institute of Practical Medicine ” be 
established, and supported at the expense of the city. 
In the institute the student will see the practical 
application of the theories he has learned in the 
lecture room. Wards containing about twenty beds 
each will be utilised for clinical instraction. Each 
ward will be devoted to a specialty, and be under the 
care of a specialist who has attained distinction in 
bis branch of medicine. Post-graduate lectures 
and clinical instraction will bo delivered, and 
it is hoped that many practitioners will avail 
themselves of a four or six weeks' course every 
year for the first five years of their professional life. 
Patients are eligible from all parts of French terri¬ 
tory, the desire being to secure specimens of the 
pathological states that call for careful investigation 
either from their pathology being little known or 
from their not being amenable to treatment. We 
heartily wish the scheme success; the home of 
Pasteur should be an attraction to students, and our 
French con/rerf« aie well advised in teaching Pas- 
teur’s theories and demonstrating his teaching in 
Paris and not relegating the duty to German pro- j 
fesBors in Berlin. 


Veratrum Viride in Puerperal Bclampeda. 

Ant drag which can be proved to have influence 
over this serions malady is worthy of note. Accord¬ 
ing to the Clinical Bevievo of July, 1901, “ at the late 
meeting of the American Medical Association a 
number of speakers firmly held to the conviction of 
the superior efficacy of veratram viride in puerperal 
convnlsions in comparison with any other drag we 
possess. While in the convulsion cboloroform, of 
couise, would give a rest and relief to be procured 
in no other manner. Beattie, of Kansas City, 
recommended that the veratram be given in ten 
minim doses, hypodermically, to keep the pulse low. 
Confield, of Cincinnati, held that in fnll-blooded 
persons with a high pulse veratram could be sud 
to be quite a specific. He advised that from fifteen 
to sixty minims of Norwood's tincture (according to 
the patient) be given every fifteen minutes until the 
pulse reached sixty, where it should be held for 
several days. In thin ansmic patients with small 
pulse this drag should not be used. Chloral and 
morphine were the agents to employ in such 
instances.” 

The Treatment of Goitre. 

At the last annual meeting of the German Surgi* 
cal Society Professor Koeber presented the following 
statistics of his treatment of 1,000 goitres by opera¬ 
tion. Of these 929 were cases of simple glandular 
enlargement, of these four died; twenty-seven were 
cases of malignant growth, of which six died; 
twenty oases were of an inflammatory character, of 
which but two died; twenty-four were cases of 
exophthalmic goitre, of which two died. These 
statistics are not alone valuable from their number, 
the care with which the cases were registered 
greatly enhances their value: thus we find that of 
cases of simple growth of the gland, in four cases the 
growth returned and he had to enucleate the gland. 
As a rule be found it sufficient in simple enlargements 
to excise such portions of the gland as were inter- 
fei ing with respiration. His most troublesome cases 
were those of proptosis ; the extirpation was both 
troublesome and dangerous. Such a brilliant record 
cannot fail to influence medical opinion. The older 
methods of blisters, setons, iodine painting, and so 
forth, were eminently unsatisfactory, and the thyroid 
extract treatment too often failed to produce the 
desired effects, and not unfrequently caused un¬ 
desirable results. 

The Antiseptic Duel. 

A DUEL has lately taken place between the son of 
a celebrated novelist and a well-known journalist of 
Paris, in which it is reported that in the course of 
the encounter the tip of the sword of one of the 
oombatants was observed to touch the ground. The 
duel was immediately interrupted, and under medi¬ 
cal supervision the weapon was carefully and scien¬ 
tifically disinfected. It is gratifying to hear that in 
consequence of the extreme precautions observed a 
wound inflicted on one of the parties to the duel is 
proceeding satisfactorily, and it is probable that in 
DlUllIZCU . ■ • ' - 




Ato. 28,1901. _ NOTES ON CURRENT TOPICS. Tm Mjdiojj. Pbibb. 225 

future anj danger that m&j appertain to modem were shown bj obemioal analTsis to have been simplj 


Frenob duelling will be entirely obviated, to the 
great satisfaction of all concerned. 

Able-bodied Soldiers. 

Thb annonncement is made that Lord Kitchener 
has ordered home a number of tbe new yeomanry 
lately sent over sea to the strength of 16,000. The 
allied reason is that hundreds of the men are 
suffering from complaints of physical disabilities 
that would have been detected by the most cursory 
medical examination, and many of them are at pre¬ 
sent in hospital suffering from such diseases as vari¬ 
cocele, heart disease, deafness, lameness, and 
defective vision. As usual, the blame is thrown on 
tbe unfortunate Medical Department, which appears 
to be the favoured scape-goat of our chivalrous 
combatants. It must be clear as daylight to 
the man in tbe street that an unusual demand for 
soldiers means a lowering of physical standards. 
In tbe piping times of peace it is possible to pick 
and choose, so that the regular Army is supplied by 
recruits who, from a bodily point of view, are fittest of 
tbe fit. Tbe demand for troops at the Cape is still 
unslaked, and it is to be hoped that tbe medical in¬ 
spectors at home will resist pressure in future and 
med out remorselessly all men who are unlikely to 
withstand the rough-and-tumble of an arduous cam¬ 
paign. Headers of the casualty lists must have 
noted the number of soldiers who are reported to 
have succumbed to heart disease and phthisis, which 
in a certain proportion of cason must have existed 
previously to their joining tbe Service. It is 
a question whether moderate errors of eyesight 
should be held a disqualification, for in the German 
and some other Continental armies the class of men 
laboaring under this defect is found useful enough. 

A Lay Indictment of the General Medical 
OounciL 

Ik our correspondence columns will be found a 
communication from a medical man, commenting 
somewhat severely upon a letter from Colonel le Poer 
Trench, published in the Times of August 20tb. 
Tbe gallant gentleman in question made a frontal 
attack upon the General Medical Council on the 
ground that they were created for the protection of 
the public against unqualified practice, and “ not to 
prevent research and new departures in medicine 
by qualified practitioners.” The Council certainly 
do not adopt the first proposition, for they decline to 
prosecute unqualified practitioners, and assert that 
their function is purely to maintain certain 
ethical and educational standards among regis¬ 
tered and duly qualified medical men. It was 
in accordance with that interpretation of their 
administrative powers that they took proceedings 
agmnst the gentlemen who are mentioned by Colonel 
Trench, namely. Dr. Irvine, Mr. B. M. Theobald, and 
Dr. Alabone. Of these three the first. Dr. Irvine, 
capitulated upon an ethical matter. Mr. Theobald 
was struck off the Register for his connection with a 
notorious quack, Count Mattei, whose costly remedies 


water. Dr. Alabone was proceeded against for treat¬ 
ing consumption by methods the worthlessness of 
which was fully exposed not only in tbe medical but 
also in tbe public Press. His advertised nos¬ 
trum — " Laohnanthes ” is accepted by the 
Colonel as a Heaven-sent specific for the cure 
of consumption, apparently on the strength 
of a single case which improved between March and 
May. It may be remarked that any medical man 
who finds a cure for a disease and endeavours to 
make money by selling his discovery is running 
counter to the sound traditions of a noble profes¬ 
sion. As to the suppression of quack practice by 
the Council, it has lot^; been the earnest desire of 
medical men throughout tbe kingdom that the 
Council would undertake that most desirable 
task, or, if their powers were inadequate, that 
they would take steps to secure the necessary 
amending legislation. The second point of the 
gallant Colonel’s indictment—namely, that the 
Council attempt to prevent research and new de- 
partui'es by qualified practitioners—is too absurd to 
need discussion in the columns of a medical journal. 
Legitimate scientific work is outside their control* 
and their action in the case of Theobald and 
Alabone was directed agunst pseudo-scientific or 
quack methods foisted upon tbe public in ways con¬ 
trary to professional usage—in other words, both 
matter and manner were illegitimate. 

Ordnanoe Maps and Medical Men. 

To the country practitioner of medicine good local 
maps are essential, and it is somewhat doubtful 
whether, as a general rule, he is fully alive to tbe 
advantages of the Ordnance Survey maps. The 
recent change from a four-mile to the inch to a one- 
mile to the inch scale has greatly enhanced the 
value of these charts. For the small sum of one 
shilling a minute key to a district can be obtuned, 
with full details as to villages, roads, canals, streams, 
bouses, and a host of other physical facts. Tbe cost 
of the map is only one shilling, so that the Govern¬ 
ment have not hindered the sale of their valuable pro¬ 
duction by burdening it with an exoesaiveprice. Forall 
that, tbe sale of their publication is of a most meagre 
description. The inwardness of that curious state 
of affairs appears to lie in the complicated methods 
of sale which the Treasury have imposed upon the 
sale of the Ordnanoe map. The apparently simple 
plan of selling through the agency of local post- 
offices is so muddled and mismanaged that the in¬ 
tending purchaser finds himself faced with a quite 
unnecessary amount of formality, delay, and addi¬ 
tional cost. In spite of these drawbacks, however, 
provincial medical practitioners may nevertheless be 
advised to turn to the Ordnance maps for accurate 
and trustworthy topical charts. 

A 8E&IOVS outbreak of typhoid fever has occurred 
in Wales at Ebbwvale. Several deaths have resulted. 
There is no isolation hospital, and medical men are 
experiencing much diffi culty in treating the patient 

Dir;:!ized ; 


Aua. 28 , 1901. 


226 Th. Midicxl Pbrdb. NOTES ON CURKBNT TOPICS. 


Infantile Pneumonia. 

At.t. phjBicians dealing with infantile diseases 
have recognised the difficnltj of diagnosing pneu* 
monia in the earlj jears of childhood. We need not 
repeat for our readers the symptoms of the disease 
or tell how prone the disease is to be overlooked 
iTTitil too late, or ennmerate the diseases for which 
it may be mistaken; such information is to be found 
in every good text-book on infantile diseases. Un¬ 
fortunately students are taught nothing of infantile 
troubles, and the young practitioner soon finds how 
insufficient has been his training when he comes 
to attend children. It is a revelation to him 
to learn that a child may die of pneumonia 
without showing any of the symptoms of the 
disease that be is so familiar with in the adult 
patient. Even to those familiar with the diseases of 
early life the recognition of pneumonia is not always 
easy, and the profession should be grateful to H. 
Weiss, of Lyons,'who describes a sign of the disease 
in infancy which be has been acquainted with for 
months past. He finds that there is deficient expan¬ 
sion of the infra-clavicular region of the affected side. 
From his account the sign is pathognomonic. He has 
sought for it in other thoracic troubles in vain. It is 
not to be confounded with the want of expansion of 
the whole side, whichis found in pleurisy and pneumo¬ 
thorax. The pneumonic sign is limited to the 
infra-clavicular space, and with it is found some¬ 
what less than normal expansion over the site of the 
lesion. What adds to the value of the sign is the 
fact that it appears at the beginning of the attack, 
being well marked before the fifth day. To get the 
sign clearly it is recommended to strip the little 
patient and place him on the broad of his back, and 
when the excitement of the child at being undressed 
has passed off and the breathing has become normal 
the difference in the movements on the right and 
left side of the thorax will be readily seen. Care 
must, however, be taken not to confound the elevation 
of theclavicle with pulmonary expansion. The differen¬ 
tial diagnosis between meningitis, typhoid fever, and 
influenza from pneumonia is greatly facilitated by 
this sign. It is also of much value in recognising 
the onset of pneumonia in children worn out with 
the wracking cough of pertussis—a danger not un- 
frequently unnoticed until the impending death calls 
attention to it Consideringthatevery general practi¬ 
tioner of medicine numbers many children among his 
clients, it is an amazingfact that the medical student 
is taught nothing of children’s diseases, and gets his 
qualification without being asked one question on 
the subject. 

Coroners and Post-mortem Examinations. 

The lady resident of a London hospital. Dr. 
Louisa Garrett Anderson, gave evidence at an 
inquest lield last week upon the body of a child that 
was brought to the institution dead. She stated 
that the child was obviously dead, and having ascer¬ 
tained that fact she had not examined the body 
further. Later it transpired that she expected to 
have been called upon to make a post-mortem exa¬ 


mination. This drew from the coroner the remark 
that it was usual for a hospital doctor to examine a 
body under such circumstances to see whether there 
were any marks of violence. Where the cause of 
death was obvious an autopsy was not ordered 
unless subsequent criminal proceedings were likely to 
be taken. The matter evidently rests with the dis¬ 
cretion of the coroner, who has in turn to depend on 
the results of the inquiries of his subordinate officer. 
While the holding of unnecessary inquests is to be 
deprecated on various grounds, it may be open to 
question whether post-mortem examinations might 
not be held more frequently to the public advant^e. 
The consideration of criminsd negligence sometimes 
crops up unexpectedly in the course of an inquest. 
So far as hospital residents are concerned, they are 
expected in the majority of cases to perform an 
autopsy, for which no fee is paid. On the other hand, 
they receive fees for evidence when a body is brought 
dead to the hospital, and a further fee for a post¬ 
mortem under those circumstances would be a small 
recompense for much gratuitous work. 

Low-flaah Oil. 

The fame of Napoleon Bonaparte as a great mili¬ 
tary genius was founded on the lives of millions of 
his fellow-creatures. If one were to seek latter-day 
parallels in civil life they would probably be found 
amongst the millionaires who have amassed their 
money from industrial sources. The brewing trade 
will at once occur to many readers as an instance of 
a lucrative trade that brings misery in its train. 
At the same time it must be admitted that the 
brewers as a rule furnish good liquor to consumers. 
It is quite another matter, however, when an inferior 
and dangerous commodity is supplied to the public 
simply and solely because of its cheapness. That is 
the case of low-flash oil, out of which the for¬ 
tune of at least one American multi-millionaire 
has been delved. Hr. Balfour's Government, in 
their wisdom, fixed the flash-point at 73 degrees, 
whereas the London County Council held that the 
minimum should be at least 100 degrees. This 
difference, formally sanctioned by the Legislature of 
the United Kingdom, helps to enrich American 
oil-trusts at the cost of the lives and property of 
English consumers. Statistics show that last year 
I twenty'three lives were lost in London alone through 
the use of low-flash oil, while during the period from 
July, 1890, to March, 1900, there occurred from the 
same cause 2,055 accidents, of which no less than 
250 were fataL The whole question demands instant 
attention at the hands of any Government solicitous 
of the safety of His Majesty's subjects. 

The Abuse of Out-patient Departments. 

Whenever any unfortunate oversight of hospital 
administration takes place a cry of horror is at once 
raised by a certain section of the public Press. No 
one can say that the administration of the medical 
charities is free from many a serious flaw and abuse, 
but, on the other hand, it may reasonably be urged 
that, considering the vast amount of good that is 


DiuiiiZ-..-.! bv 


Googie 



Itro. 28. 1901. 


OOBRESPONDBN CE. 


Thi Mbdical Pbcss. 227 


effected, there is s vonderfoll/ small margin of 
serioQS blander. Bat there are two sides to every 
question, and in the present case the public have 
themselves to thank for many of the evils of 
which they so bitterly complain. Overcrowdbg 
lies at the bottom of ntoety*nine out of every 
hnndred of those unfortunate incidents that 
^re in the newspapers under the heading of 
“Another Hospital Scandal.’’ Attendants, nurses, 
hoase saigeons, and medical staff find themselves 
swamped day after day with an endless array of 
work. The out>patient rooms contain scores of 
patients who ooght to be under the care of private 
practitioners. Every morning hundreds and hun* 
dreds of patients from the suburbs and neighbour¬ 
ing county poor into the general hospitals of any 
great town, where, as often as not, they are treated 
by junior house surgeons or by students. Then, 
ag^, many a well*to-do person who is treated at a 
hospital for some surgical accident, returns thither 
for the whole course of treatment instead of going 
to a private medical attendant. Abuses of this kind 
it is clearly within the power of the public to con* 
troL Some day, no doubt, the out-patient depart¬ 
ments of hospitals will be rigidly reserved for their 
proper duty, namely, to relieve the medical necessi¬ 
ties of the poor. 

PERSONAL. 

SoBOEON-OBKBaAL W. Tatlob, M.L., C.B., whose 
ai^intment to the Headquarters’ Staff in London we 
referred to in our last issue, has now been appointed an 
honorary Physician to the King. 

The Liverpool School of Tropical Medicine learns 
that Major Boss is returning temporarily to England 
from Sierra Leone to arrange for the despatch of an ex¬ 
pedition, similar to that now under his charge, to the 
Gambia and Gold Coast. 

A HABBivB and handsome marble fonntain was un¬ 
veiled last week at Baddleworth to the memory of the 
late Dr. Bamsden, who bad resided at Saddleworth for 
thirty-six years. This fonntain was erected by the 
public in token of their profound respect. 

Lixut.-Colohbl F. W. Tbbvob, M.B., Royal Army 
Medical Corps, has been gazetted to the local rank of 
Colonel in South Africa whilst Principal Medical Officer 
of a Division, and the following officers of the R.A.M. 
Corps to the local rank of Colonel in South Africa whilst 
Principal Medical Officers of General HospitalsLient.- 
Cots. J. L. Hall, G. H. Sylvester, G. £. Twiss, and F. A. 
B. Daly, H.B. 

Thb grant of the local rank of Colonel in South Africa 
made to the undermentioned officers of the R.A.M. Corps 
is continued to them whilst holding special appoint¬ 
ments :—Lieut.-Colottel J. D. Edge, M.D., Principal 
Medical Officer Johanneebnrg District; Lieut-Colonel 
J. A Gormley, M.D., whilst Principal Medical Officer of 
a General Hospital; Lieut-Colonel J. C. Dorman, M.B., 
whilst Principal Medical Officer, Eastern Line, Trans¬ 
vaal; Lieut.-Colonel A. T. Sloggett, C.M.G., whilst 
Principal Medical Officer of a General Hospital. 


Thb will of the late Dr. McKim, Kelvingrove Street, 
Glasgow, has just been proved at over .£22.000. Dr- 
MoKim was a bachelor, and died quite recently at an 
extreme old age. He had retired from the active duties 
of his profession for a number of years. He was a 
typical Highlander, and his practice was largely among 
the Highland people of the city, by whom he waa mnch 
esteemed and bis memory is greatly revered. Although 
possessed of ample means he lived a quiet and unpreteo- 
tions, but, at the same tim^ a very useful life. 


(HotreBpcmiata. 


[We do not hold ounelvee responsible for the opinions of onr 
oorrespondenta] 


THE PROPOSED BRITISH AND COLONIAL 
JOURNAL OP OBSTETRICS AND GTNiECOLOGT. 
To the Editor of Thb Mbdical Pbbbs amu Cibculas- 

Sib. —It is quite unnecessary to reply in detail to the 
plaiuible, if somewhat prolix, letter of Dr. Sinclair, 
which appeared in your issue of the 14th inst. His 
natural deeire to be the originator of what he hopes 
will be regarded as an “ Imperial Journal of Obstetrics 
and Gynmoology ” would obviously find expression in 
the steps which he took to bring his “ venture ” to a 
sncoesunl issue, and found a journal which should be in 
the future, as certainly it has been in its inoipiency, 
associated with his name. 

It is obvious from Dr. Sinclair's account of the 
obstacles to bis project, that tbeee were to be found in 
the “ apathy ” and “ hostility” among" certain circles of 
London gynaecologists,” andfrom "quarters” which evi¬ 
dently were not t^en into consideration by Dr. Sin«tiw 
when he worked out his scheme, to which however, as 
he statee in his letter, he found " many opponents ” 
"entirely unexpected.” Further, it is evident that he 
assooiatw such oppoeition with the British Gynseoo- 
logioal Society, or at least with " its most influential 
members ” residing in London, an oppoeition which be 
is kind enough to say is " highly creditable to their 
loyalty,” referring, I assume, to ^eir relation to their 
S^iety and their journal. 

Now, Sir, thie is exactly the point at issue, namely. 
Dr. Sinclair’s ideas of " loyalty ” to a Society of which 
he is a Fellow, and those of otoer fellows of the Society 
differently circumstanced to him, and who happen to 
take a different view of ita intereets and relations to 
other Societies. That his action was regarded at least 
with enspioion, is evident from the quotation Dr. 
Sinclair gives from one of its most respeotel and in¬ 
fluential membexs, who "dvclined to move loithout fully 
miederatanding hou> the 0ynxcoloyical Society wot likely to 
be affected." 

There was a rumour, possibly n'A the outcome of 
"unconstrained conversation and gossip only,” that 
the proposed journal was the first step towards the 
I formation of a new Oynseoologioal Society, which would, 
in time, swamp the British Gynseoologica). Will Dr. 
Sinclair say if he never contemplated the formation of 
such a society ? If memory serves me rightly, I think 
he put forward such a scheme in a letter which he 
wrote to the British Medical Journal. How would the 
Fellows of the British Gynecological Society regard 
their participation, under the cover of promoting the 
success of a journal, in a movement which might ulti¬ 
mately tend to the assassiuation of their Society ? This 
would mean a little more to it than the staxting of a 
rival journal! 

Let me say plainly why " leading men in the 
Gynecological S^ety resident in London rightly 
regard this movement with suspicion.” I will put the 
reason briefly. Certain leaders of the Obstetrical 
Society of London, or, as they prefer to designate them¬ 
selves, "the teachers of cbstotrics” in London, have 
b^n, and are, the persistent antagonists of the Gyneco¬ 
logical Society .though a few of the more liberally-minded 
of them have not shown such animosity. The splendid 



228 Thb Mbdioal Pbbbb. 


MEDICAL/ NEWS. 


iv«. 28. 1901. 


work done by the Gynsoologioal Society, and the die* 
tinction it has earned as the pioneer of modem gyo»o(^ 
loffioal work in this coontzy, may explain this. Its 
*' Journal ” is the standing record of that work. When, 
therefore, a proposition is made to start a new " Gynte* 
oological Journal ” it is moot natural that the Fellows 
ot the Gyniecologioal Society should inquire as to the 
relation that journal would hold to theirs, and further, 
how far the Fellows of their Society were inrited to 
co-operate iu view of what Dr. Sinclair terms “ the un¬ 
happy differences among London gynecologists.” This 
"difference” erery br<^-mindea man must deplore, 
and no one does so more than the writer. 

When they find that they hare been deliberately 
excluded, while the Obstetrical Society ialately repre¬ 
sented, naturally they are inclined to hold aloof. Xnd 
this is just what has happened. I saw the first printed 
iuTitation with the inTiters' uames, and with the excep¬ 
tion of some few prorincial Fellows (two from Ireland) 
there were no names on it of Fellows of the Gyneco¬ 
logical Society. Why was this, unless Dr. SinoWr had 
already concluded that the Fellows of the Gynecological 
Society would regard his journal as inimical to the 
Society ? Surely the proper way to have initiated a 
"ITntvsrsal Impmial Jounud ” would have been to have 
had a truly "representative” meeting, summoned by 
as many of the leaders of one metropolitan society as 
the other, and to which the Fellows of the two leading 
sooietieB should have been equally invited to attend. 
This would at once have shown the Iona fidtt of the pro¬ 
moters, and have made the journal " representative of 
British gyneeoology in the fullest sense.” As this was 
not done, bnta meeting held at which only *‘fnend» 
of th« tchevM ” (the italics are mine) were ^owed to be 
present, Dr. Sindair will pardon the reiteration of my 
conviction that this jonnud has been " taken in hand 
mainly by those who are openly and avowedly hoetile to 
the Brimh Gynsoolc^osd S^ety and its journal,” 
though I accept his avowal that there was no such hoe- 
tilityon his p^ iutended in its concejition. In conclu¬ 
sion, I would remind Dr. Sinclair that it does not follow 
that because the method ot starting a journal is anim¬ 
adverted upon, that those who do so are necessarily its 
" opponents,” nor in my previous letter did I assert or 
infer that the first meeting was a "private*' one. I 
affirm that it was " one sided.” This Dr. Sinclair himself 
admits. I certamly in no way " prophesied failure,” but 
I did assert, and now repeat, that tne method of launching 
the journal will prevent its being ”in the truest sense 
representative of British obstetrics and gynecology.” 

I am. Sir, yours truly, 

A Lohdon Obstbtbician and Gtn^oolooist. 


THE CONGEESS ON THBEECULOLTS. 

2*0 the Editor of Tai Mbdical Paiss and CiacuLAB. 

Sir, —In The Times of to-day (August 20th) there 
appears under the above heading a remarkable letter 
from Col. W. Le Poer Trench. This letter is certain to 
give rise to a correspondence; and this, no doubt, 
will receive the editorial attention it may call for 
at the hands of Thb Mxdical Pbbbb and Cibculab. 
My object in writing is simply to emphasise what 
I have more than once referred to in your 
columns, the fact that a vast amount of ignorance 
and prejudice ex'sts in the minds of the educated 
public with regard to the medical profession. Col. Le 
Poer Trench may be taken as a fair sample of his class. 
HU letter shows that he is not highly intellectual, and 
that he is completely ignorant of medical science; but 
he is intelligent enough to be a colonel in the Army, 
and wealthy enough to be able to offer a contribution of 
£1,000 towards a public test of " Dr.” Alabooe’s " Laoh- 
nanthes ” treatment of consumption. Colonel Le Poer 
Trench seriously believes t^t owing to prejudfice or 
professional etiquette or trade union rules framed by the 
General Medical Council and observed by the profession, 
a great discovery has been practically keptfromthepublic 
since the suspension of "Dr.” Alabone fifteen years 
ago, " with the result that many thousands pronounced 
hopeless and incurable under the recognised treatments 
have been left to die.” Colonel Trench’s argument 


amounts to this, that Dr. Alabone was unjustly expelled 
from the profession for infamous condnot, whilst, in 
fact, the whole profession has been engMed in an in¬ 
famous and mniwrons conspiracy in withholding from 
their dying patients a remedy likely to save them 
and restore them to health. Colonel Trench has not 
taken the trouble to investigate even those questions 
involved upon which he is competent to form an opinion. 
Had he done thU he would have learnt that no repu¬ 
table medical man prcffesses to hold and to purvey 
secret remedies; to do so constitutes infamous conduct. 
Every discovery, every advance in medical science, 
is made public; every supposed new remedy fully 
described so that it may be tested and tried by 
all inclined to do so. Tuberculosis causes 60,000 
deaths annually in these islands; if anyone has dis¬ 
covered a drug or combination of drugs capable of 
curing this malady in any stage, let him make known 
the composition of his remedy, and if it sta'^d the tests 
of science he need not fear that wealth and honour will 
not be shouered upon him, not only in his own land, but 
in every country where toberonlosis claims an equal, 
or greater number of victims. Col. Trench’s letter is a 
tissue of misconceptions from beginning to end; but 
these misoonoeptions could not have been entertained by 
anyone not grossly ignorant of the constitution of our 
profession, of its government, of its written and un¬ 
written laws, and of the moral tone which characterises 
the bulk of its members and raises them far above the 
trades union level upon which Col. Trench places them. 

I am. Sir, yours truly, 

August 20tb, 1901. Ubiqub. 


©bituarg. 

DR. A. LAWSON KELLY, OP GLASGOW. 

Wb regret to announce the sudden death of Dr. Adam 
Lawson Kelly, 26 Blytbswood Square, Glasgow. He 
suffered from osurdiao disease which neceesiteted him 
giving up professional work for over a year. His health 
had BO much improved, however, that he sometime ago 
resumed work. A few days ago he was walking in Reo- 
field Street when he was ob^ved to fall by a police¬ 
man, who had him removed to the Central Railway 
Station, quite near. No professional skill was of any 
avaU. Dr. Kelly, who was 65 years of age, was held in 
the very highest esteem by all with whom he was 
brought in contact, lay and profes8i<mal friends alike. 
One of his sons is a mMical man praotisiim in the dty. 
Ho has left a widow and grown up family to mourn 
their irreparable loss. The universal rega^ in which 
he was hrid makes his death to be very dmply deplored 
by all who knew him. 


Jftcbkal £it\s)s. 

An Ootogsnarlan’s molent Death- 
An inqnest was recently held at Berwick on the body 
of Dr. David Cahill, aged over eighty, who was a 
radnato of Edinburgh University, and recently cele- 
ratod his jubilee as a medical practitioner. He died as 
the result of a fractured thigh, alleged to have been 
caused through his being assaulted and knocked down 
by Henry Gardiner, of the Cook and Lion Tavern, Ber¬ 
wick. After a four hours* sitting, the jury found that 
the doctor met his death by faUing or beinw pushed 
down by Gardiner, but that the latter acted in self- 
defence as be had been struck with a stick by Dr. CahiU. 

Dublin Death-rate. 

Thb deaths represent an annual rate of mortality of 
20*6 in every 1,000 of the population for the week 
Saturday, August 17th. Daring the thirty-three weeks 
ending with Saturday last the death-rate averaged 27*2. 
It is interesting to note the beneficent effects on the 
mortality rate in Dublin of sunshine as the poor people 
in fine weather practically live in the streeits, and the 
doors and windows of the fever dens of the city, 
euphemistically called unfurnished lodgings, are open to 
sunlight and fresh air. Uncertified deaths are still 
numerous. Tmi such occurred daring the week, and of 




Auo. 28 , 1901. 


PASS LISTS. 


Tex Uxdical Pbxsb. 229 


these dgbt were children, seven of whom were under one 
year of 

Fallnre of Water Supply. ’ 

LxieH-OB^BS is unfortunate in the matter of its 
water supply. Twelve months ago the town was without 
water for no lees a period than three weeks, an nnplea* 
sant experience that does not appear to have warned the 
local Council to set their house in order. Through 
another breakdown in the waterworks it is announoira 
that the town is once i^^ain without water. The inoon* 
veoienoe caused by this failure is extreme, inasmuch as 
the place is full of visitors. The damage likely to be 
ean^ to a rising watering-place by recurrent water 
famines is obvious, and its full meaning is likely sooner 
or later to be brought home to the powers that be in the 
matter of the water supply of Leigh-on-Sea. 

Small-pox Outbreak In Ion don- 

NuxxBOns cases of small-pox are being reported from 
various parte of London. During last week there were 
thirty-five patients under treatment for that disease in 
the hospital ships and wharf shelters of the Metropolitan 
Axioms Board, being an increase of twenty over the 
previous week. For several years London has been 
almost free of small-pox. The preemit outbreak will be 
watched with a gora deal of interest because of the 
known hostility of some lodal governing bodies, notably 
that of 'Whitechapel, to vaooinatioc, and also (m account 
of the new generation of unvaodnated infants that is 
being yearly added to the population unprotected gainst 
small-pox by Mr. Balfoura 'Vaccination Act. 

The Mortality of Foreign Cities. 

Tex following are the latest official returns, and re¬ 
present the last weekly death-rate per IfiOO of several of 
the populations:—Calrotta 88-60, ^mtoy 46, Madras 41, 
Paris 18, Brussels 16, Amsterdam 16, Copenhagen 14, 
Stockholm 16, Christiania 28, St. Petersburg 30, Moscow 
80, Berlin 20, Hamburg 26, Breslau 81, Munich 20, 
Vienna 17, Prague 22, BndapPeeth 19. Trieste 21, 
Venice 17, Cairo 88-48, Alexandria 88 88, New York 
(including Brooklyn) 24. Philaddphia 18. 




loyal Colleges of Physicians and Surgeons, London. 
Thx following candidates passed the second examina¬ 
tion of the boud in anatomy and physiology at the 
recent quarterly meeting of the examiners:— 

£. F. Bimington Alford and James Armstrong, of Univ. 
GolL, London; Berkeley N. Aab, St. Barts. Hosp.; Cecil 
E. Attlee, B.A.Camb., St. Thomas’s Hosp. ; J. Landells 
Blakie and Frederick J. Borrie, Otago Univ. and Middle¬ 
sex Hosp.; John H. Burridge, King's Coll., Lond. $ 
Arthur H. Bond and Harold CUtpham, St. Mary’s Hosp.; 
'William Byam and H. O. Shackleford Courtney, St. 
George's Hosp. ; Thomas C. A. Cleverton, London 
Hosp.; Robert H. Cotton, St. Thomas’s Hoep.; Walter 
CnuDpton, Univ. Coll., Liverpool; A. Maroellns De 
Silva, Ceylon Med. CoU. and London Hoep.; W. Leonard 
Dickson, Middlesex Hosp.; Kenneth A. C. Doig, West¬ 
minster Hosp.; William S. Edmond, St. Barts. Hoep.; 
Evan K. Evans, Univ. Coll., Liverpool; Harry L Evans 
sod Charles B. B. Eyre, St. Thoznas’s Hoep.; Harry A. 
Fenton and Walter T. Finlayson, St. Mary's Hosp.; 
George E. 0. Fenwick, Otago Univ., New Zealand, and 
Univ. CoU., Lend.; Harold N. Fink, B.A.Camb., and 
David H. Fraser, B.A.Camb., Camb. Univ.; William H. 
France, Weetminster Hoep.; Edgar H. Geod, London 
Hoep.; Q. Cbri8t<^her Grundy, Yorks. CoU., Leeds; : 
Percy OuUy, CbaringOroes Hoep.; Arthur L. Heiserand 
Diaid M. Unmby, L.D.8.EBg., Middlesex Hosp.; George 
W. Heron, Weetminster Hosp.; CecU D. M. Holbrook, 
Hugh M. Hoggins, and Algernon M. A. James, St. Burts. 
Ho^; Thomas M. Hughes and William H. Kaye, Owens 
ColL, Manchester; A. HUderbrand Jacob, Lon^n Hosp.; 
Hsnry B. Jenkins, Guy’s Hosp.; Tikiri B. Kobbekadnwa, 
C^lon Med. CoU. and Univ. ColL, London t Harold A. 
Emoh and Geoi^ M. L. Lester, M.A.Oxon., 8t. Thomas’s 
Hosp.; John E. LssceUes, St. Mary’s Hosp.; E. Brown¬ 


ing Lethbury, St. Barts. Hoep.; Frederick B. Lowe, 
WUliam N. May, Percy F. Minet^ C. Sonlthorpe Morris, 

L. D.S.Eng., and Maurice J. Mottmm, Guy’s Hoep. $ W. 
Cameron Macanlay, B.A.Lond., Middlesex Hosp. ( J. C. 
Stuart McDongall, Otago Univ, New Zealand; PhiUp J. 
Marett, Westminster Hosp.: Aurelius V. Maybnry, 
Durham Univ. and Guy's Hosp.; Boy C. Merrywea^er, 
Univ. CoU, Lond.; E^in S. Molynenx and Idris N. 
Morgan, London Hoep.; Harold B. Moxon, St. Thomas’s 
Hoep.; Alexander H. Mnirhe^, Francis M. Newton, and 
Charles W. O’Brien, St. Barts. Hosp.; 'HtMwiwb Niool, 
Westminster Hoep.; Gerald Nunn and Edward C. Peers, 
Guy’s Hoep.; George B. Painton, London Ec^,; George 

A. Paulin, Boyal CoUege of Siugeons, Edinburgh: 
Christopher T. Pellow, St. Thomas’s Heap, and Cooke’a 
School of Anatomy and Physiology ; Alan F. C. PoUard 
and H. Hammond Bolfe, 8t. Barts. Hoep.; Ge(^^ H. 
Bains, Westminster Hosp.; Cecil E. Reynolds, Univ. 
ColL, Lond.; Cyril S. 8. Bqi'by, Birmingham Univ.; 
Alexander Buete, Univ. CoU., Liverpool; Griffith H. 
Bees, Gerald C. F. Robinson, Fn^rick Bo^reon, Richard 
P. ^wlands, and Bandol^ St. G. Sea^ve, Guy’s 
Hoep.; Edward A. Smith, Univ. ColL, Livmpool; lid. 
ward J. B. Sorrage, B.A., LUB., and Cedi Vesper, 
King’s CoU, Lond.: Herb^ B. Soott and J. E. L 
Alexander Tnmly, B.A.Camb.. St. Bs^s. Hoep.; Kenji 
Takaki, St. Thomas’s Hoep.; Francis Thompson, Alfred 
G. Treeidder, James Tortie, Albert J. Walton, Tbomaa 
J. Williams, John H. Wolfe and Percy C. Wollatt, 
London Hosp. ; Alfred E. Weaver, Birmingham Univ.; 
Salomon J. 'woinbei^, Owens CoU., Manchester; Arthur 
D. White and Frank E. WhiteheiMi, St. B^’s Hosp.; 
Edward K. Williams, B.A.Camb., St. Andrew's Univ.. 
James A. Williams, 'Univ. ColL, Lend. Mr. Alexander 
V. Benson, London Hosp., passed in physiology only. 

Society of Apothecaries of London. 

Thx foUowing candidates have passed in 
Surgery.—J. C. Baggs, Section IL; P. C. Burgess, 
Section II.; D. Fletcher, F. I. M. Jape, G. J. W. Keig- 
win. Sections L and IL: E. B. Bisien, Section IL; W. 

B. Skelton, M. J. WUliaxns. 

Medicine.—J. W. W. Adamson, Section I.; J. H. 
Beasley, Sections I. and II.; B. 0. Bennett; 0. E. H. 
Lei^tt, Sections I. and U.; E. T. Loaghnrst; D. J. 
Morgan, Sections I. and IL ; E. Osborne, ^tions I. and 
II.: J. E. Skey, Section II. ; A. W. D. Thomson; P. P. 
Tobit, Section II. 

Forensic Medicine.—J. W. W. Adamson. B. C. Ben¬ 
nett, H. A. ChapUtt, C. E. H. Leggatt, E. T. Longhurst, 

D. J. Morgan, E. Osborne, A. W. D. Thomson, P. P. 
Tobit, S. C. Wilkinson. 

Midwifery.—B. C. Bennett, T. B. Davies, J. W. H. 
Morrison, E. S. Perkins, B. Bmb, 8. C. Wilkinson, F. W. 

B. Young. 

The L.S.A. Diploma of the Somety was granted to the 
foUowing candidates, entitUng them to practise medi¬ 
cine, surgery, and midwifery.- J. C. Baggs, E. T. Long, 
hnret, D. J. Morgan, J. W. H. Morrison, E. S. Perkins. 

E. B. Bisien, W. B. Skelton, A. W. D. Thomson, and 

M. J. WiUiama. 

Indian Medical Service. 

Thx foUowing is an official list of the candidates for 
His Majesty’s Indian Medical Servioe who were suoceas- 
ful at the Competitive Examination held iu London on 
February 9th, 1901, and foUowing days, arranged in the 
order of merit as issued from rae India Office. Antrust 
20th:- ^ 

Marks. 

Bradley, B. J. ... 2,633 

Loch, E. A.2,693 

Carter, B. M. ... 2,650 
Hagger, B. L. ... 2,646 
Baker, D. G. B. 8. ... 2,600 
Harley, T.W. ...2,472 
McCoy, J.W. ...2,306 
WiUco^, B. A.‘ ... 2,264 

Paterson, T. G. F. ... 2 220 
Bai, D. G.2,207 

7Prl byC^iOO^lC 


Marks. 

Lister, A. E. J. ... 8,246 

WilUama, T. F. B. ... 3,185 

Abbott, 8. H. L. ... 8,077 

Greig, A. W.3,016 

Lloyd, B. E.8,013 

Woods, J. .2,965 

Steen, H.B.2,940 

Munro, D. .2,929 

Bisset^E.2,910 

Clements, J. E. ... 2,890 

Overbeuk Wright, A. 

W.2,665 



230 Thi M.DIOAL Pe»bb. NOriCBS TO CORRESPONDENTS. 


Aua. 28. 1901. 


^lOtiCtB t 0 

®0n:£0ponbent0, S^axi fetters, ^c. 


iV* CokUBPOVDBVTB reqnirlugr B reply in this aolnmn ere par- 
tlenUrlj requested to make ose of a diftincitr* fipnaturB Of 
{titial*. andaroid the pmctioe of signing themselTss “ Header,’* 
"Sabsorlber,” “Old Sabscriber,'’ &o. Mooh confusion will be 
spared by attention to this rule. 

BspniSTS.—Beprints of articles appearing in this journal can be 
had at a reduced rate, proriding authors give notice to the pub¬ 
lisher or printer before the type has been distributed. This should 
be done when returning corrected proofs. 


,^l]i)xahrtmtntB. 


I' S C.P.Lond., A»eistant Besident Medical 
Officerto the General Infirmary at Leeds. 

DiviEs, W. N. M.D.B.U.I.,Certifying8urgeon under the Factory 
Acts. fOT t^Llsntrisant and LUntwit Fardre Bural District. 

Evshb, D.E.. M.B., B.8.Lond., Certifying Surgeon under the Fac- 
tory ^te for the Pontypridd Urban District. 

Gbunss, 0.,M.B.C.8., L.B.C.P.Lond,, fass been appointed House 
Physician to the General Infirmary at Leed*. 

M.B.. C.M.Aberd., Aadstant Director of the 
Patboloncai Institute, London Hospital. 

Potts, B. TnuaLOw, M.B., Ch.BEdin., Besident Medical Officer 
for Sick Children, Newcastle-on-l^ne. 

Baw, Natham, M.D.Durh.. P.B.S.E., D.P.H., Visiting Medical 
ouperintendcQt to tbo W6«t Dorbj Union Indnu^rT. Liverpool. 

Sm^, C. Lawsok, Ch.B.At>erd.y Senior Bocident Medical 

Officer tc the Tottenham HMpitaL 


Obioiitai. Abticleb or Letters intended for publication should 
be written on one side of the paper only, and must be authenticated 
with the name and address of the writer, not necessarily for pnbUoa- 
tion, bnt as evidence of identitT. 

Bbadiho Cases. —Cloth board cases, gilt lettered, containing 
twenty-six strings for holding the numbers of Tee Medical Fresb 
avd Circular, may now be had at the office of this journal, 
price 8 b. 6d. These eases will be found very usefol to keep each 
weekly numberintact, clean, and flat after it has passed through 
the post. 

INCBEA8E OF HYDBOPHOBIA IN PABIS. 

To tht Editor of The Medical Press ako Cibcolar. 

SiR,-l am greatly surprised that deaths from hydrophobia in 
Pni^ have not reached a higher fisure, seeing that there is in that 
city a huge Paetenrian Institute largely dependent for Its prosperity 
upon the sale of aiiti-rable serums and upon a constuit influx of 
dog-bitten Mtients. Common sense will supply the links in the 
chain of this aigumrnt. 

I am, Sir, yonrs truly, 

Frbd, E. Pirkib. 

Nutfield, August 23rd. 

Dr. 8. B. (Bedford.)—Appendicitis in infancy is not unknown, 
allhongb it is extiemely rare. A case was recently recorded in an 
American joarnal, in an infant of tbr^e months' old. About six¬ 
teen cases in all have been published, of which nine were operate 
upon, with seven recoveriee. 

Westpealia.—T he total popnlati/'D of Greater London, includ- 
the outer ring of suburbs, is now 6,578,964. 

U.B.C.S. (Exeter.)—Our correspondent's letter is not eAplicit 
enough. Nor ' an we gather when the occurrence deecribed in the 
newepeper cutting which is forwarded took place, inaamneh as no 
<^te IS appended. 

H. D.—Undoubtedly tl^e attention of tbe Boyal College of Physi¬ 
cians, London, should be called to any Fellow of the College who 
could be proved to be a shareholder in one of the many sanatoria 
now exploited for tbe open-air treatment of tuberculosis. Whether, 
however, the College would take action or not remains to be seen. , 

Dr. Bernard (Birmingham).—Copies of the souvenir voinmes 
which were presented at tbe festival dinner of the Boyal College of 
Surgeons (England) last year, can now be purchased from the 
Secretary of the College, atSe. pervolume. 

AN INVALID EXCUSE. 

“ No,” said the doctor, “I haven't voted yet, and I am not going 
to vote. I am not feeling well to.day. Isn't that a valid excuse ? ” 

" Not at all,” responded the iirofeseor severely. “ That's an invalid 
excase.”—CAicofTO Tribunt. 

E. A.—We were unable to publish your former contributions 
beoauae tbe language was so involved as to render the meaning 
dubious. 

Bacteriologist.—T he subject is not one to the disoussion of 
wbichwefeel disposed to open onr columns. 

YooBe Medico.—W ith capital at hand it wonld be more expe¬ 
dient to take a honse and pnt up a brass piste, and wait for prac¬ 
tice in a likely neigbbonrhood than to embark upon a partnerohip 
under tbe circumstances named by onr correspondeot. 

BoNDHOLDEa —Tbe enstom is fonnded upon strict equity. 

THE QEOQEAPHICAL D18TBIBUT10N OP CANCER. 

T. M. W.—Much useful information in regard to the distribu¬ 
tion of cancer in Great Britain will be found in Hr. Alfred Havi- 
land'e “Geogiaptaical Distribotion of Disease.” The proposal to 
compile “cancer maps” is not a novel one, and might be 
advantageouslv caniea ont, eapeclally as tbe cost wonld be trifling 
having regard to the importance of the qneetion involved. 

OxEOA.—Several cases of dermatitis from wearing stockings 
impregnated with anenio have been recorded. 

Absistamt.— Tbe proposal seems to ns to be scarcely consistent 
with tbe justice of the case, and we cannot advise onr correspon* 
dent to accept it. 

ETiqcBTTE.—Tbe necessary bond most be gives, otherwise the 
negotiations most tall throngh. 

Colonial Surgeon.— Apply to the Dean of the West London 
Poet Graduate College, West London Hospital, Hammersmith, W, 

Dr. B. 8.—We have made inquiry, but have been unable to osoer- 
tain the present address of the gentleman, tbe subject of your letter. 
He is probably still at the front, or thereabouts. 


Bacandts. 

Birmingham Workhouse Infirmary.—Issiitant Resident Medical 
uffloer. Salary £I00 per annam, with apariments, ntions. 
coala gas. laundry, and attendance. Immediate applications to 
tbe Clerk to the Gnardiane, 

Bradford Boyal Inflrmary. -Dispensary Surgeon, nnmaiTied, Salary 
£100 per annum, with board and residenoe. Also Jonior Honae 
Snmon, unmarried. Salary £50 per aunum. with board and 
residence. 

Cheshire Countv Asylum, Parkside, Macclesfield.—Senior Assistant 
Medical Officer, unmarried. Salary £175, rising to £200 per 
annum, with board, apartments, washing, and attendance. 

Connty Asylum, Lancaster.—Assistant Medical Officer, anmarried. 
Salary £150, increasing to £200, with apartments, board, wash¬ 
ing, and attendance. 

Connty Borough and Port of Sonthamptun.—Medical Officer of 
Health, Port Medical Officer, and Medical Snperintendent of 
Infections Diseases Hospitals. Salaiy (combined offlcei), iBSOO 
per annum. 

Cumberland Infirmary, Carlisle. Resident Medical Officer. Salary 
at rate of £80 for first six months, and £100 second six months 
per annum respectively, with board. lodging, and washing 

East Biding of Yorkshire.-Connty Medical C^eerof Health. Salary 
at rate of £400 per annum, li ling to £500 per annum, with allow¬ 
ances. (See aavt.) 

Glamo^«n County Asylum, Bridgend.—Assistant Officer 

unmarried. Silary £175, with beard, lodging, attendance, and 
laundry. 

Glasgow University.—Additional Examinershlp in Medicine 

Sdenoe. Annual emolument £30. Doties to commence in 
January, 1902. (Seeadvt.) 

Great Northern Central Hospital, liondon. - Vacancies for Honse 
Physician. Salary £60 per annum; Junior Honse Physician, 
Salary £30. Board, residence, and washiog provided in each 
case. Aleo Junior Honse Surgeon, Salary £30, with board 
residence, and washing ; and a non-resident As-istant House 
Surgeon, with Salary at rate of £30 jer annum, and partial 
board. Pull particulars of these vscancies will be found lq onr 
advertisement oolnmne. 

Easr-el-Ai^ Hospital and School of Medicine, Cairo, Egypt.— 
Physician to the Hospital and Profeesor of Clioicu Medurine 
at tbe School. Salary £E320 per lumnm and private pnotioe 
allowed. 

Metropolitan Asylums Board.—Assistant Medical Officer, unmar¬ 
ried, at the Fever and Small-pox Hospitals. Salary £160 per 
annum, rising to £200, with bow, lodging, and washing. 

Nortbampton General Infirmary.—House Physician (unmarried) 
Salary £100 perannnm, with apartments, board, attendance, and 

washing. 

Notts County Asylnm.-Temnorary Assistant Medical Officer. Four 
guineas per week, with board, lodging, attendance, and 
washing. 

Owens College, Manchester.-Junior Demonstrator in Physioloer. 
Salary £lw, rising to £150per annnm. 

Scarborough, iBorongh of.—Medieel Officer of Health. 8tUary£325 
perannnm, rising to £375 per annum. Full particulars on appU- 
c ition to the Town Clerk, 


Francis.— On August 20tb, at Arnold, Notts, the wife of Harvey 
Francis, M.D., of a son. 


dKarrisoeB. 

Bicbabdson—Mansell.— On August 20th, by the Bsv. A. B. w.,. 
sell, M A., brotherof the bride WalterSilverwoedBicha^eon, 
M.D„ H.B.C.S., of Melbnry, Bosoombe, yonngest son of T. 
Bichardson, M.D., M.B.C.S., of Highbnry New Park, to Ada 
Mary, youngest daughter of Thomas Henry MauselL of Temole 
Balaall, Warwickshire. 

Wild—Z wBirBL.—On Angnst 22nd,at Zurich (Switserland), Bobert 
Oecat Wild, M.D., eldiest SOD of Frans Wild, of Freibnrg-i/tt., 
to Maria Id^ yoongeet daughter of Henry Zweifel, of Znricb. 
formerly of PiQace Bond. Streatham Hill, London, S.W. 


^esthB. 

Baier.—O n August 21st, in London Thomas Young Baker, Brigade 
Burgeon, Army Medical Staff, Retired, youngest son of tbe late 
Bev. W. Lake Baker, Beotor of Haigiave, Nortbamptonshiie. 
Oebar.—O n August 2l8t, at Danedalo Lod^, Sheppey, Kent, 
Gerard, and on the 22Dd, Eric, the infant twin sons of Julius 
Ciesar, F3.C.S.L 

.G^ie 


lilt SHitdial Wtm and Cirmlat 



••8ALUS POPUU SUPBEMA LEX.’ 


VoL. CXXIII. WEDNESDAY, SEPTEMBER 4, 1901. No. 10. 


Clinkal IDcrturt 

ON 

HYDROCELE, (a) 

By A. MABMAPUKE SHEILD, M.B., F.B.O.8., 
Soxseon to St. George’s Homtal; ConsnltiD; Sar^eon to St. John 
and St. Elixalwth Hospital. 

Bbpobs disoossing the diagnoeia of hydrocele, a word 
fniist be aaid about causation. Thia ia aommed ap at 
oBoe by declaring that in a large number of caaea of 
hydrooAle no cerbun canae can be aaaigned for the 
diseaee. The booka aay that hydrocele is doe to a loss 
of the balance between the absorption and secretion of 
fluid in the tunica Taginalia, but the fact remains that 
in a considerable number of cases of hydrocele the sac 
of the tuuioa Taginalia ia distended with fluid without 
any rational cause being assignable. A very anggea* 
tire point ia as follows: A certain number of cases of 
hydrocele are associated with definite disorders of the 
teatiole. Thus, in syphilis of the testicle, concomitant 
hydrocele is familiar. In tubercle of the testicle, 
malignant disease of the testicle, chronic orchitis and 
epididymitis due to catheterisation, hydrocele is also 
found, though far more rarely. Thus a certain number 
of cases of hydrocele are undoubtedly caused by the 
spread of inflammation to the tunica Taginalia from the 
testis, or rather from the epididymis. This suggests 
that hydrocele is usually inflammatory in origin, 
which is Tery important in the matter of treatment, for 
the method of curing hydroceles dependent upon 
syphilis or tubercle of the tutis, is la^^ly bound np in 
the treatment of the testicnlar affection which causes 
and underlies the hydrocele. In some hydroceles a small 
pedanculated body is found near the head of the 
epididymis. This is a fcetal relic and is sometimes 
found in the tunica when no hydrocele is present. It is 
to wondered whether the rubbing of this snbstance 
against the serons surface might produce excess of 
secretion. The analogy of serous exudation in the 
knee, due to the rubbing of a pedanculated body from 
the edge of the cartilage, seems Tery close. 

The symptoms of the ordinary hydrocele of the tnuica 
TEginalis, each as are often met with in the ont-patient 
department of a hospital or in private practice, are 
really exceedingly simple. First of all the shape of the 
swelling at once tells that it is a distended tunica 
Taginalis. The swelling is pear-shaped and the neck of 
it is narrow, so that the cord can bedistingaished above 
the swelling by the pressure of the thumb and finger, 
showing that no hernia exists, and that it is definitely 
isolated from the abdominal cavity. Large hydroceles 
have often a slight constriction about their centre, '* hour¬ 
glass contraction," which ia also very oharaotoristio. There 
is no impulse on coughing; the swelling cannot be re¬ 
placed into the belly; and it is very generally translu¬ 
cent. In the vast majority of oases of ordinary hydro- 
cele the position of the testicle is behind the collection 
of fluid. As a rule the patient ia able to dietinguish 
testicular sensation when this part of the swelling is 
squeesed. It is advisable never to carry out such an 

(a) Abstract of a Clinical Lecture delivered at 8t. George's Hot- 
yital, London. 


examination, for patients' statements can rarely be 
relied upon as to their sensations, and a oarefnl examina¬ 
tion by transmitted light will usually show the position 
of the testis by the opacity produced. In a large 
hydrocele, moreover, the volume of the fluid is so great 
t^t it is generally impossible to feel the testis at all, 
still less to squeeze it. In a few instances of hydrocele 
the teetiole is in front of the hydrocele. This anusual 
circumstance may be due to maIp(»ltioD of the teetiole, 
the epididymis being in front instead of behind. It 
may also be caused by the *' anchoring " of the testis to 
the front of the sac by inflammatory adhesions. Thus 
this condition is found in old hydroceles, which have 
been tapped many times, and perhaps fruitlessly inject. 

The fluid which is contained in hydroceles is highly 
albuminous, and ia generally of a pale straw colour. In 
some oases of old hydroceles, which have existed for 
many years, the fluid becomes more opaque and mixed 
with obolesterin, the colour of old ale, which may 
greatly mar the certainty of the “ translncency " test. 
Hydn^les associated with sarcomatoos testis may 
contain bloody fluid. It woold be more correct to caU 
them htemat^les, except that the serum is often in 
great excess over the blood mixed with it. Tbe fluid in 
a hydrocele ia as a great rarity chylous, and in a ease 
of ohylons hydrocele which came from abroad tbe 
presence of filaria in the lymphatics was suspected by 
experts. 

All hydroceles are not translucent. Those which 
have existed for a great many years, and have, perhaps, 
been tapped many times, and have become cbronic^v 
inflamed, are notably not transparent Tbe sac in such 
oases, from repeated inflammatory attacks, may attain 
to a great thickness. Such a swelling will be 
non-tnmsluoent, and tbe diagnosis may ^ puzzling 
enough, nnless a clear history, of long duration and 
frequent tappiags be obtained. ‘'Histories" are very 
deceptive, and sometimes these oases can only be cleared 
up by exploratory incision. The only way of certainly 
diagnosing hydrocele with thick walls is by an explora¬ 
tory incision. It is impossible to distinguish a hydrocele 
wi^ thick walls from an old hiematocele except by 
catting into it. A swelling may be a hydrocele at one 
tapping, a heematocele at the next, tbe trocar having 
pierced a vein, which slowly oozes into the cavity. In 
these opaque swellings, too, tbe position of the testis is 
very problematical. There are frequently ioflammatory 
adhesions, which displace the organ. Hence the incision 
is safer than the trocar, for the latter may pierce the 
testis, and lead to the erroneons oonclnsion that there la 
a solid tnmoar. 

Confasion between ordinary vaginal hydrocele and 
soft sarcoma of the testicle ought, in reality, never to 
occur. Soft sarcomatons growth of the testicle is, on 
the whole, rare; hydrocele is very common. Soft sar- 
oomatons growth of tbe testis is non-translnoent; it is 
heavy when lifted up on the hand. It feels solid in 
some parts, fluctnating in others. The scrotal veins are 
much enlarged, and the cord above is thickened. An 
exploratory incision immediately clears the matter up, 
because iostoad of opening into a cavity containing 
fluid, a vascular brain-like tumour is found. The 
, appearance of the patient must not be taken into 

Diu, OOgIt 




232 Thm Midical Pexbb. ORIGINAL COMMUNICATIONS. 


soooxiiit. Large malignant growths of the teatia may 
be foond in persona wbo have the appearance of perfect 
health. 

Ability to feel the elemente of the cord above the 
arrelling is the main differential symptom on which to 
rely in the diagnosis of common hydrocele from hernia. 
Bat the ahape of the neck of a hernia is different from 
that of a hydrocele. In hydrocele the awelling is defi¬ 
nitely cat off from the abdomen at the external abdo¬ 
minal ring; in hernia there is a wide neck which passes 
np into the abdomen, distending the ingninal canal. 

The treatment of hydrocele is very variable. In a 
large number of instances, thepatiento will be satUfied 
with the swellmg being tapped at ceitain periods. 
This is termed the palliative treatment of hydrocele, 
namely, performing paraoentesia when the awelling gets 
inconvenient from its bulk. This operation should be 
done with an exceedingly fine and sharp trocar and 
cannula. The patients will appreciate the use of a 
fine instrument. The hydrocele trocars sold in the 
shops are often too large for use by a sensible and 
humane surgeon. The akin of the sorctum should be 
carefully cleansed, and the instrument boiled before 
and after using. The sac should be made very tense 
by the pressure of the left hand before the trocar is 
introduced, and a spot should be selected free from 
veins. Ba^cal cure of hydrocele dependent upon dis¬ 
ease of the testicle shonld not atttempted. Under 
such circuinstanoes it would be unwiae to undertake, 
for instance, the injection method ; the diseased testis 
would be left, and, perhaps, the mischief in it aggra¬ 
vated by the irritant fluid. Tapping is often employed 
in hydrocele associated with testicular disease, and 
indeed is sometimes essential in diagnosis. Not until 
the fluid be withdrawn can the surgeon properly feel 
the enlarged testis, and estimate its nature. 

Another case where the injection cure should not be 
attempted is where there is a very thick sac. Iodine 
injected into a hydrocele with very thick walls only 
makes matters worse. Again, radical cure by injection 
should never be attempted where there is communica¬ 
tion between the sac and the abdominal cavity. Such 
hydroceles are found in young infants and boys (con¬ 
genital hydrocele). Many hydroceles in the very young, 
however, are quite ordinary, and do not communicate 
with the belly. 

One of the objections to radical cure by injection of 
iodine is its uncertainty. It has been computed by 
some authorities that 20 or 25 per cent, of the oases of 
hydrocele treated by injection are not cured. Another 
objection to injection, especially with iodine, it that the 
epididymis is generally inflamed by it, and so for weeks 
after the injection there it a painful, indolent swelling 
of the testu and epididymis, set np by the injection. 
The injection is very painful when the iodine enters the 
tunica vaginalis. Patients have not infrequently been 
known to faint. Injection of iodine is a remedy which 
is practised largely, especially in hot countries like 
India, where hydroceles are very common and very 
large. 

It is importmit to draw off all the hydrocele fluid: a 
very common error is to leave several drachms of hydro¬ 
cele fluid in the sac, and thus when the tincture of iodine 
is thrown in it probably gets diluted. Many of the in¬ 
stances of recurrence” ^ter injection may be explained 
by some faulty procedure on the part of the operator. 
One to two drachms of the Edinburgh tincture of iodine, 
which is rather stronger than the usual preparation, is 
injected into the cavity of the sac. The next step is to 
shake the sac well, so that the iodine is diffused all over 
it. This may be acutely painfifl, and it is wiser to per¬ 
form the operation with the pat'ent lying down on a 
sofa. Some surgeons make a practice of previously 
throwing into the sac of the tunica vaginalis a 2 per 
cent, eolation of cocaine. Not more than a quarter of 
a grain shonld be introduced, but it certainly diminishes 
the smarting caused by the iodine. The day following 
the injection the scrotum will be swollen and red, and 
the epididymis inflamed and tender. The patient will 
sometimes complain of very great discomfort, so that 
he has to be kept in bed for a few days, though this is 


Sift. 4, IfO l. 

ususnal. As a rule, there is more or less epididymitis, 
and a chronic indolent swelling results, which only 
slowly subsides. 

An injection which, perhaps, is becoming more 
popular than iodine is carbolic acid. This is at leasb 
as likely to cure as iodine, and it is very much 

ainful. Having emptied the hydrocele, 40iri to e 

rachm of a mixture of equal parts of liquefied carbolic 
acid and glycerine are thrown into the sac The 
scrotum is shaken after injection, so that the whole sac 
comes into contact wiiih the remedy, and a ouro is 
generally the result Carbolic acid does not infli^n^ 
the epididymis to the extent that iodine does, neither 
does it cause such severe pain. There are various other 
fluids recommended for injection into hydroceles. All 
of them, however, are inferior to iodine and carbolic 
acid. 

The method of treatment which most modem sur¬ 
geons perhaps advise for hydrocele is the radi^ cure 
by operation. It is an exceUent proceeding in boys or 
young men who have to enter the services of the army 
and navy. If the radical cure by excision of the sac is 
performed, it necessitates resting in bed or on the sofa 
for upwards of a fortnight or three weeks. The opera¬ 
tion 13 done in various ways. The first is the simple 
incision method. The hydrocele is incised, and the 
interior of the sac is lightly rubbed over with carbolic 
acid with a strength of one in ten; a drainage tube is 
then put in, and the incision sewn np. This is a good 
method for small hydroceles in boys. Then there is the 
method of excision of the sao. The sac of the hydro¬ 
cele is exposed, and a considerable portion of the 
parietal layer of the tunica vaginalis is cut away with 
sbarp-pointed scissors. The remaining portion, which 
covers the front of the testis, is lightly touched over with 
one in ten carbolic acid, or with a solution of nitrate 
of silver, twenty grains to the onnoe, a drainage- 
tube is put in and the parte sewn together. The tube 
is withdrawn in twenty-four hours, and the part- 
carefully dressed and elevated. A certain amount of 
inflammatory epididymitis will ensue. Especial care 
must be taken in replacing the organ in the sorotum 
that the cord is not twisted. This is easy enough to do, 
and it may lead to very unpleasant after-consequences. 
In both these prooedures the strictest asepsis mast be 
maintained in the dressing, and elevation of the part- 
must be carried out carefully. It is necessary to guard 
against secondary haemorrhage. In a big hydrocele the 
little vessels are very much stretched by preesnie' 
of the fluid, and are diminished in calibre. As soon aa 
the fluid is let out the vessels become engorged. Some¬ 
times a little artery or vein will bleed very persistently 
into the loose scrotal tissues in these oases. Every* 
single bleeding-point must be tied before uniting the 
wound and sending the patient back to bed, using liga¬ 
tures of the finest catgut. If this is not done there 
may be troublesome secondary haemorrhage into the 
scrotum, which becomes “blown up,” and blnish in. 
colour. 

Male infants sometimes get hydroceles like their 
seniors, and the greatest alarm is manifested by the 
anxious female relatives. The symptoms of hydrocele 
in a baby are exactly the same as those in the adult. 
A little pear-shaped swelling is observed, which ia 
readily translucent, light showing through it as a red 
glare. One of the first things to determine is whether 
the swelling is a congenital hydrooele, and if the fluid 
can be reduced into the abdominal cavity. If iodine or 
carbolic acid be injected into the hydrocele of a little 
child, the scrotum will inflame and may possibly slough, 
and the life of the infant may be endangered. This ia 
not a fanciful danger. The mistake has bmn made in 
practice. The ordinary hydrocele of infants will nob 
infrequently go away if it is left alone, but this wilk 
seldom satisfy the parents; they demand some active 
treatment. The first measure therefore to adopt is to- 
paint the outside of the scrotum persistently with a- 
slightly irritating lotion, such as chloride of ammo¬ 
nium—a saturated solution of the drug in reotifled 
spirit and water This remedy really cores very few 
of these oases, but it is harmless. 

e 


o 



8kft. 4, 1901. 


ORIGINAL COMMUNICATIONS. 


Tbi Msdical Pbi88. 233 


The next method is aoapnnotnre. The scrotum is 
made tense, and a floe sharp needle is wsed into the 
hydrocele in various situations ; the nuid exudes in 
drops, and passes into the cellular tissue. This method 
is advocated in the text^books, but it is not a certain 
cure. In the case of a large hydrocele in an infant, 
especially if it has resisted other treatment, incision is 
the beet method. Let out the fluid and rub the interior 
of the sac wi^ a solution of nitrate of silver, ten grains 
to the ounce, or one in ten carbolic acid, ^is may be 
done by dipping the end of a probe into the “ irritant," 
and passing it lightly over the surface of the 
tunica vaginalis. A small piece of gauze is inserted 
for the first twenty-four hours. If the sac is very large 
a portion of the parietal layer can be excised just as in 
the adult. The most careful asepsis must be maintained. 
This is practically vary difficult \ soaking in a warm boric 
bath is useful in these eases. There is another point 
about hydroceles in infants ; it is as followsIn certain 
hydroceles in little babies the sac goes a long way up 
into the inguinal canal, distending it, and simulating 
hernia. This is due to failure of obliteration of the 
lower pirt of the funicular process. This variety is 
called infantile hydrocele. A mere septum may separate 
the fluid from the abdomiosl cavity, and careful exami¬ 
nation is needful to ascertain that the rapture is not 
really of the congenital variety, and that the fluid can¬ 
not be pressed slowly into the Iwlly. 

Encyst^ hydroceles of the epididymis are said to 
have their origin in dilatation of »ome of the fcetal 
tubules which are found in that neighbourhood. The 
(^sts do not, as a rule, attain to lai^e dimenmous—about 
the sise of a hasel nut or a walnut. They are tightly 
distended with fluid, and are sometimes mistaken for 
solid swellings; (indeed, the sensation to the hand is 
exactly like a double testicle. Whenever there is what 
seems to be a double testicle on one side, the oase will 
probably turn out to be an encysted hydrocele. These 
remarkable swe^gs contain perfectly clear fluid, which 
is non-albnminous, and also a large amount of phoephatee 
and carbonates. On the addition of nitric acid, effer¬ 
vescence occurs. But inasmuch as a seminal tubule 
frequently raptures into them, they beoime full of sper¬ 
matozoa, which may give them a milky appearance end 
spoil th»ir trsnslucenoy. Then the flni^ of course, 
becomes albuminous. The walls of these cysts may also 
be thickened, and this prevents translnoency, and an 
exploratory incision may be needful to establish a 
certain diagnosis. They are treated in the same way as 
other hydroceles, namely, by iu jection, or radical cute by 
laying them open. 0 wing to their close connection with 
the epididym's, the cutting away of a portion of the sac 
is far the best method to ^opt. 

With regard to the treatment of congenital hydrocele, 
which is found in boys and young children, where the 
fluid be reduced into the abdominal cavity it would 
be risky to inject these swellings, for the fluid might 
find its way into the peritoneal cavity and set up grave 
inflammation. It is difficult to advise regarding the 
faoatment of congenital hydrocele. Great difference of 
opinion exists. Many surgeons recommend a truss, and 
state that the pressure of the pad obliterates the open¬ 
ing. This is always a dubious aud tedious method. It 
is far better to perform an operation like that for radical 
core of hernia, the incision being longer and lower 
down, tying the neck of the sac high np, and sewing 
together the pillars of the ring, and at the same time 
excise the front wall of the sac. 

Hydrocele with enlaced testiv, so-called hydrosarco- 
cele, is often a puzzling condition. Hydrosarcocele is 
differentiated at onoe from hydrocele by the fact that 
when the swelling is lifted up it is extremely heavy, 
and on palpation the fingers will displace fluid, and 
come down with a sndden impact upon the solid mass 
i pfide Hydrosarcocele may be non-translnoent. exc^t 
to a very limited degree in front. In tbe great majority 
ot oases these saroocelev are syphilitic, and are often 
bilateraL And the hydroceles may take irregular 
form, being, indeed, mere collections of fluid limited by 
adhesions and false membrane. Hydrocele associated 
with tuberculous disease of the testis may be foud. 
The hydrous effusion is very often acute, and if a 


young man has hydrocele which is painful and has 
form^ within a month or six weeks it is almost always 
sure to be due to some disease of the testicle. Such 
hydroceles should be tapped and the testicle carefully 
palpated before giving a complete opinion or prognosis. 
In certain exceptional cases there may be large collec¬ 
tions of fluid Burrounding malignant disease of tbe 
testicle, and the fluid may be bloody. Incision will clear 
the diagnosis np. Again, old mea who use tbe catheter 
often get chronic epididymitiv and orchitis, and this 
condition may be associ^tM with hydrocele. 

In the treatment of hydrosarooceles there is no objec¬ 
tion to tapping provided care be taken cot to wound tbe 
enlarged t^tis inside, and the patient will be consi¬ 
derably relieved. After drawing off t he fluid with a flue 
trocar, if tbe case is syphilitic, tb-) part should be 
strapi^ with blue ointment, and iodide of potassium 
given ictemally. In hydrosarcocele, when tbe testis is 
tuberculous, io removing the disease which causes it, 
the whole condition is cured. In saroonut of the testis 
there is a progressively increasing swelling, which has 
probably dated from six to twelve months before, and 
it will be non-transluoent. The story of a blow or 
" squeeze ” is common enough. In addition, the veins 
over the scrotum are markedly enlarged, and there are 
frequently nodules of growth iu the cord, and to the 
hand the swelling is very lieavy. As soon as incision is 
made into it the nature of tbe growth is determined. 


A STUDY IN HEREDITY: 

IN ITS RELATION TO IMMUNITY IN 
TUBERCULOSIS. 

By HERBERT MAXON KING, M.D., 

Delegate for the United Stetea OoTemioent to the British Congreae 
on Tuberculosis, iSOl. 

The material for t his study waa taken chiefly from 
private practice, with tbe addition of a few cases 
occurring in the author’s hospital service, whose 
opportunities for close observation at the time and 
personal knowledge of tbe subsequent histories of 
the several cases after leaving the wards were sufficient 
for the purposes desired. Some apology it would 
seem necessary to offer for presenting before such a 
body as this honourable congress deductions and 
conclusions based upon researches in so limited a 
number of cases as this present study includes, more 
especially since certain of the conclusions are at 
variance vrith traditional axioms in phthisiology. 
However, in the present inquiry all facte were col¬ 
lected and recorded person^ly and without preju¬ 
dice, BO that, however unique may be the conclusions 
to which a study of my cases has led, they are 
warrantable at least so fur as the limit in number of 
observations will permit. Tbe material at my 
disposal consists ot carefully recorded histories of 
242 cases of pulmonary tuberculosis. In every in¬ 
stance 1 have endeavoured, besides studying tbe 
influence of heredity and environment, to ascribe, 
whenever possible, a cause for such peculiar mani¬ 
festations of the disease as became apparent, and 
also to establish the relation which certainly exists 
between tbe selective activity of the disease and 
hereditary influence. 

The theory that a phthisical parentage predisposes 
tbe offspring to tbe disease by virtue of heredity, 
while very firmly grounded in the medical mind, and 
still more so, of course, in that of tbe laity, has never¬ 
theless, I believe, always been a subject of more or 
less controversy, and especially since the isolation 
of tbe specific micro-organism. Without, however, 
entering upon a riaunU of this controversy, which 
the limits of tbe present occasion and inclination 
alike prescribe, I have, like most phtbisio-thera- 
peutists, always been disposed to discredit the 
theory and, until within the last four or five years, 
to place a negative value upon "family history" 

C 




SiPT. 4. 1901. 


234 Thi Midical Pbibb. ORIGINAL COMMUNICATIONS. 


except in so far as a tubercnlons parentaf^e subjected 
an indiTidnal to additional risks of infection. Tbe 
following instance, which came to my notice seTeral 
years ago, first suggested to me that there might be 
a certain degree of immunity conferred to the off¬ 
spring of phthisical parents. I published this in¬ 
stance as an illustration in 1898, in a paper in which 
I first Tentnred the opinion that " phtnisical parents 
might impart to their progeny a certain immunity to 
the disease.” (a) As it is brief and to the point I 
quote it:—“A clergyman and his wife, the latter 
having borne two children after developing pulmo¬ 
nary tuberculosis, took into their household by 
adoption the orphan child of a non-tuberculous 
family. After surviving tbe birth of her last child 
six yeain tbe wife died. Both of her children are 
living and in excellent health to-day, the younger 
having passed her twentieth year. The adopted 
child came under my observation at tbe age of seven¬ 
teen ^ears, having developed acute pulmonary tuber¬ 
culosis from which she died.” 

To adopt as a working theory this idea of con¬ 
ferred immunity in tuberculosis against all traditions 
requires, I admit, considerable temerity. One is 
constantly confronted with the question of inherited 
predisposition and cannot fail to be influenced by the 
demonstrable fact of ‘‘ percentage heredity,” a term 
employed by Dr. J. Edward Squire, to express in 
percentage the difference between the number of the 
offspring of consumptive parents subsequently de¬ 
veloping tuberculosis and that of tbe offspring of 
non-consumptive parents subsequently developing 
the disease. Dr. Squire’s paper was published in 
November, 1897 (&), and was a most valuable contri¬ 
bution to tbe subject of hereditary influence in 
phthisis. Tn it he refers to a former paper, by him¬ 
self, i-ead before the Royal Medical and Cbirui^cal 
Society of London in December, 1894, on “ The In¬ 
fluence of Heredity in Phthisis.” Both papers were 
based upon results of thorough investigations in 
sufiBcient numbers of instances to warrant the adop¬ 
tion of bis conclusions as atandarde in future inquiry 
along this line. I have no hesitation in accepting 
them as final so far as they are carried. 

This “percentage heredity’■ Dr. Squire found to 
be only 9-51, and he points out that it is easy to 
explain this small percental of influence due to 
paients by the additional risks of infection to which 
the children of phthisical parents are exposed. Now, 
it has seemed to me almost certmn, that if these 
children of consumptive parents, especially that 
usually weak and unaer-nourisbed class from which 
Dr. Squire made bis observations, were not in some 
manner protected, this percentage would be much 
larger, since in such cases we may take it for granted 
that all of them fulfil every required condition for 
the development of the disease. Therefore, while 
admitting the fact of a“percent^e heredity,” the 
very figures which express it are such as to support 
the theory of an hereditarily conferred immunity. 

It is, I think, the rule to find among the children 
of consumptive parents p<wr nutrition, imperfect 
digestion, and other functional derangements, to¬ 
gether with certain almost characteristic marks of 
degeneracy in the bony skeleton, the long, shallow, 
and comparatively immobile chest, prominent 
scapulee and sunken sternum. Yet with such 
features, more or less marked in a family of several 
children of consumptive parentage, it is a matter of 
common experience to see them all reach maturity 
without succumbing to an affection which, from the 
very nature of things, it would seem inevitable that 
they could not escape ; while, on tbe other band, the 


(a) N*\e Ynrh Mrdical ifern, D«o«Biber 3rd, 1898. 

(b) “Heredity in Phthiais," AtMnean Jvurnal nf MetUetU 
Scieneti, November, 1897. 


more acute, unresisting, and progressively fatal cases, 
I think, it is the common experience to find among 
those of a much more normal physical habit and 
where the source of infection is frequently most diffi¬ 
cult to locate. ObseiTations of this character, how¬ 
ever, prove nothing, of course. It is from the 
analysis of a ^ven number of cases occurring under 
somewhat similar conditions, and among individuals 
of like hygpenic and social relations, that statistics, 
to be of any value, must be drawn. Even so obtained 
statistical figures are very apt to be misleading, and 
are no doubt open to much just criticism on that 
score. I would not attempt to prove a theory by 
conclusions baaed upon an experience in 242 cases 
unless the results were very positive, but I would very 
much like to provoke discussion of a subject which 
cannot be devoid of interest in such a society as this 
Cong^ss represents, and to stimulate further in¬ 
quiry into a matter of such far-reaching importance. 
li I shall have accomplished this object I shall rest 
content with tbe assurance that the theory will take 
care of itself. 

To proceed, then ; the cases which I have utilised 
in this series have occurred in a community for the 
most part moderately well-to-do. Small tr^esmen, 
mechanics, artisans, operatives in wholesome, well- 
lighted, clean and well-ventilated furniture factories, 
and small farmers. Nationality has been various. 
Next to American bom, Dutch, German, Scandi¬ 
navian and Irish predominated. Because of tbe 
comparatively recent development of the section of 
the country in which my observations have been 
made, and tbe more or less migratory habits of the 
first generation or so of foreigners in America, it 
has b^n the exception rather than tbe rule to be 
able to secure accurate data beyond tbe immediate 
parentage; but while it would be desirable to secure 
such data for purposes of demonstrating the transi¬ 
tory character of inherited immunity in tuberculosis, 
ifsuch exists, for present requirements it is, I think, 
needless to do so. 

The individuals comprising my series, by reason 
of their comparatively well-to-do condition and the 
customs prevailing in the locality, have none of them 
experienced the vicissitudes incident to life in the 
cheap tenement house districts of large cities. As 
a rule this class lives in small, compact but well- 
lighted and comparatively new frame houses, sepa¬ 
rated from each other by lawn spaces, and heated 
by stoves, or occasionally hot-air furnaces. In the 
course of inquiry, when phthisis was found in either 
or both parents, it was the rule, with very few ex¬ 
ceptions, to find it to have been present during the 
early life of tbe case under observation, and to have 
been the cause of death. Frequently it could be 
traced back prior to the birth of my patient, and to 
have persisted with remissions in activity for a con¬ 
siderable time afterward; more particularly was this 
the case among women, where in several instances 
I have satisfied myself of its presence during most of 
the child-bearing period. Without exception these 
instances occurred among women of consumptive 
parentage. Of course, positive demonstration of the 
long existence of the disease in these cases was 
obviously impossible beyond the time of my own 
acquaintance with the case, and as scientific evidence, 
therefore, such citations are valueless. 

Of my 242 cases, the parents, one or both, had 
phthisis in sixty instances, or 24'8 per cent., while 
the parents were non-phtbisical in 182 instances, or 
75'2 per cent. Of the sixty who had phthisical 
parents, tbe father was found to have been affected 
in thirty-one cases, or 1*28 per cent., tbe mother in 
twenty-nine cases, or 12 per cent., and both parents 
to have been phthisical in four instances, or 1*6 per 
cent. 




StPT. 4. 1901. 


OKTGINAlj COMMUNICATIONS. Tm Midical Paiss. 235 


It was more common in mj experience to find a 
prerions inbercnloeis in a brother or sister or both 
than in the parents, and in each cases an almost per¬ 
fect history of infection could be traced. It was 
often possible to designate the date of infection to 
within a few weeks, and in some instances to within 
even narrower limits, a point of some value in esti¬ 
mating the period of incnbation, or studying that 
qaestionable quantity, the “ period of latency.’ 

^venty-four of my oases, or 30‘6 per cent., gave a 
history of previous tuberculosis in a brother, sister, 
or both, and it is a point of some interest that of 
these seventy-four only twenty-two were of phthisical 
parentage; furthermore, as will be recalled, there 
were sixty cases in which one or both parents were 
phthisical, and of these twenty-eight had brothers or 
sisters who were non-pbthisical; or. to put it a little 
differently, out of sixty families with phthisis in one 
or both parents, there were twenty-eight instances of 
the disease affecting only one of several children. 
This does not, of course, imply that in the remaining 
thirty-two there was necessarily more than one 
child affected, for in many instances the patient 
was an only child. 

It will further be seen that while twenty-two indi¬ 
viduals having a phthisical parentage gave a history 
of previous tuberculosis in one or more brothers or 
sisters, there were fifty-two cases of non-pbthisical 
parentege giving such a history. 

These figures would certainly fail to show an 
hereditarily conferred predisposition to the disease, 
and if they have any value at all, it is on the side of 
a conferred immunity instead. Of the whole number, 
—242 cases—I can, at present, account for 235 ; of 
these 132 are living, and 103 have terminated fatally. 
Although it has a negative bearing upon the present 
inquiry, it may be of interest to note that in each 
group the percentage of phthisical parentage is the 
same. That is, of the 132 living, 26 per cent, had 
phthisical parents ; and of the 103 de^, thei'e was 
alaft 26 per cent, whose parents, one or both, bad 
died of the disease. 

The most interesting development in the course of 
this investigation has resnlted from a study of the 
103 fatal cases. As above suggested, 26 per ^nt., 
or twenty-seven cases, were found to be of phthisical 
parentage, while seventy-six had non-phtbisical 
parents. My histories show that the averaye dura¬ 
tion of the disease from its apparent incipiency to the 
fatal termination was, in the incidence of the tweuty- 
seven cases of tuberctilous parentage, 4 01 years, 
while in that the seventy-six cases of non-tuber- 
culous parentage it was 2'93 years, a difference of 
more than a year in favour of those having a 
phthisical parentage. 

Now it has been my experience that the develop¬ 
ment of phthisis in individusls living or having liv^ 
for any length of time with consumptive parents is 
more subtle and indeterminate as to commencement 
than is the case in the more robust offspting of non- 
consumptive families, where the onset of the disease 
is far more apt to be comparatively sudden, and 
consequently more easily determinable as to date of 
commencement. In this latter class the so-called 
“ pre-tnbercnlons stage” has no existence as a rule, 
and the measurement of the duration of the disease 
is accordingly much simplified. This “pre-tuber- 
culous stage ” is, in reality, I am sure all will admit, 
a part of the life history of the disease and should be 
included with aU subsequent stages of phthisis when 
estimating the duration of the disease in a given 
COM; bnt because I desired to free my inquiy as far 
as possible from misleading results or error in judg¬ 
ment as to what was and what was not the early 
stage of tuberculosis, I have, in this series of obser¬ 
vations, limited the definition of phthisis to a sta^ 
of the disease where it has been clearly demonstrable. 


I have, therefore, a considerable leeway over and 
above the one year in favour of my cases with con¬ 
sumptive heredity, and had I included the ” pre- 
tuberculons ” stage in my estimatesi am very certmn 
that the difference in duration of the disease between 
the two classes would have been more marked than it 
is. 1 have, like many other observers, frequently 
demonstrated the presence of tubercle bacilli in the 
secretions of the air passages of healthy children 
and adults occupying apartments with consumptives, 
particularly consumptive parents, when subsequent 
events failM to show a development of tuberculosis 
from their presence. As an illustration: in a family 
consisting of a widow and four adult children, one 
of whom, a daughter, has been a consumptive for 
seven years (easify demonstrable during the whole of 
that time), the father had died after having had 
phthisis for upwards of twenty years. The con¬ 
sumptive daughter above referred to continued the 
local focus of infection after the death of the father, 
although to a less dangerous degree because of sani¬ 
tary ^ucation. A few years ago one of the sons 
contracted typhoid fever, during the course of which 
the usual bronchitis developed. In the expectorated 
matter many tubercle bacilli were found during the 
coarse of the complication. Doubting the diagnosis 
of typhoid, I verified it by a positive Widal test and 
the diazo reaction in the unne. There was no pul¬ 
monary consolidation, and the case ran a typical 
course with good recovery and, to my surprise, has 
never shown the least evidence of tuberculosis since, 
although daring several subsequent winter attacks of 
bronchial catarrh a search has been made for bacilli. 
I might add that in this family every one of the four 
children is apparently a olassi^ subject for phthisis, 
with the long, shallow, and immobile chest, and the 
imperfect nutrition above remarked; yet, though 
having lived almost their entire lives in the house 
with a consumptive, only one has developed the 
disease, and that one presenting every evidence of 
being able to snccessf ally resist a fatal termination 
for many years to come. 

Vital statistics show a gradual declining death- 
rate from phthisis. This is doubtless in part the 
lesult of improved methods in restricting the spread 
of the disease, but, in view of many facta, is no doubt 
also due in part to one or both of two not unim¬ 
portant factors— t.e., natural selection and inherited 
immunity. If the conclusions reached by Otto 
Naegeli, based upon 500 autopsies made in the 
Pathological Institute of Zurich, on bodies of indi¬ 
viduals dying of various diseases, shall be verified in 
other parts of the world, the question of inherited 
immunity must be acknowledged to play a very essen¬ 
tial part in the decline in frequency and severity of 
phthisis. Naeeeli found indubitable evidence of 
active or latent tuberculous lesions in 97 per cent, of 
all sections In individuals between eighteen and thirty 
years of age, and in 99 per cent, of those over thirty 
years of age. (a) 

If it is true that all individuals I'eachmg thirty 
years of age develop tuberculous lesions which are 
demonstrable post-mortem, the only explanation for 
the comparatively small percentage who die from 
phthisis ues in that of an inherited or acquired im¬ 
munity. 

Within the memory of men still living there was no 
phthisis among the Indian tribes roaming the high 
plateaux of Colorado, Arizona, and New Mexico. 
But a very few years after it became popular to send 
white consumptives to those regions as a therapeutic 
measure; the infection thus spread among the 
Indians ga^e rise to an almost epidemic form of 
phthisis of an unusually acute and fatal type. The 
same is true of the negroes of certain sections of tbe 


(a) Virckow'a Arcbivei,” 1900. 



236 Thc MsDtCAi. Psiae. 


ORIGINAL COMMUNIOATIONC5. 


?BPT. 4, 1901. 


Southern States, whose heredity was entirely clean 
so far as tuberculosis is concerned, yet who sue* 
cumbed in prodigious numbers as soon as the infec¬ 
tion was brought them by the consumptive whites 
from the north, who, by reason of their greater 
immunity, often recovered by virtue of a climatic 
influence which, like that of Mentone, was insuffi¬ 
cient to protect the unimmunised native 

The older writers, in speaking of the influence of 
family history in phthisis, often remarked upon the 
frequency with which the disease affecting the 
grandparents would skip one generation to reappear 
in the grandchildren. If there is truth in such a 
statement, it would seem plausible to attribute the 
phenomenon to an inherited immunity sufficient to 
protect the children, but not sufficiently permanent 
to protect the second generation. In my own 
experience I have not attempted records with this 
idea in view, and therefore have no facts to bear 
it out. 

I must acknowledge one rather serious omission in 
the course of my investigations in the present series 
of cases. It was to a certain extent unavoidable, 
but in future inquiry along this line it seems to me 
most important that it be not again omitted if we 
are to arrive at any positive conclusions by such 
methods as I have employed. It lies in my failure 
to determine whether or not, when there was a con¬ 
sumptive parentage, the parent affected was tuber¬ 
culous prior to the birth of the patient under con* 
sideration; for if such were not the case, and the 
patient became tuberculous only after the child was 
bom, obviously any immunity to the disease which 
the child afterwards developed would be simply an 
acquired one; and if the child afterwards l^ame 
phthisical, the disease in the parent would have no 
more bearing upon the case than had it occurred in 
a brother or sister. In such a case it would be quite 
proper to include it in the class of non-pbthisical 
parentage, for the purposes of present study. 

Briefly then, to summarise the results of observa¬ 
tions in my series of cases, it will be remarked 
that:— 

(a) Of 242 consecutive cases of phthisis, one in 
every four gave a history of phthisis in the parents. 

(b) Nearly one in three gave a history of previous 
phthisis in a brother, sister, or both. 

(c) More than two-thirds of those giving a history 
of previous phthisis in brother, sister, or both, had 
non-phthisical parents. 

(d) As a rule, in the incidence of individuals of 
phthisical parentage afterwards developing phthisis, 
a much longer period was found to exist between the 
supposed exposure to infection and the subsequent 
appearance of the disease, than was the case in the 
incidence of those giving a non-phthisical heredity. 

(e) Of 103 fatal cases of phthisis, the average 
length of life after development of the disease of 
those giving a history of phthisis in the parents, was 
to that of individuals of non-phthisic^ parentage 
approximately as 4: 3. 

So that, from a study of the foregoing series of 
cases, the following conclusions naturally follow:— 

Fii-st, the percentage of consumptives having a 
tuberculous parentage is actually smaller than that 
having a non-tuberculous parentage, and much 
smaller than would be more than accounted for by 
the additional risk of infection to which the former 
class is subjected ; and 

Second, tuberculosis in the parents renders to no 
inconsiderable extent an immunity to the disease in 
the offspring, an immunity which, of course, is but 
relative, and not sufficiently protective, but still 
demonstrable, ss is shown by increased resistance to 
the progress of the disease and increased tendency 
to recover among this class. 


EPILEPSY AND ITS PHENOMENA. 

By GEORGE M. FOT, M.D , F.B.C.S., 

Sai^eon io the Whitworth HoRpitah 

Thb group of symptoms that the early Greelc 
physicians named epilepsy remain after a'l the past, 
centuries unexplained. .And the disease remains 
an opprobrium to medicine and a mine of wealth to 
quacks. 

From the great progress made in the study of 
cerebral pathology it might naturally be expected 
that more light would be thrown on this obscure 
disease, but so far we know little more than wbat we 
did when Moore’s edition of Van Der Kolk's mono¬ 
graph was published in 1859. The study of the 
{etiology of the disease in Great Britain seems to 
have been neglected since Dr. Duckworth published 
bis work on the efficacy of bromide of pot^sium in 
epilepsy and certain psychical affections in 1865. 

Recently, on the Continent, there appears to be a. 
revival of interest in the disease and ite phenomena. 
To place a summary of some of the more interesting 
accounts that have been published is the object of 
this paper. M. Bourneville, at the recent meeting of 
alienists and neurologists of France, told of five 
cases of epilepsy which came under bis notice in 
which the attack was fol'owed by a rash which re¬ 
sembled purpura in some part;) and in other parts 
took the form of rows of flea bites. 

The face and neck were attacked in all of them» 
and in one case the eruption spread all over the |x)dy. 

Except for the epilepsy, all the patients enjoyed 
good health and were not at all ansmic. He drew 
attention to the similarity of these rashes, which 
remained but a few hours, to the stigmata, which are 
permanent, of the hysterical. 

M. Crocq told of a patient sixty-five years old, 
who, after each epileptic attack, suffered from a. 
pui'purio rash on the face and from bsematuria. 
He placed the patient on moderate doses of 
tincture of the percbloride of iron—the h{Bma- 
turia ceased, and never afterwards had be the pur¬ 
puric rash. M. Doutrebento drew attention to the 
association of epilepsy and haemophilia—a patient 
of his died from bleeding due to the extraction of a 
tooth. M. Bourneville mentioned that none of his 
five cases suffered from haemophilia. 

In this connection the experiments of MM. Dide 
amd Sacquepin are interesting. They drew off some 
of the cerebro-spinal fluid of epileptics immediately 
after an attack and injected it into guinea-pigs. The 
first effect of the injection waste cause the animals 
to fall forward, to become stupefied, and to have 
convulsive movements. After the attacks the cerebro¬ 
spinal fluid when injected in doses of from four to 
one hundred cubic centimetres produced violent 
general convulsions. A dose of half a cubic centi¬ 
metre injected produced death, the fatal result oc¬ 
curring from a few minutes to balf-an-hour after 
the injection. In every case death was preceded by 
epileptiform and tetanoid convulsions. 

PR^PHTHISIS AND PHTHISIS IN 
RELATION TO CONSTITUTION. 

By WILLIAM H. PBABSE, M.D.Ed., 

Senior Fbysiclui, Flymoath Public DStpenury. 

In February last I was favoured with space in Th* 
Mbdical Pbbbb and Cibcolab for a paper on the 
“ Corelations of Phthisis.” Since then I have gone 
through my case-book for the last two-and-ai-half years, 
and have cast iuto the following Table an abstract of all 
the oases of prsphthisis and phthisis which hare 
presented. , , . . 

In my February paper I viewed the varied deviations 
of function and struoture of praephthisis and phthisis 



Sktt. 4, 1901. 


ORIGINAli COMMUNFCATIONS. 


Thb Ubdical Pbbss. 237 


ia tbeir rel«taoD to heredity, and to the epi* meso* and 
bjpo-blast. I also indicate the principle of Atavism, 
is relation to fonction and stmctnra; bat, farther, 
I especislljr pointed to the gp«at principle of Altema- 
i.e., thst deviations of fonction in one generation 
had biolc^eal and essential continuity with deviations 
of itractore in other mnerations and vice vtr$a, and, yet 
more, that such fnn^mental deviations or conditions, 
in other individoaU and gmierations, were expressed or 
shown by weak moleoolar bonds of the bioplasm of 
one—nsoally one—or both long apices, and that thus 
the long apex partially dying too early in the life of 
the individual, gave a nidus for the stronger molecular 
sttrsctions of the unicelled bacillus. The greater basis 
of phthisis was thns seen to be in the constitution. My 
esses carried the mind far more toward the great Itws 
of the biological evolntion than toward bacilli as mea- 
soring the fuller Form of pbtbisis. (a) 

Haring in February last pretty folly enlarged on 
BDch facts and hypotbeees, I shall not go over the same 
pound now, but simply record in the Table the results 
d two-and«a'half years’ observation; following tbe 
Ikble I shall add a few illustrative cases, and the 
" illumirsting Ideas ” (Coleridge) which flow from them. 

The Table shows in tbe two groups of prsphtbisis and 
phthisis a great similarity in the deviations, both of 
fonction and structure; a Continuity is seen in the two 
groups; prior tc the final bacillary development in tbe 
oues of phthisis, the two groups are indistinguishable; 
is other words, phthisis has a long pre-stage of deflected 
fusction and structure; we may not be able to state 
this orderly continuity and pre-stage with the precision 
oi a syllogism or a sum, but it is not the less clear if we 
hsre any approach to a justly wide Method of viewing 
the biological evolntion. Tbe Table also shows that the 
continaity of prEephthisis and phthisis has its roots far 
bich into heredity. 

—Tbe most striking condition of the early 
stage of phthisis and preepb^isis is the sensation of 
wetness. A great number of patients, both preephthisi- 
cal and in phtbisu, have told me that the first thing 
they found wrong was an extreme sensation of weak¬ 
ness; in many such prsphthisical cases there was 
DO wasting, bnt the feeing was present in fine 
yonng men and women, and existent often for a 
year or two p^ior to any other sign or symptom 
of disease. It is but to deceive ourselves with 
“ words,” (b) to rest for explanation of this phenomenon 
in such expressions as *' exbanstion of the nervous 
system,” or in “ muscular weakness ”; the conditions of 
rach “ weakness ” are general, in defective molecnlar 
modes, and deficient potential vital *' energy ” of bio¬ 
plasm, conditions too subtle for any of our present 
powers of analysis. 

T!ie same class of oases will often say that for years 
they have suffered from sensation of " coldness,” espe¬ 
cially from cold feet at night. The explanation must 
be sought in tbe same general deficient “ potential ” 
which is tbe basis of tbe “weakness.'' “Beats” and 
sweating were complained of far less often than was 
" coldness.” 

Prephthisis oorelatee with much disturbance of the 
sexual system, of which amenorrhces is the most fre¬ 
quent phenomenon, sometimes, but rarely, total 
amenorrbcea; on the other hand, menorrhagia some¬ 
times exists. Bnt both these conditions so often exist 
whsre there is no tendency to phthisis, that they mast 
not be looked on as “ canses ” of phthisis. At the same 
time, observation of Nstnre shows that in those who 
will erentoally pass into phthisis, there is a deficient 
or disturbed corelation of the great fundamental 
oezual origins; even barrenness has been seen to have 
corelation with, and to be atavic to, those conditions of 
bioplasm which have passed into phthisis. 

(a) The word Form is preferable to the word Ltic; Bacon, fol- 
loWins Plato, makes the word Form to imply mil the contain^ 
proeesset of Matter and Flaergy, goiag alon^ with the inspiring 
IdaM which should arise from a riew of facte, “ That forms we^e 
^tme objects of knowledge.” Coleridra beantlfnlly exponnde 
the aune philosophy in his treatise on “ Method.” 

(t) Bicon eaye, “. . . yet certain it is, that words, as a 
Tirtar bow, do shoot beck upon the understanding of the wisest, 
andaightily entangle and perrert the jndgmeat.’’ 


When a refined, spiritnally-minded, poetic girl of 
from sixteen to eighteen, and who has a fine type of 
physical formation, is brought for amenorrboea, it is a 
miserable conception of biology and pathology to con¬ 
fine onr mental view t) the sexoal organs. The sexual 
organs are but differentiations of a universal ene^y of 
bioplasm. We have to deal, in such a case, with modes 
or defects of bioplasm of infinite delicacy, defects which 
are in continaity with that failure in energy in the 
attraction of tbe molecular bonds of lung-apex bioplasm 
whiob in a few years may give nidus for the molecular 
attractions of the unioeUed bseiilus. The amenorrboea 
of tbe young girl of the type I have depicted, and her 
fotnre phthisis, are parts of a progress of universal laws 
acting in orderly continaity. 

Contrast tbe above-typed girl with the rapidly deve¬ 
loped, plump, fair, and somewhat lethargia yonng 
country girl of tbe S.W. counties, who has amenorrhcea 
and is a littie chlorotic, but who will balance tbe 
jnst order of evolution in a year or two, and live to bear 
and suckle from fifteen to twenty cbildrnn, and we shall 
see at ones bow deep down in the constitution are the 
paths to phthisis in the former and how absent they are 
in the latter'; tbe complexity—yet so orderly—of the 
involvements are not yet unravelled, but we must justly 
learn by observation and ana’ogy long before we have 
mastered the subtle bio-chemistry and bio physics of the 
different tjpes. It is sufficient here for me to point to 
tbe “ constitution ” of a type of young woman who, now 
in amenorrhcea, will, in absolute isoDtinaity, pass in 
future years into phthisis. 

Trousseau long ago pointed oat tbe sometimes danger 
of giving Iron, and of forcing tbe monthly function, in 
those who tended to phthisis. In the delioate-typed 
class of girls to whom 1 have referred, the absence of 
tbe monthly function seems to be a normal or natural 
and harmonic canditiun, justly oorelating with the whole 
system, and it may be most dangerous to hastily disturb 
the balance of the complex system. In modern theory, 
we may thus aid to create a nidns for the baoillas in 
the Inng apex. The monthly period should be re-estab¬ 
lished by tbe slow and harmonic development of the 
whole system. I make these remarks because chemists 
tell me that they sell Bland's pills by tbe gross to young 
girls—and old—under tbe hope or fancy that the com¬ 
plexion is improved by their use. 

Tbe basis of tbe future pbtbisis may often be seen 
years prior to the bacillary stage in a prevailing poor¬ 
ness of appetite, and especially in a repulsion to fat, 
excepting batter, which bolds an organic acid in its 
constitution, Yonng people who will repel every par¬ 
ticle of fat meat, will eat bnturic-aoid-batter with 
avidity; often, too, each patients will readily eat the 
fat of smoked or salted meat. I have known many who, 
repelling all other fat of meats, would hea'tily eat the 
fat of roast pork. Snob facte point to some “ deep, 
hidden law ” in tbe bio-cbemistry of tbe cell and 
system. 

In a very great series of oases 1 have known tbe 
prsepbthisi^ and phthisical possessed of a passion for 
onions, raw or cooked; hundreds of yonng, delicate 
prsphthisioal natients have told me of their passion 
for onions, and that no food agreed with them so well, 
or seemed to give them so much strength. Is such 
result due to the energy of the allyl molecule ? finch 
facts put us on the path leading to fonndations in 
pathology. 

Similarly, though in a less degree, there is often in 
the prsephthisical a great desire for pickles. I always 
enoonrage such longings, as promoters of appetite, 
purifiers of the primee 'Am, and, it may be, just bal^oers 
of metabolic processes. The Native of India has a 
passion for limejuioe, tamarind and other fruits; by 
them his anasmia, night blindness, proneness to vast 
nlceration of the intestinal mucous membrane and 
skin are prevented and relieved. 

Both with the Native of India and the prsephthisioal 
European, the benefits from such kinds of fo^ are not 
to be explained by any present chemistry; such long¬ 
ings are the abeolute expressions of orderly laws, as 
moch so as when the stone falls, or the needle points to 



238 Thi Hsdical Pbxsb. 


ORIGINAL COMMUNIOATJONS. 


S»PT. 4, 1901. 


the N. The full Form or nature of phthieie ia involved 
in these allyl and other longings. 

Sfruelural. - But the profound nature or Form of 
phthisic is not only seen in the long preceding deviation 
of varied functions, but also in marked deviations of 
sbucture. As 1 have on former oooasions pretty fully 
depicted the structural changes of the prsephthisical and 
phthisical (a), I shall now confine mys^f to a mere 
reference to the facte of the Table, nor shall I repeat an 
attempt to corelste such structural deviations to the 
blastoderm and its layers. 

FoUowiog the order of the Table, in the prsephtiiisioal 
there is often marked deviation in the hands; the hands 
are often unduly large, long, and cold; now and then 
the hands may be unduly small; the clavicles are often 
unduly big; they too, now and t^en are small and fine. 

I have seen young men, otherwise fully grown, in whom 
the entire thorax had almost ceased to develop during 
many years. In other cases, children of sixteen had 
hardly grown since ten or twelve years of age. 

But more frequent than any of the above deviations 
are those of the terminal cartilages of the nose. Unduly 
lai^ terminal cartilages which are non-symmetrical 
on the two sides and non-mesial, and which tend to point 
laterally, semi-truncated ala nati, have a very marked 
corelation to phthisis. These structural variations are 
often atavio and alternate with phthisis. 

L. B., f., eet. 17, came for " weakness.” No physical 
signs in chest. Nose to left; terminal cartilages big and 
nnsymmetrical: nails rounded; eyebrows big. Father 
and brother died of phthisis. 

S. F., f., set. 35, came for ” weakness." No physical 
signs. Nails almond-shaped; index nails most so. 
Terminal cartilages of nose very pointed laterally. 
Her father, mother, and brother died of phthisis; alro 
her mothers sister and brother. 

J. S., f., set. 27, came for "weakness” and cough; 
suffered extreme sensation of coldness; no appetite ; she 
had phthisis of right apex; nose sharp at end and 
pinched; slight median terminal sulcus; one brother 
med of phthisis. 

Skin tystem.—l am carried far away from some recent 
utterances: " Phthisis ... is the work of a microbe, 
the tubercle bacillus discovered by Eoch,” by the great 
stream of prcephthisioal and phthisical cases, of which 
the foregoing remarks and cases are but a tiny part; 
nor less enlarging to our view of phthisis, is the study of 
its corelated skin deviations. Nails cnpp^,transversely 
ridged, exquisitely fine, friable, Ac-, er^ may corelate 
with phthisis, sometimes in the same individual, but 
more often as alternate and atavic phenomena. Heavy 
eyebrows which tend to meet in the centre, coarse and 
abundant hair, ears which stand out at a big angle,con¬ 
ditions of teeth, such as translucent enamel, small 
upper lateral incisors, congenital absence of the upper 
lateral incisors, all these corelate with phthisis. 

I would illustrate these prsconditions, these wide co- 
related formative stages of the soil, in which the bacillus 
can flourish, by a great array of recorded cases, but I 
hope that 1 have said enough to make clear the co- 
relatability and continuity of Function and Structure, 
and yet further, their atavism and alternation, extend¬ 
ing sometimes over many generations. 

Heredity .—Though at the same time a constitutional 
base was admitted, tbe world has lately been authori¬ 
tatively told that " phthisis is not an inherited vice in 
the constitution. . .” This dictum recalls Bacon’s words, 
" It is almost necessary in all controversies and disputa¬ 
tions to imitate the wisdom of the mathematicians in 
setting down in the very beginning the definition of 
onr words and terms.” In this instance we should have 
to define tbe word ” phthisis.” 

If we assert that phthisis “is the work of a microbe, 
the tubercle bacillus discovered by Eoob,” and confine 
onr view to that final st^e only; or if we are enchained 
by nosological definitions, that “phthisis is a disease of 
the lungs,” we may fairly assert that “phthisis is not 
an inherited vice.” But the great stream of preephthisical 
and phthisical cases which passes before me has shown 
that the final lung bacillary invasion is but a very minor 

(<i) Hbdical Prisb asd Circular, Uay, Jone, ; Febraarx, 
1901. 


part of tbe full Form of phthisis; if we woold rise to » 
just conception of phthisis we ma»t use the Method of 
Evolution and Continuity, in genenU, as applied to the 
organic kingdom ; our definition of phthisis then would 
embrace the modes of the ovum and sperm cells, the 
blastoderm and its layers; and yet more, phthisis in* 
volves the differentiations of those layers as eventually 
passing both to function and structure. Why should 
tbe physician and pathologist be limited and confined to 
a verbal nosologii^, or bacillary foundation or measure 
of disease, whilst tbe trend of all other organic and bio¬ 
logical science is toward common forma, general alliances, 
and unity of law and order. Phthisis thus should be 
viewed from its primary roots and origius up through aU 
its transitional stages; and in this Method it will be 
found that Heredity bolds an ever present influence. 

Slow EvoluftOM.—Withinberited tendency, the poten¬ 
tial energy of the lung apices lasts on variously to 
adult age; then expiring, the bacillary bioplasmic 
attractions overpower those of tbe lung. It is a common 
experience that even then some patients will last for 
many years, so nearly perfect are tbe vital bonds and 
eoergy of Inng bioplasm; in other cases tbe long ia 
destroyed in a few months. 

Far^lel phenomena are seen in a family where several 
die of phthisis, and one escapes ; no other explanation 
seems possible, but that that individual who escapes has 
received at birth a higher potentisJ in tbe lung apex 
bioplasm. I think that we should carry into our view of 
disease tbe la^rest general views of biology, in its wide 
corelations and great periods of time, which we, in this 
day, ever apply to paleontology, geology, physics, and 
to all other oraerly and naturally evolving phenomena 
of Nature. To cite one illustrative case. S. E., f., set. 
38, has come to me every year for twelve years past, 
sometimes for “ weakness,” at other times for varied 
neuralgic paic s, at others for “ indigestion ” ; she's not 
wasted. I have never found any physical signs in the 
lungs. The noee has big termioal cartilages, the 
are rather rounded, the right index nail cupped, the 
right middle nail has transverse ridge?. She had a 
child twelve years ago, but has since been barren. Her 
father and two of her brothers died of phthisis. Prom 
a wide biological view, I am compelled to view this 
woman’s deviations of structure, and especially her 
deviations of function, as in absolute and orderly con¬ 
tinuity with the phthisis of her father and brothers 
ebe has been all these years in hovering unstable 
biochemical equilibrium. But bow exquisitely delicate 
in difference must be the modes and bonds of her lung 
bioplaam, which save her from those losses of energy, 
which led tea fatal result in her father and brothers. I am 
compelled to fall somewhat into the Method of the 
naturalist who is studying variation in specieR—pre¬ 
sent or paleontological—when I am in presence of anch 
instances of “ variation” and continuity in disease. 

Bacilli .—Tbe experienofd eye can, in a large propor¬ 
tion of cases, predicate of certain individuals, that at 
early ages Ibey will pass into phthisis; mth no leas 
certaicty can we say that individntls of another type 
will never pass into phthisis. 

Tbe types of the preephthisical and phthisical are 
approximately given in the Table. 

One may justly bold the hypotheeis that the bioplasm 
of an organic ceU can be resolved into tbe substituted 
ammonia groups of alkaloids, Ac., down to more stable 
elementary bedies—carbon dioxide, urea, ammonia, 
water, Ac., by and through the inherent bio-chemical 
dynamics of its contents; but it is no less true that 
parallel ohanges are often set agoing by the molecular 
motions of unioelled organisms, yeaste, t^llli, Ac. 

Thus theory and experience both accord with the 
great place which bacilli bold in the last stages of the 
lung destruction of phthisis. 

But the pollen falls in vain on tbe stigma, exoept at 
certain recurrent harmonic modea or molecalar motions 
of tbe stigma’s protoplasm, and so throughout the 
vegetable and acimRl kingdoms, the molecalar activities 
of the sperm cells are in vain, exoept in presence of cer¬ 
tain harmonic modes and motions of receptivity and 
absorption. ^ 

O 



PHTHISIS AND PR®PHTHI818 AND THEIR COBBLATION8. 


SlPT. 4, 1901. 


Oi&IGINAIi COMMUNICATIONS. The Medical PaBBo. 239 




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The facte of genuination by fission do not militate 
against snob theory, bf canoe the creative power of sperm 
and ova cells are bat differentiations of a nniveraal 
energy and motion existent, more or less, in every cell 
of the organism. 

Darwin says;—''All the forms of reproduction gra¬ 
duate into each other, and agree in their product, for it 
is impossible to distinguish between organisms produced 
by buds from self-division or from fertilised germs.'* 

Similarly, the tubercle bacillus falls in vain on the 
lung bioplasm of ceixain types of men and women; 
hypothetioally, we may assert that the lung molecular 
bonds are singer than are those of the unicelled 
tubercle bacillus. 

The Table shows the congeries and corelations of 
functions and structure, extending often back through 
many generations, of those iu whom the molecular bonds 
of the bioplasm of the lung apioea cease their powers too 
early in the life of the general organism of the indi¬ 
vidual. 

This constituticnal mode or state, oorelating with the 
most fundamental laws of the biological evolution, 
seems to loom up as the major Form of phthisis. 

In view of the various phenomena of function and 
structure, and of their wondrous commingling and co- 
relations tho words of Goethe arise— 

' Thus the whole of the throng points to deep-bidden 
law. 

Points at a sacred riddle.” 

TTealmtnt .—Treatment should in the main be preven¬ 
tion ; recognising that a child is not of robust type we 
apply the tonic regimen—exercise, pure outer air, in all 
its known and unknown mighty potentialities of sun¬ 
shine, light, motion, chemical action, electric energy, 
&c. The atmosphere is truly cosmic in its corelations 
to life and health; by exercise in the open air we use 
the greatest fulness of all the energies which make for 
and are true parts of life. Pure sdr in the day and the 
active metabolism which exercise produces; pure air at 
night, but with jadioious warmth. Such physical 
energies should be used in no excess, but in harmony 
with the capacity of the system to enjoy them, for 
different individuals need them in different degrees. 
Moderate, but continuous through years, should 
be the method of the tonic regimen, in har¬ 
mony with the processes of the growth and evolu¬ 
tion of the oiganism. We find that those who 
are hovering on the brink of phthisis get a ^ great 
restoration by a month or two of wandering in the 
Bummer on Dartmoor. The body, mind, and feelings 
are all greatly infiuenoed for good; I conceive that the 
restoration of a bright and happy mental state is of 
supreme importance in warding off phthisis. My 
impression is, that it is better to send an early phthisi¬ 
cal case to wander on the moors, and to be there men¬ 
tally interested in its geolc^, botany, srcheeology, and 
Bceneiy. and to be absorbing its full stimulating physi¬ 
cal and psychical influences, than to send such a case to a 
“home.'* I should say to the patient—“Go and enjoy 
yourself, ‘ eat drink, and be merry,' and don’t take a 
clinical thermometer with you! ” When I recall 
remembrance of the great stream of phthisis and pne- 
phthisis which I have seen during the past twenty-five 
years I am compelled to accept the words which Dr. 
Baly used after his grand review of the conditions 
and phenomena of cholera, as no less true iu reference 
to phthisis:—“Moreover, no aimplt theory (the italics 
are Baly's) that has yet been proposed, will account for 
all the facts in the history of epidemics of cholera.” 


Strmmts. 


[Fboh Our Own Corrxbfondbnt.] 


Bbslih, Auxiut SIst, 1901. 
The Significance of tbb Salts as bboards the 
Bacterial Action of Serum. 

The Ztiiath. /. Hygiene, &c., has an article on this 
subject by Dr^ Lingelsheim. Fromtheinvestigationsof 



GERMANY. 


SiPT. i, 1901. 


240 Thb Medical Pbibb. 

the writer it appears impossible that the effect of serum 
can depead on tbe osmotic process. The osmotic pres- 
sure is far too small to effect any considerable diminn- 
tion of germs. In its qnalitatire aspect the sernm 
action in the solution of cholera bacilli in rat serum 
is quite different from that occasioned by purely 
osmotic powers. All the conditions observed favoured 
the view that the bactericide power depended on special 
chemical substances nearly allied to the known ferments. 
One objection created some difficulty in an explanation, 
and this consisted in tbe fact already communicated 
by Behring that anthrax bacilli dried on silk threads 
grew and developed apparently without hindrance in 
active serum. A similar behaviour has been observed as 
regards bacilli contained io pledgets of lint, and the hypo¬ 
thesis has been brought forward that the serum cannot 
come into contact with tbe bacilli in the dried material 
and that the bacilli in tbe capillary spaces are less acted 
upon by tbe alexioes. But all this cannot explain the 
fact that such bacilli grow in the presence of bacteri¬ 
cide material. Experiments have led the writer to a 
more comprehensive explanation. The hypothesis of 
Fischer that the action of immune serum is attributable 
to an increase in the salts is in distinct cont/adiotion 
to tbe elementary facte of immnnity. The existence of 
bactericide ferment like active bodies in extra-vascn'ar 
blood or serum can no longer be denied. Their relation 
to congenital natural immunity is still unknown for the 
reason that it is not known whether this material in its 
active state is contained in the living circulating fluids. 
The fact that they are in combination with certain 
specific immune bodies that come into action says 
nothing as to their behavionr with these bodies. Natural 
immnnity no doubt depends on quite a series of com¬ 
ponents which may vary from case to case. 

Tbe Archiv.f, Oyji., Bd. 63, contains an article by 
Prof. Kroenig on 

Tub PBOoyosiB of Ascended Oonobuhcba in Women. 

On tbe basis of hie own observations the Professor 
comes to tbe conclusion that tbe prognosis of ascended 
gonorrhoea in the female is not at all nnfavonrable. 
The greater part of his thirty-eight cases of gonorrhoeal 
adnexa disease rocovertd in a not lengthy period so far 
that pain no longer rendered them unfit for work. Tbe 
treatment in the klinik was as follows:—If pain was 
great along with fever puigatives were given, 
generally saline, and ice bags were placed on the abdomen. 
No treatment was carried out per vaglnam. After 
evacuation from the bowels, which was carried out to 
four to eix stools per diem, the fever subsided in every 
case. With rest in bed the severe pains in most cases 
subsided. As soon as the symptoms subsided iebthyol 
tampons were inserted in the vagina, alternating with 
douching with hot water. In case of excessive hasmor- 
rhage stypticine in three daily doses of 005 grm. 
was ordered, whereupon as a role the hsmor- 
rbage ceased. During treatment care was taken 
to avoid firm stools, fluid diet only was given- 
On discharge from hoepital complete recovery 
had not by any means taken place, but tbe patients 
were qnite capable of attending to their domestic duties. 
When the patients were treated as out-patients the 
treatment was the same, with the difference, however, 
that the measures could not be carried out so strictly. 
Want of the needful rest in bed was one cause of failure, 


and also continued cohabitation on the part of the 
husband, even when strictly forbidden. This was a 
more disturbing factor than even continnaoce at work. 
Bnt as a rule the polyclinic treatment was not longer 
than a few weeks, possibly partly for the reason that 
work at home prevented their attendance as long as 
was desirable. 

Dr. Th. Nenbiuger, Frankfort, hsa an article in the 
A Med. Woch. on 


The Belation between Sclbbosis of the Cobonakt 

Arteries and Disease of the Cardiac Muscu¬ 
lature. 

His observations have led him to the view that the 
disease of the coronary arteries and tbe disease of the 
cardiac muscle caused by it develop in a certain and 
fixed manner, that they form a distinct clinical entity, 
and that tbe disease called angina pectoris is only a 
part of the complex of symptoms. The disease attacks 
men more than women, as a rule those of higher ages, 
and leads after months or years not nnfreqnently to 
sadden death. It may at times come to an apparent 
standstill, or recovery may be simulated. 

The author distinguishes three stages in tbe develop¬ 
ment of the disease. Tbe first he designates distnrbance 
of sensibility, tbe second disturbance of motility, and 
tbe third disturbance of nutrition. In the first stage 
the patient complains of tbe well-known pains that 
cease on standing still or resting. As the disease ad¬ 
vances the pain comes on on the least exertion or even 
when at rest, sleep is disturbed, and some patients com- 
plaia of giddiness. After a varying length of time the 
second stage appears. The working power of the heart 
diminishes, tbe patient is easily tired, the breath is 
short, tbe pulse becomes small, empty and quick or 
abnormally slow. Percussion and anscnltation reveal 
nothing abnormal, if there has been no previons valvular 
disease. This stage is not of long duration, and the 
third soon supervenes, that of disturbance of nutrition. 
The breath is short and snperficial, the pains are more 
frequent and severe, tbe chest is affected, and thin 
frothy Bpntum is brought up, sometimes tinged with 
blood. Tbe organic changes in the coronary 
arteries and in the fibres of tbe heart are so great that 
the heart ruptures. It rarely happens that patients in 
the third stage, after violent attacks, maintain their 
ground. 

Tbe treatment is that of heart diseases generally. 
Mental and bodily rest are essential. Nitrite of amyl 
gives passing relief, small subentanenus doses of morphia 
are nsefnl, and also the hypodermic nse of caffein, sod. 
salicylate is to be commended. In case of long stasis, 
digitalis given for three or four days every two or three 
weeks is nsefnl. Dropsy may ba suitably treated by 
diuretlo. Mounting steps is injurious. Besidence in 
high altitudes or on the sea is less to be feared. Syphilis 
and free living have no inflnence on the origination of 
the disease. Neither does valvular disease predispose 
to it. On the other hand, hereditary predisposition has 
a powerful inflnence. Among the 143 cases treated by 
the antbor, thirty of these were blood relations. 


Death of Subobon-Obnebal Von Colbb. 

Dr. von Color, tbe head of the Army Medical Corps, 
died of cancer on Monday week: he was bom in 1831, 
and studied medicine at tbe Army Medical Academy in 
Berlin. He began his military career in 1856 as s 


DiuiiiZku by 


Googic 



Sift. 4, 1901. 


SPECIAL ARTICLES. 


Thx Medical Pbiss. 241 


Tolunt«er sn^eon in the Dragoon Guards, and was 
appointed staff surgeon seven years later. He took 
part in the campaigns of 1864, 1866, and 1870-71, and 
distingQuhed himself so greatly during the operations 
that he was appointed as one of the first members of 
the medical section of the War Office, which was estab¬ 
lished after the end of the Austrian war. He played an 
important part in the reform of the Army Medical 
Corps, of the field and other military hospitals and the 
general sanitary condition of the army, and was eubse- 
^nently appointed bead of the Army Medical Corps. 

Austria. 

[>-K0M OUR OWN COBBIBFONDSNT.] 

ViKMXA. August 3l8t, lf>01. 

NaBCOBIS, OB An.£BTBS81A. 

The great ambition of the surgeon in modern times 
is to discover a narcotic or ansesthetic that will prove 
efficient and safe. To operate is now an essy and familiar 
art. but the performance without pain and yet secure 
safety is not quiteso easy. Nc thing in our armamentarium 
can surpass chloroform for efficiency, but its fatalities 
are on the increase. Schneiderlin proposed a form of 
narcosis by means of skopolamin hydrobrom with mor¬ 
phia, which be seems to have practised with consider¬ 
able snccess. Eorff now comes forward with a modifica- 
ticn of this treatment and combines chloroform. His 
mode of procedure is first to clear the prima via. About 
seven in the morning of operation be orders a light 
breakfast of some fluid, at 8'46 be gives 0 004 gramme 
of skopolamin hydrobrom, with O'Ol gramme of 
morphia hydrochlorate subcutaneously; at 10 30, a 
second similar dose. If by this time the external reflex 
is not quite abolished a third dose may be given 
according to individuality an hour later, or about 12 
o'clock. An hour alter the last doee a few drops of 
chloroform are placed on an inhaler and administered 
in the usual way; only or possibly | of the usual 
quantity is required to accomplish perfect anesthesia. 
In eighty operations under this asesthetio he had per¬ 
formed amputations, extirpation of mammary carcinoma 
with removal of glands from the axilla, gastrostomy, 
carcinoma of bowel, &o. The results were of the 
hsppiest hind, the patient renting quiet and calm after 
tbe operation. 

A Cbtstallinb luNUNisiNO Pboduct. 

Bordet was tbe first to draw attentirm to the im- 
monising power of soluble albumen taken from an 
animal that had been previously immunised with blood 
serum, and that a precipitate could be obtained from 
the fame blood by adding tbe same serum. In 
pursuing this experiment futther Buchner an'l Jeret 
hare found that a pure peptone, or tbe blood of tbe rein¬ 
deer, fian be acted on in a similar manner by the serum 
of the guinea-pig, which produces a crystalline precipi¬ 
tate with tbe property of a globniite. This globnlite 
has an irregnlar round bean or kidney-like shaped 
crystal, strongly refracting light, and ranging in size 
from one to ten m ^ diameter, and very resistent to 
chemical agents. Its organic nature may be proved by 
origin, its behaviour with beat, and colouring with 
iodine. 

Chobea and Absenic. 

Artraio was recommended in cases of chorea by Comby 


in such large doses that fatal results were often attri¬ 
buted to the drug and not to the disease. Although the 
drug has decided power in allaying tbe reflez action, it 
fell into disuse for a long time, till Becbterew awakened 
tbe old method by commencing with small doses and 
gradually increasing the quantity till very la^e doses 
can be taken with immunity, but never reaching a 
dangerous dose ss Comby preached. 

Becbterew also favours the use of bromide of 
potassium along with the arsenic, while salicylate of 
soda and cardiacs are also combined in many cases. In 
addition to these internal remedies be recommends 
hydropathic treatment, quiet in bed, and plenty of fresh 
air. Two weeks he considers tbe average time of treat¬ 
ment, although severe caaes may be a month before 
convalescence sets in. 

Multiple Sclebobib. 

Gaup is in favour of injury being the real origin of 
this morbid transition. Anything that will injure the 
general system will affect tbe organism, disturb tbe 
sleep, andact as the initial factor in the nerve disturbance, 
Multiple sclerosis may be diagnosed if after an accident 
no cerebral or spinal effects seem to persist or remain 
prominent, but on tbe contrary a slow progressive de¬ 
velopment of the characteristic symptoms appests : For 
example a man falls five metres, and becomes uncon¬ 
scious, with pain afterwards in the occiput, more parti¬ 
cularly on tbe right side, associated with tbe right foot, 
this being accompanied by vomiting. After this there is 
general pain, vertigo, with an easily tired feeling, an 
unsteady gait, weakness in tbe right leg, muscles of 
the neck, and a stiff feeling in the fingers. Next follow 
changes in the eye, the temporal papilla quadrant 
becomes white, the range of vision is narrowed, red and 
green are confused for one colour in tbe left eye, while 
there is increased tendon reflex and lowered cutaneous 
reflex. Along with these there is paresis of the mnsoles 
of tbe back and abdomen, and muscular groups of the 
lower extremities without spasms, although there may 
be distinct ataxia present. The paresis of the left side 
is usually greater than that of tbe right. Tbe Bom- 
berg symptom is slight at first due to the paresis, ahile 
the ataxia and vertigo go on increasing. 

Gaup considers tbe sclerosis commences first in tbe 
cerebellum from tbe tonus regulating function of tbe 
brain being early affected. 

glpaial Articles. 

DISINFECTING STATIONS AND TEMPOEARY 
ISOLATION HOUSES. 

Tbs threatened invasion of Europe by tbe plague is 
keeping the Continental medical world on tbe alert. 
Tbe need of preventive measures is being pushed before 
Governments and Legislatures, while aiministrative 
sanitarians are doing their best to perfect national 
sanitary defences. The necessity for providing means 
to insure disinfection of houses in which zymotic diseases 
had occurred has long been recognised. Paris possesses 
a decidedly efficient Services des Etnres Monicipales. 
which is divided into two branches (1) Stations where 
bedding, household linen, clothes, Ac., are disinfected by 
steam nnder pressure; and (2) domiciliary disinfection 
of walls, floors, furniture, &o., by means of a spray 
of corrosive sublimate at a strength of one in the 

Digitized by ' .oog . 


242 Thb Mxdioal Pbbbu. 


SPKGIAL ARTICLES. 


SspT. 4. 1901. 


thoasand. At Berlin, house disinfection following man; 
diseases is compulsor;, and is carried out by the 
municipality. The means employed are: For bedding, 
household linen, and wearing apparel, steam at 212^ F., 
under pressure; for the houses, rubbing down the walls 
with bread cut in large lumps, followed by a thorough 
sprinkling of carbolic acid at two and a-half to fire in 
the hundred. Other munioipaltiesoarryoutsimilardnties 
more or less systematically and stringently. But it 
was felt in some quarters that these precautions were 
not sufficient, as enormous difficulties arose in practice 
where poor folks lived crowded together in one or two 
rooms. Hamburg, we believe, was one of the first 
Continental cities to organise a disinfection at d tem¬ 
porary isolation station on a large loale. The in¬ 
stitution is meant both for townspeople and the 
seafaring classes. The whole station is arranged on 
the dual system: entrance section for suspected goods 
and individuals, and exit for the purified. In this in¬ 
stitution poor people are received, their property disin¬ 
fected, they themselves brought under the beneficial 
inflaence of baths, &c. While they are kept under 
observation for a day or two, their rooms are thoroughly 
disinfected and cleansed. In this way efficiency is 
attained with the least possible hardship to the people, 
and really at very little expense to the munioipalitr. 
This system has been boldly adopted in Belgium, 
and Dr. Alfred Fillasier, of the Prefecture de la 
Seine, has written a most interesting pamphlet on 
Lea * Postes Stnitaires ' dans les Orandes Villes,” in 
which he gives valuable details of this branch of 
municipal sanitary work. At Brussels, the " Poste 
Sauitaire" has been at work for some years, 
doing excellent service. The building consists of a 
ground floor and first floor. On the ground floor are 
the rooms for the attendants, w.c-’s and spray baths. 
On the first floor are found a dormitory with nine beds, 
lavatory, bath-room, and refectory. Persons brought to 
the station are conducted direct to the spray baths, and 
then to the dormitory. Meanwhile the clothes are dis¬ 
infected, and their homes cleansed. T^sually the next 
morning they ate given a light breakfast, their clean 
clothes are returned, and they are at liberty to return 
home. The whole cost amounts to about Is. 8d. per 
head per night. Antwerp poesesses two similar stations, 
capable of receiving respectively seventeen and eighteen 
persons. The cost of the two stations for 1900 was nnder 
£300, including dinner, supper, and breakfast for each in¬ 
mate. It is found that by these means domiciliary disinfec¬ 
tion can be effectively carried out, at little trouble to those 
most interested, while people who conld with difficulty 
be reached otherwise are brought under the control of 
the sanitary authorities. Thus greater efficiency is 
attained than if merely the sufferer from an infectious 
disease was treated at an isolation hospital. The system 
is so simple and free from hardships that persons of the 
poorer classes quickly recognise its value, and volun¬ 
tarily submit to the sanitary authorities, as they see 
that by following this course they obtain greater per¬ 
sonal security, and are not inconvenienced by the house- 
cleansing processes. M. Fillasier is anxions that 
“Postes Sanitaires” should be established at Paris, 
in order to complete the present disinfecting ser¬ 
vice the work of which, although carried out as syste¬ 
matically as possible, is often rendered nugatory 


to the difficulty of cleansing a single room occupied by 
a whole family, who have nowhere else to go. It is 
claimed that such a step will be absolutely necessary if 
the recommendations of the Commission de la Tnbereu- 
lose are adopted, in order to insure thorough disinfectiou 
of rooms and persons brought under the deleterious in¬ 
fluence of ooDsnmptive patients. Such stations are also 
invaluable at maritime ports, as they are so easily 
mantled at very little expense, and do not involve the 
hardships connected with isolation hospitals. It is also 
to be observed that municipal “ Pcstes Sanitaiies as 
here deecribed would greatly lighten the work of Port- 
sanitary antborities, and being nnder municipal snper- 
vision and frequented by ratepayers would not be so 
liable to the slovenly, and too frequently most insanitary, 
mani^ment of purely quarantine stations. Undoubtedly 
these “Postes Sanitaires “are admirable adjuncts to 
isolation hospitals, oompleting the sanitary circle at 
little cost, and at practically no inconvenience to the 
working classes, who are mostly concerned in the matter’ 
Indeed, if all circnmstanoea are borne in mind, tbe 
system means economy to municipalities and to citisens, 
as tbe flgnres and statistics in H. FillasieriB pamphlet 
so clearly demonstrate. 

HEALTH MATTERS IN SALFORD.—ANTI- 
DIPHTHERITIC SERUM. 

Thx Annual Report of the Hospital Department of 
the County Borough of Salford for tbe year 1900 eon- 
tains references to many points of general interest con¬ 
cerning the public health. 

Like all such reports, statistics in tabular and 
schematic form occupy a considerable portion of tbe 
book. 

The great question of “ return’* cases is touched on» 
and the erection of convalescent pavilions is considered 
to add " another line of defence to those already exist¬ 
ing between the public and the rt currenoe of infections 
disease, more particularly becanss more necessary in 
scarlet fever.” It has been pointed out elsewhere 
that convalescent pavilions probably lesson sdso the 
liability to early second attacks in the same individual. 
The medical superintendent, with admirable foresight^ 
and, wo think, with great justice, warns his readers 
against expecting that even with tbe most carefully 
arranged system of convalescent pavilions, cases, 
apparently “return,” will cease entirely to appear. 

Tbe infections diseases principally dealt with ic the 
report are scarlet fever, enteric, and diphtheria. 

Of scarlet fever cases 1,328 were admitted with a mor¬ 
tality of 7‘6 per cent. The average number of day 
spent by each patient in hospital was 44*7. This period 
will appear to some readers a somewhat short average 
time for isolation. The number of oases of enteric ad¬ 
mitted were 2i6, and tbe percentage mortality was 25 0. 
Tbe daily average number of days spent by each patient 
in hospital was 29'6. This will also appear to some 
remarkably short, especially in view of the fact that 
the percentage mortality was as high as 24'2. Of course, 
it must not be forgotten in this connection that many of 
the deaths amone enteric cases in hospital occur 
shoitly after admission. 

The number of cases of diphtheria was 294, the per¬ 
centage mortality was 24'2, the daily average number 
of days spent by each patient in hospital was 19'9. 

Wglc 


:zed ; 





8»yr. 4, 1901._THE OPEBATING THEATRElS. The Medical Pbbss. 243 


The medical eapermtendent eaye:—'* I have no hesi¬ 
tation in assexting that such heart failures, or any of the 
■eqnels of diphtheria, are from my experience unaffected 
by the use of anti-diphtheria Eerum.” This opinion is 
thereeultof his experience of previous years as well as 
that of last year. He ui^ee the importance of exhibit¬ 
ing this remedy as early as possible in doubtful cases as 
well as in certain cases of diphtheria. We may point out 
that in Liverpool the five fever hospitals in the city are 
used as depdts from which practitioners may obtain 
gratia a supply of serum at any time, day or night, for 
the use of poor patients. 

“During the past twenty years,” the report says, 
“only three members of the hospital staff have con¬ 
tracted diphtheria, while twenty .three contracted enteric. 
As no mention is made of it, it must be assumed that 
anti, diphtheria serum was not used as a prophylactic 
measure. 

It seems a pity that the bacteriological work, for the effi¬ 
cient performance of which the superintendent acknow¬ 
ledges his indebtedness to bis assistant medical officer. 
Dr. Pringle, has not been given more space in the report. 
More particularly would one appreciate bsoteriological 
details in connection with the report on the use of anti¬ 
diphtheria serum in the treatment of “ secondary malig- 
nant sore throat ” among the scarlatina patients, which 
is said to have beenaitended byvery marked andgratify- 
ing results. In fact, not one death has followed this “ com- 
pUcation.” It is not noted whether bacteriological eia- 
mination of the throat is made preparatory to the patient’s 
dischai^e from hospital. It would be interesting if in 
future reports a table were included showing the ratio of 
cases admitted to the total notified. 

The medical superintendent. Dr. J. W. Mullen, is to be 
congratulated on his report; the arrangement of tbe 
matter makes reference easy and rapid. 


®)ieratin9 ^luatrts. 

GUY’S HOSPITAL. 

Nxpbbxctoht. —Mr. Abbdtbkot Lane operated on 
a woman, st. about 30, who had suffered for a consi¬ 
derable period from constant pain in the right loin, 
which was greatly aggravated at times when her abdo¬ 
men became distended; the belly was tender, so that 
she could not bear the pressure of her garments. 
The swelling and pain diminished slowly, and 
this subsidence was associated with the passage 
of a quantity of milky urine. She consulted a 
medical man who found a tumour in tbe right 
loin which he took to be renal. The urine was 
loaded with pus; it had been examined for tubercle, 
with a negative result. A radiograph was also taken, 
but it showed no evidence of stone. 'When she was 
admitted into the hospital the condition was practically 
the same. The right kidney was very much enlarged, 
its surface was lobulated and firm; pressure 
on it produced great pain. The uretre was 
not enlarged or thickened beyond the normal, 
a further examination with the X rays showed nothing 
definite. The fact that the ureter was normal as far as 
could be detected suggested some cause other than 
tnbercnle. The kidney and ureter were free'.y exposed 
by a long oblique lumbar incision. The latter was per¬ 
fectly normal to within one inch of its upper limit, where 


it entered an infiammatory mass, which was inseparable 
from the kidney. With much difficulty it was partly 
cleared, when a small hard, nodular lump was felt. It 
was very cicatricial, dense, and the lumen of the ureter 
was clearly constricted irreparably; besides this the 
kidney subetanoe had been subjected to much prolonged 
pressure; it was therefore felt to be hopeless to do 
anything but remove the damaged organ. This was 
carried out. When the indurated mass was examined 
it was found to consist of a small stone no bigger than 
a pea lying in an ulcerated thick walled cavity formed by 
tbe upper limit of the uretor. This was surrounded by 
the dense cicatricial infismisatory material already 
referred to. The conditions present were such that at 
this stage of the disease it was evident there was no 
possible treatment other than that of nephrectomy. This 
case illustrated very well, Mr. Lane said, the fact that the 
negative evidence of stone in the radiographic picture, 
however perfect, does not necessarily eliminate the pres¬ 
ence of a small stone, indeed, frequently of one of a Mr 
size. It also illustrated the fact that a very small stone 
may stick in the ureter, and that it may produce very 
much more damage to the kidney than one mudi larger in 
size in the pelvis. Mr. Lane also urged the importance 
of examining the ureter thoroughly in every case of 
obstruction to the fiow of urine from the kidney. 

NORTH-WEST LONDON HOSPITAL. 

Removal of Suppueatino Cholsstbatoha. — Mr. 
Templeton operated on a hoy, et. 16, who had been 
sent up to him by Dr. George Cathcart. The patient 
was suffering from headache accompanied by pain behind 
the left ear, with a history of discharge from the meatus 
on and off for two years. About ten days before admis¬ 
sion a swelling commenced to appear behind the ear, 
which slowly increased, the skin becoming red and 
cedematoos and the headache gradually getting worse; 
the temperature was 102, and the hoy was in a dull 
sleepy state. There was no facial paralysis and no on- 
larged glands at the angle of the jaw. The discharge 
from the ear was slight and not offensive. Tbe ear itself 
was stuck out,and,owing to the displacement of the pinna, 
had the characteristic appeuunoe seen in esses of acute 
mastoid disease. On inspecting the membrana tympani 
the edges of the small perforation seen were quite 
healthy. Mr. Templeton said it was rather a curious 
point that there was so little discharge, and that even 
this small amount was not offensive, this being, he 
thought, rather a contra-indication to mastoid diseases. 
An operation was deemed advisable, and was performed 
at once after admission. After the part of the scalp 
adjacent to the ear had been shaved, a curved iucision 
was made a quarter of an inoh behind, and parallel to, 
the pinna; almost immediately under the skin a 
quantity of pus (three or four draohms) welled up; the 
mastoid process was then folly exposed, and the portion 
of bone superjacent to the antrum carefully cleared. 
Fart of tbia formed the floor of the absoesa cavity before 
opened. The periosteum and other materials were next 
cleared away with an elevator, and then a small yellow¬ 
ish bulging was noticed in the position of McEwen’s 
triangle. The opening was therefore cantionsly enlarged 
by a gouge, and a small quantity of this yellowish stuff 
taken np with a spoon. It was found to consist of the 
pntty-like material characteristic of a cholesteatoma. 
The opening was now still further enlarged, and the 
l.'iniTired : 



244 The Medical Tbebs 


LEADING ARTICLES. 


Sept. 4, 1901. 


tamour, the size of a la^ filbert, was lifted ap with its 
capsule and easily removed, the capsule separating from 
the adjacent bone without difficulty, there being no adhe¬ 
sions of any moment. There was, of course, considerable 
absorption of bony tissue from pressure of the mass, so 
that the upper portion of the tumour was in contact 
with the dura mater, therefore great care had to be exer¬ 
cised in cleaning out the cavity; this was done by first 
iropping it out, and then thoroughly irrigating it with 
1-40 carbolic lotion. Ihe tympanum was not interfered 
with by scraping through the external meatus, as there 
had been so little evidence of disease in the middle ear* 
The cavity was packed with iodoform gauze; a few 
stitches were placed in the upper part of the wound, the 
lower part being left open so that subsequent dressing 
could be applied. Mr. Templeton thought the interest 
in the case lay in the fact that it closely simulated an 
ordinary one of acute suppuration of the mastoid ; the 
absence, however, of any offensive discharge, he pointed 
out, was somewhat in favour of cholesteatoma; the pain, 
too, had not been very acute. This kind of tumour, he 
said, was very uncommon. The growth Itself, he re¬ 
marked, was very easy to shell out, in fact, it came 
away quite in the same manner as an ordinary sebaceous 
tumour. 

The patient was discharged in about a fortnight, and 
sent to a convalescent home. Only a small sinus re¬ 
mained, and all symptoms were quite relieved. 


BrOISTEBEO rOR FRANSMISSIOH ABROAD. 

^lu (IllliJical fuse mtb Qlirctilar. 

Poblished ererj Wednesday morning, Price Sd. Pest free, Std. 
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POB 0X1 IxeiBTioxWhole Page, £5 Os. Od.; Half Page, 
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Fob a Sibiks or Ixsirtioxb Whole Page, thirteen Inaerttona 
1 weekly, fortnightly, or monthly), at £S Ida. Od. j twesty-six 
Inaortiong (weekly or fortnightly) at £S 8i. Od.; flf^-two 
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^hc (IHcbical frtBs anb Circular. 

“ 8ALU8 POPCLI 8UPRSMA LEX.” 


WEDNESDAY, SEPTEMBER 4, 1901. 


TOWN CHILDREN AND HOLIDAY FUND 
INFECTION. 

The risk of catching infectious disease is never 
altogether absent from children who are taken, for 
their summer holiday to a health resort. To a great 
extent parents and guardians are at the mercy of 
the lodging-house keepers and the sanitary authori¬ 
ties of the district they have elected to visit. On 
the other hand, of course, it happens nut infre¬ 
quently that reckless and selfish persons convay the 
germs of active infection hither and thither in the 


persons of sick or convalescent children. But apart 
from these dangers, which are by the nature 
of the case restricted to the well-to-do classes, 
there has of late sprung np a separate and 
peculiar danger that demands careful con¬ 
sideration in the interests of the community at 
large. As happens in not a few analogous instances, 
the evil is wrought by want of head rather than by 
want of heart, a fact that will be at once apparent 
to readers when they learn that it is due to the 
philanthropic effort to send the slum children of our 
towns for a short holiday in the country during the 
summer months. A moment’s consideration will 
show that in the absence of effie'ent medical super¬ 
vision at each stage of the sojourn the door will be 
thrown open for the mutual conveyance of infectious 
diseases of all kind between town and country. The 
risk is clearly just as great for the country folk 
as for the citizens. The children sent out are ob¬ 
viously at an age and of a class predisposed to in¬ 
fection, and under ordinary arrangements they are 
distributed among cottagers whose chief claim to 
selection is the fact that they themselves possess 
a family of companionable age with that of their 
guests. Under such circumstances the town chil¬ 
dren’s holiday movement, unless under rigid medical 
control, becomes practically an ingenious plan for 
maintaining the incidence of communicable 
maladies upon town and country. The prin¬ 
ciple of this philanthropic movement is above 
reproach, and it would be a thousand pities were the 
town children to lose their holiday for want of a little 
organisation. The question is purely medical and 
it seems one that should be to a great extent settled 
by the medical officers of the districts involved. A 
medical certificate of freedom from communicable 
disease of any kind, including not only the more 
commonly recognised specific contagious diseases, 
but also those of skin, eye, and scalp, should be 
exacted in the case of each child. A similar certi¬ 
ficate should be required of the families visited. 
Arrangements should also be made for the 
systematic medical supervision and care of 
the town children during their absence. In a 
recent case one of these unfortunate holiday 
charges was sent back to town in a dying 
condition suffering from acute abdominal com¬ 
plaint. for which he had received no medical atten¬ 
tion in the country. It need hardly be pointed out 
that all medical certificates and supervision should 
be paid for and be made a part of the cost of the 
funds. There is no reason, so far as can be seen, why 
a special tax should be laid upon the services of 
members of the medical profession any more than 
upon the railway companies or the caterers who are 
employed by the managers of the holiday funds. 
There is another aspect of this particular branch of 
philanthropic work with which as a medical journal 
we are not closely concerned, but which is almost 
precisely analogous with the intercommunication of 
bodily infection, namely, the moral damage likely to 
ensue from planting a number of children bred in 

Digitized by oogie 



Sift. 4. 1901. 


LEADING ARTICLES. 


Tbs Midioal Pbsbs. 245 


tbe slams among those who have been reared in the 
parer and simpler atmosphere of the country. That 
is a matter, however, for the consideration of those 
who devote themselves to the ethics of practical 
life, and we may look to them with confi¬ 
dence to treat the subject with the caution 
and sense of responsibility that it demands. 
From a medical point of view, we have felt it our 
solemn duty to dwell upon the dangers that are in¬ 
herent to an essentially benevolent scheme. There 
was never any period in the history of preventive 
medicine when the necessity of joint action between 
urban and rural sanitary aixthorities in the preven¬ 
tion of infectious disease was more fully recognised. 
In onr opinion, it would not be impossible to safe¬ 
guard the organisation of the Holiday Funds in a 
satisfactory manner, chiefly by way of stringent 
medical Bupervision, and perhaps, secondarily, by 
an extension of tbe camp as against the boarding 
out system. In any case, it is to be hoped that by 
next summer some well-considered plan will have 
been framed to meet the exigencies of the present 
situation. 


COXALGIA. 

To the patient and intelligent study of M. Ollier, 
of Lyons, we are principally indebted for our know¬ 
ledge of the pathology of coxalg^a. We well remem¬ 
ber the earlier pathology that saw nothing but an 
inflammation, and combatted tbe disease by killing 
the inflammation by exciting a greater one. The 
surgeon gave his whole attention to drawing out the 
inflammation, and blisters, setons, caustics—actual 
and potential—were used as tbe poor sufferer lay a 
willing victim to the well-intentioned but tor¬ 
turing attempts to kill the disease. Lucky was 
the victim who lived to afterwards gu about 
on crutches, with the injured limb a useless ap¬ 
pendage. Later tbe joint was cut down on, tbe bag 
of puo the capsule held was opened, and tbe head 
of the femur excised. It was as a treatment a dis¬ 
tinct advance on the older method, and was the 
first-fruits of tbe new pathology. Months of suffer¬ 
ing were saved to tbe patient, and tbe limb was 
neither so useless nor deformed as by tbe other 
treatment. Immobilisation of tbe joint and good 
feeding, with outdoor exercise, may fairly be claimed 
as a natural outcome of the recognition of the 
tuberculous character of tbe disease. And when 
commenced in the earlier stages the results 
obtained were excellent. Unfortunately patients 
did not come under treatment in the first stages of 
the disease when the apparatus and the constitu¬ 
tional treatment offered a chance of an arrest of the 
disease and the full use of the joint. Yet even in 
advanced casee progress was marked—a limb of the 
normal length without deformity, and, though stiff, 
more comely and useful than acrutcb. The great draw¬ 
back to this immobilisation treatment was the appara¬ 
tus; as a rule they were costly and cumbrous; badly 
borne by children and young adults, and if not re¬ 
adjusted at short intervals more injurious than bene¬ 


ficial. Where, to secure immobilisation, the child is 
placed on a bed and the limb extended by weights at¬ 
tached to it, the child suffers from the loss of outdoor 
exercise, and is liable, lying immovable, to all 
forms of chest troubles. If brought out on a reclin¬ 
ing couch the risks of pulmonary disease are in¬ 
creased. The desideratum of the surgeon—fixation 
of the joint with mobility of the limb from the hip 
down—was not secured. To meet the want, M. Paul 
Archambaud has, especially in tbe case of infants, 
recommended an apparatus (La Revue Medicale) 
by which he hopes to secure correction of 
deformity, immobilisation of the joint during 
exercise, restoration of the muscular vigour and 
functional activity of tbe articulation, and 
facilities for general treatment. Bis lines of measure¬ 
ment are from the anteriru' spine of the ilium to the 
superior external border of the patella of the same 
side, and from the anterior superior spine of the 
ilium to tbe tuberosity of the ischium; and from tbe 
ischium to tbe patella as above. By drawing a base 
line from tbe anterior superior spine of tbe ilium to 
the tuberosity of the ischium a base line of an acute 
triangle is formed, whose apex reaches to the 
superior border of tbe patella. Made with adhesive 
plastic material this immobilises the joint and yet 
allows of exercise. To secure good results both sides 
are bound by theapparatrs. We hope the results may 
equal tbe author’sexpectations; but weconfess to a cer¬ 
tain amount of scepticism of new apparatus for the 
hip joint. Since our early student days we are 
familiar with new apparatus for fractured clavicle 
new splints for Colies’ fracture, and new methods of 
immobilisation of the hip-joint. An apparatus to 
Becure the advantages for tbe patient that M. Paul 
Archambaud claims his will give is much to be 
desired, and we wish the distinguished surgeon 
every success in his attempt to improve our treat¬ 
ment of coxalgia. 

TREATMENT OF ACCIDENTS UNDER 
CHLOROFORM. 

The treatment of accidents under chloroform is 
a question full of interest to most medical men, and 
one, too, on which all who undertake to administer 
tbe drug should have formed some definite opinion. 
In the recent numbers of the Manchester Medical 
Chronicle Mr. Wilson, Administrator of Anesthetics, 
Royal Infirmary, Manchester, endeavours to classify 
tbe different accidents which are likely to occur, and 
to consider the mode of action and range of utility 
of the Various remedies which have been suggested. 
The three classes which he adopts are shortly:— 
1. Irregular and uncontrolled action of muscles 
during the stage of excitement. 2. Paralysis 
or loss of tone of muscles altering the patency 
of the respiratory passages and so causing 
mechanical obstruction to the breathing. 3. Specific 
paralysing action of tbe drug on the fundamental 
nerve centres in the medulla. It is obvious that few 
cases of danger can be allocated to any one of these 
classes, for even presuming that the danger arises at 
DlUm/_- ■ 'Og C 


246 Thi Msdioil Pbibb. 


NOTES ON 00 RBENT TOPICS. 


8bpt. 4, 1901. 


first from the irregular action of certain muscles 
interfering with respiration, still what makes this 
reallj serious is the danger of the sudden onset of 
the specific paralysing action of the drug on the 
medullary centres. It is probable that any classifi¬ 
cation of accidents would be open to similar objec¬ 
tions, but if it enables the administrator to grasp 
more clearly the general principles of danger it 
must be considered to have answered a usefitl pur¬ 
pose. The indications for treating these acci¬ 

dents are three-fold — to remove the anses- 
thetic-laden air from the lungs, to encourage 
the flow of blood to the neiwe centres, and to stimu¬ 
late the circulation and respiration. The various 
methods which are used to attain these ends Mr. 
'Wilson groups into five classes—1. External reflex 
respiratory stimu'ants; 2. Direct mechanical or elec¬ 
trical stimulation of the heart; 3. The mechanical 
performance of natural functions such as artificial 
respiration; 4. Mechanical measures designed to 
counteract the effects of the failure of the circulation 
by raising the general blood pressure ; 5. Drugs ad¬ 
ministered to stimulate the depressed nerre centres. 
Of the first group, the best that can be said is that 
they do no harm unless persevered in to the detriment 
of more important measures, and of the second, that 
they are either impracticable or positively harmful. 
Faradic stimulation of the precordial area, if any 
of the current reaches the heart, probably inhibits 
its action. Acupuncture of the heart is equally 
useless, and direct manipulation of the heart after 
opening the heart-chest is a remedy which re¬ 
quires more evidence of its utility before it 
can be recommended. Mr. Wilson believes that as 
good, if not better, results, can be obtained by inter¬ 
mittent pressure on the chest wall, accompanied by 
alternately raising and lowering the patient so as to 
empty and fill the heart. The difficult question has 
first to be decided whether the circulatory failure is 
the result of paralytic dilatation of the heart, or of 
paralysis of the vaso-motor mechanism. The 
methods of treatment suitable for each of these 
cases are absolutely antagonistic, and it is by no 
means easy to say which is the cause in any given 
case. It would appear that sudden failure of 
the circulation, accompanied by pallor of the face, 
and acceleiated or gasping respirations denotes vaso¬ 
motor paralysis and requires inversion of the 
patient with pressure on the abdomen. On the other 
hand, if the dangerous symptoms are preceded by 
struggling, and the face is suffused, with signs of 
venous engorgement, the patient should be alter¬ 
nately raised to nearly the vertical position in order 
to empty the heart, and then returned to the hori¬ 
zontal position. Artificial respiration should be 
systenaatically persevered in in each case. If there is 
actual failure of the circulation little that is useful 
can be done by efforts to nuse the blood pleasure by 
such means as transfusion, &c. The same objection 
also applies to the use of drugs. Wheie there is 
failure of the respiration or circulation the difficulty 
is to get the drug to the nerve centre which it is to 


stimulate. In those cases in which this can be effected 
hypodermic injections of strychnia and the extract of 
suprarenal capsule, with inhalation of ether, are 
probably the most useful. 

Jtotfs on (Current ^o^jus. 

The Duration of Pregfnanoy. 

It would seem that in the human oiganism those 
phenomena which are of the most everyday occur¬ 
rence are usually the most difficult to explain. A 
concrete example of this is given by the various 
phenomena of pregnancy. Pregnancy is, one would 
think, a sufficiently long-estabtished condition to 
enable us to understand something about it, and vet 
our ideas on many points connected with it are of the 
vaguest description, and our definite knowledge prac¬ 
tically non-existent. When does impregnation occur P 
Where does impregnation occur ? What are the 
causes of the onsst of labour? Wbat is the exact 
duration of pregnancy P and, Istbere a fixed period for 
gestation P Perhaps the most practically important 
of these questions, not alone to medical men but also 
to the legal world, are, “ What is the duration of preg¬ 
nancy P ” and, Is the period of gestation capable of 
variation P ” Of course the time which is usually fixed 
in the medical aod lay mind is a period of ten lunar 
months, or nine calendar months, or 280 days. The 
statistics of Loewenhardt, Hasler, and Hecker, ob¬ 
tained from the records of a large number of cases 
in which pregnancy resulted from a single coitus, 
gave an average duration of from 272‘2 to 273-5 
days, a period which is somewhat shorter than the 
popularly accepted one. Perhaps the latest statis¬ 
tics on this interesting subject are to be found in a 
recently published article by P. von Winckel. The 
writer considers that as the methods of estimating 
the length of human pregnancy hitherto proposed 
have proved unsatisfactory, the important question 
whether a pregnancy had been unduly prolonged 
might be better determined by estimating the length 
of the gestation of abnormally large and heavy 
children at birth, and comparing this with the 
average duration of pregnancy in all uninterrupted 
cases. During the thirty years he had charge of the 
clinic at Dresden and Munich he met with 1,007 chil¬ 
dren over 4,000 grms. when bom. Only five were over 
5,000 grmB.,andtbebeaviestwa85,320grms. v. Winckel 
draws a series of oonclusions of which the follow¬ 
ing are the most important:—Prolongations of preg¬ 
nancy, that is to say, delayed labours, undoubtedly 
occur; impoi-tant evidence of their occurrence and 
of their frequency is given bythe number of children 
which at birth weigh 4,000 gnus, or upwards; the 
frequency of such children in large clinics amount 
to 3'15 per cent, and about 14'5 per cent of them 
have been more than 302 days in the uterus. The 
frequency of delayed labour is 2*8 per cent. The 
proofs now advanced that so many children (14'5 
per cent.) remain more than 302 days in the womb 
shows that this, the German limit of legitimacy, is 
too low. 


Diym^cu by 


Google 


8kpt. 4, 1901. 


NOTES ON OUBRENT TOPICS. Thi Hsdical Pbcsb. 247 


Ovarian Extract. 

The trend of modem therapeotioe has of late 
been in the direction of oi^no-therapy. In moet 
cases glands erith external secretions contain a 
member of the groap of ferments, bnt in the case 
of the internal secretions of glands the product is 
usoallj of a complex substance, and it is exceptional 
for it to be of the nature of a ferment. Thyroid 
extract, orchitic extract, and supra-renal extract, 
together with ovarian extract, are among the 
latest additions to the list of therapeutic agents. 
The reason underlying the administration of these 
•extracts is the undoubted fact that diseases may be 
caused by interference with the activities of these 
glands. In the case of ovarian extract an extremely 
interesting report has jnst been issued by Dr. Krueen 
in the Johns Hopkine Hospital Bulletin, in which 
he gives his expeiience for the past three years of 
the uae of this extract in amenorrhoea, in dys- 
menorrhcea, in those suffering from symptoms follow¬ 
ing the removal of the uterine appendages and for 
the disturbances in connection with the menopiuse. 
The conclusion arrived at is that the theory of the 
use of this extract is faulty, and its administration 
based upon a wrong assumption as to the function of 
the organ. This is quite in agreement with the views 
of many authorities on therapentics, but it is cer¬ 
tainly reassuring to be told that the extract is prac¬ 
tically harmless. In those cases where relief has 
been noted it is questionable whether the improve¬ 
ment was not doe to mental suggestion, and it is 
quite evident that no definite reliance can be placed 
upon the preparation. 

A Penny a Week for the Doctor. 

Evebt now and then the medical world receives 
a sharp reminder that Nemesis sits behind their 
want of business method. Sooner or later the re¬ 
daction of fees that has resulted from unworthy 
■competition educates the public into the belief that 
all medical advice should be obtainable at a low 
remuneration. The tendency then naturally arises 
to cut down salaried appointments, an occurrence 
that is reported almost every day of the week in 
various parts of the United Kingdom. An instance 
of this landing economy was shown last week by 
the Mile End Board of Guardians. That body has 
taken the progressive step of boarding their Poor- 
law school children out in scattei'ed homes. When the 
question of medical attendance came under discussion 
it was reported that some medical men had agreed to 
attend when necessary, and to supply medicines and 
dressings at sums varying from sixpence to three¬ 
pence per week per child, while one doctor tendered 
at twopence. Even the last-mentioned offer failed 
to secure the acceptance of the guardians, who have 
deferred the matter to a sub-committee, on the 
ground that the figures were too high.” One of 
them said that be paid only a penny a week for his 
doctor, a statement which appeared not to have 
■caused him any shame or compunction. Clearly, 
medical men have themselves to thank for the ; 


diminished estimate of their public worth by attach¬ 
ing so low a value to their services to clubs and 
medical aid societies, to say nothing of other kinds 
of cheap and gratuitous work. 

Fatal Treatment of Aneurism by the 
Gelatine Method. 

Two cases of considerable medical interest were 
investigated last week at Guy’s Hospital by the City 
of London coroner. As most of our readers prob¬ 
ably know, a new method of treating aneurism by 
the subcutaneous injection of gelatine has recently 
been introduced. One of the house-sui^^ns at 
Guy’s, Mr. L. Stamm, had three cases of thoracic 
aneurism under this specific treatment. He him¬ 
self sterilised the gelatine, of which several ounces 
were injected into the leg or other part of the body, 

I so as to enter the general circulation, where it in- 
! creases the coagulability of the blood and so leads to 
' the consolidation of the sac. Of the three cases 
I thus treated one was discharged cured, while 
I the two others developed tetanus and died. There 
can be no doubt that the specific organism of tetanus 
was introduced along with the gelatine. This acci¬ 
dent is most unfortunate, as it will tend to cast a 
stigma upon what is undoubtedly a valuable scientific 
method of treating an incurable disease. No blame 
can be attached to the house sui^eon, who bad taken 
every precaution possible from a human point of view. 
The treatment was first introduced by Lancereaux, 
of Paris, who administered every six or eight days 
four to five grammes of gelatine in two hundred cubic 
centimetres of 0*7 chloride of sodium solution. If 
properly sterilised there should be local reaction at 
the point of injection. Lancereaux reported five 
cases of aneurism, of which three were cured. It is 
therefore obviously unfair for the newspapers to 
speak of the method as hospital experimentation 
upon patients. 

Anti-Vivisectionists, Take Note I 
The worthy folk who refuse to sanction experi¬ 
mental inquiry iuto physiology and disease in the 
lower animals must find plentiful matter for wring¬ 
ing of hands in the busy universe of science. 
Pathological laboratories are being daily added to 
all our large general hospitals, where technical 
vivisection is carried out on a large scale in order to 
discover what is the exact nature of the maladies 
from which patients are sufferiog in the wards. To 
take an example: a patient is afflicted with some 
obscure lung complaint, as to which prolonged and 
careful observation has failed to form a decided 
diagnosis. A portion of his sputum is inoculated 
iuto the tails of a couple of white mice, or under the 
skin of two or three guinea pigs, and it is 
noted whether the animals recover or die, and if 
the latter, whether they succumb to pneumonia, 
tubercle, or some other disease set up by known 
micro-organisms. The verdict thus obtained, due 
technically to vivisection, is clearly of vital 
importance to everyone concerned. On the one 


DiiJiiized by 


Googic 


248 Th» Mwical Pbmb. NOTES ON CURRENT TOPICS. 


SiPT. 4, 1901. 


hand it may carry the death warrant of the patient, 
or, on the other, may determine a course of treat* 
ment which will end in his complete recovery. 
Withont a biological test of the hind in doubtful 
cases no physician could sincerely say be had given 
his patient the fullest advantages afforded by 
modem scientific medicine. The matter, therefore, 
resolves itself into a direct balancing of the lives of 
mice and guinea pigs against those of our fellow- 
creatures. 'Which is to win P Medical men are on 
the side of humanity, on which side are the vivi- 
sectionists P 

British Medical Association Meeting, 1002. 

The announcement has been made that the next 
annual meeting of the British Medical Association 
will take place at Manchester. As a busy Lancashire 
centre that town offers a considerable contrast from 
Ipswich and Cheltenham, the last two places visited. 
The population of Manchester is over 500,000, while 
its suburb, Salford, contains 198,000 persons. A 
large increase has taken place in this direction since 
the last visit of the Association some twenty-five 
years ago. The proportionate growth, how¬ 
ever, has probably nothing like equalled that 
of the Association, which now reckons some 
19,000 members. The President-elect is the well- 
known surgeon, Mr. Walter Whitehead, who has held 
many surgical appointments in the city, as well as 
the professorship in clinical surgery at Victoria 
University. The association of the place with a 
young and vigorous University will doubtless add to 
the brilliancy of the meeting from a scientific point 
of view. It will be of much interest to note the 
course of affairs now that the constitution of the 
Association has been so materially altered. 

Medical Miracles. 

The fashion of the present day is to consider that 
medical miracles in the healing of the sick occur 
only with Christian Scientists or at Lourdes. The 
following two cases, out of others, are sufficient to 
show to all unbiassed minds that what may be justly 
described as miraculous cures occur now and then in 
patients under the care of duly qualified prectitioners 
of medicine. The first case is given on the unim¬ 
peachable evidence of Dr. Osier, of Baltimore. A 
woman came to him with cancer of the breast, and 
on his advice it was thoroughly removed by Mr. 
Halstead. The prognosis was, of course, unfavour¬ 
able, and two years afterwards she came again to Dr. 
Osier, suffering from sarcoma of the choroid. The 
patient went from bad to worse, and in June, before 
going away for his holiday. Dr. Osier went and said 
good-bye to her- She was then in great pain, secon¬ 
dary tumours bad appeared near the breast, the liver 
was invaded, and she was paraplegic. A year 
later Dr. Osier was astonished to find that the 
nodules round the breast bad gone, she had recovered 
from the paraplegia, and she was regaining vision in 
the affected eye. A short time ago this lady w> nt 
two miles to the railway station to meet Dr. Osier. 
A yet more astounding recovery has been reported. 


About four years ago Mr. Tiffany, a surgeon, re- 
moved at Dr. Osier's request a cancerous breast, and 
the case appears to have at first followed the usual 
course—that is to say, secondary growths made their 
appearance. About twelve months ago she was not 
expected to live, and she complained much of girdle 
pain, and pains down the leg, ultimately becoming 
paraplegic. The woman, however, did not die, but 
g^dually improved and went away into the country. 
A few months ago this patient walked a consider¬ 
able distance to see Dr. Osier, who found that she 
still had some secondary nodules and a certain stiff¬ 
ness of the back. She continues to take morphine, 
but gets about and attends evening parties and 
general entertainments of that kind. There is no 
desii'e on the part of the medical profession to put 
themselves into competition with the therapeutical 
agencies mentioned above, but it is well to remember 
that there is no monopoly even in so-called miracles. 

Christian Science “Testimony” Meetings 
The BritUh MoitHilytox September reports some 
astounding “ testimonies of cures’’ said to be adduced 
at the meetings of this strange cult. “ 'Were there 
no fools there would be no knaves” is a dictum more 
frequently exemplified in quackery than in aught 
else with which we are acquainted. Unfortunately 
there are always considerable numbers of emotional 
people with little to do, who are leady at any 
moment to be cai'ried away by the latest craze. In 
this case we have educated and aristocratic i>eople 
making themselves I'idiculous in the eyes of their 
neighbours. They are a psychical study, and therefore 
the advice given in the British Monthly is worthy 
of careful consideration. It sajs: “If doctors of 
repute would attend the Wednesday evening testi¬ 
mony meetings, and talk privately with the men and 
women who describe these cures with such evident 
sincerity, they would be able to judge for themselves 
of the facts which at the present moment are so 
puzzling to inquirers. So long as the narratives 
remain unsifted, credulous and excitable people will, 
we fear, be more and more drawn into the ranks of 
the Christian Scientists.” Quite recently an 
American physician offered a cheque for £200 to 
anyone who would bring forward convincing evi¬ 
dence of a complete cure being effected of any bodily 
deformity by the methods referred to. The issue 
may be awaited with confidence, for there is not the 
slightest risk of the depletion of the bank balance of 
the medical man in question by his apparently sport¬ 
ing offer. We would here draw the attention of the 
editor of the British Weekly and the British Monthly 
to the objectionable advertisements in journab sup¬ 
posed to circulate among clergymen He there serves 
up as a literary bash from his own pen “ The fieli- 
gious Use of Memory,” with advertisements inviting 
readers to a free trial of galvanic belts, free trials of 
cui-es to all the ills to which human flesh is heir; 
the ‘‘ cure of consumption ” by E. W. Alabone, &c., 
which make most unsavoury and questionable read¬ 
ing. Such advertisements do much barm, and yet they 


Skpt. 4, 1901. 


NOTES ON CURRENT TOPICS. 


Thb Mbdicai. Pbus. 249 


(oatinne from week to week and month to month. Aa 
die editor profeases hia anxiety to know the truth 
of the ao>called " cnrea by Chriatian Scientiata he 
thoold give evidence of hia zeal by taking care that 
hii readers shall not be driven hither and thither by 
■0 many forma of rampant quackery. One at a 
tima shnold be enough for their mental balancs. 

Obesity and Politics. 

Accobdino to some lately publiahed statiatica 
the number of fat men counted in a firat-claaa 
hotel, out of a total of 100 was seventy. The 
statistician is not ao rude as to call these gentle¬ 
men fat or even to style them obese, be politely 
refers to them as men from the age of twenty 
upwards who showed an abnormal development 
in the abdominal region. It would further ap¬ 
pear that these well-covered gentlemen included in 
the 70 per cent, united imperialistic politics with 
their inclination to embonpoint. The medical 
journal giving these figures infers, somewhat 
severely, that imperialism is usually obese in type. 
In a hotel frequented by the upholders of demo¬ 
cratic principles the percentage of fat men was only 
eleren, and the conclusion drawn is that if de¬ 
mocracy and radical ideas are to be maintained, 
careful heed must be taken to prevent any 
ondue tendency to abdominal expansion. The 
energetic compiler of these statistics pursued hia 
observations in a residential quarter where the 
dwellers were well known to hold imperialistic views 
and the percentage of fat men was 35; in a radical 
Buburb, however, the percentage rates of obese per¬ 
sonages was 14. It has not been attempted before 
to maintain a connection between obesity and 
imperialism by means of statistics, which are 
notoriously fallacious, hut both among adults 
and children there Is certainly an increase in the 
number of persons corpulent to the degiee of 
deformity. It is generally supposed that luxurious 
and sedentary methods of life with over-indulgence 
in sleep and absence of mental occupation are among 
the recognised predisposing causes of obesity, and 
though it may be convenient to suggest the cult of 
imperialism as the cause, the true bearing of the 
figures cannot be overlooked that increased pros¬ 
perity generally means increased seif-indulgence 
with its attendant drawbacks. 

Surgical Interference in Appendicitis. 
The question of the surgical interference in cases 
of appendicitis is one which as yet can hardly be 
said to be satisfactorily settled either from the point 
of view of the physician or the surgeon. In the 
August number of the Edinburgh Medical Journal 
Ur. Walter Spencer helps materially towards its 
solution. Mr. Spencer classifies these cases clini¬ 
cally as follows: (1) Cmcal distension. In these 
cases the treatment is purely medical and the pro¬ 
gnosis good. (2^ Perityphlitis. This may yield to 
medical treatment, but if it produces adhesions they 
may necessitate surgical interference later. (3) 
Appendicitis proper, of which there are four varieties. 


(a) Acute perforation in which early operation 
affords the only chance of success, (h) Suppurative 
appendicitis in which extra-peritoneal draining of 
the abscess should he done as early as the diagnosis 
can be made, (e) Relapsing and recurring append! 
oitis, which must be distinguished by careful exami¬ 
nation after the attack, and if the signs of chronic 
appendicitis are found the appendix must be removed 
at once, (d) Chronic latent appendicitis with septic 
anmmia is the most difficult of all varieties to dia¬ 
gnose, and there is great danger that it will not be 
recognised till too late for useful surgical interfer¬ 
ence. 


Motoring versus Horse Exercise. 

The great Horse Show in Dublin last week at- 
which there was so brilliant a gathering both of 
feminine and equine beauty, recalls the medical 
mind to a contemplation of the physical effects, 
likely to compass future generations by the use or 
misuse of the vehicle which is to supersede the horse 
for locomotion and exercise. We believe that the 
old hygienic proverb “ the outside of a horse is the 
best medicine for the inside of man,” has been 
received within the canon. We may perhaps be 
permitted to add of our own personal inspiration 
I that a thoroughbred woman seated on a thorough¬ 
bred horse represents the highest standard 
of bumsn grace and dignity in physical exercise- 
With the growth and multiplication of the motor 
car one of the most telling factors in the production 
and maintenance of a perfect physique must neces¬ 
sarily dwindle more or less rapidly. Horse exercise 
will gradually become less immediately useful and 
less fashionable. The bicycle rider could say much 
in favour of his mode of progression, even although 
neither graceful nor dignified. Now we have the 
“ motor,” favoured by “ business-men ” because of 
its swiftness, and by snobs and parvenus because of 
its expensiveness. Its vibrations may recall to the 
memory of our readers the chair so ostentatiously 
used by the well-known French specialist in the 
treatment of some forma of nerve disorder, and the 
element of explosiveneas may bring up recoUectiona 
of the “earthquake treatment” of hysteria. That 
its discordant notes must modify the auditory 
and collateral centres is, we think, unquestion¬ 
able. Accordingly, we fully anticipate the 
development of new features—some of them of a 
decidedly pathological tint in the future generations 
of the votaries of the motor car. Of course further 
progressive modifications may tone down or remove 
some of those features of its construction and action 
which we now feel least disposed to admire. That 
there are too many horses on the streets of our large 
cities must have been strongly felt by any person who 
lived in London during the burning days of the past 
July. So that the multiplication of motor cars will 
at least tend to lessen one of our substantial metro¬ 
politan grievances. Its early defects may be rapidly 
outgrown, like those of other infancies, under judi¬ 
cious culture, so that there may. be hope for the 

oogle 


Diuiiized t;. 


250 Thk Msdicxl Pbbss. 


NOTES ON CUBBBNT TOPICS. 


SsFT. 4^ 1901. 


'f atare of the *' motor/' although we confesa, for the 
present, to a feeling of discomfort in that quarter. 


vent tjphoid infection from this method of washing 
the bowel for the purposes of investigation. 


The Certification of Lunatics. 

OuB readers will recollect a resolution passed bj 
the Belfast Board of Guardians on June 5th with 
Tegard to a change in the procedure at present 
.adopted in certifying lunatics, in which, among other 
points, it was suggested that the Poor-law medical 
•officer should be obliged to visit the supposed lunatic 
at his residence, and, fi'om the results of that visit, 
issne a certificate of lunacy if necessary. For this 
task, the medical officer was to receive the magnifi- 
•cent fee of five shillings. We suggested at the time 
that such a procedure was illegal, and that it was 
•doubtful if BO radical a change could be made, and 
we are glad to find that the Local Gk>vemment Board 
take the same view. It is unnecessary to dwell 
•on the absurdity of the fee, or c>n the almost in¬ 
superable difficulties which woiUd surround themedical 
•officer in the discharge of such a duty. The follow¬ 
ing is the reply of the Local Government Board:— 

The Local Government Board have had before 
them the resolution adopted by the Board of 
‘Guardians of Belfast Union on the 4th ult., respect¬ 
ing the procedure to be adopted in the removal of 
lunatics to the District Lunatic Asylum, and the 
'Board desire to state that they are advised that the 
proposed arrangement could not be carried out under 
lihe existing law, because there is no legal duty as to 
the examination and certifying of lunatics other than 
dangerous lunatics imposed upon dispensary medical 
officers, and no legal authority to pay the fee or 
-other expenses incurred out of the poor-rate. In 
these circumstances the Board regret that in the 
present state of the law they are unable to approve of 
the arrangement proposed by the guardians.” 

Post-mortem Rieka 

The increasing number of post-mortems that are 
now made both in this country and abroad is not 
unattended with certain serious risks, some of them 
■capable of being easily prevented, others unfortu¬ 
nately, however, offering greater difficulties. A 
•striking example of the latter type of danger 
is well shown in the account published by a 
Dr. Fuenrohr of his own attack of typhoid 
fever from infection to which he was exposed 
at a post-mortem on a case of enteric. The 
autopsy unquestionably was conducted with the 
most scrupulous attention to every precautionary 
-detail, but the facts nevertheless point undoubtedly 
to the truth of the assumption that the fever was 
imparted to Dr. Fuenrohr at the examination of the 
body. The only explanation of the way in which the 
infection was carried is that during the process of 
rinsing the intestine with water, which he, as usual, 
-effected by means of running water, small particles 
of virulent matter were splashed upon him. The 
possibility of this accident occurring is not suffi¬ 
ciently appreciated by those whose duty it is to con¬ 
duct autopsies, and means should be devised to pre¬ 


Disreputable Advertising in ** Reputable * 
Journals. 

Many of our home journals might with advantage 
copy the action which has been taken by the Phila¬ 
delphia Timet^ under its new management, and which 
can be gathered from the following resolutions 
recently passed by the Medico-Legal Society of that 
city:—" Wherea*, the advertising of abortionists and 
their drugs, as well as other disreputable secret 
medicines, has for years been a notorious disgrace to 
the newspaperdom of this city, an evil seemingly 
without redress, and, Whereat, the Philadelphia 
Timet under its new ownership has declared for a high 
ethical plane, avoiding all sensationalism, while at the 
same time furnishing ‘all the news that is fit to 
print,’ excluding all medical and other questionable 
advertisements so as to make it indeed a newspapmr 
fit for the family circle, therefore be it Betolved that 
the Medico-Legal Society of Philadelphia highly 
approves of the advanced stand taken by the Timet 
and urges upon the medical profession generally its 
active support in aiding to carry out that journal's 
elevated ideals.” There are papers in Great Britain 
also laying claim to the title "family ” which are a 
disgrace to journalism and an insult to moral 
standards by reason of the advertisements they admit 
into their columns. We fear it is too much to hope 
that they will take a lesson from the foregoing until 
compelled by law to do so. 


Pregnancy Following Myomectomy. 

Some years ago Dr. Alexander, of Liverpool, read 
a paper before the British Gyntecological Association 
on the removal of multiple myomata of the uterus by 
myomectomy through a single incision in the uterine 
wall. The operation was not received with any great 
favour at the time, as it was thought that the uterus 
after this proceeding would be so mutilated as to 
render its absence preferable to its presence. Ac¬ 
cordingly, it is interesting to find that in the Medical 
Record for August 17th Dr. James N. West, in a 
paper records a case in which he removed sixteen 
tumours, through nine incisions, from the uterus of 
a woman on March 16th, 1899. On January Sth* 
1901, he attended the same patient in her confine¬ 
ment, when she was delivered after a perfectly 
normal labour, lasting twelve hours, of a healthy 
boy weighing lbs. In spite of the extensive 
scars iu the utenis the expulsive force was ample, 
and the only complication was a lacerated perinsum. 
Dr. West gives an interesting analysis of the 
recorded cases of pregnancy following myomectomy. 


The Society of Apothecaries, London, announce 
that the Gillson Scholarship in Pathology, value £90, 
will be open for competition in January next. Com* 
X>etitors most hold the L.S.A., or obtain it within 
six months aftei gaining the scholarship. Further 
particulars can be obtained of tbe Secretary to the 

’ Google 


Examiners. 



Skpt. 4, 1901. 


COBRE8PONDENOB. 


Thi Msdical Pbbb8. 251 


The Doctor in Fiction. 

It is apparently almost impossible for the writer 
of fiction to tonoh upon medical subjects without 
falling into error, and an exceptionally glaring 
instance is afforded in Mr. Hall Caine’s novel, “ The 
Eternal City,” that has jnst been published. Chap* 
ter Vni. of the part of this work entitled ” The 
Boman of Borne” describes how a medical man 
examines the breast of a patient and the glands 
under her arms, and, finding cancer, announces that 
a nurse must be summoned immediately. On the next 
page this practitioner, who is supposed to be the 
mort costly and fashionable doctor in Borne, is made 
to tell the friends that if the cancer had been 
diagnosed earlier nephrectomy might have been pos- 
siMe, but that the case as he found it was beyond 
the reach of legitimate surgery. Hr. Hail Caine has 
ponrtrayed in an earlier novel an impossible 
hospital nurse, but tbe medical man he has pre¬ 
sented ns with in “ The Eternal City’’ is more im¬ 
possible still. 

Are Rontgen Baye Infallible? 

A irnHBEK of papers have been recently written 
concerning tbe fallacies and difficulties in tbe dia¬ 
gnosis of fractures by means of the Bbntgen rays. 
A case has recently come under our notice which 
iliustrates forcibly the difficulty in localising foreign 
bodies in the alimentary canal below tbe oesoph^^. 
A patient swallowed a deotal plate made of gold 
with two teeth attached. When admitted to hospital 
tbe plate had passed tbe cardiac orifice of the 
stomach. For three consecntive days an expert 
radiographer manipnlating the most up-to-date ap¬ 
paratus failed with either finoroscope or sensitive 
plate to demonstrate tbe presence of the denture, 
and this notwithstanding tbe fact that buttons, coins, 
and other objects could be distinctly seen through 
the whole thickness of the body. Tbe peristaltic 
movemen* s of the intestines would account for the 
failure in the case of the photographic plate, but it is 
difficult to understand how these movements would 
interfere with tbe view obtained by means of the 
screen. 

Inoculation in Enteric Fever. 

Those interested in the preventive treatment of 
enteric fever by inoculation are still looking forward 
to the results of tbe statistics on this snbject which 
may be derived from tbe Army Surgeons in South 
Africa. The figures given by Mr. Andrew Balfour, 
late Civil Medical Officer, South African Field 
Force, in his paper entitled A Ship of tbe Veldt,’’ 
in the current number of the Edinburgh Medical 
Journal, are of great interest. Tbe figures cover a 
period of five months, and si's as follows :— 



Admitted. 

Becovered. 

Died. 

Inoculated 

... 92 

89 

3 

Uninoculated 

..551 

.. 511 

40 

Died inoculatioix 



unknown 



17 


Percentage mortality of those inoculated, 3*25. 
„ „ of those not inoculated, 7'2. 


In all cases the diagnosis was confirmed by Widal’s 
reaction, and though the number of the cases is 
not sufficient to base any definite conclusions, still 
the results must be regarded as eminently 
satisfactory. 

We regret to learn that Dr. Alfred E. A. Lawrence, 
Professor of Midwifery and Diseases of WomeninUni- 
versity College, Bristol, died suddenly on the 30tb ult. 
while on holiday with his family at Bishop Steignton, 
Devon. He was supposed to be in good health when 
be left Clifton three weeks ago, and the news of his 
sudden death has been received with startling sur¬ 
prise and sincere regret in Clifton. 

At the meeting of tbe British Association for the 
Advancement of Science, to be opened at Glasgow on 
September lltb, Major Bonald Boss, I.M.8., will read 
a paper on “ Tropical Parasitology.” 

Me. Teevob N. Smith, J.P., F.B.C.S.L, has been 
appointed Assistant Master of tbe Coombe Hospital, 
Dublin. 


Corrteqionbmt. 


tWedo not bold oozMlTMiespoaalble for tbe opinions of our 
oorrespondents.] 

VERATBUM VIBIOE IN PUEBPEBAL 
ECLAMPSIA. 

To the Editor of The Medicax Pbess and Cibculab. 

Sib,— Tour annotation on tbe value of veratrum 
viride shows the continued faith of American 
physioiaQS in one of tbe oldest remedies for puerperal 
eolampsia. It was tbe remedy of the ” medicine man ” 
from Manitoba to tbe Gulf of Meiico, and its use by tbe 
Indians introdnoed it to tbe first settlers in the Colonies. 
As far back as 1849 Dr. Poroher pnblish^ an 
aooonnt of its tberapentic properties, and soon 
' afterwards Dr. Norwood, of South Carolina, pub¬ 
lished in the CharUtion Medical Journal his fcrmnla 
for the tinotnre, which there is known by bis name, and 
has been freely used throughout the United S’ates. He 
recommended it to be given in '’six to eight drop doses, 
repeated cantionsly.” I fear the dos^e yon mention, 
** fifteen to sixty minima of N orwood’s tinctare ” every 
fifteen minutes, could not be taken, for each a doee would 
act as a powerful emetic and produce toxio symptoms of 
an alarming character. 

Indeed, Norwood’s tincture is so strong that it has 
been latterly displaced by one not half the strength. 
The Am. J. Pharmacol, N.S., iv.,p.89, iiave a formula for 
a tincture so weak that tbe ordinary dose was thirty 
minims. 

The fullest account of tbe therapeutics of the ding is 
B. C. Wood’s: "A contribution to tbe knowledge of 
the physiological action of tbe alkaloids, viridia, vera- 
troida, and of the resin of veratrum viride,” published 
in 1870, as a reprint from the Am. J. Med. Se. He 
conclndes that ” Veratmm viride slows the pulse by a 
direct depressant action on the heart musole. and by 
stimnlating the pneumogastrlc mrves; it lowers blood 
pressure by action on the heart muscle and by depres¬ 
sion of the vasomotor centre.” 

The more recent investigations by Dr. C. Briz are 
eren less favourable to the drug. 

Of its action on the heart he writesAt first there 
is a oontinuous stimulation and increase in tbe pulse- 
rate and in tbe blood-pressure. The duration of the 
contraction then becomes longer and longer, tbe rate 
being diminished to one-balf owing to the duration of 
the systole. All parts of tbe heart finally become in¬ 
sensitive, even though it still contracts occasionally, 
atropine now prodnoes no effect. The poise-rate and 


252 Thx Mbdioxl Prisb. 


LITERATURE, 


Sift. 4. 1901. 


blood-precenoe gradu&lly become less and less, and if 
artificial respiration has been maintained, deatii takes 
plaoe from paralysis of the heart.” 

Yeratrine, which Ueisner disoorered in the seeds of 
cevadilla in 1819, and in hia description of it in 1821 
was the first to use the word “alkaloid,” is not fonnd in 
the rhizome of either veratmm riride or reratrum album. 
The product obtained by M M. Pelletier and Casenton. 
in 1819, in the root of ventmm a<bnm, was a mixture of 
jeniue discovered by Bemon in 1837, and veratroidine 
di>coTered by Bullock in 1866. 

The last namfd alkaloid slows the pulse by stimnlat* 
isg the pnenmogastric centres, and finaUy quickens it 
if given in very large doses by paralysing the peri* 
pheral vc^. In toxic dcses it causes purging and 
vomiting. 

Jervin according to Hare, causes great slowness of 
movement, relaxa^on of the muscles, through which 
thrills continually run, and finally the animal faUs to 
the ground. Violent epileptiform convulsions may now 
ensue, but no tetanus is present. The convulsions now 
give plaoe to paralysis, and are characterised by their 
lack of force. Sensation is not affected until the near 
approach of deaU brings on anesthesia. 

The convulsions are due to the disturbance of the 
circulation at the base of the brain (Wood), and the 
spinal cord is directly depressed by the effect of the 
jervin on its motor tnmts. 

The tincture of the rhixome of the plant is the 
preparation generally used. In some parts of the Con¬ 
tinent Norwowl’s tincture is the favourite, and bis 
writings are favourably quoted by Dr. Gaetano Mala- 
cudd in bis “ Manuale de Materia Medics,” 1896. The 
drug is also recommended by Dr. Larea z Cerezo in his 
** Diocionaris de Medicina,” 1894. In Germany it is well 
spoken of in the writings of Eocher, 1866, Liebmeister, 
1876, and F6gaitar {Ar^.f. Klin. Med.), 1869. Beferenoe 
to its anti-pyrezial properties are frequent in French 
medical literature. Trousseau's recommendation of the 
veratmm album needs no repeating. I may just add 
that the chemical composition, veratrum viride, is closely 
analogous to that of veratrum album, and the specific 
distinctness of the American veratmm viride from the 
European veratrum album is very doubtful. Certain 
Alpine forms of the veratmm album are saud to exactly 
resemble the veratmm viride. 

I am. Sir, yours truly, 

F.E.C.S. 


©bituarg. 


DE. H. C. BUCKLEY (KENSINGTON). 

Db. HxNar Cbild Bocklit, whose death from heart 
failure hap tsAen place, at the age of 67, at his residence. 
Linden Gardens, Kensington, was the son of Mr. James 
Buckley, of Fenyfai, Llanelly, at one time high sheriff 
of the county. After going through his curriculum at 
St. George's Hospital, London, he obtained the L.S.A. 
and M B.C.6., and subsequently be took the M.D. of 
Aberdeen University in 1868, and commenced practice 
in his native town of Llanelly, and was appointed 
medical officer of health, which position he held for 
many years. Fossessed of ample means, he retired from 
practice in 1890 and left Llanelly to reside in London. 
On several occasions Dr. Buckley was asked to stand as 
a candidate for the Parliamentary representation of the 
Eastern Division of the county, and also for the 
Carmarthen Boroughs, but this honour, however, be 
firmly declined. 




LAWEIE ON CHLOEOFOEM. (o) 

It seems paradoxical that anesthetics should excite 
passion and stir up strife. But from the first it was so. 
Edgeworth, Southey, Coleridge, Darya, and Beddoes had 

(a) “Chloroform; a Manual for Students and Practitioners.'' 
By Edwa-d Lawrie, H.B Kdin., M.B C H.Rnv.,Lieutenant-Colonel 
Bepidency Knreeon Hyderabad, Pcioclpol of the Hyderabad 
Medical School. London: 0. and A, Chutchill. 1901. 


just tested the properties of nitrous oxide gas, and 
Count Enmford was securing Davya' services to popu- 
Imise it and ol^er chemical discoveries, when Mitchell 
uttered his warning that nitrons oxide was a lethal 
agent and should be banished from the laboratory and 
the lecture room. 

A whole library of books tell of all the heart-bnmioga 
that followed on Crawford W. Long's introduction of 
ether as a general anssthetio, even Simpson's introduc¬ 
tion of chloroform called forth the Wudie and otiier 
oontroveniefl. 

But worst of all came the heated dieoussions that 
followed each attempt to learn the physiological 
action of the different anesthetic agents. The inter¬ 
pretation of each fact was disputed with a warmth of 
feeling and a lack of courtesy quite out of plaoe in oon- 
sidering a scientific question, and such as we associate 
with rmigions controversy alone. 

Dr. liawrie’s book keeps clear of controversy, though 
he finds it neoessary in the introduotion to recount the 
oiroumstanoes that led to his series of cross-circulation 
experiments, and to print Dr. W. H. Gaskell's letter 
telling why Dr. Oaskell and Dr. Shore's experiments 
failed; the ligature which Shore tied at the time of 
eetab’ishing the orose-ciroulation “ was not tight, so that 
the injection was able to pass both into the vertebral 
and into the arm on that side.” 

The book is divided into five parts and an appendix; 
in the first part the author considers the physiological 
action of chloroform; in the second he deals with the 
application of the physiology of chloroform to praotioe ; 
in the third he considers how to give chloroform; in the 
fourth be gives his clinical observations; in the fifth he 
details a few original experiments made in Hyderabad 
to illustrate the points in the physiological and clinical 
portions of the work. 

The book to the student of medicine—and every 
member of the profeision worthy of the uame is a student- 
of medicine—is worthy of attention and oarefnl read¬ 
ing. It is the outcome of years of study by one who 
possesses the intuition of Clande Bernard as an experi¬ 
mentalist, the dexterity in carrying them ont and the 
capacity of making them intelligible of a Hunter. We 
have h^ many books on this subject—books that told 
of the industry of the compilers, and were creditable as 
, evid^oes of the author's familiaritynvitb the literature of 
: the subject, narrativee of long and fruitless physio'ogioal 
experimentolon frogs, amoeba, dead tissue, and so forth— 
labors as nseleos for scientific purpo.^ee as those of the 
philoBOpbers of Lapnta. We have read of instances of 
ansestbesia in many varying compounds that might one 
and all have been made by any druggist’s assistant, and 
we have books made up of such olla podrida occnpyiog our 
shelves. They reflect no credit on British medioine; they 
in no way advance science; they contribute notfaing^ 
to our s^k of knowledge. 

Standing apart from these, different with the differ¬ 
ence bom of genius and originality, are the works of 
Snow and Lawrie. Their works are as a bright light in 
a dark plaoe, they make clear the path, they point out 
the safe road that scientifio knowledge has traced for 
the guidance of all who desire to follow. Since Snow’s 
book appeared no such valuable book on anscsthetics has 
been published as Dr. Lawrie’s. 


FAKES’ HYGIENE, (o) 

This book is the most complete laboratory guide to 
public health work hitherto published. Its author has 
gained the uecessary experience for teaching purposes 
as bacteriologist aod demonstrator of sanitary science 
at Guy’s Hospital. His aim has been to treat the 
whole of the practical work required for a public 
health diploma. He has divided his subject into 
five sections, namely, bacteriology, microscopy, che¬ 
mistry, physics, and vital statistics. Under bac¬ 
teriology is given a concise description of the more 
important bacteria and the method of their exa¬ 
mination. The section of microscopy is particularly 

(o) “ The Science of Hygiene." By Walter C. C. Pakee, D.P.H., 
F.C.S., Bacterioloirlst and Demonstrator of Sanitary ^ience, Qny’e 
Hospital, &o. LondODi Hethuenand Co. 1900, PricelSe. 

C 



8»n. 4^ 1901. 


MEDICAL KEWS. 


Tbc Mcdical PasBB 253 


fa]I and will he foond of special ralue to the student 
vho is preparing for examination. There are namerons 
illnstTatiODS which add materially to the nsefnlness of 
a book of tbis kind, which is presumably intended to 
be at the worker’s side in the laboratory. The plan 
adopted by the anthor is systematic and clear. In deal* 
iog with the (diemical analyses of albuminoid ammonia, 
for instance, he first describes the process in a series 
of pithy sentences, to which he appends an “ explana¬ 
tion,” giving the rationale of the proceeding. Short 
notes are aoded dealing with points of importance. In 
most oases examples are given of problems that 
bare been actually worked out in the laboratory, so that 
the student is able to follow the practical application of 
hie knowledge. In reviewing this book one recognises 
the great development that public health has experienced 
dnrng recent years. While it is most essential that 
earnest scientific workers such as Dr. Fakes should 
undertake high standard researches, it is evident that 
they are somewhat outside the field of labour of the 
average medical ofiScer of health. All who have to 
encounter high standard examinations, or who wish to 
have a trustworthy book at hand, either to guide their 
work in the laboratory or to use as a book of reference, 
may with confidence be advised to buy forthwith Dr. 
Fakes’ excellent volume. 


BAKS’S DISEASES OF THE EAR. (a) 

Tex fact that this excellent manual has already 
passed through two editions, and has now entered on 
its third, testifies to the worth of the book. 

Dr. lays down in the preface that his aim is to 
prreent the main facts of otology in such a form as to 
meet the wants of medical students and practitioners.” 
This end is quite achieved. ’Without giving too many 
details he has contrived to present a picture of otology 
which should be of great mnefit to advanced students 
and practitioners of medicine. 

The first six chapters are devoted to a general survey 
of the symptomatology, methods of treatment, Ac., of 
ear diseases and those of the nose and throat which may 
be in relation to them. The remaining chapters describe 
more in detail the various subdivisions of aural 
disease. The chapter on the “Treatment of Intra- 
craoial and Vascular Complications of Purulent Disease 
of the Middle Ear” is especially deserving of praise, the 
iOostratioDB being particularly good. 

Special chapters are allotted to “ Tinnitus Aurium ” 
and‘'Deaf-mutism,” in the latter of which the author 
ftates, with truth, that instruction by lip-reading to 
adults who have become totally deaf after childhood, 
and can make out but little of what is said to them is 
not sufficiently taken advantage of. 

The method shown at page 18 as being PoHtzer’s way 
of inflating the middle ear was not in general use in his 
Clinic in 1899. As the book is more particularly written 
for students and general practitioners the addition of a 
fuU page diagram of the normal membrana tympani 
might Im of advantage. 

A very usefnl appendix gives a list of formula recom¬ 
mended in the body of the book, and a fall bibliography 
and in^x complete it. 


(Iftcbicai ^ctDB. 


Dublin Sanitary Assoolatlon. 

At a meeting of the Dublin Sanitarv Association, held 
on August 29th, the following resolution was unani- 
monely adopted:—“That the Conncil of the Dahlia 
flanitary Association view with ccncem the great preva¬ 
lence and fatality of diarrhceal diseases among very 
young ohildxeu in Dublin at present, and urge npon the 
parents of children resident in tenement honses the 
necessity for great care in the preparation of the food 


(a) *' Kanual of DiMsiw of the Ear, inoludiiur those of the Nose 
ud Throat in relation to the Ear, for the Uee of Students and 
Practitioners of Medicine.” By Thomas Barr, M.D. Third 
Edition reviacd, partially rewritt^ Glasgow: James Maolehoee 
and Sons. 1901. Pp. xrilL and 4SV. Dlnstrationa 2%. 


ir>te'>ded for young children. The Cou’ cil advise those 
parents to apply to the Public Health Office, Cork Hill, 
or at one of the city diapeusaries for information as to 
the preparation and keeping of infants’ food.” The 
Council then adjourned. 


Vital BtatisUca 


Thx deaths registered in the week ending August 
24th in 36 lai^e towns of Oreat Britain and Ireland corre¬ 
sponded to an annual rate of 21'd per 1,000 of their 
aggregate population, which is estimated at 11.463,028 
persons in the middle of this year :— 

Birkenhead 26, Birmingham 27, Blackburn 23, Bolton 
20, Bradford 19, Brighton IM, Bristol 14, Bumley 17, Car¬ 
diff 14, Croydon 16, Derby 18, Dublin 24. Edinburgh 17, 
Glasgow 18, Gateshead 30, Halifax 17, Huddersfield 14, 
Hull 27, Le^s 24, Leicester 24, Liverpool ^2, London 19, 
Manchester 26, Newcastle-on-Tyne 28, Norwich 21, 
Nottingham 23, Oldham 26, Plymouth 18, Portsmouth 21, 
Preston 21, Salford 27, Sheffield 26, Sunderland 29, 
Swansea 27, West Ham 22, Wolverhampton 21. The 
highest annual death-rates per 1,000 living, as measured 
by last week’s mortality, were:—From measles, 1*9 in 
Birkenhead, and 2'5 in West Ham j from scarlet fever 
IT in Wolverhampton and 1*2 in Blackburn; from 
whooping-oongh, 1*7 in Swansea; and from diarrhosal 
dieea^, 8*7 in Nottingham, 8*8 in Birmiu/ham, 9*3 in 
Sheffield, 9 7 in Newcastle-on-Tyne, 10*1 in Salford, 104 
in Manchester, 10*8 in Hull, 11*0 in Sonderland, and 14*6 
in Gateshead. In none of the large towns did the 
death-rate from “fever” reach 1*0 per 1,000. The 68 
de«thB from diphtheria ioclnded 27 in London, 6 in 
Leioester, and 4 in Salford. No (^th from so^-pox 
was registered in any part of the United Kingdom. 

The Mortality in Foreign Cities. 

Thk following are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several of 
the populations:—Calcutta 51, Bombay 50, Madras 47, 
Paris 16, Bnusels 14, Amsterdam 14, Copenhagen 26, 
Stockholm 18, Christiama 22, St. Petersburg 23, Moscow 
33, Berlin 24, Hambni^ 26, Breslan 86, Mnnich 20, 
Vienna 17, Prague 21, Bnda-Pesth 16, Romo 20, 
Venice 20, Philadelphia 19. 

The Chemists’ and Druggists' Exhibition. 

Fob the last seven years an annual Exhibition of 
Mann'aotnring Cbemiste and Druggists has been 
oi^anised by the proprietors of our contemporary, the 
British and Colonial Dmgjist, that for the present year 
being held at the London Opera House daring last week, 
and, judging by the number of exhibitors, it is evidently 
appreciated by a large section of the wholesale trade. 
Although exhibitions as a whole have been considerably 
overdone, and one is moreover very much like another, 
a good deal may be said in favour of a gathering of this 
nature, whereat manufacturers and importers bring 
their goods together under one roof and invite the 
retail chemists to come and inspect; the two branches 
are thus brought into personal contact, one might hope 
with mutual advantage. Few of the large houses were, 
however, represented on the present occasion, and one 
missed such well-known firms as Allen and Ha bury’s, 
Burroughs and Wellcome, Martindale’s, Southall’s, 
Savory and Moore, Squire's, etc. The limited capacity 
of the building may, however, be in some measure 
accountable for this apparent want of interest. American 
houses were fully represented, Messrs. Parke Davis, 
the Merrell Chemioil Co., Messrs. Warner and Co., 
Mnesrs. Stiles and Son, and the Abbey Effervescent 
Salt Co., Ac., having large shows. Sponges, perfnmery, 
soaps, and disinfectants were strongly in evidence, 
whilst cnre-adls and pick-me-ups were to be bad for the 
asking. Of the more serious British exhibits those of 
Messrs. Newbery and Sons, Tbos. Christy and Co., 
Price’s Patent Candle Co., Vinolia, Limit^ Messrs. 
St. Dalmas and Co., Messrs. Wyleys of Coventry, the 
Somatoee Co., the Sanitas Co., Bovril and Virol, 
Limited, and Messrs. Ingram and Boyle may be men¬ 
tioned as excellent representatives of home products, 
whilst the lighter portion of the programme was filled 
by an up-to-ute lakes’ orchestra. r") 



264 Thi Midical Paiss. NOtlOBS TO CORRESPONDENTS. 


8»rr. 4, 1901. 


4 ^ 0 tiCt 0 to 

(ttorrcjB^JOTtbentB, ^hoxi f etttra, Ac. 


19* COKMsrovoms raqoiriag • reply in thie oolamn ere per 
tienlwlj reqoeeted to nuke oae of a diftincttoa (ipnaCure or 
{alttaif, and avoid the pmotice of aiding tbemaelrea ** Reader,” 
'* Snbooriber,*’ **OId Bubeeriber,'’ do. Mnoh oonfoaion will be 
spared by attention to this role. 

BBPBiKTa.-~Beprinta of articles appearini; in this joomjil can be 
had at aredaoel rate, proridin; author* ^ive notice to the pub¬ 
lisher or printer before the type has baeu distributed. This should 
be done whenretamiovcorreeted proofs. 

OuoiHAi. Abticleb or Lbttbbs intended for publication should 
be written on one side of the paper only, and most be authenticated 
with the name and addieea of the writer, not neceeearily for publica¬ 
tion, but as evidence of identity. 

SUOaEBTED COLLECTIONS FOB MEDICAL 
BENEVOLENT FUNDS. 

To the Editor of Tsa Medical Press amp Circdlab. 

Sib,—O n or about St. Luke's Da^ the members of the Guild 
of 8t. Luke hold their aoDual meeting, and have an anniversary 
oervice at St. Paul's GatbedraL I be^ to surest that a slmilu' 
service be held in every town in the kinjrdom on that day or the 
following Sunday, and that a collection be taken at each, which 
one-fifth be ^ven to the British Medical Beoevolent Fund, one- 
^th to theB.M. B. College. Epeom, one-fifth to the Society for the 
Relief of Widows and Orphans of Medical Men, one-fifth to the 
Lancashire Belief Fund, and one-fifth to church expenees. Ac. 
These most cleserving charities would benefit greatly by these 
coUections. St. Luke’s Day, Oct. 18th, will thi* year fall on a 
Friday, 

I am, Sir, yours truly, 

Bobacb E. Havksb. 

OuB Pabis Cobrespompsmt.— Translation of the Clinical L ctnra 
on '* Vomiting in Pregnancy'' waa delayed in post, but has now 
oome to hand. 

Dr.Ht O’Haba (Melbourne).—Your interesting ease of “Tota* 
Gastrectomy for Carcinoma of Stomach " has been leceived, and 
will appear in an early number. 

Db. w. W. - It is hardly worth while calling attention to the 
matter nnless correspondence should result. The explanation is 
obvious, we imagine 

Patbetamilub The Beotchand Irish schools open somewhat 
later than those in England. You will fin i fees and relative cost of 
earriculum in our " Educational Nnmbsr,” to ho publishei next 
week. 

PBOF. BOBIN ON THE TREATMENT OF CANCEB OF THE 
STOMiCH. 

A coBBispOMDEMT having read the ” Paris Clinical Lecture" on 
tbia subject in our issue of August 2Ut, and having much interest 
therein, wrote us that it woe of extreme importanoe, but that there 
appeared to be a little discreiiancy in the dosage. We thereupon 
raerred the letter to our Paris correspondent who famished the 
lecture, snd append bis reply, as it may be of interat to other 
readers also. He says 

” There were evidently some slight errors, which may have been 
my fault in rapid translation or that of the printer. In any case, 

I proceed to correct them as follows, giving tne exact copy of Prof. 
Bobln’s formuls 

Persulfate de soude ... 1 gramme. 

Eau .150 

Une o. B cafe avant leu deux principaux repas. 

Mela vanadate de soude ... O'Odceniigr. 

Eau .150 

Une c. a cafd avint les deox principaux repas. 

Your correspopdent can convert these figures himself, remember¬ 
ing that 

One centigramme equals 0'15432 grains. 

One gramme equals 15 432 grains. 

One ounce equals 28 3495 grammes. 

I am always very particular about formula, but it would be in¬ 
vidious to state fiactions of ounces and grains. For instance, one 
grain ought to represent five centigrammes, while in reality it is 
seven oentignmmes. Ounces, drachms, scruples, Ac., constitute 
an anachronism to-day. The French metric system ought to bs 
adopted everywhere. It is much easier." 


Emimsom, L, L F.P.8.Qlasg., L.S.A., District Medical Officer of 
Costord Union. 

Fobbss, N. Hat, F.B.S.Edin., J.P., Honorary Consulting Surgeon 
to the Blsck Bock Convalescent Hospital, and Consulting Bur¬ 
geon to the Bother Valley Railway Oompany. 

Lairo, C. F., M.B., C.M.Qlasg., Mescal Superintendent to the 
Somerset and Bath Asylum. 

Miles. U. P., M.B.C.S. L.B.C.P.Lond., District Medical Officer of 
Klngabridge Union. 


l&candeB. 

British Medical TemMtance Association.—AnUtant Secretary. 
Must be a qualified^motilioner, a total abstainer, and able to 
speak in public. Mlary £150 per aunum, with lecture fees 
and board ano residence. Applications to the hon. sec., 
Bidge, Carlton House, Enfield. (Seeadvt.) 


Birmingham and Midland Ear and Throat Hospital, 109, Edmund 
Street, Birmineham.—Hotue Surgeon. Suary at rate of £40 
per annum for first six months, and if re-appoint^ at rate of 
£60 per annum, with board, lodging, and waebing. 

Cheshire Couctv Asylum, Parkside, Macclesfield.—Junior Assistant 
Medical Officer, unmarried. Salary £130, rising to £150 per 
aannm, with board, apartments, wasbiog, sad attendance. 

City of Nottingbam Workhouse lofirmarr.—Assistant Medlesd 
Officer. Salary £160 per annum, with furnished rooms, 

Cornwall County Asylum, Bodmin.—Junior Assistant Medical 
Officer, unmarried. Salary £120, rising to £150, with board, 
furnished apartments, Ac. 

Conntv Asylum, Lancaster.—Assistant Medical Officer, nntnamed. 
Ssdary £150, increasing to £200, with apartments, board, wash¬ 
ing, and attendance. 

East Biding of Yorkshire.—Coun^ Medical Officerof Health. Salary 
at rsteof £100 per annum, riling to £500 per annum, with allow¬ 
ances. (See advt.) 

Glamorgan County Asylum. Bridgend.—Assistant Medical Officer, 
unmarried. Sdary £175, with beard, lodging, attendince, and 
laundry. 

Glasgow University.—Additional Examinenhip in Medicine and 
Spence. Annual emolument £30, Duties to commence in 
January, 1902. (Seeadvt,) 

Great Northern Central Hospital, London. - Var-tucies for Honae 
Physician. Salary £60 per annum; Junior Bouse Physician, 
Salary £30. Bomra, residence, and washieg provided in each 
case. Also Junior House Surgeon, Salary £30, with board, 
residence, snd washing; and a non-resident Assistant Honae 
SnrgeOD, with Salary at rate of £30 per annum, and imitla) 
board. Full partioulars of these vacancies will be found in our 
advertisement columns. 

Easr-el-Ainy Hospital and School of Medicine, Cairo, Egypt.— 
Physician to the Hospital and Professor of Clioical Medicine 
at the School. Salary £E320 per annnm and private practice 
allowed. 

Manchester Children’s Hospital.—Junior Resident Medical Officer, 
unmarried, for six months, and eligible for election as Senior 
foranothersix months SaU'y at rate of £80 a year when 
Junior, and £100 a rear aa Senior, with board and lodging. 

North Walea Countiea Lunatic Asylnm, Denbigh —Second Assist¬ 
ant Medical Officer. Salary £120 per annum, rising to £16(K 
with board, rertdence, and washing 

Owens College, Manchester. Junior Demonstrator in Physiology. 
Salary £100, rising to £160 per annnm. 

Boyal South Hants and Southai^tun Hospital.—Junior House 
Surgeon for first six months, ^ary at rate of £50 per annum, 
with rooms hoai^, and wssbing. 

SalfordBo^ Hospital.—House Surgeon, salary, £100 per annum: 
House Physician, salary £80 per annum; and Junior Honae 
Snigeon, s^ary £70 per annum, with board and residence In 
each case 

Svransea Union Workhouse.-Assistant Medical Officer. Salary 
£200 per annum. 


Boxall.— On August 26th. at PortlandPlaoe, London, W., the wife 
of Robert Boxall, M.D.Cantab., of a daimhtor. 

QiLLXBPiE. - On Angust Slst, at 12, Walker Street. Edinburgh, the 
wife of A. Lockhart Gillespie, M.D., F.B.C.P. B., of a dauvhter 
JoscELTMB.—On August 26tb, at The Bom*atead, Southwiek, 
Sussex, the wife of E. W. Josoelyne, M.B.I>urh., of a son. 
Mattbkws.— On August 27tb at Holly Lodge. Crawley, the wife of 
Sidney Matthews, M.B.C.S.Ed 2 ., L B.C.P.Lond., of a sou. 
WisLD,—On August 29th. at Wickham Terrace, Brisbane Queens¬ 
land, the wife of David Wield, M.D., of a daughter. (By cable.) 


JIarrtageB. 

GoTCH—M ettalpe.— On August 27tb, at St. Micbsel's Church. 
Sutton, Wansford, Nortbants, John Outoh M.D.Cantab., oi 
Ipswich, eldest son of tbe late John James Outeb, of Holnte 
Lodge, York, to Dorothy Emily, second daughter of tbe late 
Fnmk Metcalfe, of Mote Bouse, Wisbech, and of Mis. A. Met¬ 
calfe. Manor House, Sutton. 

Niwsohe—Gibbs.— OnAugust 22Dd, at St. Stephen's Church. Bed- 
diteh, Herbeit Newsome, M B., B.S.Durh., late B.N.. to 
Christine Margnerite, yonugeat daughter of William Oibhs, 
Evq.. Crosslea, Redditeb. 

SuLLiVAM— Ddscam.— On August 27th, at 3t. Katharine's Church, 
Bow, P. Sullivan, L.B.C.P., L.E.C.8., Ac., of Campbell Road, 
Bow, to Janet Rlantberne. younger daughter of Cap ain Robert 
Duncan, of the B.M.8. Kinfavne CatUe, and of Forest Gats. 


Staths. 

BrcKLBT.—On August 26tb, at Linden Gardens, Kensington, Henry 
Child Buckley. M.B., M.S.Aberd., J.P.. ag^ 57years. 

COLTABT. On August 29ib. at tbe Grange, Buthin, Wales, Charles 
H. B Coltart, eldest son of William Coltart, i,.&C.PH 
M.B.C.S., of Epsom, aged 30 years. 

KxLLT.—Suddenly, on August 18th, Adam Lawson Kelly, M.D., 
F.F.P.8.GUS.. aged 66 years, of 26, Blythswood-square, 
Glasgow. 

Lawbekce.— On August 30th, suddenly, whilst on a holidv u> 
Devonshire, Alfred E. Austin Lawrence, M. D. Aberd.,M.D..(^M., 
of Clifton, Pr^eeaor of Midwifery and Disease* of Women In 
University CoU^e, Bristol. 

Livbtt. On August 2lBt (the 87tli anniversary of hm birth), at 
Wells, Somerset, Henry William Livett, MD , L.B.C.P.Edin. 

TOKs—On August 26th, at 39, Drayton Gardens, South Kensiiig- 
ton, verv xudienly, John Henry Tuke, M.B.G.S., L.6.A-, for¬ 
merly of Week S. Mary, Stratton, CornwaU. 

t 




'tm and 


Ctmtiat 


“SALUS POPUU 8UPEBMA LEX.” 


VoL. CXXIII. WEDNESDAY, SEPTEMBER 11, 1901. No. 11. 


EDUCATIONAL NUMBER, 1901—1902. 


INTRODUCTORY REMARKS. 

In the present nomber will be foond a synopsis of the 
infomiation likely to be nsefol to those who intend to 
eater upon the study of medidne.and toserreasagnide 
to parents and guardians upon whom devolTee the 
rsaponsibility of selecting, not only a partioolar school, 
batalsoaplanofoampaigD in general. Thededsion must 
neoessarily be lately influenced by the student^s means* 
bf his aptitude for study, and by indiridual oironm- 
etanoes, in so far as they b^ on his future career. It is 
ootalways possible to determine at that early stage what 
particular line of practice is to be aimed at. The great 
thing to compass is a thorough knowledge of the sob* 
jecta which form the basis of medical education, leaving 
it to oironmstanoes to settle the question whether 
general practice or some more specialised department is 
to be followed. 

One point, however, must be settled at the very out* 
set, under penal^ of losing much valuable time, viz., 
whether the student is to content tiimaalf with an ordi¬ 
nary license to practise medicine or whether he will aim 
at university graduation. As years pass by students 
display more marked appreciation of the advantages 
which the poassesion of a university degree unquestion¬ 
ably offers, but there will always remain a large pro¬ 
portion who are oorutrained to be satisfied with a mere 
hoense I 7 reason of a oomparatirely low standard of 
prdiminaiy education or because, for pecuniary reasons, 
they desire to obtain the right to practise at the SMliest 
posnble moment. Having msKle up his mind which 
oratse he will pursue the next step is 

Thi Choicb of a School. 

The difference in the amount of the fees exacted by 
the various medical schools is hardly such as to make 
the choice of a school a matter to be decided merely by 
lefsrmon thereto. In many instances the choice will be 
determined by heredity, 10 to speak, that is to say, by 
the fact that the student’s father or friends has or 
hive been previously associated with a particular school. 
A. more judicious choice may be made by considering 
the neo-student’s intellectual calibre. In a large school 
he will be subjected to more severe oompetitioD, but, as 
a set-off to this, the prisee are more valuable, and the 
aaperienoe gained in certain respects more oompreben- 
nve. Moreover, he is brought into contact with a 
larger nomber of those who have attained eminence in 
their profession, and he makee a larger number of ao 
qaainta no es-as fellow students. In the smaller schools, 
on the other hand, he comes into far more intimate 
<^taot witii his teachers, who oonseqnently take a 
^cer intereet in his subsequent career. The chances 


of obtaining resident appointments at the close of his stu¬ 
dent career are greater than in the la^r sobools where 
the 00 m petition for snch posts is very sharp, and as dreeser 
and clerk his opportunitiee for obtaining practical experi¬ 
ence are often greater than in the large schools where the 
number of students is out of proportion to the number 
of beds. We need not allude here to the possibility of 
gaining an entrance scholarship, of which there are 
nsnally several at moat medical schools, because the 
ezaminatioDB have already been held. 

Thb Cboich or a Qualification. 

While all qualifications nominally confer equal rights 
in regard to medical practice the selection is fraught with 
oonsequenose of exceeding gravity. The public, no 
doubt with some reason, accord special importance to a 
medical degree as compared with a mere license to 
practise, so that it is desirable, within the limits 
of the posable, for the student to aim at obtaining a 
degree. Apart from this, there are certain qualifica¬ 
tions which confer special privileges; for instanoe, no one 
can hold an appointment in any of the la^r hospitals 
without being a Member or Fellow of the Boyal CoU^;e 
of Physioians or Fellow of the Boyal College (rf Surgeons, 
This is a relic of byegone times, but it still holds good, 
and has to be borne in mind. The Membership oi the 
Bsyal College of Physicians is a trying ordeal, not so 
I much by reason of the high standard of knowledge r^ 
qnired as of its nneertainty. It is well not to enter the 
lists ontil some years have elapsed since qualifica¬ 
tion. The Fellowship of the College is conferred 
by a kind of “ selection by election,” and the 
selection is made on grounds often qnite foreign to 
professional attainments. The Fellowship of the Boyal 
College of Snrgeons, on the other hand, is obtained 
almost exclusively by ezaminatiou. All that is required 
is a high standard of knowledge, both theoretical 
and practical. Although the popooosion of the licence 
of the Apothecaries* Society as a single qualification is 
looked at askance, even in general practice, it is often 
useful in order to qnalify for a resident appointment 
pending the student’s snbsequentiy obtaining a d^ree. 
It must not be forgotten, moreover, that the nature of 
the qnalifioation i 8 >n all-powerful factor in competing 
for public appointments, to obtain which will be the miw 
of so many students when prepared to launch forth. 

Apart from the resident appointments in the general 
hospitals there are a large number of appointments 
available in special hospitals, where experience of a 
useful kind is to be obtained. These, it is tme, lack the 
social charms of residence in large hospitals where the 
esident offloers are numeroqs, but, on the other hand 


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262 TsB Midical Pbxw. 


ENGLAND—EDUCATION. 


Sbpt. 11, 1901. 


they present ftdTsntag'es which the others do not offer 
and which cannot fail to favourably influence the 
pisotitioner’s snbeeqnent career. We do not advise 
these appointments being taken immediately after 
qualification with the object of paving the way to taking 
up a specialty. It is an old maxim that no man should 
become a specialist until he has had some years eiperi* 
ence in general practice. 

Consultant rank is only to be obtained by long ser. 
vice and tedious waiting. Apart from the special 
qualifications which the consultant must possess he has 
to climb the ladder of promotion in competition with a 
crowd of rivals, and it will be many years before be can 
reach the point at which he may hope to reap the fruits 
of his labours. 

Tax Public Hbaltk Sbbvicx. 

Under existing circumstances the public health ser¬ 
vice offers plenty of scope for intelligence, tact, and 
activity. Those only are eligible for any important 
post in the service who are provided with a diploma in 
State Medicine. This diploma cannot be obtained for 
at least two years after qualification, and it entails a 
somewhat ardnous course of study, both theoretical and 
practical. These appointments, which are determined 
by election, are under the disadvantage of a oeitain in* 
security of tenure in that they are made for a term of 
years, usnally three. To men possessed of the requisite 
enei^ and eoientifio spirit the position of medical 
officer of health offers exceptional opportonitiei for 
carrying on scientific investigations, and sncoess 
^ this department may pave the way to an ap¬ 
pointment under the Local Oovemment Board, 
though this department of the service is by no 
means exclusively recruited from among medical offiaers 
of health. In addition to a fairly liberal salary these 
appointments carry the right to a pension after a cer¬ 
tain period of service. We would point out the advan¬ 
tage to all students of obtaining the special diploma in 
State Medicine. Not only is the knowledge thus ac¬ 
quired of extreme utility in practice, but it may prove of 
inestimable valne in later life under circumstances which 
cannot always be foreseen. Ono engaged in general 
practice the difficulties in the way of obtaining it are 
well nigh insuperable. 

Thx Sxbvicxs. 

Under the head of “The Services*’ we include the 
Army, tiie Navy, the Indian and the Colonial Services. 
For the time being these outlets foil to attract their 
quota of the newly-qualified, owing to circumstances 
into which we need not enter. No better evidence of 
this is needed than the fact that at the last competitive 
examination not a single candidate entered for either the 
Army or Navy. Students therefore will do well to hesi¬ 
tate before they decide on joining one or either of them. 
The quasi-impossihllity of filling the cadres will doubtless 
induce the Government to reconsider the terms and con¬ 
ditions under which candidates axe invited to compete, 
and then the Services may once again prove an attraction 
to many young medical men. The nomad existence which 
these posts ent^ is of itself a great drawback and to 
smne extent ttie routine work tends to unfit fit men for 
general practioe. These, however, are probably not the 
reasons which tend to create a innjudioe against the Ser¬ 
vices which indeed is based rather on the nnsatisfaotory 
nature of the position per m. 


The CouasB of Study. 

There is so much work to be got through in the 
present-day ourricnlnm that the student will find it- 
absolutely necessary to be methodical in his studies. 
He will have to plan out his day with attendance at 
lectures, practical work at dissection, laboratories, or in 
wards, and so many hours reading. At the same time 
he will fiud well to keep up regular exercise by walk¬ 
ing, cycling, cricket, tennis, towing, football, and other 
athletic games. Those who enter in the VFinter Sea- 
sion will devote most of their attention to anatomy 
and pbysioli^y, and it vrill be found greatly to their 
interest to have got rid of the preliminary scientific 
work—chemistry, physics, and biology—before entering 
the medical school. Anatomy and physiology form two 
of the most essential bases of study, and on the thorough¬ 
ness with which they are handled will depend much of 
the anocess of the student’s subsequent career. The 
importance of practical work in the dissecting-room qm* 
hardly be ov^-rated, and we are fain to endorse Uie 
protest which has been raised against the modem ten¬ 
dency to soamp aetoal dissection in favour of book work 
with text-books and atlases. The atndy of anatomy affords 
a valuable training to the mind, as v<«ll m fivnishing 
information that is of daily use in the practice of after 
life, to say nothing of the-manual skill and dexterity that 
is acquired by careful dissection. 

Tax Wabds.. 

After the student has passed the examination in 
anatomy and phjrsiology at the end of the second 
academical year his transfer to the wards of the hospitid 
will come as a pleasant (fiiange. That will he his first 
entrance into the arena where medical science is ever 
oarrying on the war against d is o as o and death. In the 
wards it will be his privilege step by step to- unravel the 
tangled threads of the history of each patient, and from 
the oarefnl ooUeotion and examination foots to arrive 
at the systematic conolnsion known as diagnosis, This 
period of a student’s life is big vrith possibiUtiee both 
for god and for evil. It is then that he will lay the 
fonndation of bis future grasp of the principles that lie 
at the root of his profession, a oompetmit knowledge of 
which can be gained only by oareful and oonscsen t ioas 
attention to 

GtXNICAL. WoaK. 

This may be called the coroer-stone ol medical educa¬ 
tion. In each patient brought under his notioe the 
student has the means of aoqairing piactioal knowledge, 
bnt the value of the opportunity depends abeoluMj on 
his ability and his willingness to observe. It may be 
said that all science is observation, and it is certainly 
tme that the chief end and aim of all cliuioal training 
is to teaoh the student how to observe. The difference 
between a trustworthy and an untrustworty practi¬ 
tioner lies mainly in the fact that the lOTiner has learnt 
how to test his obeervationa in sneu a way as to arrive 
at the truth. This faonlty is one that can be acquired 
by systematio training, which in its turn mainly con¬ 
sists in takii^ anaoourate and foithful record of clinical 
caees. The habit of oarefnl observation is one which 
becomes a secondnatare to the individual who has ance 
become its poseessoi. 

Thb Posx-mobvui Bomc. 

We would strongly advise every student to spend Ss 
much time as postible during the last three yean d bis 

Diuiiizeci'' 'OO^ C 



ENGL A K D—EDUCATION. 


Sspr. 11, 1901. 


Thb Mxdxoal Pbbss. 263 


studies in the post-mortem room. The post-mortem 
room is the natural oomplement of the clinical wards, it 
is often onljr in this room that the clinical problem 
is unrarelled, it is there that the student can see for 
himself the physical results of the processes of disease 
which he has been watching at the bedside. He learns 
too, as he can never learn in the dissecting room, to 
recognise the post mortem appearances of the varions 
viscera, and to distingnish between changes due to 
decomposition and those caused by the ravages of 
disease. The lack of this familiarity has over and over 
again led to errors of the gravest hind, errors which have 
had for effect to jeopardise the administration of justice 
and perchance to place innocent persons in the most 
serious predicaments. 

Pobt-Graddat* Instruction. 

The earnest student will soon recognise that his five 
years’ training do little more than to fit him to carry 
on the acquisition of knowledge under favourable condi¬ 
tions. Woe to the man who conceives that he has done 
all that is required of him when he has obtained the 
right to practise! The need for further opportunity 
for study, so generally felt of late years, has found ex¬ 
pression in the provision of multiple facilities for post¬ 
graduate study. At many of the larger hospitals 
post-graduate classes have been instituted for the 
benefit of practitioners who are desirona of remedying 
the lapens of medical edncstion, and in London an 
admirably organised institution—the Polydinio—is now 
in fall working order, and renders immense service to 
those who are fortunate mongh to be able to avail 
themselves of its advantages. We would urge upon 
practitioners the importance of belonging to some 
local medical society which has the advantage of 
bringing them into personal contact with their fellow 
practitioners, and of generalising the knowledge which 
each individnal practitioner has gleaned. 

Thi P&acticx of Mbdicini. 

To those possossod of the proper spirit and who are 
equipped with the requisite knowledge, the practice of 
medicine is not only the means of gaining a livelihood, 
it is also a congenial and interesting oocnpation. It 
brings a man into contact with all classes of society on 
terms of qnasi^qoality, and affords unlimited scope for 
the cnltivation of the noblest qualities of humanity. 
The duty of the practitioner is two-fold—he has a duty 
to toe public and a duty to his profession. His 
attitude towards his fellow practitioners should be 
chaiaoterised by the oonrteonsnees dne to a labonrer in 
the field, and he should studionsly avoid all 
poesible sources of friction. It is an immAnga advantage 
to be personally acquainted with one’s fellow praoti- 
tioners in the district, for, as it has been aptly observed, 
every man is an enmny until yon know him. The code 
of medical ethics in reality does not go farther than to 
enjoin oar leting towards others as we would have them 
act towards onnelves. Any infringement of this code 
reocdls upon the delinquent who thereby forfeits the 
esteem of his fellows, and, toongh he may not believe 
H, the respect of toe pnblio. Iiastly, xdl should remem¬ 
ber that they are members of an honourable profession, 
whose traditions should oonunaod respect. 

FoBnoN Hiplokas—Pbacticb Abboad. 

The principle of reoiproeity of medical practice has 


at last been formally recognised by the Privy Connci 
diiecting the admission of medical graduates of Italian 
nniversities to practise in this country subject to recog¬ 
nition by the General Medical Council. In virtne of 
this agreement, certain, or rather uncertain, facilities 
are conceded to British practitioners to practise medi¬ 
cine in Italy. The exact terms have not as yet been 
made pnblio, but in all probability it would suffice to 
make application to the proper Government depart¬ 
ment to obtain permission to practise in that country, 
though as matters stand that right only extends to 
attendance on the fellow countrymen of the practitioner. 

In France the difficulties of obtaining the right to 
practise have been considerably enbanoed of late years; 
indeed, measures are contemplated which would have 
for effect to exclude foreign students from pursuing 
their studies in Paris altogether on the gronnd that the 
faculties are already overcrowded. A modified d^pree 
is conferred upon foreign students on certain conditions, 
bnt this does not carry the right to practise, so that 
it possesses a merely decorative value. To obtain the 
right to practise medicine within the territory of the 
F.’ench Bepnblio the stndent most pass the matrionla- 
tion examination (baccalanr^at), and go over exactly 
the same ground as the native student, and no exemp¬ 
tion from any part of the oonree study or examina¬ 
tions is now accorded. The onrrionlnm in Fruoe 
nominally extends over four years, but in practice it 
extends to five and even six years. The details can be 
obtained on application to the Dean of the partioolar 
university selected. 

LONDON SCHOOLS. 

The Schoole of Kedicine in the XetropoliB are 
the following’, the scholanhips, prisee, itad^nts’ 
appointments, fees, ftc., being set forth in connec¬ 
tion with each place named. The names of the 
hospital Bta£ lectures, residential temu, and 
detailed information will be found, as a rule, in 
our advertisement columns. 

St. Babtholohkw's Hospital.— This hospital has 760 
beds, and for many years past the school attached has 
^d a larger number of entries than any other medical 
school in London. CoU^ate residence is here permis¬ 
sible, subject to the ordinary rules. The recreation 
gronnd for the nse of students is at Winohmore Hill. 

Appointments .—Ten honse physicians and ten house 
surgeons are appointed annually. Daring the first six 
months of office they act as “junior” house physicians 
and honse surgeons, and receive a salary of £25 a year. 
During their second six months they b^me “senior” 
honse physicians aod honse sn^eons, and are provided 
with rooms by the hospital authorities, and receive a 
salary of ^BSO a year. A resident midwifery assistant 
and an ophthalmic honse surgeon axe appointed every 
six mont^, and are provided with rooms and receive a 
salary of £80 a year. Two assistant ansssthetists are 
appointed annn^y, and receive salariee of £120 and 
£100 a year respectively. An extern midwifery assistant 
is appointed every three months, and receives a salary of 
£80 a year. Two assirtant electricians are appointed 
every six months, and in-patient dressers, in-patient 
clerks, clerks and drassers to the assistant phy 
sicians, and to the physicians and surgeons in charge of 
BpMdal departments are appointed every three months 
without fee. 

SeholarsA^, —There are fonr open scholarships 
in sdenoe, £7A ^6. £160, £60, tenable for one year, a^ 
a Jet^reeoo e^bitioB, valne £20; four junior scholar¬ 
ships of £80, £26, £20 and £10, rei^>ectively ; Treasnrexs' 


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264 The Hbdioal Pbmb. BNGLAND- 


price for praotioal anatomy; Poster prise in prtctical 
anatomy | senior sobolarships. value £60, for anatomy, 
physiology, and chemistry; Wix price, Hiohens prize, 
Lawrence scholarship and gold medal, value 40 guineas, 
for medicine, surgery, and midwifery; two Blakenbnry 
scholarships, of £39. in medicine and sni^ry ; Bentley 
prise, for reports of st^cal cases; the Kirkea gold 
medal for clinical medicine, with scholarship of £30. 
Shuter scholarship of £60; Skynner prise of £16; Sir 
G. Burrows’ prize of £10 and Matthews Duncan medal 
and prise, v^ue about £20 ; the Treasurer's Besearch 
Studentship, of the value of £100, is g^veo annually, 
the elected student being required to engage in original 
research in pathology. 

Fees .—Fees for perpetual attendance on lectures and 
hospital practice, 160 guineas, payable in the following 
instalments:—First year, 40 guineas; second year, 40 
guineas; third year, 40 guineas; fourth year, 40 guineas; 
or a single payment of 160 guineas. Fee for general 
subjects for students of den^ surgery: First winter, 
81i guineas; first summer. Sit guineas, or a single pay* 
meet of 68 guineas. Fee to University students, 80 
guineas; fee for laboratory instruction for D.P.H., 20 
guineas ; composition fee to University of London 
students for one year’s instruction for the Preliminary 
Soientifio Examination, 20 guineas. Composition fee to 
University of London students who have passed pre* 
Uminary scientific examination, 150 guineas. 

The Warden, Dr. James Calvert, will furnish further 
details on application. 

Chxbino Cross Hospitxi..— The school attached to 
this hospital is situated in central London, and contains 
new physiological, pathological, and bacteriological 
laboratories, materia medica museum, an anatomical 
theatoe, enlarged dissecting-room, and chemical theatre. 
The hospital, which is now being snolarged, oontains 180 
beds, m^ing. with the 80 be^ at the adjoining Soyal 
WestminstCT Ophthalmic Hospittd (to the practice of 
which general students are admitted free) a total of 210 
beds available for clinical study. 

Clinical instruction is given in medicine, surgery, and 
obstetrics, and in the special department, diiftnsfrn of the 
skin, diseases of children, mental borders, ^e thnMt, 
the nose and ear, and in the orthopedic, Bontgen, and 
electrical departments. 

Sckolarekips, Medal*, ^c.—Five entrance scholarships, 
the Livingstone scholarship, 60 guineas, and 66 guineas; 
Huxley s^olarship, 40 guineas and 30 guineas. Three 
(100 guineas, 60 guineas, and 40 guineas) are open to all 
gene^ stndrats, one (66 guineas) is reserved for the sons 
^ medical men, and one (80 guineas) is open to dental 
students only. All are awarded annually. Two Uni¬ 
versities eoholarships, value 60 guineas each, are open 
to students from we University of Oxford who have 
passed the let H.B., to students of the University of 
Cambridge who have passed the 2nd M.B., and to 
students of the University of London who have passed 
the intermediate examination in medicine. Canudates 
must give notice to the librarian of their intention to 
comp^ OB or before September 21gt, 1901. The Golding 
Prize of £10 is open to students at ^e end of their first 
winter session. The Huxley Medal, with prize of £10, 
is open to students at the end of their second winter 
session. The Pereira Prize of £5 is open to all general 
students. The Llewellyn Prize of £26 is awarded 
annually at the end of the curriculum. The Governors' 
Clinical Gold Medal is also open to students at the end 
of their ourrionlum, and a silver medal or its equivalent 
in books, is awarded to the most distinguished student 
in each class. 

Appointment *.—The curator and pathologist is ap¬ 
pointed annually, and receives £100 a year; medical and 
surgical registnm to the hospital receive £40 a year 
each, with luncheon in the hospital; obstetric r^utrar, 
six house physicians, six house surgeons, and two resi¬ 
dent obstetrical officers areappointed each year; oiini<»l 
^erks, dressers, and sni^cal ward clerks are appointed 
in all the general and special departments of ^e hos¬ 
pital. 

Fee*.—For the curriculum of study required by the 
various examining bodies and hospital practice, 110 
g^uineas in one sum, or 121 guineas in five instalments. 


-BDTTCATION. _ Sift. 11, 1901. 

The composition fee for sons of registered medical 
practitioners is 110 guineas, and the fee by instalments, 
121 guineas. For dental students, 64 guineas in one 
sum, or 60 guineas payable in two instalments. 

St. Gbobob’s HosprrxL.—This hospital is situated in 
a favoured position in the West End, fiming Hyde Par^ 
It contains 860 beds, and special wards for ophthalmic 
cases and diseases of women. 

Appointment* —Four house physicians and four house 
surgeons, entitled to reside and board in the hospital 
free of expense; two assistant house physioiaus, two 
assistant house surgeons, four assistants in the special 
departments. Can&datM for the above offices are se¬ 
lected quarterly by competition from among the per¬ 
petual pupils, and hold all the offices in suooesaioa 
during a period of two years, sixteen pupils being in 
office at any one time. Obstetric assistant with a 
yearly salary at the rate of £100 and board and resi¬ 
dence in the hospital; pathological curator with a salary 
of £100; assistant curator with a salary of £60; two 
medical registrars, with salaries of £60 and £30 per 
awnnm • a suigictd registrar with a salary of £60 per 
ftfinnm ; an administrator of anssthetics with a salary 
of £60 and two with salaries of £30 per annum; a sur¬ 
gery officer with a salary of £100 a year; three demon¬ 
strators of anatomy with a salary of £60 each; and 
assistant demonstrators. All offices are open to candi¬ 
dates without additional fee. 

Ezkibiiion*, The Brown exhibitions, one of ^100 
per annum, tenable for two years, and open to perpetual 
pupils possessing a registrable diploma; and one of £40 
per annum, tenable for three years and open to students 
in their third year. The Brackenbnry prizes of the 
value of £40 each, one each in medicine and surgery. 
The Webb prize in bacteriology, value £30. The Clarke 
good conduct and clinical work prize in surgery, the 
Thompson medal, the Brodie clinical prize in surgery, 
the Acland edinii^ prize, the Johnson prize in anatomy, 
the Pollock clinical prize in physiology, the Treasurer’s 
prize for clinical reports, and four general proficiency 
prizes of ten guineas each, 

Seholsrshtps.—One in arts of £160 for sons of medical 
men who have entered the school during the current 
year. Two in arts of £60, open to oommenoing students, 
and a further scholarship in arts of £60 to sons of officers 
of His Majesty’s service, who have met their death by 
serving in the South African campaign. ExaminatioD, 
8eptemb« 24th. Two of £86 in anatomy and physio¬ 
logy. open to students who have signed up for or passed 
the first M.B. Oxford or second M.B. Cambridge. One 
of value for students of Provincial University 

collies of similar standing. Examination, ^ptember 
24th. 

Fes*.-—Composition fee for perpetual pupils, £160, or 
£160 in the following instalments: First year £50, 
second year £60, third year £40, fourth year £20. The 
fee for gener^ subjects in dental surgery is £66, pay¬ 
able in two instalments: first year £80, second year £26. 
Only perpetual pupils can hold house office or compete 
fOT the Brown exhibitions. 

Gut's Hospitxl. —This hospital is situated on the 
Surrey side of London Bridge, and oratains 564 beds 
wi^ special wards for oph^a^io and obstetric cases. 
Attached to the hospital is a large residential college 
with rooms for about sixty men, whilst for students who 
prefer to live in the suburbs, no other hospital is so con¬ 
veniently placed, the railway accommodation being good 
and close at hand. There is now a complete -School of 
Dental Sni^ry at this Institution, which is recognised 
by ^e Boyal College of Surgeons of England, the 
facilities thus afforded of completing the whole ooniee 
of dental study within the wmls of one hospital will be 
appreciated by those intending to practise dentistry. 

Se-opened Ward .—One of the wards which have for 
many years been closed for want of funds was re-opened 
in October, 1898, as a special ward for diseasea of women, 
eight beds being set apart for difficult oases of labonr. 
An obstetric registrar and tutor and an ophthalmic 
registrar and tutor have been appointed to augment the 
teaching in the special departments. 

Appointment *.—Eight house sn^eons, eight bouse 
physicians, eight assUtant house physidans, twenty-four 


C 



BNGLAJ^D—EDUCATION. 


Smpt. 11. 1901. 


Ths UxDioix Puss. 265 


Mristant house surgeons, elg^t obstetrio residents, 
twentj-fonr oHnicnl sssistents, and ninety-six dressers 
are selected annually from the stodents according to 
merit, and without payment. There are ijso a lai^ 
number of junior appointments, erery ps^ of the lu^ 
pital practice bmog systematically employed for in* 
struotion. 

Sckolartkipa. —Opra scholarships of ^100 or j 660 in 
olsssics, mathematics, and modm languages. Open 
scholarships of X160 and £60 in chemistry, physios, and 
biology, and an open scholarship of £60 tor University 
students in two (£ the following subjects:—Anatomy, 
physiology, organic chemistry, ecology, physios. ^ 
scholarships, varying in value £18 to £26 each, for 
genwal proficiency in medical study, open to students of 
different years, llie Treasurer’s gold medal in medicine; 
the Treasurer’s gold medal in surgery; the Sands Cox 
scholarship of £16 per annum for thiw years for physi* 
the Michael Harris prise of £10 for anatomy; 
fieaney prise in pathology, 80 guineas; tiie Beaney 
scholarship in materia medioa, 80 guineas; the Golding- 
Bird gold medal and soholarsMp (£20) tor Mnita^ 
adenoe; and tite Gull Research scholarship of £160 per 
annum. The Physical Society awards two prises, each 
of £5, to the authors of the b^ essays on selected sub- 
iects, prises of £10 and £5 for the beet papers read 
before the Society, and a prise of £5 to the member who 
has most distinguished himself iu the debates of the 
session. 

Utw Behoal BuHAingt.—K considerable addition to the 
school buildings was opened in 1897, comprising a series 
of class-rooms, laboratories, and a lecture thea^ for tlm 
teaching of physiology. 

Pesf.—For the entire course of lectures and hospital 
practice, 150 guineas, if paid in one sum on entrance; or 
payment may be made by four instalments of 40 guineas 
ea^, payable at the beginning of the fiirst, second, third, 
and fourth years respectively. 

Kino’s Collxob Hospital.— This hospital iscentrally 
situated, being contiguous to the Royal CoU^e of Sur¬ 
geons. Lincou’g Inn Fields. The CoUeM adjoins 
^meieet House, and is close to the hospitm, in which 
there are 220 be^ available tor clinical teaching; oph¬ 
thalmic, ear, throat, skin, and dental departmente, are 
sittaehed to the hospital. Some wards are specially 
devoted to children’s diseases. The wards have been 
recently refloored and the electric light installed through¬ 
out. 

.Vchofaralipa.—£800 are awarded annually in scholar¬ 
ships and prises. At entrance two science exhibitions 
of £60 and £40 value are open to all candidates under 
the age of nineteen; two scholarships of the value of 
£76 each (subjects literary) and two exhibitions of the 
value of and £40 each (subjects scientific) are open 
to students commencing their curtionlum. Two scholar¬ 
ships, value seventy and sixty guineas, are <^n to 
stodents of a British University wbo come up to London 
to complete their ourrionlnm; two junior soholarships 
of £20 each for first year students, one of £30 for second 
year students, one of £60 tor third year students in 
residence, and one of £40 for fourth year students. In 
addition students may compete for the Uaniell scholar¬ 
ship, value £40; the Wameford prizes, value £40; the 
Babbeth scholarship, value £20; the Carter, Todd, 
Jelf, Tanner, Leatbee prises, and all class and clinical 
prizes. 

Appointment *.—Medical and surgical Sambrooke re- 
gistrarships. tenable for two years, each £50 per annum. 
Resident hospital appointments, viz., senior aud junior 
house physicians, assistant house physician, physician 
aoconohe^s assistant and assistant bouse aosonoheur, 
and three house surgeons with free txMrd and residence 
at thehosiHCal; and senior and junior clinioal assistants 
in special departments. 

Bendene* of Stndentt. —There are ohambers allowing 
a limited number of students the opportunity cA residing 
at the College. 

Vnivtrtity of Xoadtw.—Special courses of lectures and 
pnmtical instruction in the chemical, physical, and 
physiological laboratories have been arranged for 
students preparing for preliminary scientinc, and 


intermediate soienoe examinations of the University of 
London. 

F.B.C.8. Fxaminaiiotw.^Sperial olasscs an aroanged 
for both the primary and F.R.C.8. examinations. 
Further partionlars can be obtsdned from the Dean. 

London Hospital.— This hoe^tal is the largest in 
the United Kingdom, oontaining as it does. 800 beds. 
It has, moreover, wards and a teaming staff tor almost 
every special department in the domain of medicine: 
the soholarships and prises are many and valuable, and 
both school and staff are deservedly popular with 
students. 

ScholarthipKmd /Vtzer.—AtEntranoe.—Pfioesdholar- 
j ship in soienoe, £120; Price scholarship in anatomy 
and physiolygy, £60; entrance soholarships in soienoe, 
£60 and SM ; Epsom soholarriiip, £128; Boxton 
scholarships in arts, ^0 and £20. After Entrance.— 
Anatomy and biolon soholarship, £20; anatomy md 
physiology soholarahip, £25; Letheby prize, s^or, 
£20; Letheby prize, junior, £10; soholmhip in cl ini ca l 
medicine, £20; scholarship in rfiBinal surgery, £20; 
scholarship in nlininAl obetetrios, £20; Duckworth 
Nelson Prize, £10; Hntohhison prize, £86; Sutton 
prize, £20; Sir Andrew C3wk prize, JtXi Anderron 
prizes, £9; Ont-patieat dressers' prizes, £60; practical 
anatomy prizes, £10. 

Afipmntownti.—The “ House ** appointments, which 
are more numerous than at any other hospital in the 
Kingdom, are made without fee of any kind, and all 
resident offioers are provided with free board and rooms, 
and in a few instances with a small salary also. 

The additional buildings for the department of public 
health, for the bioli^eal, ohemioM, acd physical 
laboratories, materia medioa museum, Ao-, and the new 
bacteriological department with general laboratory, 
research laboratories, olsss rooms for D.P.H. work, 
sterilising room, anii^ room, Ac., are now open. For 
all these departments, specif teachers have alre^y 
been appointed who are devoting their entire time 
to the particular subjects that they have undertaken. 
In addition to these alterations and additions, arrange¬ 
ments have been in the hospital for additional 

nliniftal teaching. 

Feet .—Perpeteal fee for lectures, demonstrations, and 
Hospital Practice, payable in thrro instalments of 46, 
46. and 40 gnineas at the oommencement of the Ist, 2Qd, 
and 8rd years respectively, 180 guineas; or if in one pay¬ 
ment, 120 guineas. A reduction of 8 guineas tor 
ofaemistry and physics, and 6 gnineas for elementary 
diol<^ is made ^m the above fees, in the case 
stndrats who have passed in these subjects at the First 
Conjoint Examination before entering the College. Fee 
for students entering in tbeir third year (their first 
and second years having been spent at a reoc^ised 
medical school elsewhere), 66 guineas. (This fee is pay¬ 
able by students entering wbo have passed the first M.B. 
Oxford; the second M.B. Cambridge; or the Interme¬ 
diate M.B. London.) Dental stodents (seneral hospital 
praotioe and leotnra), 40 guineas. General fee for 
dental praotioe. 10 guineas. 

Note .—A reduction of 15 gnineas will be allowed to- 
the sons of medical men from the perpetual fee if paid 
in full, or 6 guineas from Mch instiument. 

Special entries oan be made either for single oonrsee 
of leotnrea tor boepital practice. 

Accommodation is obtainable at a very reasonable rate- 
close by. or in the snbnrbe a few minatee’ distant by 
train. Dinners and Inncbeons are provided in the- 
Stndents’ Club, which, with the reading and smoking 
rooms, now form part of the college bnildings. The 
“ London Hospitals’ Club Union ” has a field for 
cricket, football, Ac., with an excellent pavilion, at Lower 
Edmonton. The olnbs and societies are open to all the 
students, and are warmly encouraged by the staff. The 
new clnb rooms, gardens, and foreoonrt are now open. 
Full particulars of the Warden, Dr. Munro Scott. 

St. Mabt’b HosFirAL. —This hospital is situated at 
Paddington, near the terminos of the Great Wtwtern 
Railway, and at present contains 281 beds. Fresh 
laboratories, fitted with electric light and all modern 
improvements, for the study of pathology and 



266 Thb Msdical Pkms. 


ENGLAND—EDUCATION. 


Sbpt. 11, 1901. 


bacteriology, have recently been added, and also a ne<r 
physiological lecture-room. Daring the past year a 
special d^>artinent of pathological chemistry has been 
instituted. 

The New Wing. —The new wing, the ground-floor of 
which, comprising the new out-patient department, was 
opened in lh98, is about to be completed. This will 
add to the hospital lOU new beds, and will include an 
additional operating theatre, a new clinical laboratory, 
and an X-ray department. 

Appoiutmenta .—All clinical appointments in the Hos- 

S ital are free to students of the Medical School, and 
iie resident medical officers are chosen by oompetitire 
examination. Six house physicians, six house surgeons, 
four obstetric officers, and two resident anaesthetists 
are appointed in each year, and receive board and resi¬ 
dence in the Hospital. 

Seholarahipa, <ke. —One scholarship in natural science, 
of the value of £146, open to any gentleman who has 
not completed a winter session of study at a medical 
school. Two scholarships in natural science, each of 
the value of £78 159., and one of £62 lOs., under the 
same conditions. Two scholarships, each of 60 guineas, 
open to students from the Uaiversities of Oxford and 
Cambridge. The scholarships will be awarded by 
examination oif September 24th snd 26th, 

Feta .—Fee for attendance on the full five years' cur¬ 
riculum of ho^ital practice and all lectures, demonstra¬ 
tions, and special tutorial classes, including membership 
of the Library, Uedioal Society, Students' Club, and all 
the athletic clubs, and the receipt of the hospital 
Gazette for five years, £140 paid in one sum on entering 
the school; or in instalments, £145 

Students who have completed their examinations in 
anatomy and physiologv at the Universities of Oxford, 
Cambridge, or other University, are admitted as per¬ 
petual pupils on pajrment of a fee of 60 guineas in one 
sum, or 66 guineas in two annual instalments. Uni¬ 
versity students, prior to completing the anatomy and 
physiology examinations, pay an annual fee of 25 
guineas. Aiter completing the anatomy and physiology 
examinations, the inclusive fee may be paid. 

Prelvninary ^cienti^e Conrie .—Special classes, includ¬ 
ing lectures and laboratory work, are held throughout 
the year. 

Mxddlssbx Hospital.— This hospital, which is con¬ 
veniently situated in the centre both of business and 
residential London, contains 340 beds. There are 
special departments for cancer, and for ophthalmic, 
throat, aural, skin, dental, and children's diseases. 
Wards are also devoted to cases of uterine disease and 
of ^philis. The new school buildings are now in 
regmar use. Besidenoe for students is obtainable in 
the residential college, which has its frontage on tire 
hospital garden. 

Appointmente. —Casualty surreal officer, casualty 
mescal officer, six house su^eons, six house physicians, 
and two resident obstetric physicians. The above officers 
have residence and board in the college free of expense. 
Clinical clerks and dressers in alt the departments are 
also appointed in addition to the foregoing. 

St'holarahipt, ^e .—Two entrance scholarships of the 
value of £100 and £60 respectively. One entarance 
scholarship of the value of £60, open to Oxford and 
Cambridge students only, (Subjects—Anatomy and 
physiology, including histology.) Two Broderip Bipolar- 
ships of £60 and £40 respectively, for medicine and 
surgery; John Murray med^ and scholarship, awarded 
every third year; the Governor's prize of £2lfor8ta- 
dento in their final year. Hetley clinical prize, value 
£25, awarded annually for proficiency in practical clinical 
medicine, surgery and obstetrics; the Lyell Gold Medal 
in snidery and surt'ical anatomy ; the lipoid Hudson 
prize, value 11 guineas, in surgical pathology, including 
baot^ology; Freeman scholarship, £30, in obstetrics 
and gynteoology; exhibitions of 10 guineas and 5 
guineas for anatomy and physiology to second and first 
year’s students respectively, as well as class prizes in all 
subjects. 

Fete .—General fee for the entire course of hospital 
nractice and lectures, 136 guineas if paid in one sum on 
entrance, or by instalments of 60, 60, and 36 guineas. 


pa^ble at the oemmenoement of the first, second, and 
third years respectively. General -fee for members of a 
Univetsity who have completed one year of medical 
study, 90 guineas if paid in one sum, or by instalments 
of 60 and 40 guineas. For Hiose who have completed 
their anatomical and physiological studies the fee is 70 
guineas on entrance, or in two instalments of 40 and 35 
guineas. The composition fee for London University 
students who have paseed the preliminary science exami¬ 
nation is 116 guineas. The fee for ^ecurricnlam for 
dental students is 64 guineas on entrance, or two instal 
raente of 40 guineas and 20 guineas. 

St. Thomas’s Hospital. —This hospital, with its 
medical school attached is one of the echools of the 
University of London. It is situated ou the southern 
embankment of the Thames, facing the Houses of Par¬ 
liament, and contains 672 t^a, of which about 512 are 
in use. The school buildings, which are separated 
from the hospital by a quadrangle, comprise numerous 
theatres, laboratories, aud class rooms, which are well 
adapted for the modem teaching of large bodies of 
students in all the subjects of medical curriculum. 
There is a large library and reading room, and a very 
complete museum and gymnasium. A ground of more 
than cine acres in extent is provided at Chiswick for 
out-door sports. 

A clinical laboratory has lieen recently built, iu which 
all the more difficult methods of diagnosis, bacterio¬ 
logical, chemical, and microscopical, are carried on 
under the direction of a superintendent. .The depart¬ 
ment for out-patients has been re-arranged, so that 
large numbers of students are enabled to follow closely 
che practice and teaching of the assistant staff. 
this department there bu been added a completely 
fitted operating room. 

Appointments are open to all stndents A resident 
assistant physician and a resident assistant surgeon are 
appointed annually at a salary of £100 with board snd 
lodging. Two hospital registrars, at an annual salary 
of £100 each, are appointed yearly. The tenure of these 
offices may renewed for a term not exceeding two 
years. An obstetric tutor and registrar is appointed 
each year at an annual salary of £50. Poor house phy¬ 
sicians, two assistant bouse physicians, four house sur¬ 
geons, four assistant house surgeons, two obstetric 
house physicians, two ophthalmic house surgeons, and 
eight clinical assistants in the special departments are 
appointed every three months. Clinical clerkships 
and dresserships to in- aud out-patient departments 
are avaJlable to the number of more than 400 each 
year. 

Seholarehipa, Prizta, ^e .—Three entrance scholarships 
are offered for compeUtion in September, viz., one of 
£160 and one of £ffi3 in chemistry and ph 3 r 8 ic 8 , with 
either physiology, botany, or zoology at the opUon of 
candidates for first year’s students; one of £50 open to 
University students who have passed in anatomy, 
physiology, materia medica, and pharmacy for a medical 
d^ree in any of the Universities of the United King¬ 
dom. and have not entered as students in any London 
medical school. Copies of the examination papers of 
last year may be obtained on application to the medical 
secretary. Applications must be sent in not later than 
September 17&, with certificate of birth and of prelimi¬ 
nary examinatioD, and with a notification as to the 
optional subject chosen. Numerous scholarships, prizes, 
and ttioAilIw are open to competition throughout the 
whole career of a student, including a Fellowship of 
£100 given by the Salters’ Company for research in 
pharmacology. 

Fees .—The fees may be paid in one sum or by instal¬ 
ments. Entries may be made separately to lectures or 
to hospital practice. Special arrangements are made 
for students from the Universities and elsewhere enter¬ 
ing in their second or subsequent years, also for dental 
students and for qualified practitioners. 

Special classes for the Preliminary Scientific and 
Intermed., M.B.Lond., for the Oxford* and Cambridge 
examinations, and for the Primary F.B.C.S., are held 
throughout the year, 

A register of approved lodgings is kept by the medical 
feoretary, who has a list of loc^ medical practitioners 




Skpt. U , 1901. 


BN gland—BDUCATIOIT. 


Tai tfkmoiji Pbkb. 267 


«Bd others who reoeire stodente into their hooses. The 
^roepeotoe of tfie school, containing fall particolan m to 
feee, course of study advised, &o., and all necessary in- 
Tformation, may be obtained on application to Ur .Bendle, 
the medic^ secretary. 

TTnitebsitt Coi,LBOB HosPiTaL. — This hospital is 
fiitaated in Gower Street, not far from Easton Sailway 
terminns. The college where the chuses are held faces 
the hospital, on the opposite side of the street. The 
<naraber of b^.available for teaching porpoees is 210. 

Appoimimenti. —Eight honee physicians, six boose 
snrgeons, four senior and four jonior obstetric assistants, 
and two ophthalmic assutante, are selected annually by 
-examination from among Uie senior students, without 
fee. The house physicians and house surgeons reside in 
the hospital for a period of sis months, and the senior 
obstetric assistanto for three months, and receive their 
board and lodging free. 

The ofBces of oat>patient physicians’ and sni^eons’ 
assistants, clinical clerks, surgeons' dressers, and oph* 
thalmic surgeons* assistants are filled by pnpils who are 
also students of the college, without additional fee. 

Seholarahips,.^c. —^Entrance scholarships: One of the 
value of £120, and two of 55 guineas for proficiency 
in science, the subjects being those of the Preliminary 
Scientific Examination of the University of London, 
and two of 76 guineas each, the subjects being anatomy 
.and physiology; the Atkinson*Morley surgi^ scholar* 
ship of £45 a year, tenable for three years ; Atchison’s 
scholarship, value £55, tenable for two years ; Sharpey 
physiological scholarsbip, value about £110 a year, 
tenable for three years; Filliter exhibition for profi- 
ciMiey in pathological tmatomy, value £30; Erichsen 
prise, operating case, value £10 10., awarded for 
practical surgery, Dr. Fellow’s clinical medals, the 
Liston gold me^, Alexander Bruce gold medal, Cluff 
memori^ prize, Tuke medals for pathology, class medals, 
-<bc.; gold and silver medals, or other prizes, as well as 
certificates of honour, are awarded t^er competitive 
examinations in particular brancdiee of study. The 
Tnffnell scholarship of £80 for chemistry, two years; 
and the Clothworkers’ exhibitions in chemist^ and 
physics of £30 each, can also be held in the medical I 
-faculty. 

Per#.—The following bave been grouped to meet the 
reqairemeuts of the various exauiining boards:—1. For 
the medical examinatiou required by the Examining 
Board in England and the Society of Apothecaries: 
150 gs, if paid in one sum at the commencement of the 
course; 355 gs. if paid by instalmeuts. 2. For those 
•students who do not require to attend chemistry, 
pharmacy, and elementary biology at a medical school 
(under the regulations of the examining board in 
England) the fee is.- 135 gs. if paid in one sum; 140 gs. 
if paid by instalments. 8. For the courses uecessary 
for the Preliminary Scientific Examinations of the 
University of London, 25 gs. 4. For the course of in- 
■ stmetion for the Intermediate Examination in Medicine 
of the University of London, 60 gs. paid in one sum. 
.6. For tbe course of instruction for the final M.B. 
examination of tbe University of London, 80 ot. if paid 
in one sum; 82 gs. if paid by instalments. Inis coarse 
of instruction is also suitable for the corresponding 
examinations at the Universities of Oxford, Cambridge, 
and Durham. 6. Composition fee for dental students, 
-for tbe courses required for the L.D.S., 05 gs. or exclu* 
rive of chemistry, practical chemistry, j^ysics, and 
■materia medica, 50 gs. The composition fees, 1, 2, 4, 
and 6, admit to attendance on systematic lectares and 
to hospital practice, where this is included in tbe fee, 
during five years. 

WxsTMiNSTXB HOSPITAL.— This hospital is conveni¬ 
ently situated, facing the Abbey, and is readily acces¬ 
sible from all parts of tbe metropolis. It contains 206 
beds for general cases, and all the special departments. 
Hew school buildings have been erected close by which 
afford accommodation for 150 students. The class rooms, 
dissecting rooms, and lecture theatre are excellent 
samples of modem erections, affording ample scope for 
Btudy. 

Jppotntmcnfr.—Medical and surgical registrars, each 


£40 per annum; two bouse physibians, two house snr- 
gMDB, two assistant house surgeons, and resident obste¬ 
tric assistant. These officers, except tbe two first wamAd, 
are all boarded free of expense. Fourth year's students 
are appointed to be clinical assistants in the various 
departments. 

Scholarthips, «^c.—(a) Winter Session—The Guthrie 
scholarship £60, entrsnoe scholarship £40, entrance 
scholarsbip £30, dental scholarship £20; subjects, Latin, 
mathemarics, experimental physics, chemistry, and 
either Greek, French, or German. Oxford and Cam¬ 
bridge scholarships, £40 and £30, subject, anatomy and 
physiology. Natural science scholskrship, £m, same as for 
Prel. Sci. of University of London. Natural science 
scholarship, £40, chemistry and physios. Free presenta¬ 
tion, open to pupils of Epsom Medical College, (b) 
Summer Session.— Natural science scholarship, £60, 
same as winter. Natural science scholarship, £40, neTna 
as above. Arts scholarship £60, arts scholarship, £40, 
Oxford and Cambridge scholarships £40 and £30, sub¬ 
jects same as in winter session, (c) Prizes.—Treasurer’s, 
10 guineas, for first year’s men; Chadwick. 20 guineas 
for students of any year not exceeding fifth. To be 
competed for by unqualified men. Bird me^l and 
prize, £14, for students who have completed fourth 
winter session. Sturges prize in clinical medicine £8, 
clinical surgery prize £5, to be competed for by unquali¬ 
fied men. And class prizes in the various subjects. 

feet.—In one payment of 110 guineas, or two pay¬ 
ments of 60 guineas each, payable on entrance, and at 
tbe commencement of second year respectively, or by 
six payments distributed over six sessions of 26 guineas 
and 20 guineas alternately. Fees for shorter periods or 
for single courses may be learned on application to the 
Dean. Fees for dental students, payable in one sum on 
entrance, 50 guineas, or in two instalments of £27 lOs. 

London School of Mbdicinb fob Woueh (Royal 
Fbex Hospital). —This school, which is situated in 
Hunter Street, Brunswick Square, opens at the same 
time, and the periods of study, lectures, Ac., are similar 
to those at the ordinary medical schools. A dieseoting- 
room, physiological, chemical, biological, physical, and 
pharmaceutical laboratories, and library are provided at 
tbe School, and clinical lectures are regularly delivered 
at the Royal Free Hospital close by, which institution 
is appropriated to the students at the School as a field 
of practical study; clerkships, dresserships, being ten¬ 
able there without fee by women. 

Scholarshipt, Entrance Scholarships of £30. Tbe 
St. Dunstan’s Medical Exhibition, value £60 a year for 
three years, extendible to five years. Bostock Scholar¬ 
ship, £60, for two or four years, given on the result of 
tbe Ibieliminary Scientific Examination of the Univer¬ 
sity of London. The John Byron Sobolar^ip of £20 a 
year for four years, the Stuart Mill ScbolarsUp of £30 
a year for four years, tbe Fanny Butler Scholarship of 
£14 lOs. a year for four years are offered from time to 
time. The Mabel Webb Research Scholarship, value 
£30 for two years, for research work in chemistry, 
physiology, or patholo^ry. Tbe Helen Prideaox Prize of 
£50 is offered every other year to graduates of the 
School. Prizes of £10 each are awarded in the classes 
of anatomy and physiology. Three Evans Prizes of 
£3 3 b., £2 28.. and £1 Is. respectively are given in the 
midwifery class, and two Durham Prizes of £5 and £3 
are given in tbe gynaecology class every second year. A 
prize of £6 is given in alternate years in the midwifery 
and gynaecology classes. An Evans Prize of £5 Ss. is 
given for operative midwifery. Two Mackay Prizes of 
£20 each are offered annudly. There are otuer scholar¬ 
ships for ladies willing to qualify themselves ss prac¬ 
titioners in India. There is also a small fund from 
which assistance can occasionally be given to students 
who specially require pecuniary help. 

Pets .—The fee for the ordinary curriculum of clinical 
lectures is £90 if paid in one sum, or £96 if paid in 
I instalments. The fee for clinical teaching is £35, or 
I £40 if paid in instalments. 

! Special Classes for the Preliminary Examination of 
the University of London. For the whole course, 20 
guineas. 



268 Tei Hbdicil Fbbm> 


BKGLAND—EDUCATION. 


Sept. 11, 1901. 


BXTRA-AOADBMIOAL INSTITUTIONS 
IN LONDON. 

Cooke's Mbdicel School.— This sohool is prqwredto 
admit to its snpplemestaiy work all who may wish to 
join same, hot in regard to its cnrricnlnm work it 
does not receive more than half>a>doeen stndents in the 
oonrse ot the year; titese have special advantages both 
as regards anatomy and physiology, at charges bnt 
slighuy in excess of oorrent ratee. By decision of 
various examining bodies gentlemen rejected at their 
anatomical and physiological examinations (second 
conjoint, &c.) can get signed up for the snpplementsffy 
work they are requred to put in before re-examination. 
The sohool is also recognise for the special dissections 
for the Fellowship of the Boyal Collie of Surgeons. 
The surgical operations are performed on the dead 
body, and these oonises are recognised for army ext- 
minations, the Indian Medical Service, &o. The school 
posseeses a good collection of physiological and chemical 
apparatus, and gentlemen proparing for the higher 
examinations, the F.It.C.8.Eng., M.B.London, Cam¬ 
bridge, Oxford, &o., receive special instruction in the 
more difficult subjects by separate classes. 

Lohdom School or Dbntal Subobbt.— This institn- 
tion is the oldest of the Dental Colleges in the United 
Kingdom, and its teaching is recognised by the Boyal 
College of Sn^eons for the dental diploma. It is cen¬ 
trally situated in Leicester Square, is open daily, and 
under the supervision of a special staff and house sur¬ 
geon. The mechanical laboratory is the most perfect 
of its kind, and its usefulnees can hardly be over-esti¬ 
mated. The Hospital having been rebi^t during the 
past yearthe accommodation is equal to all requirements. 
Four demonstrators have been appointed to instruct the 
new stndents in the elements of operative dental snr-' 
gery, and at the thinning of the session each demon -1 
strator gives a course of lectures on this subject. There ' 
is the Saunders Scholarship and Walker Scholarship 
(entrance) value ^920 each, awarded yearly, and the 
eight house surgeoncies are filled by stndents of the hos¬ 
pital boding the L.D.S. Fee for two years’ hospital 
practice required by the curriculum including lecture?, 
jB 60. The fee for three years’tuition in mechanical den¬ 
tistry is 160 guineas. 

National Dbntal Hospital. —This institution is 
situated in North-West London (Ureat Fortland-street), 
and the same teaching facilities and hospital practice 
are obtainable here as at the foregoing institntios, 
special demonstrations being given by members of the 
staff daily. There are also a mechanical laboratory, 
students' common room, a metallnrgical laboratory, ex¬ 
traction and stopping rooms, students’ hall, Ac., all 
lighted by electricity, and warmed and ventilated after 
the most approved requirements; in fact, this institu¬ 
tion may be pronounced a model dental hospital and 
school. The winter session commences at the same time 
as at the medical schools on October let. The medical 
tutors bold social classes before each College examina¬ 
tion. The prizes include one entrance exhibition, value 
£16, and the Bymer prize of £6 68. The fee for two 
yetrs’ hospitil practice required by the onrriculnm, in¬ 
cluding lectures, is £40. 

^NDON School op Tbopical Mbdicinb. —This insti¬ 
tution is the outcome of a suggestion by the Bight Hon. 
Joseph Chamberlain, H-M. Secretary of State for the 
Colonies, and is situated at tbe Boyal Victoria Docks, 
in connection with tbe Seamen’s Hospital, than which 
no more suitable spot could be found, as ships arrive 
there in greater numbers than elsewhere from all parts 
of the Tropics, affording immediate opportunity for the 
treatment of patients and for the study of tropical 
diseases. The school buildings are placed within the 
hospital grounds, and systematic conrses of instruction 
are obtainable from dnly authorised teachers through¬ 
out the year. Stndents also have the privilege of 
attending the medical and surgical practice at the Dread¬ 
nought Hospital, Greenwich. Information as to fees, 
Jcc-, can be obtained of tbe Dean or tbe Secretary. 

Univbesitt Examination Postal Institution.— 
This is an Institution conducted by Mr. E. S. Wey¬ 
mouth, M.A. (27, Southampton Strmt, Strand), which 


offers special oonxsee of leesons throtmb the post for the 
M.D. (London or Durham), D.P.H. JCamMdge, 
London, Ac.), and the F.B.C.S. (Eng. or Edin.). 
tutors have the MJ). or M.S. d^ree. Two are gold 
medallists. 

Medical students are admitted to the practice 
at the following metropolitan hospitals, to which 
no medical school is attached. Detailed par¬ 
ticulars will be supplied on application to the 
various seeretaries. 

Wbst London Hospital, Hammersmith.— This con> 
tains over 160 beds, and has an extensive out-patient 
department. Dreseershipe and clinical clerkships may 
be obtained. Two house - sorgeons and two bouse 
physioians are elected every six months. Special d^ 
partments have recently been opened for disfmspn of tito 
throat, ear, skin, and deformities. An electrical depart¬ 
ment has also been added. 

Gbbat Nobthbbn Cbntbal Hospital, Holloway 
Boad, N.—This institution has been recently enlaimd, 
and now contains 169 beds. The practice of ^e noe- 
pital is open to praotitioners and senior students, and 
clinical and pathological a s sis tants are appointed in the 
wards and ont-patient dqiartmente, as in the larger 
general hospitals. 

Bbthlbm Botal Hospital. —Two Besident House 
Physicians who have recently obtained their diplomas to 
praotise medicine and surgery, are elected every siK 
months, and are provided with apartments, complete 
bosrd, attendance, washing, and an honorarium of 
26 guineas per quarter. The students of certain specified 
London medical schools receive clinical instmction in 
the wards of tbe hospital, and qualified prsctitioneie 
may attend for a period (ff three months on payment of 
a fee. 

National Hospital fob Epjlbpst and othbb. 
Disbasbb of thb Nbbvous Svstbh, Queen’s Square, 
W.C.—Contains 200 beds. It has on its staff men of 
European reputation, and the Institution is recognised 
by the Conjoint Bcttd where part of the fifth year of 
stody may devoted to clinical work. Clinical clerks 
are appointed to the physicians for out-patients, and 
courses of lectures and clinical demonstrations are given 
each year. 

Hospital fob Consumption and Disbasbs op tbs 
Chbst, Biompton.—Tbe latest institution for the treat¬ 
ment of affections of the chest in the United Kingdom, 
there being 320 beds in the two buildings. There are- 
four house physicians, who reside in the hospital, 
for a period of six months. Lectures and demonstiationa 
are given by members of the medical staff on Wednes¬ 
days and Fridays at 4 o’olook, save during the vacations. 
Papila are admitted to the praotioe of the hospitaL 
Terms, £3 Ss. for three montos; six montiis, £6 5s. p. 
perpetu^, £10 lOs. 

CiTT OF London Hospital fob Dibbabbs of thb- 
Chest, Victoria Park.—This is a large and well-equipped, 
hospital at the East End, containing 164 beds. Clinical 
' lectores and demonstratioas are given by the members 
of an exceptionally experienced staff. Fee for three 
months’ at^danoe on hospital practice, 2 guineas; six 
months, 8 guineas. 

I Cbntbal London Throat, Nosb, and Eab Hospital, 

I Gray’s Inn Boad, contains seventeen beds, with an 
I extensive ont-patient department recently enlai^fed. 
Clinical demonstrations and instruction to qnal&ed 
praotitioners and senior stndents daily during the hours 
of the surgeon’s visits. Twelve olinical assistants who 
mnst be duly qualified are elected to assist the surgeons.. 
Operation luys—in-patients, Tuesdays, 2.15 p.m.; out¬ 
patients, Tuesdays and Fridays, 2 p.m. Fees for the 
three months’ attendance, £3 Ss.; six months’, £6 5e- 
Full details of this institution will be found on reference 
to our advertising solnmns. 

Hospital fob Disbabxb of thb Throat and Chbst, 
Golden Square, W., with branches at Newington, Wal¬ 
worth and Netting Hill,oontains 50 beds. Stodents are 
admitted to hoepital practice on payment of fee of 
three months* course, £3 Ss.; for six months, £5 5a. 
perpetual, £7 7s. 


Saw. 11, 1901 . 


BNGLAITD^EDTTOATIOy. Thb Hssioal Pubs. 269 


Thb Hospitai. roB Womm, Soho Square.—^The hoe- 
P*y contains 61 beds. In oonneodon with insti* 
tataon there is now an organised school of gynsooli^, 
to qualified medical men and to stndente after their 
third jeu. Clinical assistants to the physicians and 
surgeons in the in>patieut and outpatient departments 
are appointed every three months. Fee for the three 
months' course, £6 Ss. 

SiicABrrAN Pbbb Hospitjil fob 17011*5 and 
Cbilobbh, Lower Seymour Street, W., offers excellent 
opportunities for clinical study and training in the 
®»t»ils of operative gynaecology. The success of the 
iu this duartment have gained for them an 
Buropean reputation. There are 47 beds. 

Hospital pob Sick Csildbbn, ciieat Ormond Street, 
Queen's Square, and Cromwell House, Highgate.—Fee 
for three months' attendance, JtS 8a; perpeti^, £5 6b. 
There are now 200 beds, besides 62 Mditional at the 
oonvaleecent branch, and it is probably the lai^^est in* 
stitntiem of the hind in the world. The practice of the 
hospital has been thrown open gratnitmisly to pupils 
of uie d^erent hospitals and memoal schools of London, 
on oonditions to be ascertained from the secretary. 

Botal London Ophthalmic Hospital (formerly in 
Hoorfl^ds, rebuilt during the present year in the City 
Bead), is the lugeet hospital devoted to this specialty 
in Gh^t Britain, and contains 181 beds. Students and 
practitioners are admitted to the practice daily at nine 
o’clock. Opeiations, 10 o’clock and after. Fee for six 
montbp, £8 Ss. ; peipetnal, £5 68. Further particulars 
of the secretary. 

^TAL WbSTMINSTBB OPHTHALMIC HOSPITAL, King 

William Street, Charing Cross, has about 84 be^ and 
a very laty out-patient oliniqne. The lectures and 
demonstimtions are arranged with special reference to 
the r^niremeuts of practitioners and senior students. 
Fee, six months, £8 8s.; perpetual, £5 6s. 

Botal Etb Hospital, m. Georges Circus, Southwark. 
—There are 40 beds and 2 ooto. Fees £2 2b, for 8 
aoonths, £8 8a for 6 months, and £6 5s. perpetnal. 
Courses are held on ophthalmoeoopy, refra^on and 
di s oa s o s of the eye; fee £1 Is. for each course, but 
perpetnal students nmy attend each course once without 
extn fee. Pathology class, £I Is. extra to oover cost of 
nsaterials. 

St. Pbtbb’s Hospital fob Stonb.— This is the only 
special hospital for the treatment of stone and genit(y 
arinary d isoa s o e in the United Ein^om. It contains 
87 beds and one private ward, and has an excellent 
record. Stndents are admitted on the usual terms. 

London Tbmpbbakob Hospitai. —The hospital con¬ 
tains 110 beds. The medical and sur^pcmlpraotm is open 
to students and practitioners. Appoiutinents (vacancies 
tor whh^ are advertised in the medical journals); 
Surgical and medical registrars, resident medical officer, 
and one assxstant resident medi^ officer. 

BCbtbofolitan Hospital, Eingsland.—This was 
until recently known as the Metropolitan Free Hos- 
idtal, is sitnated in the north-eastern district of the 
metropolis, and contains 160 beds. It is a general 
hospi^ with various special departments for the 
treatment of diaoasos of the eye, throat, ear, Ao. 

Bkot Hospitals.—** St. John's Hospital for Diseases 
the Skin.” Ont-Mtient department, 40, Leicester 
Square; In-mtient Department, 288, Uxbndge Bead. 
This hespitaJ has now a well-equipped in-patient de¬ 
partment with 60 beds. A School of Der^tology in 
eoimection with the hospital was opened last April, 
md conducted by tiie medical staff of the hospital. 
During the past year the free course of Chesterfield 
Lectures given by Dr. Morgan Dookrell has proved a 
gmt success, being well attended by the profession. 
The next course (free) will commenced in October next, 
and the dates and times will be doly annonneed in our 
columns. 

One of the oldest institutions of the kind is the 
Western Skin Hospital, which was started as long ago 
as 1861. In recent years the number of i»tients has 
neatly increased. Tm practice of the hospital is open 
to studeuti and practitumers. Stndente this specialty 
have also the ''London Skin Hospital,’' in Fitsroy 
Squun^ with seveo beds and an out-p(Uie&t depart 


ment of over 1,400. There is also the Stamford Street 
Skin Hospital, in the sontbem part of the metropolis, 
with 10 beds and an out-patient department of 6,600, 
so that the studentsf' nee^ in this direotion are well 
catered for. 

PEOVINCIAL MEDICAL SCHOOLS. 

Bbjstol Univkbsitt Collbg*.—Faculty or M*m- 
ciNX.—This is the only medical school in the West of 
England. The lectures and instruction given in the 
Faculty of Arts and Science of University College 
Bristol, are adapted to the various preliminary examina¬ 
tions, and stndents can complete in Bristol the entire 
oouxse of study required for the medical and surgical 
d^ees of the University of London and the Boyal 
College of Surgeons of England, and of the Apothecaries' 
Society of London, and for the examination of the Army 
and Kavy Boards. It is now acraeged that students of 
the collie shall be admitted to the olinieftl praotioe of 
the Bristol Boyal Infirmary and the Bristol General 
Ho^ital conjointly, and consequentiy both these insti¬ 
tutions ate open to all students. The infirmary and the 
hospital comprise between them a tot^ of 470 beds, and 
both have very extensive out-patient departments. 
Special departments for the diseases of women and 
children, and of the eye, ear, and th^t, besides large 
outdoor maternity departmento and dental departments. 
Stndents of the college also have the privil^e (ff 
attending the praotioe of the Bristol Boyal Hospital for 
Sick Chudren and Women, oontaining 104 beds, and 
that of the Bristol Eye Hospital, with 28 beds. The 
total number of beds available for clinical instrnction is 
therefore 602. Very exceptional facilities are thus 
offered to students for obtaining a wide and thorough 
acquaintance with all branches of mescal and soigieal 
work. 

Appoinimtnts .—At the Boyal Infirmary, and at 
the General Ho^tal, olinioal clerks and dressers reside 
in the honse in weekly rotation. A pathological clerk 
is appointed every thi^ montha AIm olMtetrio clerks 
and ophthalmic dressers. 

Clinical leotnres are given r^pilarly at both institu¬ 
tions. 

8eholar$hiju, Prises, Prises and oerUfioatee of 
honour are given in University College in all the sub¬ 
jects of the currionlnm, open only to perpetnal students. 
There are two entrance s^olarships, v^ne £60 and £30 
respectively, two Martyrs’ memori^ scholsfships (patho- 
1<^ and morbid anatomy) of £10 each, the Tibbit's 
memorial prise, value £9, for proficiency in practical 
surgery, one gold and silver medal awarded b^ the com¬ 
mittee, and various prises for nliwi/w-l work m salary 
and medic i ne. 

Feet.—School fees for attendance on all coorsesof 
leotnres, except comparative anatomy, 66 guineas, or 
66 guineas. composition fee, 65 goineas. Clinical 

fees—Surgical practice, one year, 12 guineas; perpe- 
tnai, 20 spineas. Medical practice, 20 guineas j perp^ 
tnal mescal and surgery, 35 guineas; clerk or dresser, 
6 gnineas; obstetric clerk, 3 guineas. 

Prospectus and further information on application to 
the Dean, Professor £. Markham Skerritt 

Tobkshibb Collbgb School of Mbdioinx, Lxbds.— 
This school, which was founded seventy years since as 
the Leeds Medical School, forms the mescal department 
ot Torkshiie College, one of the colleges constitattug 
the Victoria University. Students of the Yorkshire 
College are therefore eligible for the d^rees of the 
Dorh^ and Edinburgh Universities, and for the 
or^ary diplomas. The bnilding erected on a site con- 
tignous to the infirmary, and opened five years ago, oon- 
ts^B one of the finest dissecting rooms in the kingdom, 
extensive laboratories for physiolo^ and pathology, with 
the most recent improvements in fittings and apparatns, 
ample lecture-room accommodation, a large library, and 
separate mnsenme for pathology and anatomy. Pro¬ 
fessors and lecturers are attach^ and the clinic^ teach¬ 
ing is given by the physicians and surgeons attached to 
thein&mary. Ophthalmic demonstiations and demon¬ 
strations of skin diseases are given in the infirmary by 
sorgeons in each department, where also are obtainable 
various olinioal olerkships, dreesershipe, and othw 

d 


2(0 Thb Mbdioal Pbms. £)N^0tjAIfD—EDuGATIOK^. 6sft. ll, l9Ul- 


appointments; and an extern maternity charity is 
attached, at whidi the neoessuy attendance at labours 
ora be taken; bemdes the infinnary there are a lar^e 
dispensary, a large hospital for infeotioos diseases, rad a 
hosoital for tromen rad children, all of whioh are open 
to students of the sdiool. 

Students here hare also excellent opportunities of 
acquiring a thorough insight into peyohologioal medi¬ 
ae, as ^e renoirned West Biding Lunatic Asylum is 
in connection, whereat lectures on mental diseases are 
delivered during the summer. 

HeMarthipt, PruM, ^c. —(1) A Oilohrist scholarship 
of ^660 a year for thrM years is awarded annually, and 
second biennially, to the candidate who stands highest 
at the June Preliminary Examination at the Vi^ria 
University, provided he passes in the first division, i 
(2) A university scholarship of £60 is awarded annually I 
on the results of the second esaminatiou for tbe degree 
of M.B. and B.Ch., held in March. (8) An entrraoe 
scholarship of 64 guineas (covering composition fee 
for a full cnrriculum of lectures) is offered every Sep* 
tember to university students. There are also a Hard* 
wick prise in clinical medicine, a M'Gill prize in clinical 
su^ry, each of the value of £10, and Tborpe prizes of 
£10 rad £6 in forensic medicine end hygiene, and a 
Soattergood prize in midwifery, besides silver and gold 
medals and other class prizes. The composition fee for 
attendance upon all the required courses of school leo* 
tnree is 64 guineas for university students who have 
attended the preliminary scientino courses, and the 
same for non*universi^ students, exclusive of chemistry 
and biol<^. 

At tbe General Infirmary, containing 447 beds, the 
perpetual fee for medical and surgical practice and 
clinical lectures is £42 in one sum, or two instalments 
of £22 each. These fees are not included in the com* 
position fees for lectures, and are payable separately. 

A scholarship of £42 to cover the cost of medical and 
surgical practice is also offered annually. 

Uktvubitt CoLiiioB LiviarooL (Victobia Uxivsa*: 
siTT) Mspioai. FACunTT. — New medical buildings are at j 
present in course of erection, comprising departments of i 
anatomy, surgery, anatomic^ museum, and laboratory i 
and lecture room accommodation for the School of | 
Dental Surgery, materia medical toxiool<^y, Aa These ' 
adjoin the physiological rad patholorioal laboratories,; 
which were recently built and equipped by the generoeity | 
of the Bev. S. A. ThompBon*YatM, at a cost of over 
£30,000. The labozatoriee include theatres for pbyeio- 
loCT rad pathology, laboratories for mioroeoopio, physi- 
caJ and chemical physiology, for morbid anatomy, 
bacteriology, and chemical pathology, spedal rooms for 
research, Ac., private rooms, students’ common room 
and lavatories. The chemical rooms have been 
extended, so as to provide (inter slia) more 
complete accommodation for medical students and 
those engaged in laboratory work for diploma 
in public h^th. The Chair of Hygiene has secured 
adequate permanent accommodation in Ashton Hall, an 
institute adjacent to the ooU^^, which contains ample 
class-room and laboratory accommodation for study and 
research. The museums of anatomy, pathology, and 
materia medioa are furnished with complete provision 
for tile needs of students, and have recently been 
reorganised and revised. The museum of hygiene, 
accommodated in Ashton Hall, has been reoentiy estab¬ 
lished on the lines of the Parkee Museum. It oontains 
meteorological instruments and numerous models rad 
specimens. Under tbe supervision of the professor of 
hygiene a course of lectures on sanitary science is given 
during the winter, suitable for candiiutes for sanitary 
inepe^re' oeriiflcates. 

noTAX iNViaxABT.—Tbe Boyal Infirmary, which 
adjoins tbe school, contains 800 beds, with io epeoial 
beu for the treatment of diseases of women. The Lying- 
in, Eye and Ear, Women’s, Children’s, Dental and Skin 
Hospitals are in the immediate vicinity, rad their 
praotioe is open to tbe students of the medical faculty. 

Fms.—T he oomposition fees are £24 16s. for pre- 
liminaiT scientific classes; £60 for the medical classes 
required for the Victoria, London, rad other University 
d^rees; £70 for all the classes required for the diplomas 


of the Conjoint Boards. The medical oomposition fees 
are payable in two instalments, at intervals of twelve 
months. The fee fcr hospital attendance at the iU^al 
Infirmary is 40 guineas, also payable io two awnnal in. 
stalmeuts. 

Ap^ointmtnt $.—Three house surgeons, three house 
physieianB, rad one extern house surgeon to the 
Thornton Wards are appointed for six mouths, after (if 
necessary) competitive eiainination. Candidates must 
have a legal qualification. Clinical clerks for each 
physician, dressers for esboh surgeon, and clerks to the 
Thornton Wards for diseases of women are appointed 
every three months. Post-mortem clerks are appointed 
for six weeks. All students are required to perform 
this duty before the schedule for the final examination 
is signed. 

Fellowthipt and Scholarships —Fellowships, scholar¬ 
ships, rad prizes of over £600 are awarded annually, 
(a) A Holt Fellowship in pathology rad surgery, of the 
value of £100 for one year, is awe^ed annu^y by tbe 
Medical li'aonlty to a senior student possessing a medi¬ 
cal qualification. The successful candidate is required 
to derote a year to tutorial work and investigation in 
the pathological department, (b) A Holt Fellowship 
in physiology, awarded under similar conditions, oi the 
value of £100 for one year, (c) A Bobert Gee Fellow¬ 
ship in anatomy, awardied under similar conations, also 
of the value of £100 for one year, (d) An Alexander 
Fellowship for research in pathology, of tbe annual 
value of £100, renewable, (e) A Johnston Colonial 
Fellowship in pathology and brateriology (£100 a year, 
renewable), (f) A John W. Garrett International 
Fellowship in physiology and pathology (£100 a yera, 
renewable), (g) Two Lyon Jones Scholanhips, of the 
value of £21 et^ for two years, are awarded annually; 
a Junior Scholarship, open at the end of the first ^ear 
of study to Victoria University students, in the subjects 
of the First M.B. Examinations; and a Senior Scholar¬ 
ship, open to all students in tbe school at the end of the 
second or third year of study, on the subjects of anatomy, 
physiology, and therapeutics, (h) The Derby Exhibi¬ 
tion of £15 for one year is awarded in clinical medioine 
and surgery in alternate years. Students may compete 
in their fourth rad fifth years; in 19ul the subject will 
be clinical surgery, (i) The Torr gold medal in 
anatomy, and tho George Holt medal in physiology, 
the Fletcher prize in physiology (£8 8s. in books), tbe 
Kantback me^ in pathology, the Bobert Gee book 
prize, of tbe value of £6, for children’s diseases, and 
numerous class prises are awarded annually. 

Entrance Seholarihips .—Four Bobert Gee Entrance 
Scholarships of the value each of £26 for one year are 
offered annually for competition. The holder is teouirod 
to take out the soienoe oourse for tbe University degree 
in medioine. 

Communioations should be addressed to the dean, 
Professor Paterson, H.D., University College, Liverpool. 

School or Dxntal Suboxbt. —A new meohraioal 
laboratory has reoentiy been erected at the Dental Hos¬ 
pital; it is adequately equipped with all modem 
appliances, and is under the charge of a skilled meohaaia 
The fees for dental education are £60 (payable in two 
instalments) for the Medical Sohool ourricnlnm ; £21 
payable on entrance, for two years Dental Hospital 
practice: £10 lOs. for general hospital praotioe (two 
winters). A limited number of apprentices are taken at 
the hospital: foe (for three years) £106. Numeroos 
scholarships and prizes are offerra; (a) a Fletcher 
Scholarship of £21 in mechanical dentistry; (4) s 
Phillips Scholarship of £10 10s. in denud surgeiy; a 
Council Prise for dental meohanios (£5 6s. in oMks); 
Ash’s Essay Prize (£2 2s.), A& 

Prospectuses and further information may be had on 
application to the Begistrar, University College, Liver¬ 
pool. 

MAMCHBBTia.—OWXNS COLLBUB SCHOOL OV MUI- 
oxiTB, VictobiaUmivxbsitt.—T he medical sohord build* 
ings, which include large laboratories, disseuting-rooaa 
library rad reading rooms, are on the most modbm 
principles, and students wishing to engage in anatomiosl, 
pliysiological, ur pathological research will find exoeilsst 
opportunity for study in thr ''ompleterad weU-fnrnished 




6«pt. li, 1901. BNGIiAJJD — EDUUATIOlT. Thb Medical Pesss. 271 


labwacoriee. The buildings were extended only s few 
years ago. bat owing to the rapid growth of the school 
farther large additions bare been raade, ioclading 
leotare theatres and laboratories. Hoepital praotioe is 
taken oat at the Boyal Infirmary, which contains 300 
beds. The Cheadle Lunatic Asylam, SC. Mary’s Hospital, 
tile Soatiiem Hoepital, and other special hospitals itiso 
afford te40hing fa^itiee of great importance. 

jlppom<ms»Is.->-Tbe following appointments are made 
in connection with the Manchester Royal Infirmary : 
Sai^cal registrar, at £60 per annum; a pathologi^ 
regutrar, at £100 per annum; a medical registrar, at 
£70 per annum ; two assistuit medical officers, each at 
£80 per annnm • a resident medical officer at the Con- 
raleapent Hospital, Cheadle, one year £160 per annum ; 
resident medical offloer. one year, £160; resident sot* 
gical ^oer, one year, £160 per annum; two chloro- 
fonnists, annnally, at £M; two house surgeons and one 
house physician are appointed every three months 
for a tern of six mon^s; a resident assistant at 
the ConToleecent Hoepital, Cheadle, appointed every 
six months. 

Seholarthip$.^DAltOB Entrance Scholarships, £40 per 
annum, for two years; Cartwright Entrance Scholar^ 
ship, £^ per annum, for three years; Hulme Entrance 
Scholarship, £86 per annam, for three years; Rogers 
Entrance Scholarship, £40 per annnm for two years; 
Baton Entrance Scholarship, £40 per annum for two 
yean; James Qaakill Entrance S^olarship, £40 per 
annnm for two years; Eay Shnttleworth (Sir Jas. 
PhiliM) Scholarship, £^ per annum for thrw years; 
Theodoree Modern ^ugn^es Exhibition, £16; Huno* 
rary Research Fellowships; Manchester Grammar 
School Scholarship, £18 per annnm for three years; 
Tomer Scholarship of £20 to students who have com¬ 
pleted four years of study in the CoUen; Platt Physio¬ 
logical Scholarship, value £50, tenable for two years, 
oim to students between the of 18 and 26; two 
Platt exhibitions, £16 each, for first and second year’s 
students in physiology; Sidney Bensbuw Physiological 
Exhibition, £15; Dimple Surgical Prize, £15, at the 
end of the winter session; two Danntoey Medical 
Entrance Scholarships, value £36, tenable for one year; 
John Henry Agnew Scholarship in Diseasei of Children, 
value about ^0 award^ annually; Gilbert Scholar- 
shipe ai £60 per annum tenable for three years iu any 
of the Colleges of the Victoria University, award^ 
annually to the candidate gaining the highest number 
(ff- marks in the first division of the Preliminary Exami¬ 
nation of the Victoria University; the Bradley 
Memorial Scholarship, £20, in Clinical Surgery is offer^ 
annuaily in the summer session to candidates who must 
be four^ year students; one Medical and one Surgical 
Clinioal Prise are ^so offer annnally. 

F<*m.—C omposition fee, £70, in two sums of £35 each, 
Hospital practioe: composition fee, £40, or two instal¬ 
ments uf £26 each. 

Heafal Fses.—Composition fee, £60, payable in two 
rams uf £26 each. Hospital practice, £21. 

SKxmxLD Ukivxssitt Colleos Medical Depabt- 
MBNT.—The medical department contains a medical 
library, good class-rooms, an excellent anatomical de- 
partnient, and every provisioa for medical education 
under the most modem principles. The physiologioal 
department has been entirely reconstructed and 

S nipped in memory of the late president of the school. 

r. Wm. F. Fnvelh through the generosity of anooy- 
moos donors. The department consists of a lecture and 
demonstration theatre, students' laboratory, preparing 
room and galvanometer room, all of which are equipped 
with the most modem apparatus. New premises have 
been acquired near the College for tiie pathological 
museom and laboratory, and alra for a bacteriological 
lateiatory, which has been completely equipped through 
the generosity of *‘A Sheffield Citizen.” The course of 
leetoe s and inetmotion is adapted to meet the require¬ 
ments of the various examining bodies. Full courses of 
iostrootion required for the D.P.H. are given. The new 
dental department has been recognised by the examining 
bodiee. Students at this college obtain medical and sur- 
gicai practioe at the Boyal Infirma ry, a well-appointed 
institution, eontaining 240 beds, and also at the 


Sheffield Boyal Hoepital, containing 125 beds. The fees 
for attendance, £6 Se. each for medical and surgical 
praotioe duriag the winter session, and for three months 
£3 3 b. each. Perpetual fee for medical and sulcal 
hospital practice in a single payment of £45, or in two 
payments, viz., £26 on entranoe, and £22 wit^n twelve 
months afterwards. Students are also admitted to the 
practice of the Jeesop Hospital for Diseases of Women, 
to the City Fever Ho^itals, and to the South Yorkshire 
Lnuatio Asylum at Wadsley. The winter session will 
commence on October Ist, when the introductory address 
will be delivered by Sir Thomas Barlow, Bart. 

Se/iolarships, ifc ,—An entrance soholai^ip dl the value 
of £110 is annnally awarded to the best oandidate (if of 
sufficient merit) in mathematica, elementary physics, 
ino^anic chemistry, Latin, Engli^. 

Gomposition fee, 60 guineas, or in two instalments of 
36 guineas and 80 guineas for leotures and practical 
olas^ required by the Examining Board in England. 

The Kaye scholarship, for second year’s student’s, 
natives of Sheffield, is awarded aanually, under oertain 
regulations. Prizes for clinical medicine and olinir^ 
snrgery of 10 guineas; Simon prize in pathology, £10; 
prizes in books and certificates awarded annually. 

Umitebsitt or Durham Collsoe of Mbdioine, New¬ 
castle-upon-Tyne.—A very commodious and ornate new 
building has been eraot^ here at a cost of about 
£31,000. The electric light is installed throughout the 
whole of the working part of the college. The Royal 
Infirmary, at which clinical instruction is obtained, 
contains 280 beds. Pathological demonstrations are 
given as oppoituuity offers. Practical midwifery can 
be studied at the Newcastle Lying-in Hospital. Oppor¬ 
tunities for practical study are also afforded by the 
Dispensary, City Infectious Diseases Hospital, Eye 
Infirmary, Children’s Hospital and NozthumbOTland 
County Lunatic Asylam. Lectures are given on peyoho- 
logioal medicine and public health. 

AppointrMnit .—Asssistant demonstrators of anatomy 
receiving eaoh an honorarium; prosectors for the pro¬ 
fessor of anatomy, assistant demonstrators of physiology 
and pathology, assistants to the dental surgeon, clinical 
clerks, and diessers are appointed at regular intervals. 
One year’s attendance at the College is required on the 
Mrt of candidatee for the degrees in medicine of the 
University of Durham. 

Scholarihipt, —University scholarships, value £100, 
for proficiency in arts, awarded annually at the begin¬ 
ning of winter session to full students in their first year 
only. The Dickinson memorial scholarship (valoe, the 
interest of £400 with a gold medal) for mediae, sur¬ 
gery, midwifery, and pathology, open to full students 
who have passed the primary examination of a licensing 
body. The Tulloch scholarship, interest of £400 
annually, for anatomy, physiology, and ohemistry. The 
Charlton memorialsdiolatship, intorestof £700 annually, 
open to full students entered for the class of medicine 
at end of the fourth or fifth winter. The Gibb Bipolar- 
ship, interest of £600 annually, for pathology, at end of 
summer session. Goyder memorial s^olarship in Minirtal 
medicine and clinical surgery, proceeds of £826 annually. 
The Luke Armstrong memorial soholarsbip, interest on 
£680. The Stephen Scott scholarship in surgery, interest 
on £1,000. The Heath scholarship in surgery (the next 
award will be in 1902); the interest on £4,000 is awarded 
every second year. The Gibson prize in midwifery and 
diseMes of women and children; the interest on £226 is 
awarded yearly. At the end of each session a prize of 
books is awarded in eaoh of the regular classes. 

Fmi.—( a) A composition ticket for lectures at the col¬ 
lege may be obtained—1. By payment of 70 guineas on 
ontranoe. 2. By payment of 46 guineas at the com¬ 
mencement of the first seasioitel year and 36 guineas at 
the commencement of the second sessional year. 3. By 
th^ annual inetsdments of 36, 30, and 20 guineas, re¬ 
spectively at the commencement of the sessional year. 
(&) Fees for attendance on hospital praotioe : For three 
months' medical and hospital praotioe, 5 guineas; for six 
months, 8 guineas; for one year, 12 guineas ; perpetnal, 
25 guineas; or by three insialments at the oomcnenoe- 
uienC of the sessional year, viz,, first year 12 guineas; 
second year, 10 guineas; third year, 6 guineas} or by 



272 Thi MsDieAii Pbbm ENGLAND—EDIT CATION. 


Sm. 11, ISOI. 


two inatelmentfl, vii., fint year, 14 gnineae; second year, 
12 ffnineae. 

TJvitsbsitt Ck>LLaaB, CABDirr, School or Midioinb. 
—This college which is one of the ooUegee of the Uni* 
versity of Wales, has since its fotindation, in 1883, 
prepared stndents for the Preliminary Scientific exami- | 
nation of the Unirersity of London, and for the oorre* I 
sponding examinations of other licensing bodies. In j 
1893, Cl^rs of Anatomy and Physiology and a Lecture- | 
ship in Materia Medioa and Pharmacy were established, ; 
making it possible for students of medicine to spend 
three out of five years of prescribed study at CMdiff. 
Arrangements with the managing committee of the ' 
Citfdiif Infirmary, give students of the College the privi¬ 
lege of attending this large and well-order^ Hospital 
which is situated within five minutes walk of UniTeraity 
Collie. Many students, especially from Wales and 
Monmouthshire, avail themselves of the opportunities 
thus afforded to pursue the earlier part of the medical 
curriculum near home. All classes are open alike to 
both men and women students over sixteen years of ^e. 
The courses of instruction given at Cardiff are recog¬ 
nised as qualifying for the examinations of the univer¬ 
sities, Boyal colleges, uid other licensing bodies of 
Clreat Britain and Ireland. Having spent ^o or three 
years in study at Cardiff, and having passed the oorre- 
ntonding examinations, a student may proceed to 
^ndon or elsewhere and complete his qualifying course 
for a university degree or for a college diploma. 

Students preparmg for the first and second examina¬ 
tions of the Conjoint Board for England or for the cor¬ 
responding examinationB of the conjoint Board for Scot¬ 
land, or for those of the Society of Apothecariw may 
compound for their olaasee by paying a single oompoei- 
tion fee of A40, or by paying £18 10s. and £24 lOs. at 
the beginning of their flt^ and second years respec¬ 
tively. 

Those preparing for the preliminary scientifio and 
intermediate examination in medicine of the University 
of London may compound for tiieir three years instmo- 
tion at Cardiff by paying a single composition fee oi 
£67 10s., or by paying £13 l3s., £28 and £21 at the be¬ 
ginning of their first, second, and third years respei^ 
uvely. 

In 1899 a department of Public Health was estab¬ 
lished, and lecturers in bacteriology and in public 
health and hygiene were appointed. Medical men pre¬ 
paring for a diploma in Public Health and Hygiene can 
attend complete courses of lectures and laboratory in¬ 
struction in this department. These courses are recog¬ 
nised by the University of Cambridge, by the Boyal 
Colleges of Physicians and Surgeons, and by Victoria 
University. 

Seholarthips, ^e .—The attention of students abont to 
matriculate is drawn to the numerous entrance scholar¬ 
ships for exhibitioBs which are offered at the ooUeM 
for competition in September, most of which may M 
held by medical stndents. Full partiouburs of the 
examination for these may be obtained from the 
Begistiar. 

LrvBBTooL Botal Soothbkn Hospital.— The clinioid 
school of this hospital is situated within convenient dis¬ 
tance of the school of medicine, and affords every facility 
for clinical and pathological study. The hospital con¬ 
tains 200 beds, and in Edition to the generid medical 
and surgical oases attention is devoted to the diseases 
of women and ohil«hen. There is a special ward for 
medical disonsos in connection witii the University 
College laboratories. 

The medical and surgical staff visit the wards daily, 
and the ward instruction is supplemented by weekly 
clinical lectures. Additions have been made to the 
teaching staff so that stndents may now obtain in¬ 
struction in diseases of the eye, ear and throat. Pemon- 
strations in the use of the X-ray apparattm are given at 
intervals. There is an excellent pathological depart¬ 
ment, with laboratory attached, where demonstrations 
are arranged for and regular instruction is given in 
practical pathology. The practice of St. Ceorge’s Hos¬ 
pital for diseases of the skin is free to stndents, and 
thus ample apportnnity is afforded for acquiring a 
knowledge of dermatology. In addition to the clinioal 


clerkships which are allotted to tiie students the resi¬ 
dent posts of ambulance officers are given to the 
students whom the board may think most suited to 
bold them every three months. The Alexander Fellow¬ 
ship in Patholc^ of £100 a year is open to stndents ot 
this school, toree prizes of £6 each are also awarded to 
the gentlemen who present the beet taken series of 
medical and surgical cases. Fees: perpetual, £26 6s.; 
one year, £10 lOs.; six months, £7 78.; three months, 
£44s. 

There are rooms for a limited number of resident 
stndents; terms (exclusive of foe for hospital praotioe), 
£16 16 b. per qnaitor. The practice of the hospital is 
recognised by all examining iXHliea. 

Thb Liybbfool School or Tbopioal Mbdicibb.— 
The Liverpool School of Tropical Medicine hu had 
another busy year, the chief item of interest being the 
despatch of inrther exp^itions for the purposes of 
medical research. In March, 1000, Dr. Annett, Dr. 
Dutton, and Dr. Elliott were despatched to Nigeria 
(northern and southern), where they spent a oonaider- 
able time in research work, and have published an im¬ 
portant report on the subject. In June tbe Yellow 
Fever Expedition, consisting of Dr. Durham and Dr. 
Walter Myers, were despatched to Para in BrasiL &&d 
iiaa not jret returned. One member of the expedition. 
Dr. Walter Myers, unfortunately lost his life in the per^ 
formanoe of his duties, from a faW attack of yellow fever, 
contracted whilst conducting an autopsy. The latest ex¬ 
pedition of the B^ool is that recently despatched under 
MajorEoee,P.B.8.,andDr.LoganTaylorte8ier»Leoneto 
conduct meet important Experiments there with a view 
to eicterminating mosquitoes, if possible. In memory of 
Dr. Walter Meyers, tne school have founded a Walter 
Myers'i Chair of Tr<mical Medicine and a Walter 
Myers’ Fellowship of Tropical Medicine, to which 
Major Boss, P.B.8., and Dr. J- E. Dntton have 
respectively been appointed. Drs. Fielding Quid, Grun- 
banm, and Balfonr Stewart have been appointed assis¬ 
tant lecturers to the sohooL No difflonlty hu been 
experienced in raising all the money required for the 
expenses of the school, although these ue extremely 
heavy. 

Beistol Botal Infibmaey.— This is one of the 
largest provincial hospitals in Great Britain, and con¬ 
tains 270 beds. It is provided with all the necessary 
appliances for a complete clinical education. Tbe resi¬ 
dent appointment* are five in number, the two juniors 
of which are each tenable for six months, and are in¬ 
tended for qualified students of tbe infirmary, who have 
pcevionsly acted as medical and surgical registrars. 
Several scholarships and prizee are obtainable. Fees for 
admission to the medical practice, six months, 7 guineas; 
twelve months, 12 guineas; perpetual, 20 gnineas. The 
same fees are payable for surgical praotioa Perpetual 
fee for medical and surgical practice, 86 gnineas. Dental 
praotioe, one year, £7 78.; perpetual, £12 128. 

The followiag: are the principal provineial ho§- 
pitals having the greatest nnmher of heds, to 
whi^ stndents are admitted where clmcal in¬ 
struction can he obtained, but to which there is 
no medical sebo^ attached 

Bath Botal Uhitbd Hospital.—T his is a well- 

K inted hospital in the West of England, with 120 
, at which students can obtain dinioal instruction. 
The hospital is recognised by the Colleges, and is 
licensed for dissection. It contains also an excellent 
museum and litnnry. Fee for six months’ attendaaoe, 
five gnineas i twelve months’ ton gnineas. 

Bbadfoed Ihfibmaet. —The hospital contains 210 
beds. Non-resident pnpile are received—and abundance 
of clinical material is obtainable. One year’s attend¬ 
ance is recognised by the Exa min ing Bo^ds. Fee, 
perpetual, £10 lOs. 

Bbiohton Sussex Codntt Hospital contains 178 
beds. It is recognised by the College of Suigeons and 
by the Conjoint Board. Oat-pupils are admitted to the 
clinical teaching and the dasM at a fee of £21 for two 

years. ~. v -i. i • 

Norfolk akb Norwich Hospital.— This hospiw is 
recognised by the Colleges, and oontains 220 beds. Fees, 


O 



SiPT. 11, 1901. 


ENGLAND—EDUCATION. 


Thi Mbdical Pbsss. 273 


.£10 10b. for giz znontha', £16 158. for twelve monthe’ 
medical and surgical practice. Pupils, resident and non¬ 
resident, are adi^tted. 

Livxbpool Nortbxbn Hospital, contains 180 beds. 
Clinical instmotion is given by tbe staff daring the 
summer and winter sessions. Clinical clerkships and 
dresserslups are open to all students without admtional 
fees. Fees for hospital attendance: Perpetual, £28 6s.; 
one year, £10 lOs.; six months, £7 7s.; three months, 
£4 48.; practical pharmacy, £2 28. 

Nobtrampton Gxnbbal Infibxabt. —The number of 
beds is 163. Ont>papils are received, and have every 
opiiortanity of acquiring a practical knowledge of their 
profession. Instruction is also given in anatomy and 
materia medioa and practical pharmacy. Non-resident 
pupils are taken at a fee of £10 lOs. 

Thb Botal Hospital, Portsmouth.—The hospital 
is a preparatory school of medicine and surgery, and the 
attendance of pupils is recognised by the Examining 
Bosuds. Tbe number of beds is 150, and during last 
year there were 1,303 in-patients and 0,191 out-patients. 

Botal Dxvok and Exxtbb Hospital, Exeter.—The 
hospital oontains 218 be^ (including special children's 
wards), and has a good library, museum, dissecting 
TMm, and poet-mort^ room. Attendmioe on the prao- 
tioe of this hospital qualifies for all tbe Exam^ng 
Boards. Arrangements can be made by which studente 
can attend midwifery on application to tbe House 
Suraeon. 

Wolvxbhahpton dxNXBAL HOSPITAL. —^The hospital 
contains 230 beds, attendance at this hospital l^g 
recognised by all the Examining Boards. Pupils are 
trained in clinical work by tbe medical and surgical 
staff. Fees: Six months, £6 68.; twelve months, 
£12 128.; peipetnal, £21. 

THE ENGLISH UNIVEBSITIES. 

The English Universitiee are six in number, vis., 
Oxford, Cambridge, London, tbe Victoria, Durham, and 
the recently created University of Birmingham. The 
choice of a university is usually determined by social, 
geographical, and financial considerations. Evidently 
students whose parents are able and willing to incur 
the necessary expense would do well to select one or 
other of the ancient universities for the possession of 
their degrees, which invest their holders with a status 
not accorded by the public to tiie degrees of equally 
efficient but more modem educational institutions. To 


those less favoured by fortune, but blessed with energy 
and a fair share of intelligence, the London University 
offers free scope, and its degrees are recognised as the 
outward and visible proof of high professional attain- 
merate nntxammeled by the traditions which hamper the 
older bodies. The Victoria University comprises Owms 
College, Manchester, University College, livnpool, and 
the Yorkshire College at Leeds. It tiins covers a wide 
area and attracts considerable nnmbws of students 
whose aim is essentially the possession of a degree in 
medufine. Durham University has “gone ahead’* cff 
late years, and h** done much to facilitate gradna- 
ti/igi by the abolitiQu of irritating and futile restrictions 
witiiont sacrificing tiia ideals of university traiiiing. 

OXFOBD. 

There are two degrees in medicine, M.B. and MJ>., 
pnA two degrees in surgery, B.Ch. and M.Cb. The M.B. 
and B.Ch. degrees Me granted to those members of the 
University imo have passed the second examination. 
Graduates in Arts, B.A., are alone eligible for these 
two duress. In order to obtain the .degrees of M.B. 
faiA B.(^, the following examinations must be passed:— 
1. Freliminary subject Mechanics and phyrios, 
diemistry, lUMphology and botany. 2. Pro¬ 

fessional (a) First Examination (held twice a year): 
Subjects: Orguio chemistry, unless the candidate has 
obtained a first or seoMld cWs in obemistry in the 


Natural Soienoe School; Human physiolc^, nnless he 
has obtained a first or second cIm in animal physio¬ 
logy in the Natural Science School; Human anatomy 
and Materia medioa with Pharmacy, (b) Second Exa¬ 
mination : Subjects: Medicine, Snrg^, Midwifery, 
Pathology, Forensic medicine with Hygiene. The ap¬ 
proximate dates of the examinatiouB are as follows:— 
Preliminaries — Mechanics, physios, and ohsmistry, 
December and June; Animal morphol<^ and botany, 
December and March; Profesaiood (First and Second 
M.B.), June and {December. 

Tbe degree of H.D. is granted to Bachelors of Medi¬ 
cine of the University who have entered on their thirty- 
ninth term on their presenting a dissertation approv^ 
by the appointed prorestors and examiners. 

The degree of M.Ch. is granted to Bachelors of 
Surgery of the University wbohAve entered their twenty- 
seventh term, who Me members of the surgical staff of a 
recognised hospital, or have acted as draner or house 
surgeon in such a hospital for six months, and who have 
passed an examination in sn^ery, snrgio^ anatomy, 
and sni^oal operations. This examination is held 
annnaUy, in June, at the end of tbe Second M.B. 
Examination. 

The First Examination for the degrees of M.B. and 
B.Ch. may be passed as soon as the l^liminMy Scien¬ 
tific Examinations have been completed. The subjects 
of this examination may be presented sepMately or in 
any combination or in any order, provided anatomy and 
physiology be PMsed tog^er. 

Tbe SeMud Examinati(m may be passed at any time 
after the oompletion of tbe first. The subjects of medi¬ 
cine, surgery, and midwifery must be passed at the same 
examination, bnt candidates are allowed to present them¬ 
selves in pathology at a separate examination. 

Diploma in Public BeaUh. —An examination is held 
yeMly in Michaelmas Term, open to all registered 
medi^ practitioners. No one is Mmittod as a candidate 
unless his name has been on the "Medical Begister” for 
twelve months. 

ScMatchipt, ^c. — Scholarships in some branch of 
Natural Soienoe (chemistry, physics, biok^) of the 
average value of BSO per annum, tenable for four years 
and renewable under certain conditions for a fifth ycM, 
as well as exhibitions of lees annual value, are awi^ed 
after competitive examinations every yeM some of the 
Colleges. Notices of vacancy, Aa, are pnbUshed in tbe 
" University Gtesetto." In February there is competed tor 
annually, by those who, having obtained a first-class in 
ai^ school (moderations or final), or a scholarship^ or 
prue open te general competition in the University, 
have passed all the examinations for the degree of B.A. 
A Badoliffe Travelling Fellowship is tenable for thrM 
jears, of the annual v^ne of £200. The examination is 
partly scientific, pikrtly medical. A Bollseton Memorial 
prise is awardM onoe in two years to members of the 
tFniversitiee of Oxford and Cambridge of not mote than 
ton years’ standing tat an original r esear ch in some 
subject including physiology or pathology. 

More detailed infonnatira may be obtained from the 
University CalendM and from the BegistiM. 

CAMBBIDOE* 

At the University at Cambridge five years of medical 
stody are required for tbe M.B. and B.C. degrees. The 
oancudato must have resided nine terms (thiee years) 
in the nniversitiy, and have Mssed the “previous ” exa¬ 
mination in olaseios and malmeinatioB. I^ere are three 
examinations: the fii^ in chemistry, physios, and 
biology: the second in hnman anatomy, physiology, and 
(2) ohemlstry; and the third, in the 

asiisi practical snbjeots with hygiene and pathology; 
each examination is divided into two parts, which can 
be taken separately. Snbeeqnently to the third exami¬ 
nation an Act has to be kept, which consists in reading 
an original thesis, followed by an oral examination on 
the subject of ^e thesis. As the snbjects for the 
examination fM the degree in Surgery ate included in 
the third examination for tiie M.B. degree, candidates 
are admitted to tlto degree of Bachelor of Sn^;e^ on 
peeing the third examination for Bachelor of Medicine. 

The M.D. degree may be taken three years aftor the 

C- 



274 Thu Mbdical _ENGLAND—EDUCATION. Sift. 11, 1901. 


M.B. As Act bae to be kept, witb oral exanisatioDs, 
and as eesay to be written extempore. There ie 
also the degree of Master of Surgery, for which the 
candidate, haTisg already passed for B.C., or being M. A., 
has otherwise qualified in snrgery, has to pursne extra 
etndy in snrgery, and has a special examination or 
submit original contributions of merit to the science or 
art of surgery. The yearly expenditure of astudentwho 
keeps his term by a residence in a college is from £160, 
to £200 a year. This, however, may include ail pay¬ 
ments to the University and the College—all fees as 
well as clothes, pocket money, travelling expenses. Ac. 
Non-coUegiate students haveonly to pay the University 
fees which are not large. They lodge and board as 
they like; their expenses, therefore, are entirely in 
their own hands. 

The University degree grants a diploma in public 
health without the necessity of residence, the examina¬ 
tion being in so much of State medicine as is comprised 
in the functions of officers of health, and subject to the 
latest requirements of the General Medical Council. 
These examinations are held in Cambridge the first 
week in April and October. Candidates, whose names 
must be on the Medical Begister of the United Kin^om, 
and need not be members of the TTniversity, should 
send in their applications to the Secretary of the State 
Medicine Syndicate a fortnight in advance. Every can¬ 
didate who has passed both parts of the examination to 
the satisfaction of the examiners will receive a testi¬ 
monial testifying to his competent knowledge of the 
su^ects comprised in the duties of a medical officer of 

An abstract of all Begulations may be obtained upon 
sending a stamped directed envelope to the Assistant 
Begistaary, Cambridge. Full information is contained 
in the University Calendar. 

UNIVEBSITY OP LONDON. 

The Matriculation Na;aminatton.—Candidates for any 
degree in ^his University must have passed the matricu¬ 
lation examination. It is held twice in each year—on 
^e second Monday in January and the second Monday 
in June; and may be held not only at the University of 
London, but also, under special arrangement, in other 
parte of the United Kingdom or in the colonies. 

I'he Preliminary Scientific M.B. Emamination. —Pro¬ 
fessional studies pursued before the whole of this exa¬ 
mination has been passed will not count towards the 
ooTurse re(|uired for the M.B- degree. The subjects are 
(a) chemistry and physios, (b) general biologv. The 
examination takes place twice in each year, once for 
Pass and Honours, commencing on the third Monday in 
July, and once for Pass candidates only, commencing on 
the third Monday in January. 

Intermediate Examinatio'x .—The Intermediate Exami¬ 
nation in Medicine takes place twice in each year - once 
for Pass and Honours, commencing on the second Mon¬ 
day in July, and once for Pass candidates only, commenc¬ 
ing on the third Monday in Janua^. The subjects of I 
the examination are anatomy, physiology and histology, I 
organic chemistry, materia medioa, and pbarmacentical 
chemistry. No candidate shall be admitted to this 
examination unless he is nineteen years of age and has 
passed the Prelimimiry Scientific Examination at least 
two years previously. Fee for this examination, £6. 

M.B. Paramifla^toN.—This examination is held for 
Pass and Honours in October, and for Pass only in May. 
The candidate most have passed the Intermediate 
Examination at least twenty-one months earlier, must 
have attended lectures and hospital practice in a rec<^- 
nised medical school for two years, including at least 
two months' attendance on lunacy and infectious 
diseases, one of which must be subsequent to the Inter¬ 
mediate Examination, must have conducted at least 
twenty labours, and have acquired proficiency in vacci¬ 
nation. 

Bachelor of Surgery .—The examination for the d^[ree 
of Bachelor of Surgery takes place once in each year, in 
December. Candidates must produce oertifioater to the 
follovring effect:—1. Of having passed the examination 
for the degree of Bachelor of htWlioine in this Univer¬ 
sity. 2. Of having attended a course of instruction in 


operative surgery, and of having operated on the dead 
subject. The subjects of the examination are surgery 
(including operations on the dead body), pathology, and 
surgical anatomy. Fee, £5 

Waiter in Surgery. —The examination for the degre 
of Master in Snrgery takes place once in each year, in 
December. Candidates must be bachelors of snrgery 
of at least two years’ standing; one year is, however, 
remitted in the case of candidates who passed the B.8. 
examination in the first division. The examination 
comprises mental physiology, snrgery, and surgical 
anatomy. 

Degree of Doctor of M.D.—Doctor of Medicine .—The 
degree of Doctor of Medicine is granted after examina¬ 
tion to bachelors of medicine of at least two years’ 
standing. The examination comprises medical physiology 
and mMicine, and is conducted by written papers, 
clinical examination, and viva voce. A candidate who 
presents a thesis approved by the examiners is excused 
the written examination. 

Doctor of Medicine «« Slate Medic'ne .—This degree is 
granted to bachelors of medicine after examination on 
producing evidence of having been engaged in the study 
of State Medicine for at least two years. The examina¬ 
tion is the same as for the ordinary M.D., with the 
exception that Stitte Medicine takes the place of 
medicine. 

PrtsM.—1. The Sherbrooke Prise is awarded trien- 
niallyforthe best eesay, embodying original research in 
some branch of science. 

2. The Granville Prize is awarded In each of the two 
years intervening between the several awards of the 
Sherbrooke Prize. 

Exhibitions or scholarships are awarded to the first 
six candidates in honours at the matriculation examina¬ 
tion, and. if thought proper, to the first candidate in 
honours at the other examinations. 

UNIVBRSITf OF DURHAM. 

One diploma and six d^rees in Medicine and Hygiene 
are conferred, viz., the degrees of Bachelor in Medicine, 
Bachelor in Snrgery, Mtster in Snrgery, Doctor in 
Medicine, Bachelor in Hygiene, and Doctor in Hygiene, 
and Diploma in Public Health. These degrees are open 
to both men and women. 

For the degree of Bachelor in Medicine (M B.) there 
are four professional examinations. The subjects for the 
first are: Elementary tmatomy and elementary biologv. 
chemistry, and physics. For the second: Anatomy, 
physiology, materia medioa, therapeutics, and pbarma- 
oolc^. For the third ; Pathology, medical jurispru¬ 
dence, public health, and elementary bacteriology ; a> d 
for the fourth: Medicine, clinical medicine, and psycho¬ 
logical medicine, suigeiy, and clinical surgery, midwifery, 
and diseases of women and children. 

It is required that one of the five years of professional 
I education shall be spent in attendance at the University 
College of Medicine and the Boyal Infirmary, New¬ 
castle -upon-Tyne. 

Candidates who have passed the First and Second 
Examinations of the University will be exempt from 
the First and Second Examination of the Conjoint 
Board. 

For the degree of Bachelor in Snrgery (B.8.) every 
candidate must have papsed tiie examinalton for the 
degree of Bachelor of Medicine of the University of 
Durham, and must have attended one course of leotorea 
on operative surgery, and one course on regional 
anatomy. Candidates will be required to perform 
operations on the dead body, and to give proof of prac¬ 
tical knowledge of the use of surgical instrumento aad 
applianoes. 

For the d^ree of Master in Snrgery (M.S.) oandi- 
datoe must not be less than twenty-four years of age, 
and must satisfy the University as to their knowledge of 
Greek. In case they shall not have passed in this sub¬ 
ject at the Preliminary Examination in Arts for the M B. 
degree, they must present themselves at Durham for 
' examination in it at one of the ordinary examinatione 
I held for this purpose before they can proceed to the 
I higher degree of M.S. They must also have obtained 
^ the degree of Bachelor in Surgeiy ot the Universitj of 


o 




Sbft. 11, 19U1. 


ENGLAND—EDUCATION. 


Thi Mioioal Fbku. 275 


Durham, aad mast have been engaged for at least two 
years, subeeqaently to the date of aoqnirenient of the 
degree of badelor in snigery, in attendance on the prac¬ 
tice of a recognised hospit«l, or in the naval or military 
serrioe, or in medical or surgical practice. 

For ^e degree of Doctor in Medicine (M.D.) candi¬ 
dates mast M of not less than twenty-fonr years of 
age, and most satisfy the University as to their know- 
l<^ge of Greek. In case Uiey shall not have passed in 
this snlneot at the Preliminary Exsunination in Arte for 
the M.B. degree, they mast present themselves at 
Durham for examination in it at one of the ordinary 
examina^ons held for this purpose before they proceed 
to the hitrher degree of M.D. They roust alM have 
obtained the degree of Bachelor in Medicine of the 
University of Durham, and must have been engaged for 
at least two years, subsequently to the date of acquire¬ 
ment of the d^p^ of Bachelor of Medicine, in attend¬ 
ance on the practice of a recc^piised bospit^ or in the 
military or naval servioee, or in medical and sulcal 
practice. 

Each candidate must prepare an essav, which must be 
type written, based on original research or observation, 
on some medical subject selected by himself, and ap¬ 
proved by the Professor of Medicine, and must pass an 
examination thereon, and must be prepared to answer 
questions on the other subjects of his ourrioulum so far 
as they are related to the subjects of the essay. 

For regulations for degrees in Hygiene and for the 
diploma in Public Health see Calends 1901-2. 

Candidates for any of the above degrees must give at 
least twenfy-eight ^ys* notice to the Secretary of the 
College of Medicine, Newcastle-on-Tyne. 

Besidenoe can be had in a separate hostel for female 
students at moderate inclusive fees for board, Ac., 
particulars of which and any other oolite information 
will be given on application to Prof Howden, Seorettuy, 
TTniversity of Durham Ooll^;e of Medicine, Newcastle- 
on-Tyne. 

VICTOEIA UNIVEB8ITY. 

Colleges of the University: Owens Collie, Man- 
cheeter; University College, Liverpool; and Yorkshire 
College, lieeds. Candidates for degrees in medicine 
and surgery most attend, daring at least two years, 
olaases in one of the colleges of the University. 

The degrees in the Faculty of Medicine are Bachelor 
of Medicine (M.B.), Bachelor of Surgery (Ch B.), Doctor 
of Medicine (M.D.), and Master of Snrgery (Ch.M.). All 
candidatoe for degree* in medicine and surgery are 
required to pass the Preliminary Ezammation, or to 
have passed such other examination as may from time 
to time be rec^^nised for this purpose by the Univer¬ 
sity. 

The subjects of the Preliminary Examination are— 
1, Latin; 2, Elementary Mathematics; 3. Elementary 
Mechanics: 4, English; 6, one of the following:— 
(a) French; (b) German; (c) Greek; (d) Italiam 
(e) Spanish; (/) any other modem language, permission 
to present which hu been obtained from Board of 
Studies. Notioe of intention to present either Italian or 
Spanish must be given before March let in each year. 

Before admission to the degrees of Bachelor of Medi¬ 
cine and Snrgery candidates ai« required to send in the 
usual certificate of ag6 and study as at the other 
Universities. 

AJl candidates for these degrees must pass three ex¬ 
aminations, namely—the First examination; the Second 
examination; and the Final examination. 

I’irst Examinai ion.—The subjects of the examination 
are, 1. Chemistry ; 2, Elementary Biolopfy; 8, Physios. 

Candidates mart have attended, dnnng at least one 
year, oonrses of both leotnrea and laboratory work in 
eac^ of the above-named aabject*. 

Second—1, Anatomy; 2. Physiology (including phy¬ 
siological chemistry and histology); materia medics, and 
pbarmacv. 

Candidates must have passed the First Examination, 
a nd have attended courses of instraotion in anatomy 
(systematic and practical) during two winter sessions 
one summer session, in ^ysiology for tvo winter 
eesions, in materia'medioa and pharmacy for on* summer 


session. Candidates may present tiiemselves smarately 
in (a) anatomy and physiology, (i) materia meaioa and 
phwmaoy. 

Fin-*!.—The examination is divided into two parte, 
which may be passed separately or on same occasion, 

but the first part cannot be taken before the end of the 
third year, and the second part cannot be taken lees than 
two years after passing 8Wx>nd M.B. or before tke fif^ 
year of medical study in accordance with the University 
regulations. The subjects of examination are as follows: 
1, Pharmacology and tberapentios; 2, General patholc^ 
and morbid anatomy; 3, I^>rengic medicine and toxuxK 
logy and public he^tb; 4, Obstotrios and disonees of 
womra; 6, Snrgery, s^teinatio, clinical, and practical ; 6, 
Medicine, systomatio and clinical, inoluding mental 
diseases and diseases of children. Candidates may 
select as a first part of the examination two or three 
of the subjects I, 2, and 8. 

The certificates required from candidates at the final 
examination are pnu^cally the same as for the corre¬ 
sponding examination at the London University, and 
only those who have previously passed the second 
examination are admits to it. The regulations re¬ 
lating to the M.D. and Ch.M. degrees can be obtained 
on application to the Begistrar. 

fees. —Preliminary examination, £2; for any subs^ 
quent examination, £1 ; First examination, £6; for any 
subsequent examination, £2. The fees for the second 
examination, for the &ml examination, and for the 
examination for the d^ree of Cb.M. are the same as for 
the first examination. A fee of £10 is payable on the 
conferring of the degree of M.D., a fee of £4 on the 
conferring of the degree of Ch.M. 

The Pr^iminary examination is held in Jane and 
about the end of September. The first M.B. and 
Cb.B. is held in June; also about the end of September. 
The second and final examinations are held in March 
and July, the examination for Ch.M. in July only. 

UNIVEBSITY OP BIRMINGHAM. 

The University of Birmingham szante de g r oo s of 
M.B., Ch.B., M.D., Ch.M,, and (dso a B.So. in tke subject 
of public health. In order to obtain any of these 
degrees it is necessary that a student shall have passed 
at least the first four yean of his oarricnlum in attend¬ 
ance upon the classes of the univenity. 

Degrees of Bachelor of Medieins and Bachelor of 
Surg^ —The student must have passed either tiie 
matrioulation examination of tiie nmvenity or one of 
the following examinations, which will be accepted in 
lien thereof for the present:— (a) The previous examina¬ 
tion of the Univenity of Cambridge, (i) Besponsions 
of the Univenity of Oxford, (e) The matrioulation 
examination of any other univenity in the United 
Kingdom, (d) The leaving oertifioato (higher) of the 
Oxford and Cambridge Bouds. (e) The O^ord or 
Cambridge junior local examinations (fint or second 
class bonoun). (/) The Oxford or Cambridge senior 
local examination (honoun). fy) The College of Pre- 
cepton examination for fint oIms certificate. 

Matriculation examinations are held in June and 
September each year. 

Degrees of Doctor of Medicine and Master of Snrgery. 
—Candidates for either of these degrees will be requirM 
either—(a) To present a thesis embodying original 
observations in some subject embraced in the mei^oal 
curriculum and approved by a Board of Medical 
Examinen; or (&) to pass a general examination 
(written and practical) in medicine or snrgery, according 
to the degree desired. The Univenity also grante 
degrees in public health and in dentist^, for iMth of 
which amply provision has been made. 

Dental Department. —The University grants the 
Degrees of Bachelor and Master of 3)enM Suraery 
(B.D.S. and M.D.S.). 

The Gxnxbal and Queen’s Hosipitals.—T he prac¬ 
tices of these boepitals are amalgamated for the pnr- 
pose of clinical instmotion under the direction of the 
Birmingham Clinioal Board, by whom all schedules will 
be signM and all examinations oondnoted. The hospitals 
have a total of upwards of 400 beds. 0,000 in-praento 

C 



276 Ths Midioal pBBse. 


ENGIi AN D—BDTJOATION. 


Sir. 11, 1901. 


and 80,000 out-patients are treated annually, and many 
▼alusble poets are open to students at both. 

Further information be obtained from Professor 
Windle, Bean, Medical Faculty. 

THE ENGLISH COLLEGES. 

The medical corporations in £ni;land are the Boyal 
Collegre of Physicians of London, the Boyal College of 
Surgeons of England, and the ^iety of Apotfae<^ee 
of London. The two Royal Colleges now oo-op^te to 
hold a series of examinations, on passing which the 
candidate receives the diploma of Licentiate of the Royal 
CoUege of Physicians (L.R.C.P.), and Member of the 
Royal College of Surgeons (M.R.C.8.). The Sooiet;y of 
Apothecaries grants a complete diploma in medicine, 
surgery, and midwifery. 

Conjoined Exauinino Boabd in Ekqlano (Rotal 

CoLLXOE OF PhTSICIANS OF IjONOON AND THE ROTAL 

COLLBOB OF SUROBONS OF EnOLAND). 

Any candidate who desires to obtain both the above 
licences is required to complete five years of pzofes- 
sional study at recognised medial sohook and hospitalB, 
and to comply with the following regulations and to 
pass the examinations hereinafter set forth. 

Profettional Exatni'naiimu .—There aie three e xam ina-- 
tions, each being partly written, partly or*l, and partly 
practical. These examinations will be held in the 
months of January, April, July, and October, unless 
otherwise appoint^ Every candidate intending to 
present himself for examination is required to _ give 
notice in writing to the Secretary of the Examining 
Board, Examination Hall, Victoria Embankment, W.C., 
fourteen clear days before the day on which the exami* 
nation oommenoee, transmitting at the same time the 
required certificate. 

The subjects of the first profesional examination are 
—Chemistry and physics, practical pharmacy, and ele* 
mentary biology. A candidate may take this examina¬ 
tion in three puts at'different time. A candidate will 
be admitted to examination in chemistry and physics 
and elementary biology before registration as a medical | 
student by the General Medical Council, and he may 
take pharmacy at any time during the curriculum. 
Rejection entails a delay of not loss three monthe 
from the date of rejection, and the candidates will be 
re-examined in the subject or subjects in which he has 
been rejected. If referred in chemistry or biology, he 
must produce evidence of further iustmction at a recog¬ 
nised institution. Any candidate who shall produce 
satisfactory evidence of having passed an examination 
for a degree in medicine on any of the subjects of this 
examination conducted at a university in the United 
Kingdom, India, or in a British colony, will be exempt 
from examination in those subjects in which be hi» 
passed. 

The fees for admission to the first examination are as 
follows;—For the whole examination, ^10 lOs.; for re¬ 
examination after rejection in Part I., £3 Ss.; and for 
re-examination in each of the other pa^, £2 2s. 

The subjects of the second examination are anatomy 
and physiology. Candidates will be required to pass in 
both subjects at one and the same time. Candidates will 
be admissible to the second examination at the expira¬ 
tion of two winter sessions and one summer session (or 
fifteen months during the ordinary sessions) from the 
date of registration as medical students, and after the 
lapse of not less than nine months from the date of 
passing Parts I. aod III. of the first examination. 

A candidate referred at the second examination will 
be required, before being admitted to re-examination, 
to produce a certificate that he had pursued, to the 
satisfaction of his teachers, in a recognised place of 
study, his anatomical and physiological studies during 
a period of not less than three months snbeequently 
to the date of his reference. 

The fees for admission to the second examinations 
are : £10 IDs. for the whole examination, and £6 Ss. for 
re-examination after rejection. 

The subjects of the third and final examinations are:— 
Part I. Medicine, including medical anatomy, pathology, 
practical pharmacy, therapeutics, forensic me^cine, and 


public health. Candidates who have passed in practical 
pharmacy at the first examination will not be reexamined 
in t^t subject at the third examination. Part II. 
Soi^^ery, including pathology, surgical anatomy, and the 
use of snrgioal appliances. Part III. Blidimery and 
diseases peculiar to women. Candidates may take this 
examina^D in three parts at different timee, or they 
may present themselves for the whole examination at 
one time. 

Fees for admission to the third or final examination 
are as follows:—For the whole examination, £15 168. 
Part I.—For re-examination in medicine, including 
medical anatomy, pathology, tben^ieatioB, forensic 
medicine, and public nealth, £6 6e.; for re-examination 
in practical pharmacy (if ti^en at this examination), 
£2 2s. Part II.—For re-examination in snrgetw, indnd- 
ing pathology, snigical anatomy, and the use of surgical 
appliances, £& 68. Part III.—For re-examination in 
midwifery and diseases peculiar to women, £3 3a 

A candidate referred on the third or final examination 
will not be admitted .to r^xamination until after the 
lapse of a period of not less than three months from the 
date of rejection, and will be required, before being 
admitt^ to re-examination, to produce a certificate, in 
regard to medicine and surgery, of having attended the 
m^ioal and surgical praotioe, or the medical or surgical 
practice, as the case may be, during the period tA hia 
reference \ and in regaM to mldimery and disMaoe 
peculiar to women a cmrtifloate of having received, snb- 
eequently to the date of his reference, not lees than 
three months' instmotion in that subject by a recog¬ 
nised teacher. 

Rotal Collbob op Petbioians of London. 

Luwatio^ss.—Candidates are now subject to the regain- 
tions of the Conjoint Examining Board in England. 

The following by-laws, amended in oonfonnity with 
tbe revised regnlatione <A the ConjointlExamining Board, 
were re-enacted as follows 

"Every candidate for the college licence (nnleaa 
specially exempted) shall be reouired to produce srasfao- 
tory evidence m having passed before the commencement 
of professional study a preliminary examination on snb- 
jeots of general education reoogni^ by the ooU^^e. 

“ Every candidate shall be required to prince satis¬ 
factory evidence of having completed five years of pro¬ 
fessional study, after passmg a recognised preliminary 
examination before amission to the final examination. 

"A candidate shall not be admitted to tbe second 
examination until the completion of two winter seasions 
and one snmmer session (or 15 months during the or^- 
nary sessions) at a recognised medical sohocd, nor nwt-tl 
the expiration of one winter and one summer session 
after passing Parts I. and III. of the first examination. 

” A candi^te shall not be admitted to tiie third (or 
final) examination till the expiration of five winter and 
five snmmer seBsions from the date of passing the pre¬ 
liminary examination and of four winter and four 
gammer sessions after passing Parts I. and III. of the 
first examination, and of two winter and two snsimer 
sessions after passing the second examination.*' 

Menhtrt .—The membership of the college is granted 
after examination to persons above the age of 26 yean 
who do not engage in trade, do not dispense medicine, 
and do not praot^ in partnership. This diploma is only 
granted to persona already registered, or who have paimod 
the fi^ examination for the licence. 

Medical graduates of a recognised university are ad¬ 
mitted to a pass examination, bnt otiiers must havejiaBBed 
the examinations required for the licence of the college. 
The examination, which is held in Jannary, April, Jmy, 
and October, is partly written and partly oral It is directed 
to mediciae, and is conducted by tbe president and 
censors. (Candidates under 40, unless they have obtained 
a degree in arts in a British university, are ia 

Latin, and either Greek, French, or (Jerman. Candidates 
over io are not so examined, and tiie 
medicine may in their case be modified under conditions 
to be ascertained by application to the Registrar. The 
fee for the membership is £42, bnt if the candidate is a 
licentiate £15 ISs. is deducted. In either case £6 Oa. 
has to be paid before examination. 

e 


o 



bxft. n. 1901 . 


IRELAND—EDUCATION. 


Th» Medioai. Pbms. 877 

irelanli. 


Botal Collios or Soboiokb of England. 

MemherAip .—The candidates are now subject to the 
r^n^lations of the Conjoint Board. 

FtllmtAip. —The FeUowahip of the College of Surgeons 
is grants after examination to persons at least 26 years 
ol age, who have been engaged in professional studies for 
six years. There are tiro examinations—the first in 
anatomy and physiology, which may be passed after the 
third winter session; ^e second chiefly directed to 
surgery, which may be passed after six yean of profes¬ 
sional study. The second examination may be passed 
before attaining the age of 26, but the diploma is not 
granted until that age is reaoh^. Candidates for this 
part of the examination must have passed the final 
examination of the Conjoint Board in England, and 
have been admitted memben of the college before they 
can be admitted thereto, except in the case of gradnatM 
in medicine and surgery of reoogoised oniversitiee of not 
less than four >ear8' standing. 

Fees.—A-t First Examination: Members, A6 6 b. ; non- 
Members, AlO lOs.; £6 68. returned if rejected. At 
Beoond Examination: Members, £10 10s.; if not a 
Member £21. In the latter case £10 lOs. is returned 
in case of rejection. Farther information can be ob¬ 
tained on application to the Secretary of the Boyal 
College of Surgeon, liinooln’s Inn Fields, London, W.C. 

SocixTT or Apotbxcabxis of London. 

Primary ^MannaiMm.—This examination consists of 
two parts: Part I.—Elementary Biology, Chemistry, 
Chemical Physios, including the Elementary Mechanics 
of Solids and Rnids; Heat, Light, and Electricity: 
Praotioal Chemistry, Materia Medica, and Pharmacy. 
A synopsis indicating the range of the subjects may ha 
obtained on wplioation. Part II.—^Anatomy and Ph^- 
■iolt^ and Bistolc^. The examination is held In 
January, April, July, and October. 

The Final Examination is held monthly, and is divided 
into Sections 1 and 2. 

Section 1 oonsistB of three parts. 

Part I. indudts;—Principle and Practice of Surgery, 
Surgical Pathology, and Surgical Anatomy, Operative 
Manipulations, Iiutrnmente and Appliances. 

Fartll. includes:—(a) The Principles and Practice of 
Medicine, including Therepeutioe, Pharmacology, Patho¬ 
logy, and Morbid Histology, (b) Forensic Medicine, 
Hygiene, Theory and Pxactioe of Vaooinatioa; and 
Mental Pissaeos, 

Candidates pesnng either (a) or (i) will not be re- 
nrwMnina/t therein. 

Part HI. inolttdee: Midwifery, Oynsoology, and 
Dieoaeco of New-born Children, Obstetric Instoiments 
and Appliances. Candidates may enter for Parts I., II., 
and III, together oreeparately. 

Section 1 :A the Final Examination, or any part 
thereof, cannot be passed before the expiration of 45 
months from the date of registration as a medioai 
atndent 

Sections 2.—This section oonsists of two parts. 

Part I.—Clinical Sni^ry. 

Part II.—Clinical Medicine and Medioai Anatomy. 
Section 2 cannot be passed before the expiration of the 
fiftii year. 

FbM. -The fee for examination is £6 6a, total for the 
Uoeooe, A15 168.; Be-examination—Prinmry for each 
Part, A 38.; Final, Sec. I. for each Part, £8 Ss.; Final, 
8e& IX., for eadi Part, £8 8a 

Further ioformation, with particulars ae to the course 
of study, and of the oeitiflcatM required, cem be obtained 
from the Secretary to the Court of Examiners, Apothe¬ 
caries’ E.C. 

The licence is a registrable diploma in Medicine, 8ar> 
gery, and Midwifery, and qualifies the holder to compete 
for medical appointments in the Army, Navy, and 
Indian Services, also for Poor-law, Civil, and Colonial 
appointments. 


Tbi Dmital Hospital of London (Leicester Square) 
has received the sum of £600 from the axaontors of the 
late Btohard Bowerman Wesi^ Esq. 


THE IRISH MEDICAL SYSTEM. 

Thx system of medioai teaching in Ireland differs 
from that in England in important particulars. In 
London each clinical hospital has its attached medical 
school, which is fully equipped, and which educates the 
students of that hospital, and very seldom those of any 
other. In Dublin, on the contiary, the hoeidtals and 
schools are entirely separate (except that Sir Patrick 
Don’s Hospital is officially connected with Trinity Col- 
1^^), and a student of any hospital is free to enter for 
the whole or any part of his course at any school or hos¬ 
pital he pleases. As might be expected, religion, social 
rank, and locality of residence have their infloenoe in 
causing certain classes of students to resort to schools 
and hospitals suitable to their condition. Bat scholastic 
or collegiate regulations impose no restriotions as to 
the place of study, and as the school and hospital fees 
are paid in detail in Dublin, and not in a lump sum, as 
in London, the pupil is absolutely free to do as be 
pleases. 

In London the student bargains with his hospital and 
schools, in the first instanoe, for a complete coarse 
of instruction, for which he pays, in whole or in 
par^ in advance, and his entire study is conducted 
within the one institution. In Dublin, on the con¬ 
trary, the student enters for hoepital and foroourees of 
study separately, and takes the courses at any school or 
hospital he pleases which “ givee best value," migrating 
from one school or hospital to another as he thinks fit. 

LODOJNO AND LIVING OF IBISB XXDIOAL 8TDDXNTS. 

There is in Dublin no organisation for domestic 
accommodation of medidti studrats, save for those who 
are passing through Itinity CoU^^ in whose case 
rooms and *'commons" (i.e., dinner) Me provided at 
fixed rates. Those who can afford to pay £6 66. or 
£7 7s. per month for their lodging and maintenance 
may find accommodation in the family of some medioai 
man who receives boarders, in which case ^ey become 
members of the family for the time being, ai^ subject 
to its discipline. The majority of Dublin stadants, how¬ 
ever, take a lodging in some economical locality, or they 
** ahum " with some other student for the purpoee. It 
is usual to oontraotwith the lodging-house keq>er for 
board or partial board, but some students cater for 
themselvee. 

COST OF KIDIOAL BDDOATION IN IBSLAND. 

The cost of obtaining a medical qualification depends 
to some extent on the qualification sought. In this 
connection the following tables may be of use to the 
prospective student 

COST OF VBDIOAL BDUOATION. 


School. 

Cost 

School of Physio, Dub. Univ. ... 

£119 14e. 

^yal College of Sm^eons, Dub. 
tlniv., S<£ool. 

£124 198. 

Catholic 'University School 

£124 19b. 

Queen's Coll^iea. 

£110 (?) 


COST OF DIPLOKATA OB DBGBBBS. 


Qualifying Body. 

Cost. 

Dublin University . 

£27 (to this must be 
a^ed £83 4 b., the 
oost of obtaining an 
Arts degree). 

Boyal University . 

Conjoined Boyal CoUegee 

£16. 

£42. 

Apotbeoariee’ Hall . 

£22 Is. 1 


oogle 


D 



278 THU MiDioi.1:. Pbsss. IRELAND—EDUCATION. S«pt. ll. 1901. 


ThQB,the abeolate payment vill amoantto somewhere 
between ^6126 and JB229 18s., according as the teaching 
of the Qneen's Colleges and the d^reea of the Rnyid 
University, or the teaching and degrees of Dnblin Uni¬ 
versity are taken. For the Conjoint Colleges the entire 
cost is ^16610s., taking the minimom mocm of payment. 
So that, assnming that extras or voluntary costs are 
incurred, the tot^ will vary, say from £170 to £200. 

Grinding ” usually costs £5 Ss. for eacfa of the four 
examinations, but if a student needs private grinding ” 
in imcial subjects he mnst pay extn for them. 

This sum, or something Uke it, may be expended by 
the student or his parent in paying for lectures, &o., and 
examination fees as they acorne, and there is no difficulty 
in obtaining the needful information for hie guidance 
if he likes to pay for his oonne in this fashion. If, on 
the other hand, be prefers to pay a lump sum down, he 
can “ apprentice ” himself to a teacher who will under¬ 
take all monetary responsibility for his education, and 
who may be able to give him some special advantages 
his own pupil at hospital. This so-4^ed “ apprentice¬ 
ship,” is very generally a simple contract for the pav- 
ment of fees, and involves but little of that special teach¬ 
ing which is due by a master to a true spprentioe. All 
the Dnblin schools require fees to be paid in advance. 

DATM OF >NTBT. 

The entry of names and commencement of study in 
Ireland is suppos'd to date from the let of October in 
each year, but the session really dates fron the let of 
November, and the entry of names may be delayed by 
the dilatory to the 25th of the same month. It Mould, 
however, be recollected that no credit is given for 
studies or attendance until the entry is regularly made. 
The student mnst attend three-fourths of the lectures 
delivered, and if he loses a fortnight at the b^inning 
be must make up for it afterwards by constant attend- 
anoe. 

The student begins work by attending a recognised 
medical school each morning at ten o’clock, and oocnpy- 
ing bis day, to five p.m., between lectures and dissec¬ 
tions. His vacations are a fortnight at Christmas and 
a week at Easter, and he finally returns home at the 
end of June. 

PBSLnCIHABT ■XAVINATIONS. 

The first work of the student is to pass a preliminary 
examination, without which he cannot get <tfedit for any 
medical studies pursued. The next is to oommmioe 
medical study. This he does by entering for lectures 
at. a medical school. From the school registrar he gets 
a form of certificate, and bis third act is to take it or 
send it to the Branch Medical Council, 85, Dawson 
Street, Dublin. He is thereupon plao^ upon the 
Eegis^ of Medical Students (without fee) and bis 
period of study counts from that date. He mnst 
register at the earliest possible moment, or he will lose 
credit for bis work. 

The only preliminary examination held specialty for 
medical students is now held conjointly by the ^yal 
Colleges of Physicians and Surgeons, but other examine 
tions, 6.^., the public entrance at Trinity College, the 
matricnUtion of the Boyal University, the Intermediate 
Education psMses in the required subjects, and all other 
examinationB recognised by the General Medical Council 
are accepted as equivalent. The Preliminary of the 
Dnblin Colleges has been considerably increased in 
severity witiiin the past three years, the examiners 
being now experts in education, and not necessarily 
members of the medical profession. 

The Pr^iminary is held in March and September, in 
the subjects specified by the General Medical Council. 

The subjects of examination as prescribed by the 
General Medical Council are as follows:—!. English 
language, including a specified author, dictation, gram¬ 
mar, and composition; also parsing and analysis from 
the book roeoified. 2. lAtin, including grammar, 
translation from specified authors, and translation of 
easy passages not taken from such authors. 3. Ele¬ 
ments of mathematics, oonrprieing (a) arithmetic; (b) 
algebra, including simple equations; (o) geometry, 
Euclid, Books I., II., and III., with easy d^uotions. 


4. One of the following optional snbjeots:—(a) Greek, 
(b) French, (o) German. The hooks specified are:—1. 
English—Sh^espeare, *' Merchant of Venice *' 2. Ijatin, 
—The first and second books of the ” .®neid,*’ or the 
’ Jngnrthine Wars,” orthe third book of Livy. 3. Greek 
- The first book of Uie '‘Iliad” or ^e firat book of 
Xenophon's “Anabaaia” 4. Prenofa—Fdoelon’s “Tdl^ 
maqne,” Books I, II., III. German—Sohiller'B "Wil¬ 
helm Tell.” 

QUALIFICATION IN IBBLAND. 

Thb Medical Licensing Bodies of Ireland are four in 
nomber, and, as a rule, stndents grav'tate into one or 
other of five classes:— a. Those who enter Trinity Col¬ 
lege. and take a fall graduation in Arts in addition to 
their professional deg^rees b. Those who take the licence 
of the conjoined Boyal CoUegM of Physicians and Sur. 
geons. e. Those who take the lioenoe of the Apothe¬ 
caries’ Hall. d. Those who take their qualifi¬ 
cations at the Boyal Univerrity of Ireland, where 
gnadiiation in Arts is not necessary, e. Those who 
pursoe their studies in Ireland, bnt who migrate to 
London, Edinburgh, or Glasgow for their licences* 
Almost all these last-named emigrants oome Lrom the 
Queen’s CoUegre, and the greater number of them from 
Belfast, while the Dublin students qualify, as a role, in 
Dublin. 

We do not attempt to give details as to the requisite 
oonrses of instcnotion for de g ro o s or diplomata, as our 
epitome mnst necessarily be iosuffioienc for the infor¬ 
mation of the student, and we can occupy our available 
space with information mors useful to him. The official 
information upon which atndents may dqieod can be 
obtained by sending a note to the Begistrars of the 
Lioeosing Bodies or Schools. 

The Irish Licensing Bodies are as follows :— 

THB UNIVEB8ITY OP DUBLIN. 

Thi University of Dnblin grants the degrees of M.B., 
B.Ch., and B.A.O. to stndente who have obtained tbeir 
Arts degree, and the higher degrees of M.D. M.Ch. and 
M. A O. to those who have held for at least ihree years the 
grade of M.B. and B.Ch. It does not grant d^rees to 
any bnt foil graduates in Arts, oonseqnentty its degr oo s 
hold the highest rank of social and educatioDal qmdifi- 
oatioDS, and are sought for by those who look forward 
to oooupying the beet positions in tbe profession. 

The expense of obtaining the degrees of M.B., B.Ch., 
and B.A.O. is approximately as follows:—LMtures, 
£64 Is.; Hoepitms, £65 ISs.; Degree Fees, £87.— 
£146 Ite. 

The expense of the B.A., amounting altogether to 
£83 4e., should be added, making the totel cost £229 18 b. 

Doctor or ifedieinf.—Jn addition to its ordinary qnali- 
fications, the University grants the following higher 
degree of M.D. To obtain this the candidate most 
have obtained tbe degree of M.B., or qualified to have 
obtained it for three years He must then read a thesis 
before the Begins Professor of Medicine. Total fee for 
this d^ree, £18. 

Master im 8''r7er ^.—'Ibe candidate must be a Bachelor 
in Surgery of three years’ standing, and must then pass 
an examination in olinioal surgery, operative surgery, 
snrgiosd pathology, surgery, and suigical anatomy (on 
the dead subject). Fee for the degree of Master in 
Sn^ry, £11. 

Matter in Obitetrie .Science.—The candidate most have 
passed the M.B. and B.Ch. examinations, and have com¬ 
pleted, in addition to the oonrses for M.B., B.Ch., a 
course in obstetrio medicine and snrgery. He is then 
required to pass an examination in the following sab- 
jects:—Practice of midwifery, gynecology, anatomy of 
female pelvis and elementary embryology, and olinioal 
gynecology. Fee for the degree of M.A.O., £5. 

Diplomtt* in Medieino, Surgem, nod Midw/ary.—The 
course and examination is the same as for the de g r oo s, 


8sn. 11. 1901. 


IBEL 4ND—EDUCATION. 


Tki HiDioAt Pbmb. 279 


esoepk tbat the lectnrea aad ezaminationa in bo*any 
nnd zoolo^ n«ed not haye been taken out or passed, 
and that the candidate need not have obtained an Arts 
d^ree. Fee for the diplomats in medicine, surgery, 
aad midwifery, ^1. 

Quoli/tco/ion tn Jfedirtns.—Tte candidate most 
bea M.D. of Dublin, Oxford, or Cambrid^. 

The candidate must have oompleted. subsequent to 
registration, six months’ practical instruction in a 
l^oratory, and also have studied praotacally outdoor 
eanitary work for six months, under an approved 0£Boer 
of Health. 

THE BOTAL UNIVERSITY OP IRELAND. 

Thb Royal Universify of Ireland is purely an examin* 
ing body. Its degrees are granted on one year’s acts, 
i.e., the matriculation examination of this University 
(noneother wi'l suffice) and a first Universito exami¬ 
nation " at the termination of the first t ear. 1%e cost 
of the M.B. and M Ch. of the University, with all the 
necessary onrrionlum, is about .£125. Some of the Arts 
examinations are conducted, not only in Dublin, but at 
certain local centres. 

The University confers the following medical 
degrees : — 

M.B., H.D.. B.Ch., H.Ch., B.A.O., M.A.O., a diploma 
in sanitary scienoe (a diploma in mental diseases. 

All degrees are open to persons of either sex. 

The university examinations are held in the spring, 
beginning about May 1st, and in the autumn, beginning 
about September 24th. 

All candidates for any degree must pass the 
matriculation examination and the first university 
examination. 

The course for the degree of M.B., B.i;b., B.A.O. ex¬ 
tends over five years. 

Students win be admitted to the first university 
examination after one year from matriculation, fee, £1. 

The medical course consists of three previous ezamin- 
ations,one at the end of each year, a'td one degree exam¬ 
ination at the end of the fifth year. Fee for each 
primary,£1; for the degree, j£2; for the diploma, £10. 

In addition tiie following degrees are granted;— 
Diploma in Sanitary Science. - Conferred only on gra- 
doates in medidne of the nniversity of at least twelve 
months’ standing. Fee. £2. Subjects.—Climatology, 
chemistry, geol^y, pVysicp, vital statistics, hygiene, 
eanitary law. 

Tht M.D. D'gre *.—Conferred only on graduatee in 
medicine of the nniversity of three years' standing. 
Fte, £6. The examination will comprise medical diressee 
and the theory and practice medimne, inolnding 
patholosy. 

TAs M.Ch. Degrie .—Conferred only on graduates in 
medicine of the university of three years’ standing. 
Fee, £5. 

The examination oomprisee surgery, both theoretioal 
operative; surgical anatomy ; ophthalmology and 
otol(^. 

The MatUrehip cf Ohttetrict .—Conferred only on 
graduatee in medicine of the nniversity of three years' 
standing. Fee, £6. 

1'he examination comprises midwifery and diseases 
of women and children. 

Prizse. ^e .—First Examination in Medicine. Two 
first-clasB fxhibitions of £20 each, mid two second of 
£10 each. 

Second Examination in Medicine.—Two first-class of 
£26, and two second-class of £16. 

Third Examination in Medicine.—Two first of £80 
each, and two second of £20 each. 

Medical Degrees Examination.—Two first of £40 
each, and two seconds of £26 each. One travelling 
medioal scholarship of £100. One medical studentship 
of £200 per annnm, tenable for two yean. 

ROYAL COLLEGES OF PHYSICIANS AND 
SURGEONS. 

Thx examinations held o >njointly by the two Colleges 
■re tbe inlet of most Irish students to the profession, 
especially of thoee edneated in Dublin. The coarse, a 
in otber bodies, extends over five years, with examin 


tiona at tbe end of the first, second, third, and final 
years. These examinatiAue are oondnoted by examiners 
oboeen by each of tbe Colleges for the snbjeots ai^m- 
priato to them. Tbe five years n^ be deecribed as— 
^t, preparatory; seoood, theoretioal; third and fonrth, 
application of the theory to practical work; and, fia^l, 
etnctly practical in hospitals, general and speo’aL The 
regulations are so voluminons that ui epitome of them 
would be nnsatisfactory, and we recommend students 
to apply for tbe official programme to the Secretary of 
the Committee of Ma-^agement, Royal College of Pbysi- 
clans, or to the Registrar of eitoer College. 

The total of the examination fees, epre^ over the four 
examinations, is £42, while the school and hospital fees, 
if taken in Dublin, amount to £124 103., making alto¬ 
gether £16619s, exolosive of *' grindiog ** or of re-exami¬ 
nation fee*, which have to be paid in case the candidate 
fails to pass in aU tbe sabjects of his examination at the 
one time. 

The conjoined Colleges also bold Pr^iminary Exami¬ 
nations in Gtoneral Edneation. and confer a diploma in 
Public Health, of all of which information will be found 
in tbe following pagos. 

APOTHECARIES’ HALL OF IRELAND (L.A.H.). 

This body is anthorised to grant a complete qualifica¬ 
tion in medicine, ramry, and midwifery, recognised 
and registrable nnder toe Medical Act of 1886, and en¬ 
titling the holder to oocopy medical appointments in all 
the pnblio services. It mso confers the legal right to 
dispense medicinee in Ireland. Tbe examinations are 
held on the third Monday in January, April, July, and 
October, and the reqnirements in respect of studies will 
be approximately the same as those of the conjoint 
exsminatioos of tbe Royal Colleges oil Physicians and 
Sargeons in Ireland. Tbe examination fees payable for 
the qualification of L.A.H. are as followsFirst pro- 
feesioDal, £6 5s., second, £5 6s.; third, £6 68.; final 
examination, £6 6i. 

Tbe fees for le-ezamination are £1 Is. for each snb- 
ject, excepting in the subjects of chemistry, pharmacy, 
sargeiy, and medicine, the fees for which are £2 2s. 

The fee for final al<me is £15 16«. Candidates may 
be admitted to a special examination under special oir- 
onmstanoes, at an extra fee of ten gnineas. 

Candidates already on the Rrg^itr will receive tbe 
diploma of the Hall on p^»iWg an examination in medi¬ 
cine, surgery, midwifbry, and pharmacy, and paying a 
fee ol ton gnineas. If m^ioine or sni^^ery arereqaii^ 
two gnineas extm will be charged. The candidate will 
be exempt from each of the above subjeo's, which are 
covered by his previous qaalifloation or qnalifioations. 

In addition to the qnalifying diplomata awarded by 
tbe above bodies there are diplomata in special rabjeohi 
awarded as well. These are the licence in Dentistry and 
the diploma in Public Health. 

THE LICENCE IN DENTISTRY. 

There is probably no specialty in sni^;^ which rivee 
as great a nnmber of its practitioners a living ana the 
prospect of an income as dentistry. A yonng man who 
has got bis diploma, and knows somethbig cd his bosi- 
nesB, and is willing to attend to it, seldom tails to get a 
snbi^ntial foothold in Ireland in afew years. The Irish 
diploma in Dentistry is granted by the Royal Coll^ of 
Sargeons. 

CourM of Slvdpfor the Licence tn Tlmfutry.—Caadi- 
datoa are reqnirf^ to pass three examinations, vis. 
Preliminary (in General Edneation), Primary Dental, 
and Final DentaL 

Tbe Primary Dental examination is in (1) Physios. (2) 
Chemistry, (8) Anatomy, (4) Physiology and Uistology, 
(5) Surgery—all these snbjeots with special reference to 
dentistty Tbe examination fee is £10 lOs. The Final 
examination is in (1) Dental Snrgety—clinical and 
operative] (2) Dentiu Mechanics—-.'Imioal and prac¬ 
tical, inoln^ng metallurgy. The fee for this examina¬ 
tion is, for a Licentiate of the Collie, £10 10s.; for any 
other candidate, £28 5s. Each of these examinations 
most be preceded by complete courses ot study in these 
■nbjeots. 



280 Thb Mbdioal Pbbss. 


IEEL4ND—BDUOATION. 


Sbpt. 11, 1901. 


StempHoiu. Cudidates edaoated in England or 
Scotland are admitted to tbe examination on the 
prodnotion of the certificates that would be necessary 
for both Primary and Final examinations in their own 
countries. Furthermore, the College admits to examina¬ 
tion, 6in* eurrieulo, oan^dates whose names are on the 
Dental Reguter, and who are unable to furnish the cer¬ 
tificates required by the foregoing regnUtions, on pre¬ 
sentation of a special sohednle of application, accom¬ 
panied by any certificate they may hare of general or 
professional education, and by tiie required fee. 

THE DIPLOMA IN PUBLIC HEALTH. 

This diploma is granted by Dublin nnirersity, the 
Boyal UniTersity, and tiie conjoined Royal Colleges. 
Every candidate most be a registered m^ioal practi¬ 
tioner. The examination is in(1) Chemistry (inclu¬ 
ding chemical physios). (2) Engineering and Archi¬ 
tecture. (3) Sanitary Law and Vital Statistics. (4) 
Hygiene. (6) Bacteriology. (6) Meteorology. The 
General Medical Council recommend that all candidates 
shall have studied in a special bacteriological labora¬ 
tory, also for six months as pnpil of a working 
medical officer of health, desorib^ for Ireland, as ** the 
medical officer of health of a ooimty or of one or more 
sanitary districts having a population of not less than 
30,000or a medical officer of nealtii who is a teacher in 
Public Health of a reoc^nised medical school. 

In Ireland the number of teachers in this cat^^^ory 
does not exceed, at present, ten, bnt the recent Sanitary 
Order of the L^l Government Board, which affords 
facilities for the creation of many additional superin¬ 
tendent medical officers of health, will not only supply 
the demand, but will stimulate the much-needed sani. 
tary improvement in Ireland. 

THE IRISH MEDICAL SCHOOLS. 

The Irish Medical Schools are as follows 

Thx School or Phtsio or Dublih nKivnasiTT.— 
This school is formed by an amalgamation of the School 
of Trinity College and of the College of Physicians. Some 
of the professors in the schools are o£leio medical 
officers of Sir Patrick Dun's Hospital. The school is 
freely accessible to all students, and the instruction pro¬ 
vided occupies a high rank. 

Every student of the school must be matriculated by 
the senior lecturer, for which a fee of 6e. is payable, bnt 
he need not attend any of the Arts course unless be de¬ 
sires to obtain a university licence or degree, in medi¬ 
cine, snrgery, and midwifery. [No student is permitted 
to matriculate unless he has passed the entrance exami¬ 
nation in Arts in Trinity College, the preliminary exami¬ 
nations of the Boyal University, of the College of Bar- 
geons, or some other examination recognis^ by the 
Gene^ Medical ConnoU. 

Two medicAl scbolanUps are given annually at the 
School of Physio, value £20 per annum, tenable for two 
years, the exaainations for which are held each year in 
June; one scholarship is given in anatomy and insti¬ 
tutes of medicine; the other in soology, (ffiemistry, 
botany, and experimental physica 

A prise of £100 is awarded by the Board to the snooess 
fnl candidate at a special examination in alternate years 
In Medicine cr in Snrgery, provided that the merit be 
deemed sufficient. The successful candidate is required 
to spend three months in the study of medicine or sur¬ 
gery as the case may be, in Berlin, Paris, or Vienna. 
Before he can obtain the first insMment of £60 he 
must satisfy the Senior Lecturer that he possesses suffi¬ 
cient knowledge of a Continental language to derive full 
benefit from the prise. The examination is held in 
June, and is open to students who have passed the 
DegiM Examination in Medicine or in Snrgery, as the 
case may be, within two years of the examination. 

In order to obtain the second snm of £50 the prize¬ 
man mnst have furnished to the R^iu Professor his 
formal report on the hospitals atten^d by him, within 
two years from the time of obtaining the prise. 

Cl^ prizes are given at tiie end of the session of 
between and £10 in value. 

The John Mallet Purser Medal, founded by Prof. 
Pnzser’s past pupils, is awarded annually to the student 


who, at the ordinary June half M.B. Exsunination. 
shall obtain highest marks in PhysioU^ and His¬ 
tology. 

Thb Rotal Collbob or Subobons in Ibblamd. 
Schools of Subobbt. —By the amalgamaticm of the 
Carmichael Collie and the Ledwich School with the 
School of the College of Surgeons the combined 
schools form the latest medical tMching body in Ire¬ 
land. These schooU are attached by Charter to the 
Royal Col ege of Surgeons. They are carried on within 
the College bnUding, and are specially subject to the 
supervision and control of the Coun^, who are em¬ 
powered to appoint and remove the Professors, and to 
regulate the methods of teaching pursued. The build¬ 
ings have been reconstructed, the capacity of the dis¬ 
secting room nearly trebled, and s^ial histological, 
pathological, bacteriological, public health, and phar¬ 
maceutical laboratories fitted with the moat approved 
appliances in order that students may have the advan- 
ta^ of the most modem methods of instruction. 

The diplomata of the College are open to students of 
either sex. Separate rooms uve b(^ provided, and 
careful provision made for the instruction and comfort 
of women students. 

Pbizss. —The Barker Prize, £21; the Carmichael 
Scholarship, £15; the Mayne Scholarship, £16. The 
Gold and Silver Medals in Surgery, and the Stoney 
Memorial Gold Medal in Anatomy. 

Class Prises of £8 and £1, accompanied by medal if 
anffioient merit be shown, will also be given in eac h 
subject. Prospectus and Student's Guide can be ob¬ 
tain^ on amlioation to the Registrar, Royal Collie of 
Surgeons, Dublin. 

Thb Catholic Unxvsbsitt School is situated in 
Cecilia Street, Dame Street. It prepares students for 
all medical examinations, particularly those of the 
Itish Colleges of Physicians and Surgeons, and the 
Royal University of Ireland. The school has recently 
been rebuilt and refitted, its working space haring 
thereby been nearly doubled, and several new labora¬ 
tories, inolndinff those for the study of bacteriology and 
public health, have been added. The institution has 
also been recently chartered, under the Educational 
Endowment (Irelud) Act, and it is now ooctroUed by 
a Board of Governors. 

The following Exhibitions are awarded annually 
Two first year’s, value, £1210s. each; two second year’s, 
value, £10 each s one third year’s Royal Exhibition of 
£1210s. t one final of £12 10s. t two large gold medals, 
besides several other class medals. 

A Guide for Medical Students, which gives all the 
information required by parents, and by students who 
desire to join the medical profession, may be obtained 
free on application to the R^fistrM. 

THE QUEEN’S COLLEGES-BELFAST, CORK, 
AND GALWAY. 

These three important academic institutions were the 
special schools of the Queen’s University. They have 
cea^ to have any direct relation to a central examin¬ 
ing body, but educate students for aU colleges and 
degrees, and are maintained, as hitherto, by a handsome 
Government grant. The same curriculum as that for¬ 
merly adopt^ is continued, and the various exhibi¬ 
tions and scholsbrships are still available. Each 
college has tixe disposal of about £1,500 per annum in 
scholarships and prizes. The onrricnlnm is generally 
well adap^ for preparation for the Boyal University 
examination. The colleges are well adapted for high- 
class technical education, having lecture rooms pro¬ 
vided with everv appliance necessary in the modem 
training of a medical student. The great want in the 
colleges of Cork and Galway is a summer session. This 
necessitates the loss to the student each yes« of three 
available working months. The colleges are completely 
equipped with rtudants’ reading rooms and lending 
libraries and refreshment loome, and with all adjuncts 
to collegiate life, such as literary societies and acetic 
organisations. The students do not, however, reside 
within tiie college, bnt halls of residence and Uoenaed 
boarding houses are provided for those who du not live 
wi^ friends. Tbb axpenN of living in the collegiate 


C 




8aPT. II, 1901. 


IBBIiAND*-BDlTOATION. 


Thi Uk>uui> Pbsm. 281 


towna u quite noderste. The oonne of lectoxee in the 
winter eeecion mnst be diligently attended, no student 
obtaining a oertifioate who hu not put in three-fourths 
of a oourse. The wiater medical session commences on 
October 29th and ends about Easter. The scholarships 
examinations are held in October. An account of the 
prises and exhibitions in medicine, the names of the 
professors, and other information may be found in the 
adrertuements of this issue, and full details may be 
had on application to— 

Belfast, John Purser, LL.!)., Eegistrar.; Cork, Alex¬ 
ander Jack, M.A.; Galway, Edward Townsend, M.A. 

DEPARTMENT OF AOEICTJLTUEE AND TECH- 
NIOAL INSTEUCnON FOE lEBLAND. 
Botxl Colliox or Scisnci ros Isslakd. 

Session 1901-1902. 

This College, situate in St. Stephen’s Green, Dublin, 
supnliee a complete course of instruction in soienoe 
applicable to the indiutrial arts, ewedally those which 
may be cast broadly under the heau of chemical manu- 
farttuee, engineering, physice, and natural science. A 
diploma of Aseooiate of the CoU^ is granted at the end 
of the three years'oourse. Non-Associate students may 
join for any course required. There are four Eoyu 
scholanhipe of the value of ^650 each yearly, with hee 
education, tenable for two years. Two are competed for 
by tiie asso ci ate students at the end of each 
^le chemical, physical, soologioal and Ixitanioa], geolo¬ 
gical and mineralc^oal laboiaturiee and drawing spools 
are open daily for practical instruction. The session 
commences on Tues^y, October let. 

The courses of chemistry, physics, botany, geology 
and mineralogy, and soology are reoognis^ by the 
Boyal University of Ireland, and oeitifloates of attend¬ 
ance are granted to medical and other students attend¬ 
ing these courses, as also ^e courses of the ohet^oal, 
physical, soologioal and botanical and geological 

laboratories,_ 

THE DUBLIN HOSPITALS. 

The clinical hospitals in Dublin are ten in number, 
axolusive three lying-in hospitals. There are also 
two children’s hoepitals, an orthopssdio hospital, a fever 
hospital, an ophthalmic hospital with two centres, 
a dental hospital, and other special institutions. Some 
of the clinical hospitals, though they have no actual 
or official connection with any sohooL are in oloee affinity 
with certain teaching bodies} while others, again, are 
without any special connection with any school. While, 
however, such affiliation of a school or hospital may 
exist, it should be remembered that the Dublin schools 
mad hos^ntals are open to all oomen, and the student is 
competent to attend any hospital or any school he 
wishes, and to change his place of instmotion from 
year to year ae he may see fit. 

The Irish Liee n a i n g Bodies require attendance on 
hospitals f<nr twenty-seven months, i.e., three winter 
•oesions of six months and three summers of three 
months) within the five years of stndy. The fee at all 
general h<wpitals is £8 in winter, and for the summer 
£6, or ^12 for the entire session of "inA months if 
taken together. 

GENERAL HOSPITALS. 

Sicbxono,Whitwobth, and Habdwicxb Hospitals. 
—The accommodation of these hospitals is as follows 
Hardwicke Homital, 120 beds; Whitworth Hospital, 82 
beds; Richmond Ho^ital, 110 beds—total, 312 be^ 
These hoepitals are visited each morning at nine o’clock 
by the Physioius and Su^mos, and, in addition to the 
nsnal bedside instruction, Atiwiftai lectures are delivered 
on the most^portant cases. Special instruction is also 
given on various branches of me^oine and surgery. The 
Tknss Establishment for the disMbntion of trusses to 
the ruptured poor of Ireland is oonneoted with these 
hospitals. Irore are very large ophthalmic, aural. 


throat, and gynaoologi<^ dispensaries, and instmotion 
in these important eubjeots u given. Eight resident 
clinical clerks are appointed each half-year, and pro¬ 
vided with fnmiahed apartinente, fuel, Ac. The appoint¬ 
ments are ooen not only to advanced students, as for¬ 
merly, bot also to those who are qualified in medicine 
or surgery. A house surgeon for the Richmond Hos¬ 
pital and a house physician for the Whitworth and 
Hardwicke Hospitals are elected annually, and receive a 
salary. The Richmond Lunatic Asylum, containing 
1,600 beds, adjoin these hospitals. 

Mbatu Hospital and Co. Dublin Infibhabt.— 
This hospital was founded in 1763, and now contains 160 
beds aviulable for clinical teaching. A new building 
for the isolated treatment of fevers has recently been 
added. The certificates of this homital are recognised 
by all the nniversities and licensing bodies of the United 
Kingdom. Medical and surgical resident pupils and 
clinical clerks and dressers are appointed every six 
months, and a house snrmon is elected annually. A 
prospectus giving the com{dete arrangements for medical 
and Borrical olaiues for the comii^ session may be 
obtained from the secretam of the M^cal Board, Dr. 
Lane Joynt, 84, Haroonrt Street, Dublin. 

Thb Adblaidb Medical and Svbqioal Hospitals 
are in Peter Street, and occupy a central position 
within a few minntes’ walk of the College of Snrgwns 
and Trinity College. From October let the physicians 
and sui^eons visit the wards and give insttn^on at 
the bedside at the adverti^ hours. There is a 
detached fever hospital, and also wards for infants and 
children. Operations are performed, except in oases of 
urgency, at 10 a.m. on Tuesday, Ibursday, and Satur¬ 
day. Special hours are devoid to clinical instmotion 
in the diseases peculiar to women, and students are 
individually instructed in tiie use of the stetboeoope, 
ophthalmoscope, laryngoscope, and microscope { also 
special instruction is given on practical pathologv and 
A-ray photography. Three resident pupils ue selected 
half-yearly ana a house sni^peon annually. Prise 
examinations, including examinations for the Hudson 
Scholarship, £30 and a gold medal, and a senior prise of 
£10 and a silver medal, in addition to surgical and 
medical prises, are held at the termination of the 
session. The la^ dispensaries afford facilities for the 
study of eye, ear, throati and cutaneous diseases, as well 
as of minor surgery and dentistry. Farther paitioalars 
from Dr. Heuston, 15, Stephen’s Green North. 

Sis Patbick Dun’s Hospital is situated on tiie south- 
eastern side of the city, and about half a mile from the 
University School of Physio. It is officered exclusively 
by the professors and examiners in t^t schooL For¬ 
merly all University students were compelled to attend 
this hospital, which was purely a medical institutiou, but 
some years ago the obligation was removed, and the 
hospital was opened for sorgioal oases, It is now free to 
aU students. 

Thb Eotal Citt or Dublin Hospral.— This hospital 
is situated in Upper B^^^t Street, about ten minutes’ 
walk from the Royal CoU^e of So^eons and Trinity 
College. It has jost been enlug^ and improved to a 
very OMXsiderable extent. A special course of instmo¬ 
tion is given on ophthalmic and aural disease. There 
are spemal wards for the treatment of diseases of the 
eye, of ohildren, and of women, and practical instmotion 
is given on diseases peculiar to women; there is also a 
separate building for infections diseases. Clinical clerks 
to the physicians and dressers to the surgeons are 
appoints from the most deserving of the class. A new 
operation theatre, sterilising room, imd anscsthetic room 
have been oonstruoted in aooordanoe with the most 
modem surgical requirements. A resident medical 
officer is elected annually, and resident medical and 
surgical pupils are appoint^ from among the past and 
preeent ^dents of the hospital. Operations are per¬ 
formed on Tuesdays, Thurs^ys, and Saturdays, at 10 
a.m. Full particulim can be had on application to Mr. 
G. Jameson Johnston, M.B., F.R.C.8.I., Hon. Seo. Med. 
Board. 

Matbb Mubbicobdi,x Hospital.— This hospital, con¬ 
taining 336 beds, is open at all hours for the reception 


282 Thb Mbdioal I^bibb. 


ICELAND—KDirOATlOK'. 


of BOoidentB and ni^ent ca^es. Fifty beds are specially 
reserved for the reception of patients Boffering from 
fever and other oonti^ona dueases. A coarse of lectures 
and instmotion on fever will be given daring the winter 
and summer sessiouB, A certificate of attendance upon 
this course to meet the reqairemente of the various 
licensing bodies may be obtained. OpportunitieB are 
afforded for the stady of the diseases of women in the 
wards onder the csre of the obstetric physician, and at 
the dispensary, held on Taesdays and Saturdaya. 
Leotares on clinical gyneecology will bs delivered on 
Saturdays at 11 a.m. Ophthalmic surgery will be 
tangbt in the special wards and dispensary. A special 
oonrse of instruotion in pathology and bacteriology, as 
applied to medicine, will be given. Connected with the 
hospital are extensive dispensaries, which afford vain- 
able opportunities for the stndy of general, medical, 
and surgical diseasee, aooideats, Ac, Four house phy* 
sioians and eight honse surgeons will be appointed 
annually. Ten resident pupils will be elected, each to 
hold office for six months, from the most attentive of the 
class. For the ourreni; eession the elections will take 
place in November and in May. Dressers and clinical 
clerke will be appointed, and certificates will be given 
to students who exhibit proficiency and punotoality in 
performing their duties. Leonard prises ; one gold and 
one silver medal will be offered for competition annually 
in the subject of medicine, and one gold and one silver 
medal in the snbjeot of 8ar,(ery. Jnnior Leonard prises: 
two prizes of the valne of £3 and two prises of the value 
of £2 will be offered for competition in medicine and 
surgery, respectively. They will be awarded on the 
aggregate of marks gained by reports of cases, and at a 
olioio^ examination to be held at tbe close of the 
summer session. 

Mxbcbb’b Hospital.— This hospital, founded in 1707, 
is ritnated in the centre of Dabiin, in the immediate 
vicinity of the Schools of Surgery of the Bo}ral College 
of Surgeons, the Catholic University School of Medicine 
and within five minutes’ walk of Trinity College. It 
oontaint 120 beds for medical and sni^cal cases, and 
arrangements have been made with the medical officers 
of Cork Street Fever Hospital, whereby all students of 
this hospital are entitled to attend tbe clinical instruc¬ 
tion of that institution, and become eligible for tbe 
poets of resident pupil, Ac. There is a large ont- 
patient department, and a special department for 
diseases peculiar to women. There are also specud 
wards for the treatment and stndy of children’s diMaees. 
During the past few years the hospital has undergone 
extensive alterations in order to bring it up to mod^ 
requirements. 

—A bouse surgeon is appointed annu¬ 
ally. Five resident pupils are appoints, each for six 
months, and clinical clerks and dressers are appointed 
monthly from among the most deserving memMrs of 
the class. 

The certiflcatee of this hospital are recognised by all 
the licensing bodies. 

For further partiou'ars apply to R. Charles B. Mann- 
■ell, M.B., F.B.C.S., 82, Lower Baggot Street, Dublin. 

St. Yincint s Hospital, Stephen’s Green, Dnblin, 
was established in 1834. The hospital has 160 beds, 
and in connection with it there is a largely attended 
dispensary, a oonvalevcent home, and a nureee’ institnto. 
In addition to the ordinary clinical instmction, sys¬ 
tematic courses of lectures are given in each department 
of medicine and surgery, and a<e illustrated by oases in 
the hospitals. The resident officers consist of a honse 
surgeon, a honse physician, and four resident pupils. 
Three clinical lectures are delivered daily in the wards, 
illostrated by selected oasee, and beginning at 9 a.m. 
A special feature of this hospital is the division of tbe 
stn^nta into senior and junior classes, thus providing 
for their systematic and appropriate instmotion from 
the beginning to the end of the oonrse. 

Two gold medals and other valuable prizes and 
oertifloates of merit are awarded at the end of each 
session. 

A prn<pecbu^ ow he had from Dr. Tobin. 8t, Stephen’s 
Grtwn. 

Dfk Btssvskb' Hospital, situated at Kingsbridge, is 


S»PT. 11, 1901. 

oue of tbe oldest andlargest of the nlinipnJ hospitals in 
Dublin, and contains over 200 beds. Recently a very 
fine Kursee’ Home has been added to the in^tution 
with accommodation for over seventy nurses. And this 
i year a new and thoroughly equipped dispensary and 
I out-patient department has been completed, and opened 
to patients. The hospital affords exceptional facilities 
to resident pupils, there being accommodation for four 
medical and six surgical residents, as well as one to each 
of the special departments of gyn»ool<^ and ophthal¬ 
mology. Each pupil, daring residence, is provide with 
a separate famish^ room, with coals and m, besides a 
general sitting-room. The fees for each uum months 
of residence are ten guineas with, and five guineas with¬ 
out. oertificAte. Liceuslng bodies recognise six months' 
residence as e^ivalent to a year’s ordinary attendance 
at host^ital. The manufactories and railway works in 
the neigbbonrhood supply this hospital with large num¬ 
bers of accidents uxd other cases, while tbe spedaliward 
for venereal diseases affords exceptional opporti^ties 
for the study of this important sabjeot. 

JxRvis Stbxbt Hospital, Dublin. —Jervis Street 
Hospital is the oldset established in Dublin. 'The new 
hospital was completed in 1896, since which time it has 
been opened for the reception of patients. In addition 
to the la^e medical and surgical dispensaries, the out¬ 
patient department includes special departments for the 
treatment of diseases of the skin, eye, ear, and throat, 
and dis oa a o a peculiar to women. 'Two resident surgeons 
are appointed annually. Clinical clerks and surgeons’ 
dressers are selected from among the most attentive of 
the advanoed students without the payment of any 
additional fee. Twolve interns are appointed annually, 
and are provided with apartments, Ac.. fr<)e of expense. 
Special certificates are given to resident pnpils rad 
dressers who have performed their respective dntie* to 
the satisfaction of the physicians and sni^^ns. Gold 
and silver medals are given after examinations held at 
the close of the summer session. 

SPECIAL HOSPITALS. 

The special hospitals of Dublin are the Rotunda, 
Coombe, and National Lying-in Hospitals, Cork Street 
Fever Hospital, the Royal YiotoriaEye and Ear Ho^ititi 
(amalgamation of St. Mark's Ophthalmic Hospital, rad 
the National Eye rad Ear Hospital), the Dental Hospital, 
tbe Throat Hospital, the Orthoptedio Hospital, rad the 
Children's Hospitals in Haroourt Street and in Temple 
Street. 

Thb Rotunda Hospital. —This, the lai^est and best 
known lying-in hospital of tbe United Kingdom, isevery 
year becoming more appreciated as a school of midwifery, 
rad of late, more especially, as affording peculiar advait- 
t^es both to the student and the praoUtioner for 
acqniring a tborongh knowledge of gynieoology. It oou- 
tains two distinct departuiento—viz, the lying-in hos¬ 
pital, into which abont 1,600 oasee of labour are admitted 
annually i and tbe hospital for tiie treatment of diseases 
pecoliar to women, mto which some 600 patients are now 
admitted daring the coarse of tbe year. The present 
master, Dr. Pnrefoy, was previously well known as 
GynEBCologist to the Adelaide Hospital. There is a 
large extern maternity in connection with the hospital, 
more than 2,0o0 women being attended daring the past 
year at their own homes, and also a large daily dispensary 
for the treatment of toe diseases peculiar to women. 
Every facility is afforded for the study of toe special 
departments of medicine to which the hospital is devoted, 
and both stndento and midwives are granted a diploma 
on panning an examination. Two clinic^ clerks, at a salary 
of £60 per annum each, are appointed every six months 
from among the students who have attended the full 
course of iastraction in the hospital. A considerable 
number of female pupils are also yearly trained ai nurse 
tenders and midwives. 

Thb Coombs Ltino-in Hospital.—T tais horoital has 
accommodation for sixty-five patients, in two ^visions, 
one devoted to midwifery and the other to the diseases 
of women. The present master is Hr. T. G. Stephens, 
L.B.O.F.. F.R.C.S.1. 


8>n. 11, 1901. 


tfipELAND—EDUCATION. Thb^JHidioal^Pbub. 263 


Natiokal Hatsbkitt Hobfital. —This iostitotinD, 
noderthe msstership of Dr. Barry and Dr. H. Home, is 
(itnated in Hollee Street. 

Sib Patbick Duh’b Hatbbmitt.— This is a branoh of 
Sir P. Don's Hospital, and is under tbe management of 
the Ein^'a Professor of Midwifery in Doblin Univereity. 
Stodente desirous entering for twelve months’ in* 
strootion in practical midwifery are required to pay a 
materiiity fee of £Z Ss. each to the Begistrar of tbe 
bosjntal, and to send in their names to tbe Board of 
Govemon, before Janaary 1 in each year. Students of 
Trinity College are not liable to any other payment for 
instmotion in praotioal midwifery. Other students are 
required to pay JH 3b. each to the King’s Professor, for 
twelve montbs' practical instruction, in addition to the 
hospital maternity fee. The certificates of Sir Patrick 
Dun’s HospibU are recognised by the Boyal Universitv 
and the Conjoint Boyal Colleges of England, Ireland, 
and Scotland. 

CoBK Stbbbt Fivbb Hospital is the only special 
fevw hospital in Dublin. It is supported mainly by an 
AMPTi*! Government grant, and capitation graote for 
patients. Begular clinical instruction is given during 
the winter and Bummer sessions to those who desire a 
special oourse in fevers. All particulars may be obtained 
on application to the Begistrar and Besident Medical 
Officer. 

National Childbbn’s Hospital for tbe treatment of 
all non*infectious diseases peculiar to children, 87 and 88, 
Haroonrt Street, Dublin. Tbe hospital, with which the 
Pitt Street Children’s Hospital, founded in 1821, was 
amalgsunated, is capable of containing 60 beds for the 
reception of cases of deformity and all other forms of 
Burgtoal disease. There is a large general dispensary 
for extern patients held daily from 10 to 11. Operations 
are performed on Saturday at 12 o’clock. Practitioners 
and students can attend on application to Mr. Ormsby. 

Dublin OBTHOPjinic Hospital, Great Brunswick 
Street, containing 40 b^ for the treatment of every 
class of deformities and for the practice of orthopcedio 
surgery. This institution is under the management of 
Mr. Swan. 

The Butal Victobia Etb and Bab Hospital oonsistB 
—nntU the new oombined hoepital is erected—of the 
two institutions which have, heretofore, given special 
instmotion in ophthalmolo^ separately. They are 
(1) St. Mark’s Opbthalinic Hospital and Dispensary in 
Lincoln Plfu».—This hospital was founded by the late Sir 
Williaus Wilde, and contains 60 beds. Clinical leotnres 
are delivered on the mornings of Mondays, Tneedaya, 
Thursdays, and Fridays at 11 o’clock, and operations are 
perform^ on Wednea^ys and Saturdays at the same 
hour. (2) National Eye and Ear Infirmary, Moleeworth 
Street.—This hospital contains 80 beds. Clinical in* 
stmotion in diseases of the eve, inoludi^ the use of the 
opbthalmoeoope, is riven daily. Operations at 12 o’clock. 
Instruction in aural surgery is alw given. Afternoon 
claasea for praotioal instauotion in the use of the 
opbthalmoeoope, &a, and for tbe demonstration of oases, 
are formed from time to time by the assutant surgeons. 

The Inoobpobatbd Dental Hospital, Lincoln 
Place. —This lumdsome hospital, recently erected, is 
tile only special Dental Hoepital in Dublin. It is 
officered by a very strong staff of the leading dental 
snrgeiHiB of Dublin, and has a large olienleU and exten* 
sive praotioe among the Dublin poor. The fees are 
^16 leaforfiret year's study, uxd £12 12 b. for second, 
and proportionately smaller fees for shorter periods. W e 
refer our madors to the advertisement in our oolumns 
to-day for full information as to the staff. 


IRISH PUBLIC SERVICES. 

The Poob-law Mbdical Sebvice. 

Since the early part of 1899 a vital change has taken 
place in the Iriah Poor-law Medical Service—the service 
which has, heretofore, absorbed most of the Irish rising 
medical generation. By the Irish Local Government 


Act tbe administration of the system, the appointment 
aod payment and allocation of duties of medical offioe.'s 
was transferred from the old Boards of Guardians, com¬ 
posed in due proportion of members elected by the 
local voters and members who acted «*-officio in virtue of 
property qnalifloations, to new boardj compoeed wholly 
of the elected repreeentativee. This change has had the 
most disastrous effect upon the service. The ex-officio 
guardians, ve.,the local gentry, were, thereby, eliminated, 
and the sole control of tbe service has been transferred to 
the elected Guardians, who have, we r^ret to say, 
sought to place oonsideratums of economy before every¬ 
thing—before tbe welfare of the poor, and before the 
just rights of the medical officer. Questions of religion 
and politics are so rampant on Irish elected Boards that 
the medical officer who is at variance on these matters 
with the majority of the Board, who governs him, has 
not a pleasant life. The Itish Medical Association 
whose work it is to safeguard the interests and improve 
the oondition of'the Poor-law medical officer, considers 
it an imperative duty to point ontto young practitioners 
tbe following facts:—(1) That the Poor-Uw Medical 
Service is one in which there is no promotion. (2) That 
it is a service where few facilities exist for original 
research, and still less for further medical onltnre, 
espeoially in the rural districts. (3) That, while medical 
education has become wider in its requiremente, and 
more costly and difficult to procure, the same or a lese 
rate of payment given to less educated men forty years 
ago is still offered, and this, too, at a time when tbe 
mrri prosperity of the country is less, and oonsequenlly 
lucrative private praotioe more diffionlt to obtain. We 
need go no further than to say that tbe Irish Poor-law 
Medical Servioe is a service to avoid. To all who oon- 
templste entering the Irish Poor-law Service we 
emphatically say, Don't. 

The newly.qualifled medical practitioner who may 
elect to try his luck in the Irish provinces sets his hope 
in the great majority of instances U{on obtaining one or 
more Poor-law medical appointments in some district 
where there is hope of private praotioe. There are 160 
workhouses and about 818 dispensary medical officers, 
beeides apothecaries. The number of vacancies that 
occur annually averages 100. Tbe salary in this 
servioe used to average about X114, but is rapidly 
coming down, and when it is taken into oonsidera- 
tion that in the vast majority of rural districts 
it is necessary to keep one or more horses, the aver¬ 
age area being from forty to sixty square miles, it 
is plain that there will not be a large ma^in left 
from the public emolxunents. 

The medical officer is also ipto facto the registrar 
of births, marriages, and deaths, and medical officer 
of health for the district, under the Public Health 
Act passed in 1873 and amended in 1878. The 
former office, in country districts, yields between 
and XIO a year, and tbe emolumeats of the latter ap¬ 
pointment in very few oases ro ach £20, averaging about 
£12. The medical officer is also vaooioator for the 
locality, and is required to vaccinate everyone who 
wishes to oome. For each patient a fee of 28. is 
paid, almig with his salary, by the guardians, and the 
sum total of those fees varies, aooording to the popu¬ 
lousness of the district, from £4 to £100, an average 
for the provinces being about £10. Despite the miser- 


I 



284 Tn Mastou. Pbbw 


IBBLATO-EDTJOATIOir. 


Bm. 11. ifiOl. 


able salary, and the very many disoomforte of dispen¬ 
sary life, these appointments are generally eagerly 
sought for—first, because they afford the new comer a 
oertain, though hardly-earned salary to supplement his 
private earnings; and secondly, becauee, if not secured 
by the new comer, they would of necessity bring a com¬ 
petitor for office into the field, and, inasmuch as private 
income is of far greater import than public earnings, 
ootmtry medical practitioners are obliged to undertake 
tile public duty in order to maintain the monopoly of 
tiieir private emoluments. 

Appointmmt$.—’Vhe qualifications required by the 
Local Qovemment Board are a licence in surgery, in 
medicine, and in midwifery; but registration in the 
Medical Begister, if affected since the passing of the 
Medical Act, in 1886, fulfils all requirements. The 
candidate must also be 28 yesrs of age. 

The appointment to both workhouse and dispensary 
lies with the guardians, who elect by vote. As politics 
and religious feeling run high in Ireland, these elements 
enter largely into the election of Poor-law medical 
officers. Family interest also possesses great weight. 

The candidate will do well to bear theee facts in mind, 
as his personal attendance on the day of election will be 
reqnir^ and whatever other qualifications he may have, 
he will then find that his compatibility in these respects 
with the majority of the guardians is essential, and 
acoor^gly he had better fii^ make himself acquainted 
with the local peculiarity, whatever it may be, Mfore he 
enters on his candidature, otherwise, in all probability 
any expenditure that he may make in the matter will 
be simply thrown away. 

Dufies.—The duty of the dispensary doctor is two¬ 
fold. He is to attend his dispensary on a given day or 
days in the week. Frequently there are two dispen¬ 
saries in the district, separated from each other by 
several miles, and he will have perhsps to attend two 
days a week. He has also to visit at any hour of the 
day or night a sick nerson for whose relief a visiting 
ticket has been issued by a member of the committee 
or the relieving officer, to continue his attendance 
as often as may ^ necessary to the termination of the 
case. Moreover, he has a great many reg^try books 
to keep and a multitude of returns to make, and in the 
majority of districts he hM to make up all the medicines 
for the poor. 

The pressure of these duties is in a great degree 
dependrat on the goodwill of (he guardbms. If the 
medical man be a favourite with his masters they will 
give him very little trouble with “ scarlet runners,” as 
the visiting tickets ate, from the colour in which they 
ace printed, humorously called, and will be unwilling to 
trouble him even with oases deserving of persmial 
attendance. 

If, on the other hand, it is his misfortune to differ 
from the guardians in rcd^on or politics, his position 
may become Impossible. He may be peremptorily sum- 
mcmed in any weather, at any hour, and to any distance, 
to a ease which he may probably find to be altogether 
trivial, or to a person whom he may know to be peneotiy 
well able to pay. 

Workhotu 0 HiupiiaU —Thennmbtt of unions in Ireland 
is 169, to each of which is attached a medical officer, who 
is appointed and controlled by the board of guardians 
in toe same manner as the dispensary surgMn. The 
salary is usually better than that ot the dispensary 
doctor, and the duties of a more easy and satisfactory 
description inasmuch as they are confined to daily 
attendance at the workhouse hospitals, and no night 
visits out of doors or any long journeys across the 
country are involved. 

Ths IniBB Lunaot Simviob. 

This servioe, at p re s e nt, affords a comfortable liveli¬ 


hood for 22 Besident Medical Superintendents and 88 
Assistants. The Superintendents receive fsalariee 
and allowances ranging, according to the numl^ 
of inmates of toe asylum, from <8600 to <61,000 a year, 
and the Assistants receive salaries and emoluments 
averaging about <6200 a year. There are also Visiting 
Physicians receiving about <6120 a year, but this 
of offioer is being allowed to die out, and no new 
appointments will be made. 

The Superintendents and Assistants are to devote 
their whole time to their duties and not to take any 
private practice. 

Heretofore toe appointments of Medical Supmin- 
tendents have been in the patronage of the Lord 
Lieutenant, but, under the new Local mvemment Act, 
they will be in the hands of the County Councils, with 
toe proviso that no one shall be appdnted who is not a 
fully r^^istered practitioner with five years’ service as 
Assistant. The Assistant has been, heretofore, appointed 
by toe Board of Governors, and will, in future, be 
appointed by the Committee of the County Council to 
which the management of the a^lum is entrusted. In 
addition to theee offloers, there are, in oertain larger 
a^lnnu, Clinical Beeidents, who receive about £60 a 
year and full allowances. Those appointments afford 
excellent introduction to the highn places in the 
service. 

It will be seen that the Irish Lunacy Servioe is well, 
but not too well paid, not only for the v^uable and re- 
f^nsible services rendered, but for the disagrimeiu ot 
living in a Innatio asylum. It is, however, a service 
available for cmly a very few who have political or per- 
smial influence to obtain appointments. 

Othub ArroiirntBirrs. 

There are, in addition to those which wo have mmi- 
tioned, oertain emoluments open to medical praotitionen 
in special localities. Th^ are 

1. Attendance on toe Boyal Irish Constabulary. 

2. Attendance on the Co^ Guards. 

3. Factory Surgeoncies. 

4. Attendance upon the depot soldiers who are not 
otherwise provided for. 

The Constabulary are paid for at the rate of 28. per 
month for each member of toe force on duty in the 
dietiriot, including toe wives and children of the men Imt 
not of toe officers. This includes toe supply of medi¬ 
cines. The appointment to this ^torition rests with the 
InspeotoivGenMal of the Boyal Imh Constabulary, who 
usually acts upon the advice of the local Di^iot 
Inspectors as to the convenience of the men, and, of 
course, the emoluments depend on the number of Con- 
stobuluy stations and the number of men in each. 

The Coastguard Service.—The duto of the Medical 
Offioer is to attend toe men when siox and to axatwiTiff 
can^dates either for admission or for superannuation. 
The fees vary from 6e. to 28. 6d. per visit. The appoint¬ 
ments rest with the Admiral^, but are osuMlj secure 
for toe local Peor-law Medical Offioer. In toi* case, al^ 
the emoloraents depend on the nnmber of stationa and 
men. 

Factory Sni^Keoucies are in the gift of the Chief 
Inspector of imstories in Whitehall, and are, of ooone, 
avsllable only in the few districts in which there are 
factories to inspect. Thereis a set scale of payment by 
the factory owner to toe inspeotorfor this work, but we 
believe it is not adhered to, and, in some disfanotB,atall 
events, the emolument is a matter of arrangement. The 
amount depends upon the size ot the tuetory, 
toe position being, in Dntfiin or Belfast or in other large 
manufacturing centres, a lucrative one, but in other 
places scarcely worth taking. The attendance on toe 
military d^mto is not worth mentioning. 

The name* qftha Prqfestort, Leeiwrert, and HoapUal 
Staffs of th* foregoing Schools and Soepital*, are not 
included in this ptaee^ being found in the isdveriise- 
ment of each InslUutiont as indicated on nesd page- 


Sbpt. 11, 1001. 


8C0TLAND-EDU0ATI0N. 


Thb UiDioAL Pbw». 286 


Bojsl CoUega of Phyaiduu 51 

SdiooU: 


Vjdrtt^^'ct DnbUii - 67 

Bo;ml Couage o( Borgaona 67 

Bojml Colkga of Beicnee • 63 

Qneao’a Collage, Cork 65 

Qnaa'a Collet Oalmf • 61 

Ca^olio UniTOttity • • 67 

Gtntral Uo»pitaU: 

Bojal CitT of DnUln • • 61 

Sir Fafarick Dod’i 67 

St Tincaat’a • • • 68 

Biohmoad Whitworth and 
Baidwieka • • • 68 


Horoara 

Matar Miaerioordiie • 63 

Adelaida .... 68 

Jarria Straat • • - 61 

Dr. Staaraa'a . . - 61 

Sptcial HotpiUd*; 

Bottmda LyiDg*in 53 

Bojal Victoria Bya and Ear 58 
National Childran'a - 65 

Inoorporatod Dental • 6l 


$c0tlanb. 

Scotland >tUl mainfatins her educational system at 
the high level to which it long ago attained, and, witii 
a considerably lees nninerOTis popolation inhabiting her 
whole area than that of Loodon alone, snpports four 
▼eneraUe and historic Universitiee, each with an 
h(nioared pewt and a magnificent reotnd. The UniTersi* 
ties of Edinburgh, Glasgow, Aberdeen, and St. Andrews 
have sent forth many illnstriona gradnates in all the 
different branches of higher learning; few schools can 
show more gratifying reenlte, and when the scheme 
embodied in the magnificent Camegrie beqneat is fully 
elaborated and in working order, still more brilliant 
results are anticipated. Zn Edinbn^h and Glasgow 
those who do not aspire to the honour of a University 
degrees can obtain college diplomas and excellent medi¬ 
cal tflanhing from extra-mural schools of almost equal 
renown. 

The inhabitants of Scotland have always evinced a 
deeply-rooted dislike for constraint; the regulations of 
their Universities exemplify this. The student in Scot¬ 
land is his own master; heliveswherehelikes,dines where 
he pleases, and can clothe himself in any kind of gar. 
ment he ohoosee. In but one of the Universities have 
students to don gowns. No doubt the great freedom 
granted to students occasionally leads to unsatisfactory 
results, but the advant^^ which accrue from the system 
may be held to more tha.n connterbalanoe the drawbacks. 
The student is only required by the authorities to attend 
with due regularity various compulsory classes, to give 
evidence of diligence in his work, and to conduct him- 
Nlf with proper decorum while within the University 
precincts. Several halls of residence for students have 
lately been established, bat even here the students are 
their own masters. Absence of residential colleges im¬ 
plies the absence of college fees, and of the invariable 
large extras incurred by college life. 

The oo-existenoe of teaching and degree-granting 
universities and extra-mural medical schools in Scot¬ 
land forms one of the moat important factors in the 
system of medical education in the country. That 
obtainable at the universities is the best of its kind, 
comprising courses on all branches of special medicine 
and surgery; at the extra-mural schools the speoial 
subjects are perhaps even better treated, as they are 
taught by specialists themselves. In the way of ex¬ 
pense, there is little between the University coarse and 
the obligatory currioulum for the Licence of the Col* 
leges. The minimam cost for five years' attendance for 
the lioenoe may be put down at £120, which iooludes 
class and examination fees; and at the UDiveraities at 
£146; a difference of about £5 a year only. 

Perhaps the one blot upon the Soottisb system of 
medical education at Univerdties arises from the plan 


adopted at their profeseioual examinations of delegating 
the examiners’ duties to the profesaors themselves, along 
with only one coadjutor for each subject. As University 
students are now allowed to attend one-half of the total 
nnmber oi oonrses required for graduation outside the 
University walls, it happens now and again that those 
who have done so in a subject, upon which tiiey are 
examined by the professor teaching it, are placed at a- 
disadvantage in not being thoroughly conversant with 
subjects specially lectured on by examiners during the- 
preceding session. Tbe.examining board for the diploma- 
of the Scottish colleges, indeed, is largely ap of 

the extra-mural lecturers, but the nnmber assigned to 
each subject is large enough to avoid the examination 
of a candidate by his own teacher in the majority of 
iiietanoes. 

Apart from the educational attractions offered t«> 
students of medicine by the Scottish schools, a very 
important fact aids to explain the reason why so many 
students from all parts of the Empire enrol their names 
in their books: the cost of maintenanoe is leas than in 
England or Ireland. As a general rule the higher tiie 
latitude the cheaper is the living in Great Britain. 
Edinbn^h and Glasgow are more economical than 
London and Dublin; Aberdeen still less expensive. 

UNIVEESITY OF EDINBUEGH. 

Four d^reea in medicine are granted: Bachelor of 
Hedicioe (H.B.), Bachelor of Surgery (Ch.B.), Doctor- 
of Medidue (M.D.), and Master of Surgery (Ch.M.}. 
The first two must be taken ti^ther, ^e last two may 
be taken separately. 

No one is admitted to the degrees of Bachelor of 
Medicine and Bachelor of Surgery who has not been 
engaged in medical and surgical study for five years, 
sf^ passing a preliminary examination in general 
knowlMge in aocordanoe with the medioal ord&aaoes. 
The degree of M.A. of a British University is held to 
supersede such preliminary examination, llie subjects 
induded in this general examination are English 
grammar and composition, English history and geo¬ 
graphy, Latin, aritlunetio, and &e elements of mathe* 
matios, and, in addition, as optional subjects, Greek,. 
French, or German. 

The ann«« medieus of each year is held to be oonati- 
tnted by at least two courses of not lees than one hun¬ 
dred lectures each, or by one of such oonrse, and two 
oonrses of not less than mty lectures each, exclusive of 
the clinic*! oonrses, in which lectures are given twice a 
week during preecribed periods. Two years of five 
must be spent at the University, the remaining three 
years at any University of the United Kingdom, or other 
Universities or Medioal Bohools rboognised by the 
University Court. 

During the first four years the student must attend 
elementary botany, elementary zoology, physics, prac¬ 
tical chemist^, practical phy8iol<^y, piaotdoal patho¬ 
logy, and medical jurisprudence and public health during 
courses of not less tlmn 2i months each; practical 
anatomy during two oonrses of not less five months 
each; chemist^,anatomy, physiology, pathology, sur¬ 
gery ; materia medica and ^erapeotics, medicine, and 
midwifery and the diseases of women and children 
during courses of not less than five months each. Eight 
of these subjeots must be taken at a University, fla 
must attend a oonrse of 25 meetings on practical phar¬ 
macy in a University or recognised Bcho<u of medicine, 
or have dispensed drags for a period of three months in 
a hospital or dispensary, or in an establishment recog¬ 
nised by the Pharmaoentioal Society. He must attend 
a nine months’ conrse in clinical medicine and in clinical 
surgery. During the fifth or final year he most be 
engag^ in clinical stndy for at least nine months. In 
all, ^fore graduation he must have attended for at 
least three years a hospital which accommodates no 
fewer than 80 patients, and possesses a distinct staff 


Diuu OOg t 




286 Tbb Misioal Pstse. 


SOOTL4^ D—BDUC ATIOTT. 


Sbft. 11. 1901. 


of phyaiciftni and surgeons, and he most hare acted as 
<^rk in the medical and dresser in the sorgioal wards of 
snoh a hospital, or the practice of a dispensary, or of a 
physician or sargeon. He must have had approved 
oppoitnnitiee of studying at a hospital, post-mortem 
examinations, fevers, diseases of children, ophthalmo- 
loCT, vaccination, and mental diseases. 

He must personally attend at least twelve cases of 
lahonr under the superintendence of a registered medical 
practitioner, or six such oases, and, for at least three 
months, the practice of a midwifery hospital in which 
practical instruction is regularly given. 

Every candidate must deliver before the Slst day of 
March of the year in which he proposes to graduate to 
the Dean of the Faculty of Medicine— 

1. A declaration in his own hsndwriting that he has 
-completed his twenty-first year, or that he will have 
done so on or before the day of graduation, under article 
of apprenticeship to any surgeon or other master. (This 
declaration, along with a statement of studies, is 
appended to the schednle for the final examination, and 
most be signed before the schedule is given in.) 

2. A statement of his studies, as well in literature and 
philosophy as in medicine, accompanied with proper 
certificates. 

Each candidate is examined both in writing and viva 

COM : — 

1. Zoology, botany, physics, and chemistry. 

2. On anatomy, physiology, and materia medio^ and 
therapeutics. 

3. On pathology, medical jurisprudence, and public 
health, 

4. On medicine, surgery, and midwifery. 

The examinations in anatomy, chemistry, physiology, 
botany, and zoology, materia medica, and pa^ology, are 
conducted, as.far us possible, by demonstration of objects 
placed before the candidates. 

Candidates who are ready to submit to ui examination 
in the subjects comprised in the first division, viz., 
botany, zoology, physics, and chemistry may be admitted 
to examination in all or any two of these subjects at any 
•examination held after they have attended a full eourse 
in each of the subjects professed. 

Caodidates who have passed their examination in the 
sabjeots in the first division may go up for examination 
'in ^oee of the second division at the end of their third 
winter session, but may postpone their examination in 
materia medica and therapeutics until the close of the 
Bummer session following. 

They may, in a similar way, go up for the snbjeots of 
the third division at the end of their fourth winter 
session, and may postpone their examination in medical 
-jurisprudence and public health until the close of the 
'following summer session. 

Candidates who have passed their examinations in 
the subjects comprised in the first, second, and third 
•divisions may be admitted to examination in the fourth 
or final division, when they have completed the fifth 
year of study. 

The degree of Doctor of Medicine may be conferred on 
•any candidate who has obtained the degrees of Bachelor 
of Medicine and Bachelor of Surgery, and who is of the 
age of twenty-fotir years, and who produces a certificate 
•of having b^n engaged, subsequently to hia having 
•received the degrees of M.B. and Ch.B., for at least two 
years in atten<huioe on a hospital, or in scientific work 
hearing directly on hia profession, or in the Military or 
Naval Medical Services, or in medical or surgical prao- 
~tice. The candidate shall submit to the Faculty of 
Medicine a thesis certified by him to hare been com¬ 
posed by himself, and which shall be approved by the 
Faculty, on any branch of knowledge comprised in the 
-professional examinations for the degrees of Bachelor of 
Medicine and Bacbeli^r in Surgery, which he may have 
-made a subject of study after having received those 
degrees. The candidate will also be examined in clinical 
medicine and in some of its special departments. 

The regulations for the degree of Ch.M. are very 
similar, the candidate being examined in surgical 
anatomy, operations on the dead body, clinical surgery, 
and some of the special branches. 


Candidates eettled abroad, who cannot appear per* 
sonally to receive the degree, may, after satisfying the 
Senate to that effect, have the degree conferred on them 
in ab$$ntia. 

Fees: The fee to be paid for the degress of Bachelor 
of Medicine and Bachelor of Surgery is twenty-two 
guineas and the proportion of this sum to be paid by a 
candidate at each division of the examination is regis¬ 
tered from time to time in the University Court, ^e 
fee for. the degree of Doctor of Medicine or of Master of 
Surgery is ten guineas. 

The total expenses of the ourricnlum, including ex¬ 
amination and matriculation fee, is ^146. 

Bursaries and Scholarships open for Session 1900,1901: 
Among the bursariee and scholarships open during the 
enaning yeararv:—Two Sibbald Bursaries of il80 a year 
for three years, particulars from Messrs. Mackenzie, 
Innes and ^gan, W.S., 28, Queen St, Edinburgh, before 
September 16th. Two Thomson Bursaries of ,£26 for 
four years, one conferred at each preliminary examina¬ 
tion in October and March. Five Grierson Bursaries 
(oativea of Crawford and Leadhills have a preference). 
Names must he seat in before October Ist. Two John 
Aitken Carlyle Bursaries of £28 one year for pro¬ 
ficiency in class examinations in anatomy and nbemistry 
or physiology. Two Mackenzie Bursaries of £2J in prac- 
tio^ anatomy. Benton Bursary of £20, for one year, 
for students attending olassee of natnral physlolc^y, 

I mathematics, chemistry, or political economy, who also 
I can show they are in need of pecuniary aid. Names 
to be sent to secretary before the middle of September. 
Two Crichton Bursaries of £60, for four years, one com¬ 
peted for at each preliminary examination. Stark Scho¬ 
larship in CUnioEd Medicine, of about £100. awarded in 
July, 1900; Murohison MemorisJ Scholarship of the 
interest from £1,000, to take place in Edinburgh in the 
summer of 1901 ■ Buchanan’s Scholarship of £40 10s., 
for proficiency in midwifery and gynsoology, as shown 
by class work and in the final examination. Other 
scholarships are: —The James Scott, £42 10a., aannally, 
in midwifery; the Thomson, £40 for four years, in 
botany, zoology, and elementary mechanics in October; 
the Ettles, £31 68. annually to the mo«t diatingnisbed 
graduate; two Hope Frizes, £30 annually, in chemistry ; 
two Crichton, £100 annually, in anatomy and physio¬ 
logy. 

Full partioulara of these and of the other prizes may 
be found in the ** University Calendar (published by 
Mr. Thin, South Bridge, Edinburgh, price Ss., post free, 
3 b. 6 d.), or the “Medical Programme” (price 2<L) from 
the same publisher. 

Graduation in Scienoa: The University of Edinburgh 
also possesses a Faculty of Science which may confer two 
degrees. Bachelor of Science (B.Sc.) and Doctor of 
Science (D.So.) These degrees ere given in pure science 
and in applied science. CandidatM for the degree of 
B.Sc. in pure science must attend at least seven courses 
of instruction in the subjects selected by zhem during 
the course of not less than three academical years. 
Three of these courses must be on subjects selected by 
them daring the course of not less than three academic^ 
years. Three of these courses must be on subjects pre¬ 
scribed for the first science examination, and four on 
those for the final examination. Four of these ooureee 
must be taken in the University of Edinburgh. Among 
the subjects recognised are chemistry, human anatomy, 
physiolcgy, zoology, and botany, t^dnates aa B.Sc. 
may, after five years, proceed to tbe degree of D.Sc., 
undergoing an examination In tbe suhjecte chosen, and 
presenting a thesis founded on original work. 

Graduation in Public Health ; Similar degrees are con* 
ferred in Public Health. Candidates must be graduates 
in medicine of anniversity recognised by tbe University 
Court, and must matriculate for the year in which they 
appear for examination. Before proceeding to the first 
examination they mnst produce evidence that (1) they 
have worked for at least twenty hours a week daring a 
period of not less than eight months, after taking their 
medical degree, in a reoognised Public Health Labora¬ 
tory. Five of these months must be spent consecutively 
I in the Public Health Laboratory of the University 




8«pf, 11, 1901. 


SCOTLA.ND-BDUOA'TION. 


Trs Mbdioal PBsas. 267 - 


Edinlm^h and (2) have attended a coarse of leotnres 
on physios, and one, of at least three months’ duration, 
on geoloCT, snoh as the Senators may approve of. 

(^didates for the second ezsminaticm of B So. in 
Pnblio Health are not admitted until at least eighteen 
mftntha have elapsed after having passed M.B., Ch.B., or 
sooner than six months after the first examination. 
They most have attended two separate oonrses of Public 
HealUi, or at least forty lectnres in each, one dealing 
with medicine, the other with engineering, each in its 
relation to pnblio health, in snoh manner as the Senatus 
shall determine. They most also have studied practical 
sanitary work nnder a Medical Officer of Health for six 
months, have had three months* clinical instruction in a 
recognised fever hospital, and three months’ instmotion 
in mensuration and drawing. 

Fall details of the subjects included in the different 
oonrses are given in the official programme of the 
Faonlty of Science, which may be obtoined from the 
University (price 2d.). 

In a similar manner to that described under degrees 
in pare science, a B.Sc. may after five years proceed to 
take the degree of D.Sc. in Public Health. 

Fees for Science Degrees: B.Sc., first examination. 
£3 38.; B.Sc., second examination, £S Ss.; D.Sc., 
.£10 lOs.: total, £16 168. 

University Hall, Edinburgh : In an educational num¬ 
ber it is worth while to call attention to the advantages 
now offered to students coming to Edinburgh to study, 
in the shape of social residences akin to, though very 
much less pretentions than, the Eniilish University Col¬ 
leges. During the past six years several buildings 
have been acquired in Edinburgh for this purpose, in 
which students can live in a self-governing community. 
In each house there are private studies with or with¬ 
out bedrooms, and common sitting and dining rooms. 
The charges vary from 7 b. 6 d. to 22s. 6d. per week. 
The residents elect a treasurer from among their number, 
who acts as intermediary between them and the 
housekeeper or servants. It is a satisfactory indica¬ 
tion of the comfort of the Hall that several graduates 
now live in it and are willing to help or coach the 
undergraduates for moderate fees. To gain admission 
two references must be produced from past or present 
tesidenfcs. There are considered and vot^ on at a house 
meeting. In all disputed points Professor Geddes is the 
referee, while Dr. Iticardo Stephens is the rent trea¬ 
surer, who will supply any further information required. 
The Uadi is an admirable place for parents to send their 
sons to. Any unruly member may be expelled by a 
meeting of the residents similar to that held for elective 
porpoaes. 

Medical School for Women in Edinburgh: The Medical 
Teaching of Women in Edinburgh is carried on by the 
Hcottiab Association for the Medical Education of 
Women (the Secretary, Minto House, Chambers Street). 
The classes are conducted by the lecturers of the Medical 
School of the Boyal Colleges, and quidify both for the 
Edinburgh University degree and for the Lioence of the 
Triple Board. The classes are for women alone. The 
University of Edinburgh does not recognise certificates 
presented by female candidates for mixed classes with¬ 
out special cause shown. 

UNIVERSITY OP GLASGOW. 

The University of Glasgow is both a teaching and an 
examining body, but admits to examination ooly those 
candidates whose course conforms to its own regulations. 
Within certain limits provision is made for accepting 
instmctions given by recognised medical schools and 
teachers; but eight of the subjects other than clinical 
must be taken in this or some other recognised Univer¬ 
sity entitled to confer the degree of M.D., and at least 
two yean of the coarse must be taken in Glasgow Uni¬ 
versity. Under the new regulations, laid down in Ordi¬ 
nance No. 14. Glasgow No. 1, of the Commissioners 
under the Universities (Scotland) Act, 1889, fonr degrees, 
open both to men and to women are conferred—M.B. and 
Ch.B. (always conjointly), M.D. and Ch.M. A preli- 
mioaiy examination must be passed in (1) English, (2) 
Latin, (3) Elementary Mathematios, and (4) Greek, 


French, or German, with possible option to students 
whose native tongue is not English in the case of the 
fourth subject, and on passing ^dents must register in 
the books of the Gtoie^ Hemoal ConnoU. By a r^iftila- 
tion recently enacted, it is no longer oompnlsory to pass 
in all the four preliminary subjects at once, and they 
may now be passed at two stages. For M.B. and Ch.B. 
a ourricnlnm of five yean is required. 

The fees for M.B. and Ch.B. are £23 2s., and the pre¬ 
sent fee for hospital attendance is £21. The fee for M J). 
is £10 lOs., and for Ch.M. is £10 lOs. 

Bursaries and prizes to the annual amount of about 
£900 are appropriated to medical atudente, including an 
Arthur bursary for women, £25 for three years. 

Several bursaries open to students in any faculty are 
not infrequently held by medical studente, and scholar¬ 
ships and fellowships to the annual amount of £1,600 
may be held by medical students who have gone through 
the Arts course. 

Qobin Maboauet Collxob fob WoMSK.—Founded 
in 1883 (by the Glasgow Association for the Higher 
Education of Women, which was formed in 1877 with 
the object of bringing oniversity instrnction, or its 
equivalent, within tbe reach of women), Queen Mar¬ 
garet College in 1890 added to its Faculty of Arts a 
School of Medicine for Women. This was organised 
entirely on university lines, and with the view ot pre¬ 
paring for university degrees; and when, in 1892, in 
consequence of the Ordinance of the University Com¬ 
missioners anthorising the Scottish Universities to 
admit women to instruction and grttdnation. Queen 
Marcraret College became tbe Women’s Department of 
the University of Glasgow, its classes in memcine taken 
previously to its incorporation with the Univereity were 
recognised as preparing for the degree. A fall coarse 
of study for M.B. and Ch.B. is given by University Pro¬ 
fessors and Lecturers, with excellent faeilitiee for hos¬ 
pital and dispensary work in the Boyal Infirmary and 
other hospitak. A Hall of Besidenue for the students 
was founded six years ago. 

UNIVERSITY OF ABERDEEN. 

The University of Aberdeen possesses nnder its char¬ 
ters the amplest privileges claimed or enjoyed by any 
academical institution. It confers degrees in tbe five 
faculties of Arts, Science, Divinity, Law, and Medicine. 
It also granta diplomas in Public Health, Agrioultore, 
and in Education. It is, moreover, a teaching body 
equipped with twelve dirtinot ohairs in the various 
brancmee of medicine and snidery, besides a I^tareship 
in Tropical Me^cine. Tbe majority of the professors 
devote their whole time to the work of the ohairs. 
There are fully-equipped laboratories, the accommoda¬ 
tion for which 1^ recently undergone considerable 
extension. Tbe degrees of M.B. and Cb.B. are oonferred 
together; they cannot be obtained separately. The 
ourrionlum of study is nearly the same as in the Uni¬ 
versity of Edinburgh ; the regulations in the preceding 
oolumns will therefore apply here. Two years must be 
passed at Abradeen. With regard to fees, each candidate 
for the degrees of M.B. and Ch.B. must pay a fee of 
£5 6s. in respect of each of the first three professional 
examinations, and £7 7 b. for the final examination. Class 
fees, £3 3 b. each. Total cost, exolnsive of the fees for 
degrees, is about £100. Besides the Boyal Infirmary, 
students have the opportunity of attonding several other 
local institutions where special courses of instruction 
are given. Perpetual fee for hospital practice is only £6. 
The professional examinations are held twice in each 
year, namely, in March and July, directly after the close 
I of the winter and summer sessions. 

Bubbabibs. —Bursaries, Scholarships, and Fellowships 
to the number of fifty, and of the annual value of over 
£1,150, may be held by students of medicine. See " Uni¬ 
versity ” Calendar. 

Thb Dbqbbb of M.D,—The degree of Doctor of Medi¬ 
cine may be conferred on any candidate wbo has ob¬ 
tained the degrees of M.B.andC.M. (Old Begnlationa), 
is of the age of twenty.fonr years, and has been engaged 
subseqaenriy to his having received the degree of M.B. 
for two years in attendanoe in a hospital, or in military 
' or nav^ medical service, or in medical or surgical 




Thb Hsdioal Fuse. 


SCOTLAND—EDUCATION. 


Skt. U, 1991. 


prMtioe» And han pr o a on ted a thesis wh^ has been 
Approved of by the Medioal Paoulty. Candidates for the 
degM of M J). (New Segnlations) are reqn^d to pass 
an examination in medicine in addition to pr^ 

senting a thesia. Similar regolations apply to a de^ee 
of ChJl. (Master of Sni^^. 

A Diploma in Public Health is conferred after 
examination on graduates in mediidne of any oniTersity 
in the United Kingdom.—Begnlations may be seen in 
the Calendar.or obwned on ap^ioation to the Secretary 
ci the Medical Faculty. 

Abbbdxkm Sotal IwriBJSABT.—This is awell equipped 
institutdon, containing 240 beds, snd affords excellent 
opportunities for olini^ study to students at the Aber¬ 
deen UniTersity. The citi^, moreover, offers inducement 
in tiie way of cheaper living and comparative quiet to 
that obtained in Edinburgh and GlMgow, and will 
doubtless be preferred by some on this account. 

ST. ANDBEW8 UNIVERSITY. 

Unitbd Collbob St. Andbbws and Unitbbsitt 

COLLBOB, DUNDBB. 

This University (seaeion opens October 0th) grants 
the degrees of M.B., Ch.B., M.D., and Ch.H., and aU» 
a diploma in Public Health. The degrees of the Uni¬ 
versity are open to either sex. For the degree of M.B., 
Ch.B. two of the five years of medical study murt be 
spent in the University of St. Andrews; the remaining 
three may be spent in. assy University of the United 
Kingdom, or in any foreign, Indian, or Colonial Univer¬ 
sity recognised for the purpose by the Universby Court. 

in such medioal schools or under such teachers 
as may be reo<^niised for the purpose by the University 
Court. The preliminary examination and the profes¬ 
sional examinationn are of the same character as in the 
other Scottish Universities. 

Univertity College, Dundee, was affiliated and made to 
form part of the University of St. Andrews on January 
16th, 1897, and the whole medical curriculum may 1 m 
taken in the College. The United Coll^, St. Andrews, 
offers classes for the first two years of professional 
study. 

BqBSABIBS AMD SOHOLABSBIPB. 

Unitbd Collbob, St. Andbbws. —Two Berry bursaries 
of £4/0 tenable for three years, open to men for arts, 
Bcienoe, or medicine. Fourteen '^ylor-Ttaompeon bur¬ 
saries £50 to ,£30 tenable for one year, pa^y for two, 
open to women only proceeding to graduate in medicine. 

Univbbsitt Collbob, Duhdbb. — Eleven entrance 
bursaries of ^16, open to men or women for arts, science, 
or medicine, tenable for one year. Four ^820 and three 
£16 second year bnrsariee for men or women in arts, 
scienoe, or medicine, tenable for one year. Four £20 
and two £15 third year buisaries for men or women in 
arte, scienoe, or medicine, tenable for one year. Two 
Educational Trust Bursaries of £26, tenable for three 
years. Applicants must have attended a public or State 
aided school in Dundee for at least one year before 
examination. Bute Bursary annual income from £1,000 
(men only), 

Pbblxhinabt Examinations. —The dates of the next 
two examinations are September 27th, 1001, and March 
28th, 1902. Schedules (obtainable from the Seoreta^ 
of the University) to be returned filled up, and fees paid 
by September 14th, 1001, or Maioh 9th. 1902. 

Ftee for Drgrtet. —Total fees for M B., Ch.B., are the 
same as at other Scottish Universities, i.e., 22 guineas 
(payable in instalments). Fee for the d^^ree of M.D., 
and also for that of Ch.U., is ten guineas in each casv. 
For the Diploma of Public Health Examinations the fee 
is £5 58. for each of the two examinations. The diploma 
is granted on special examination to graduates in medi¬ 
cine of any University of the United Kingdom. 

Unitbd Collbob, 8t. Andbbws. —date Fere .—The 
fee payable in eaoh of the following separate classes is 
3 guineas, viz., iu Chemistry, Practical Chemistry, 
Physics, Zoolt^y, Botany, Physiology, Practical Physio¬ 
logy, Anatomy, Practical Anatomy. 

Univbbsitt Collbob, Dundxb. — Cla^a Fete .—The fee 
payable in eaoh of the following separate classes is 
3 guineas, viz., in Chemistry, Practical Chemistry, 
Phjsics, Zoology, Botany, Physiology, Practical Physio¬ 


logy, An^my, Practical Anatomy, Hatoria 
Practical Pharmacy,Pathology,PracticalPatbolMra^ 
Bacteriology, Medioal Jurisprudence and Public H^th 
Medicine, Surgery, Operative Surgery and Midwiferv' 

In Clinical Medicine, Clinical Surgery, Ophthalm^ 
logy. Diseases of Throat and Ear, and Mental OisMaea 
the class fees are 2 guineas each, and in Fevers 1 gninaa. 
For the Chemistry required for the D.P.H. the fee is 
7 guineas. A spec^ class is also held for the D.P H. 
for which the fee is 8 guineas. * 

Dumdbb Royal Astlom.— The appointmenta include 
a qualified reeideat assistant and two resident 
clerks. Clinical instiuction is given. 

Further information will be found in the of 

the University, published by Meesra. Blackwood and 
Sons, Edinburgh, or can be had of the Dean of the 
Medioal Faculty, Professor Weymouth Bcid, F.B.S. 

Dundbb Royal Intibkaby.—T he Infirm^ 

800 beds, with a special ward for the treatment of 
children. Three resident qualified assistants are ap¬ 
pointed annually. Clinical dlerks and dressers ara 
attached to the physicians and entgeons. and students 
are appointed to assist in the post-mortem room. Ont- 
patients are seen daily at 9 a.m. The instruction 
given at the Infirmary is recognised for purposes of 
graduation bv the Scotch UniTersities, the University 
of London, the University of Csmbridge, the Royal 
UniTersity of Ireland, and by the Royal CoUwes of 
England and Scotland. Hospital Ticket for the Infir¬ 
mary, £2 28. each session, or £8 3 b. a year. Fnither 
information on application to tiie Superinten¬ 

dent. 

St. Mungo’s Collbob and Glasgow Royal Inrin- 
MABT.—This oolleRe was incorporated in 1889 under ita 
new title, being formerly known as the Glasgow Royal 
Infirmary School of Medicine. The Medioal Faculty 
occupies buildings erected for the purposes of the medioal 
Bohwl in the gronnds of the hospital, and the laboriL- 
tories, mnseums, and lecture rooms are of the most 
approved description. Attcudiuioe on the classes in St. 
Mungo’s College qualifies for the medical degrees of the 
Uxuversities and the medioal and suigical colleges in 
accordance with their regalations. 

The Royal Infirmar y, which is at the service of the 
College for teaching purposes, is one of the larg^ 
general hoepitals in the kingdom. It has 612 beds 
available for clinical instruction, including an ophtbalmio 
department, and it has special wards for diseases peculiar 
to women, for venereal diseases, erysipelas, burns, and 
diseases of the throat. At the d^pensary specUsl 
advioe and treatment are given in diseases of the eye, 
ear, teeth, and skin, in addition to the large varied 
number of ordinary medical and surgical cases— 
about 62,000 per annum—which in a great industrial 
centre dsiily require attention. Students at tihe oolleg^e 
and hospital get the beceflt of dispensary experience 
free of charge, and no better or wider field for seeing- 
hospital praotice and receivins clinical experience can 
be found than in the Glasgow Roysl Infirmary. 

Appointments : All appointments are open. There are 
five phyaioians’and seven surgeons’ assistantswho obtain 
free board and residenoe in the hospital and act in the 
capacity of house physicians and house sni^ons, and 
there is an assistant to the gryneoologistwho boards but 
does not [reside in the hospital. There is also a house 
Borgeon for the opbthalmio department. These appoint¬ 
ments are made^for six months, and are open to gentlemen 
who have a leg^ qualification in medicine and surgery. 
Clerks and dressers are appointed by the visiting physi- 
oians and surgeons. From the large namber of cases 
of acute disMses and aociients of varied character 
received, these appointments are valuable to students. 
In the pathologic^ department assistanta are aleo ap¬ 
pointed by the pathologist. 

Feee: The fees for Lectures, including Hospital 
attendance necessary for candidates for the Diplomas 
of the Eoglish, Scotch, and Irish Colleges of Physicians 
and Surgeons, amount to £72. 

Andbb8'>n'8 Collbob Mbdical School, Glasgow.— 
New and excellently equipped buildiaga were opened in 
I October, 1877, in Domba^n Road, immediately to the 
I west of the entrance to the Western Infirmary, and 


O 



Sift. 11. 1901. 


SCOTLAND—EDUCATION. 


Tai Mbdical Pbiss. 289 


within four miautoe’ walk of the Unirersity. Extensive j 
laboratory aocommodation is provided for praotioal 
anatomy, practical chemistry, practical bota^, praA | 
tical soology, practical physiology, practical phannacy, j 
operative snrgery, and hygiene and public health. ! 
There are also provided a library and reading room, and j 
a students* recreation room. The buildings are con* j 
strooted upon the most approved modern principles. 
The dissecting room is open in winter from 9 a.m. to I 
6 p.m, and in summer from 6 a.m. to 6 p.m. These | 
students are assisted in their dissection by the professor 
and demonstrators, by whom daily examinations and : 
(demonstrations on the parts dissected are conducted. 
The supply of subjects is ample, and students are con- . 
seqnentiy provided with parte as soon as they may be 
ready for ^em. The dissecting room is provided with 
a complete series of dissecting specimens mounted in 

C * iter of Paris illustrating the anatomy of the human 
y. There is also a large Bone Boom, famished with 
complete sets of painted andunpainted bones. 

Dental Curriculum: Students studying with a view 
to the dental diploma can obtain instruction in t^e fob 
lowing subjects : Physics, chemistry, anatomy, physio¬ 
logy, surgery, practice of medicine, and materia medioa. 
The special dental courses may be obtained in the 
Dental School, 6, St. Vincent Street, Glasgow. 

Fees: Fees for hospital praotioe and oUnioal lectures, 
first year, £10 lOs.; second year, £10 lOs.; afterwards 
ftse. For six months. £6 fis.; three months, £4 43. 
Students who have paid 20 guineas at another hospital 
for its perpetual ticket are admitted six months for 
£2 28.; or one year for £3 Ss. Vaccination certificate, 
recogudsed by Privy Council, £1 Is. 

THE COLLEGES. 

The Boyal College of Physicians of Edinbniii'h, the 
Boyal College of Snigeons of Edinburgh, and the Faculty 
of Phyeioians and Surgeons of Glasgow have made 
arrangements by which, idter a series of examinations, the 
stndentmayobt^thediplomasoftheoo-operating bodies 
The holders thereof are enabled to roister three 
diplomas under the Medical Acte, viz.. Licentiate of 
^yal College of Physicians of Edinburgh, Licentiate of 
the ^yal College of Surgeons of Edinburgh, and Licen¬ 
tiate of the Faculty Phymoians and Surgeons of 
Glasgow. The diplomas are also recognised by the 
Army, Navy, and omer public bodies. 

The tiuee oo-operating bodies grant their tingU 
qnaliScations only to candidates who are already regis¬ 
tered as pooBOBsing another and opposite qualification 
in medimne or snrgery, as the case may be. 

BaOUliATlONS OF TBX CONJOINT BoABD OF THS 
BotAL COLLiaX OF Phtbioianb of Edinbubuh and 
THS BoTAL COI.LSOX OF SuBOXONS OF EdiNBUBOH 
AND THX FaCULTT OF PhTBICIANB AND SUBOXOHS, 
Gdaboow. —The candidate must produce certificates of 
having attended the f<^owing separate and distinct 
course of lectures, tiie certificate distinguishing the 
sessions and the schools in which the courses were sever¬ 
ally attended. Anatomy, one oouise, six months. Frao- 
ti^ anatomy, twelve months. Chemistry, one course, 
six mon^. Practical or analytical chemistry, one 
course, three months. Matoia medioa, one oonrse, three 
mont^. Physiology, one oonrse, six months. Praotioe 
of medicine, one course, six mon^s. Clinical medicine, 
nine months. Principles and praotioe of snigery, one 
oonrse, [six months. Clinicm surgery, nine months. 
Midwifery and diseases of women and children, one 
course, three mouths. Medical jurisprudence, one oonrse, 
three months. Pathological anatomy, one oonrse, three 
months. The candidates must also produce the follow¬ 
ing certificates.—(a) Of having attraded not lees than 
six cases of labour under the superintendence of the 
practitioner who ligns the oertifioates, who must be a 
roistered medical practitioner. (6) Of having attended 
for three months, instruction in practical pharmacy. 
The certificate to be signed by the teacher, who must 
be a member of the Pharmaoentical Society of Great 
Britain, of the Snperintendent of the laboratory of a 
public hospital or dispensary, or a rostered practi¬ 
tioner who dispenses medicine to his patients, or a 
teacher to a class of practical pharmacy. («) Of having 


attended for twenty-four months the medical and surgical 
, praotioe of a public general hospital, containing on an 
I avenge at least eighty patients, and possessing diatinst 
: staffs of physicians and of surgeons, (d) Of having 
attended, for six months, the practice of a public dispen¬ 
sary specially recognised by any of the oo-operating 
bodies; of having been eng^ed for six months as visit- 
assistant to a registered medical practitioner. (<) Of 
having been instructed in vaccination. 

First Examination, Fee £5.—-The first examination 
shall embrace chemistry, comprising the following par¬ 
ticulars :—Chemical physics, heat, Hgbt, and electricity, 
the principal non-metalUo and elements, 

their more common combinations, also the leading 
alcohols, orKanio acids, ethers, carbohydrates, and 
alkaloids; the oandidatM will also be examin^ prac¬ 
tically in testing; physics and elementary biol(^. The 
first examination shall take place not sooner tiian the 
end of the first year, including a winter smd summer 
session. Candidates who desire to enter for the first 
professional examination must apply to the Inspector of 
Certificates on or before the Friday preceding the day of 
examination, and must produce oer tifloates of attend¬ 
ance on one oonrse of chemistry, one course of practical 
chemistry, one course of anatomy, and six months* 
praotioal anatomy. 

Second Examination, Fee £5.—The second examination 
shall embrace anatomy and physiology, and shall not 
take place before the termination of the summer session 
of the seoond year of study. Candidates must produce 
to the inspector oertifioa^ of attend^ce on pre¬ 
scribed conrsee of anatomy, practical anatomy, and 
physiology. 

Third Examination, Fee £6.—Comprises the subjeots 
of pathology, materia medioa, and pharmacology and 
advanced anatomy. 

Final Examination, Fee £16.—The final n y jninwti iT Ti 
shall embrace the principles and practice of medioine 
(including therapentios and medical anatomy, nliniw^i 
medioine); the principles and praotioe of suimry (in- 
oloding surgical anatomy and surgical patnology); 
clinical snrgery ; midwifery and gynasoology, medical 
jurisprudence and hygiene; and utall not take place 
before the termination of the full period of stndy. 

Subjects of Preliminary Ednoation: (1) English lan¬ 
guage, including grammar and oompoeition; (2) Latin, 
including grammar, translation from speoifio authors, 
and translation of easy pasasge not taken from <mcb 
authors; (8) elements of mathematics, oomprising (a) 
arithmetic, including vulgar and decimal fractions ; 
^b)almbra, inolndii^ simple equations; (e) geometry, 
inoludii^ the first two books of Euclid ; (4) etementary 
mechanics of solids and fluids, oomprising the elements 
of statics, dynamics, and hydrostatics; (6) one of the 
following optional subjects:—(a) Greek; (6) French ; 
(c) German ; (d) Italian; (<) any o^er modern lan¬ 
guage ; (H logic; (ff) botany; (h) zoology; (») ele¬ 
mentary onemistry. 

Qnaliflcation in Public Health: The College of Physi¬ 
cians, in association with the Boyal College of Surgeons 
of Edinburgh and the Faculty of Physicians and Sur¬ 
geons of Glai^w, confers a certificate of oompetenoy 
in public heal^. The examinations ate held m Ap^ 
and October. Fee, £10 lOs. 

For the special regulations of the Bo^ Collie of 
Surgeons of Edinburgh, intendiuk candidates should 
apply to Mr. James Bobertson, 48, George Squre, Edin¬ 
burgh ; and for those of tite Boyal College of Physicians, 
to Dr. B. W. Philip, 45, Charlotte Square. 

The Fellowship of the Boyal College of Physicians of 
Edinburgh is conferred only by election, and the candi¬ 
date must have been a member of the college for at least 
one year previously, and have attained tiie age of twenty- 
five years. 

The membership is conferred only on licentiates of the 
college or graduates of a British or Irish university 
after an examination in medicine and therapeutics, 
and in any other branch of medical eoienee to be 
selected by the candidate. Under certain conditions 
as to age and professional standing, candidates may, 
however, be admitted without examination to the licen ce 




290 Tm Msdical Pbiss. SCOTLAND—BDUCATION. 


Skt. 11, 1901. 


The licence, or single qnalification in medicine, is con* 
ferred on candidstee who already posaees a reoo^ised 
qoaliflcation in oargery. The examinations of this lioenod 
are held on the first Wednesday of each month, save 
those of September and October, on medicine, materia 
medica, midwifery, and medical jnrispmdence. The fee 
is £16 16s., and intending candidates shonld commani- 
cate with the Secretary of the College at least eight days 
before the date of examination. 

The Fellowship of the Boyal College of Snigeons of 
Fdinborgh is conferred (except under certain conditions 
as to age and professional st^ding) only on candidates 
who have passed a special examination, and have pre- 
▼ionsly obtained a diploma from the college, or from 
either of the Colleges of Sorgeons of England or Ireland, 
or the Faculty of Physicians and Snrgoons of Glasgow, 
or the surgical degrees of the UniTersities of Great 
Britain, and who are twenty*five years of r^e. The 
subjects for examination for those who are alrcidy 
Licentiates of the College are on the principles and 
practice of sui^ry, clini^ and operative surgery, and 
one optional subject. 

Those who are not Licentiates of this College: on 
principles and practice of surgery, clinical and operative 
surgery, surgical anatomy, and one optional subject; 
and in such supplementary subjects as have not, in an 
adequate manner, been included in the examination for 
the registrable surgical qualification possessed by such 
oandii^tes, and which are required in the eximination 
for Licentiates of this College. 

The optional subjects sl^ll embrace: (a) Bni^ry, 
special branches; {f>) advanced anatomy and physiology; 
(c) surgical patholc^y and morbidanatomy; (d) midwifery 
and gynescological medicine and surgery; (e) medical 
jurisprudence and hygiene; ( f) practice of me^cine and 
therapeutics. The examinations are written, oral, and 

J iractical. Three weeks’ notice must be given to Mr. 

ames Bobartsoo, from whom full particulars as to oerti* 
ficates required mav be obtained. The fee is £30 for 
those who hold the diploma of Licentiate of the Colley, 
and £46 to others (no stamp duty is payable on the dip* 
loma). B^^istereu practitioners, agM not less than 40, 
who have l^n in practice for not leas than ten years, 
and who have highly distinguished themselves by 
original investigations, may under special circumstances 
be elected wi^ont examination. Women ate not 
admitted to the Fellowship. 

Licxnck. —The examination embraces the principles 
and practice of surgery (inclnding operative surgery and 
surgical patholop^), clinical surgery, and surgical 
anatomy, and ehul not take place before the termination 
of the f^ period of study. Fee £16 168. 

Wood Bubsabt.— >The examination for the Wood 
Bursary, of £60 per annum, tenable for three years, 
will take place on October 21et and 22ad, at the 
coUege. The subjects will be found in our advertising 
columns. 

Dbntal Diploma. —Every candidate for the dental 
diploma must have attend^ the general lectures and 
courses of instmction required at a universitv or an 
established medical or dental school recognised by ^e 
CoUege as qualifying for the diploma in surgery. G^e 
fee is £10 10s. 

Edinbuboh Botal Ihpibkabt. —Clinical instmction is 
afforded at this institution, which contains 780 beds in 
the building, and 10 beds in a convalescent home under 
the snpervisioD of professors of the university, and the 
ordinarv physicians and surgeons of the infirmary. 
Special instruction is given on diseases of women,physic^ 
diagnosis, and diseases of the eye. ear, throat and teeth. 
Separate wards are devoted to venereal diseases, dtsonecs 
of women, discasoe of eye, also to cases of incidental 
delirium or insanity, and three wards are specially set 
apart for clinical instmction to women students. Poet* 
mortem examinations are condnoted in the anatomical 
theatre by the pathologists, who also mve practical in* 
stmction in pathologit^ anatomy ana histology. The 
perpetual fee, on one payment, £12; the fee, 

£6 6e.s half*yearly, £4 4e.; quarterly, £2 2e.; monthlv, 
£1 Is. Separate payments amounting to £12 12s. entitle 
tike student to a perpetual ticket. No fees are payable 
for any surgical or inedical appointment. 


The appointments are as foUows: — 

1. Resident physicians and surgeons are appointed 
and live in the bouse free of charge. There is no 
salary. The appointment is for six months, but may 
be renewed at the end of that period by special recom¬ 
mendation. 

2. Special non-resident clerks (in the special subjects 
and for out-patient work) are appointed for six months. 
These also may be similarly renewed. 

3. Clerks and dressers are appointed by the surgeons 
and physicians. These are open to all students and 
junior practitioners bolding hospital tickets. 

4. Assistants in the pathological department are 
appointed by the pathologists to conduck post-mortem 
examinations in the anatomical theatre. 

School ot Mxdicine of trb Koval Collbgbs, Edin- 
bdboh.—T his school, established in 1505. is constituted 
by over fifty lecturers especially licensed by the colleges. 

The lectures qualify for the TTniversity of Edinburgh, 
and other universities, the Royal Colleges of Physicians 
and Surgeons of Edinburgh, London, and DubUn, and 
the other medical and surgical boards. 

The minimum cost of the education in the School of 
Medicine for the triple qualiflcationg of physician and 
surgeon from the Boyal Colleges of Physicians and Sur¬ 
geons of Edinburgh and the faculty of Physicians and 
Surgeons ot Glasgow, including the fees for the joint 
examinations, is about £115, which is payable by yearly 
instalments during the period of stndy. 

The Winter Session opens October 2nd. The secreta^, 
Mr. B. N. Ramsay, 24, Forest Road, Edinburgh, will 
forward the School Calendar gratis to inquirers. 

POST-GRADUATE COURSES IN SCOTLAND. 

In Edinburgh a number of permanent post-gradoate 
oonrses oontinne more or less oontinnonsly throughout 
the year. Among those open to or especutily for post: 
graduates are: —> 

1. Ophthalmology: Daily at the Royal Infirmary. 2. 
Ophthalmoscopy: Dr. George Maokay, Eye Dispensary, 
Chambers Street, fee £2 2a.; Dr. W. G. Sym, Eye, Ew,. 
and Throat Infirmary. Cambridge Stieet, fee £2 28. 3. 
Aural Surgery, Ao.; Dr. MaoBride and assistants, Royal 
Infirinary; Dr. Hunter Mackensie, Eye, Ear. and Thr^t 
Infirmary, fee £2 2s. 4. Pathological Bacteriology: Dr. 
T. Shennan, Su^eons’ Hall, fee £2 2b. 6. Dermatolosy: 
Drs. Allan Jamieson and Norman Walker, fee £3 3 b. ; Dr. 
Stewart Stirling, Skin Dispensary, Lanriston Flaos, fee 
£1 la. 6. Diseases of ChildJ^: Sick Children’s Hospital, 
]>. John Thomson; minor surgioal dioossoa of children,. 
Mr. H. J. Stiles, fee £2 2a. 7. Chest disossow: Dr. &. W. 
Philip, Victoria Hospital and Dispensary, fee £2 2a. 8. 
Oynsecolc^: Dr. Brewi8,fee £2 28. 9. The Demonstra¬ 
tions on Modem Gastric Metoods, by Dr. A. liockhart 
Gillespie, fee £2 2s., available at any time daring the 
year on the leqneet of a sufficient number of poeW 
graduatee. All theee coureee are of short duration,, 
varying in length from three to six weeks. The 
Honorary Secretary, Post-Graduate Courses, Surgeons’ 
Hall, will snpply a full syllabus on ^iplication. 

In Glasgow, special courses in ear diseases are held in 
Novembm and May at Anderson's College, and post¬ 
graduate courses in pathology and baote^logy at the- 
University from September 18th to October 12&, 1901. 

PARTNERSHIPS, ASSI8TANT8HIPS, Ac. 

Information is often sought by recently qoalifled men 
and by their parents as to the most convenient plan by 
which to get into the position to commence general 
practice. To such we offer the following hints :-~ 

Partnerships in Oemsral Practice. —In Ireland and 
Scotland it is generally found that private practice worth 
having only exists in larjra towns; elsewhere in these 
two divisions of the Ein^om medical men live cheaply 
on the emoluments of their appointments. In Englud 
it is different; appointments are subordinate to private 
praotioe everywlu^ and the succession to a praotics 
can be ve^ ;mnerally seoured by purchase, whiou is not 
the case in either Iioland or Sootiand. Although there 
are in Eogland practices that cannot be bought, it is 
evident that no money will oommand the highest <ds« 
of Draotice, which is a peieonal thing attaching to a man 
and cannot therefore be transferred. Partnenhips see 

c 


o 


Ssn. 11, 1901. 


PARTNERSHIPS, &c. Thk Mbdical Fsbss. 291 


regarded ae safe introdnotioiu to practice; bnt apart 
fr^ the notoriously high charges for admisaions to part¬ 
nerships. we regard them as greatly over-estimate in 
value. To ohtedn a partnership a considerable amount 
of capitsd is indispensable, for th*) following reasons :— 
1. A. share in a putnership, if of any value, is not likely 
to be bad for les4 than £1,000. 2. A junior partner hae 
to live upon his own resources until the money earned in 
the practice after the date of his entry is paid, i.e., until 
the first year's bills have gone out and have been 
honoured by the patients. 

Atsi$tant»hip$. —An assistantship is a capital discipline 
for any man, especially as assistants in medical practice 
are now treated more as gentlemen and con/rtret ; but the 
salary obtainable is more a question of actual eiperienoe 
than of the diplomas held. To act as “ locum tenens " 
it is essential that previous experience of practice 
should have been obtained, a full knowledge of dis¬ 
pensing being absolutely necessary, dress and personal 
appearance going also a long way towards securing an 
engagement. 

Apeointmemig .—There are oertain appointments, 
which are usually obtained without much difficulty, and 
are often inquir^ about. The Postal Service to and 
between the West India Islands is an unhealthy service, 
bnt is not a bad one for men who can exercise a fair 
amount of self-oontrol. The salary and perquuites are 
equal to about £200 a year, with b^rd and lodging. If 
a roan lives tbrongh a few years, and does not fall a 
victim to the many temptations which present them¬ 
selves, be may nltimately get promoted into the Cape or 
Brazilian lines, which is regwded as a very good ser¬ 
vice. To the Peninsular and Oriental Steamship Com¬ 
pany it is almost impossible to obtain entranoe except 
by ^e personal infinenoe of the directors; the same may 
be almost said of other steamship lines. 

End or thx Educational Nuxbir. 


TSE OP£KlNO OF THE LONDON MBDICAL SCHOOLS. 
Chenng Cross Hospital Hedlosl Sobool—Wsdnstdav, Oct. 2nd. 

Introdnctory Address by Prof. J. W. Taylor, F.R.C.S. 

Dsntal Hospital of London—Tuesday, Oct. 1st. 

Ooy's Hosptal Medical School -Taetday, Oct. lit. 

King’s Collsgs. London, Medical Facnlty—Tuesday, Oot. 1st 
London Hospital Medical College Tneeday, Oct 1^. 

Middlesex Hospital Medical School—Tneeday, Oot. let. Introdnc* 
tory Address by Mr. T. H. KsUook, FJtC.S. 

Boyal Free Hospital School of Medicine for Wonen-Tuesday, 
0«t lat IntrMnotory Addraat by Dr. F. W, Andrewea. 

St Bartholomew's Honntal and College—Tneeday, Oot 1st. 

Bt O eorge'a Hospital Medical School—Tneeday. Oct. 1st at 4 p.m. 

Intr^nntory Addross by Ur. P. W. Latham. 

St ICary’s Hcmital Medical School-Tuesday, Oot lat. 

St Tbomaa’s Hospital Medical College - We^ssdv, Oot. 2nd, at 
^gm. Prises distributed by UsJor.Qen. lu Hamilton, 

Vuiversitv College Medical Sohsol—Tnesd», Oct IsS at 4 p.m. 

Introanetory Address by Prof. J. Bialsn Bnasell. 

Westminster Hospital Medical School—Tuesday, Oot. Ist. 
Frotibces. 

tTnivarai^ of Birmingham—Tneeday, Oot. let. 

Bristol, UniTsnity College—Tuesday, Oct lat. 

Chrdiff, Univeraity School of Medicine—Monday, Oct. 7th. 

Darham Unirereltv School of Medieine - Tassaiy, Oct 1st. 
iitvsrpool University College—Tuesday, Oct. 1st. 

Masebsster. Owens College—Tuesday, Oot Ist. 

Sheffield, University College—Tneaday, Oct 1st. Sir T. Barton, 

The TorkahiM College- Tnesd^, Oot 1st. 

laSLABD. 

Adelaide Medical and Surgical Hoepitals, Dublin. 

OathoUo Univenity Medical School, Dnbtin—Nov. 2ad. 

City of Doblin Hospital—Tneeday, Oct. 1st. 

Dr. Steevan a Hospital -Monday, Dot. 7th. 

Dtiblia Univarai^ Oot 1st 

Maath Hospital—Tnesday Oct. 1st, at 4.30 p.m. Introductory 
Ad dram by Mr. WUliain Itelor, on <^t i4(0| A30 p.m. 
Meroer'a Hoapital- Tneaday, Oct lat 

8t Vinoent’a Hospital—Oct let Inttodnotory Leotnre by Dr, 
Cox, 430 p.m. 

Qnera's College, Cork - Monday, Oct Slat. 

Btebmond, Whitwonb, and Hardwioke Hospitals — Tuasday, 
Oot lat 

Boyal CoL of Snrgeona in Ireland Sohoola of Snrgsry—Tnesdi^, 
Oot 1st 

Trinity Cultege School of Physio, Dublin, THmnntlna Rooma, Ac.— 
Fust week in October : Lacinrasbegin first wau November. 
SCOTUSD. 

Aberdeen University-Tnead^, Oot ISth. 

Dundee UnivarsHy Collage wsdaasday, Oot 0th. 

Edinburgh Dnivani^—Oot 15th. 


Edinburgh School of Medicine, Booms, and Labomtoriea, Tuesday,. 
Oot 1st. 

Edinburgh School of Medicine for Women—Tuesday, Oct. 15th. 
Olaagow, Anderson's Collem Medical School Thursday, Oct 17th. 
Olaegow, Queen Margaret College School of Medicine for Womenr- 
Oct. 17th. 

Glasgow University—Thnraday, Oct. I7th. 

Glasgow, St Mungo's CoUere -Thursday, Oot. 17(b. 

Glasgow Boyal Infirmary—Thursday, Oct. 17th. 

Boyal CoU^ee, Eiiohurgb—Tuesday, Oct 15th. 

St. Andrews Univeraity—Wednesday, Oct. 9th. 


The Opening of the Medical Schools. 

W iTH the commencement of October comes the 
annual opening of the metropolitan and provincial 
schools of medicine. In London the session com¬ 
mences at St. Thomas's with a prize distribution on 
October 2nd bj Major-General Sir Ian Hamilton, 
K.C.B., with the annual dinner, at 6.30 p.m., at the 
Hotel Metropole, Mr, H. H. Glutton in the chair. 
Guy's Hospital opens on October let with, a houae- 
dinner of the Students’ Club, tickets to be obtained 
of the secretary. On Saturday, the 5tfa, Sir Samuel 
Wilks, Bart., F.R.S.. will preside at the first meeting 
of the Physical Society, to be held in the new Physio- 
Wical Theatre, when a paper will be read by Mr. S. 
w. Macllwaine on “ Disease and its Causation.” 
St. George's has an introductory address on October 
1st, at 4 p.m., by I^. T. W. Lathanit and in the 
evening the annual dinner will be held at the Hotel 
Metropole, with Mr. Warrington Haward in the 
chair. Westminster begins its session on Ootober- 
1st, and has its aiMmaJ dinner on the 4th, under the 
onairmanship of Mr. Charles Stonham, F.R.C.S.. 
University Collie Hospital has a lecture on 
the Ist., at 4 pm., by Pkofessor J. Bisien Russell. 
The Fast and ih'esent Students’ Dinner is held, at 
6.30, at the Hotel Cecil,, with Sir Douglas Powell,. 
Bart., as president. St. Bartholomew begins on 
Octol^r Ist with a dinner, at 6.30; in the Great Hall,. 
Mr. W. J. Wal8bam^F.B.C).S., in the chair. Charing 
Cross opens on the 2nd with an address from Pro¬ 
fessor J. W. T^lor, F.R.C.S., of the University of 
Birmingham. The Old Stndents’ Dinner wall take- 
place on the 22nd of the month at the Hotel Cecil. St. 
Mary’s has an address on the 2nd from Dr, G. W. Hill, 
the Aural Sui^eon, and adinner on theSrd attbeHotel 
M6tropole, CoL A. H R. Myles in the chair. Lord 
Howard de Walden distributes the prizes at Middle¬ 
sex, after an address by Mr. T. H. Keliock, F.R.C.S.. 
The annual dinner takra place the same evening at 
the Trocadero, 7 p.m., with Mr. Bland-Bntton in the 
chair. The London commences on the 1st, and has 
its Old Students’ Dinner in the Library, lander the 
presidency of Dr. F. J. P. Daly. King’s College has 
a dinner on the let at the Hotel Cecil, with Mr. Paul 
Swain, F.R G.S., in the chair. The Royal Free- 
School of Medicine for Women has an introdneto^ 
addr»8 on October Ist, at 4 p.m.. delivered by Dr. F. 
W. Andrewes, The London ^hool of Tropical 
Medicine commences on October Ist., the Dental 
Hospital, and the National Dental Hoepital and Col- 
ege on the same day. 

Pboyinobb. 

University of Birmingham Session commenoee 
October Ist. 

University College, BristolSession commences 
October Ist 

University College, Cardiff:—Session commences 
October 7th. 

Yorkshire College, LeedsSession commences- 
Tuesday, October let. Sir W. S. Church, Bart, 
MT)., F.B.C.P., is announced to deliver the intro¬ 
ductory addreee on the following day. 

University of Durham:—The session in the Medi¬ 
cal Faculty commences October Ist 

University College, Liverpool:—Session com¬ 
mences October Ist. The opening address will be^ 


292 Thi Mkdical Pbus, NOTES ON CURRENT TOPICS. Sbpt. 11, 1901. 


delivered and the prizes distribnted on Saturday, 
October 12th, bj Profeesor Lodge, of Birmingham. 

Owens College, Manchester:—Session commences 
October let. 

University College. Sheffield;—Session commences 
October Ist, when Sir Thomas Barlow, Bart., 
K.C.Y.O., will deliver an introductory address. 

Scotland. 

University of AberdeenSession commences 
October IStb. 

University of St Andrews (United Colleges of St 
Andrews and University College, Diandee):—Session 
commences October 9th. 

University of Edinburgh:—Session commences 
October 15th. 

University of Glasgow : — Session commences 
October 17th. 

Anderson’s College, GlasgowSession commences 
October 17th. 

St Mungo’s College, Glasgow:—Session com* 
mences October 17th. 

Queen Margaret College, Glasgow (for women) :— 
Session commences Octo^r 17th. 

Ikeland. 

Queen’s College, Belfast:—Session commences 
October 15th. 

Queen’s College, Cork;—Session commences Octo¬ 
ber 17. The lectures commence on Octo^r 2lBt. 

University of Dublin :—Session commences Octo¬ 
ber 10th. 

Royal College of Surgeons in IrelandSession 
commences October Ist. 

Jlotcs on Surratt %opkB. 

The Attempted Assaasioation of the 
President of the United States. 

The whole civilised world has been shocked by the 
news of a murderous outrage inflicted on the person 
of Mr. McKinley, the President of the United States. 
The facts are simple. In the course of a reception 
held at Buffalo the President, according to custom, 
shook hands with a large number of citizens. One of 
the latter, an American, named Czolgosz, of German 
extraction, concealed a revolver in the right 
hand, which was covered with a handkerchief 
and had the appearance of being bandaged. 
As the President grasped his left hand, 
the assassin fired twice with his right hand 
in contact with the body of his victim. Of 
the two shots thus fired at close quarters, one 
glanced off the sternum and was discovered shortly 
afterwards under the skin by the President himself. 
The second bullet penetrated the abdomen five inches 
below the left nipple, and one and-a-half inches to 
the left of the median line. The abdomen was opened 
in the line of the bullet wound, and it was found that 
the missile had penetrated the stomach. The wounds 
of entry and exit in that organ were sutured, and as 
the bullet could not be found, the abdominal 
wound was closed. The operation took. place on 
the 6th, a few houis after the injury, which 
was inflicted about four o'clock in the afternoon. The 
surgical reports have since been satisfactory, as the 
fever is not high, namely, T02‘6° F. on the evening of 
the 8th. It is satisfactory to note there has been no 
sign of peritonitis. The Rontgen rays have not yet 


been called into requisition. Under tiie eircnm* 
stances there is good reason to hope that the prompti¬ 
tude with which the resources of modem sui^iy 
were applied in this case will be rewarded by the com> 
plete recovery of the distinguished patient. That 
the issue may be favourable is the prayer of civilised 
Christendom. 

The Local Goremment Board and 
Professor Koch. 

An important circular order has been issued by the 
Local Government Board with regard to the control 
of tuberculous meat and milk. The recent declara¬ 
tion of Professor Koch as to the non-transmissibilitj 
of tuberculous disease from the lower animals to man 
has been seized upon as a pretext for objection to a 
number of irksome restrictions on the part of 
farmers, butchers, cattle dealers, dairymen, and 
others. For once in a way, Mr. Balfour’s Govern¬ 
ment has risen to the occasion where a medical issue 
of vast national importance has been raised. 
They have appointed a Royal Commission 
to inquire whether tuberculosis in animals 
(why not lower" animals P) and man is 
one and the same disease; whether animals and 
man can be reciprocally infected with it; under 
what conditions, if at all, the transmission of the 
disease from M-TiimalB to man takes place; and what 
are the circumstances, favourable or unfavourable to 
such transmission. Pending the result of that 
inquiry the Local Government Board have wisely 
issued a warning to local authorities that there shonld 
be no relaxation on their part or that of their officers 
in the taking of proper measures for dealing with 
milk from tuberculous cows and with tuberculous meat 
which may be intended for the food of man. With 
the view of rendering the action of local authoritiee 
in seizing tuberculous meat more uniform, the 
Board urge once more the general adoption of the 
well-known recommendations of the Royal Commis¬ 
sion on Tuberculosis, which reported in 1898. They 
also remark on the importance of anyone who is to 
act as a meat inspector possessing proper qualifica¬ 
tions for that office. They suggest that the local 
authority shall satisfy themselves that any person 
thus appointed has the necessary knowledge. This 
advice is excellent, but it may be doubted whether 
it is not more or less a counsel of perfeetkm. To 
be able to inspect meat scientifically demands a close 
acqumntance with comparative anatomy and patho- 
ogy, to say nothing of bacteriology and minor matters. 
Such a combination of knowledge is hardly likely to 
be found except in a member of the medical profession 
who had devoted special attention to the subject. In 
our opinion the proper course in all great centres of 
the meat trade would be to appoint one or more 
qualified medical men. with a properly equipped 
laboratory and a staff of skilled inspectors. It is to 
be hoped that the present order of the Local Govern¬ 
ment Board will have a salutary effect throughout 
the United Kingdom, and will, to a great extent, 
neutralise the harm likely to ensue from Professor 

Dir- ;izecl by Google 



SpT. 11, 1901. 


NOTES ON CUBBBNT TOPICS. 


Thx M>dio4l Pbm. 293 


Eooh’s apparezitly hasty and ill'snpported deolara> 
ti<m of belief. 

An Australian Medioal Offloer's Experience 
in South AfHoa. 

Thskk is an interesting story going the round of 
medical oirclas in Sydney concerning a South African 
experienoe of Mr. R. Scott Skirring, the late con* 
suiting sargeott to the Australian contingents at 
the war. The narrative so well illustratee the 
enormous difficulties that beset the care of 
the sick and wounded in war that it is 
worth repeating, especially as it incidentally 
exemplifies the ^le assistance afforded the mother 
country by the colondea. Mr. Skirring found him* 
self in <diarge of ten wounded men and about fifty 
sick on the south side of the Zand rirer, on the line 
of march towards Kroonatadt. In obedience to 
orders be started off witli his men in bullock wag¬ 
gons ; tile only stores available consisted of one or 
two bottles of brandy, some cases oi Lazenby's soups, 
some tins of condensed milk, a little bully beef, and 
a few biscuits. There were no cooking pots, 
and no means of carrying water. The only 
orderly immediately dev^ped enteric fever and 
Mr. Skirring was thus actually left in sole charge. 
Single-handed he fed and tended the poor fellows in 
the most marrellous manner. He gathered wood, dug 
out the fire trenches, cooked all the food he could 
commandeer from far and near, served out the meals 
to the men lying in the waggons, administered hypo¬ 
dermics, supplied the thirsty with drink and gave 
medicine to the sick; how it was possible for him to 
hare stood the physical fatigue incidental to 
all this is a mystery, but he is described as 
having found greatenjoymentinthe manual labour so 
necessary to keep his charges alive. HU chief diffi¬ 
culty was in getting sufficient water for the men and 
for the cooking. His kitchen rtensiU consisted of 
two old galvanised iron buckets which he com¬ 
mandeered from the Kaffir bullock drivers, and he 
devised a means of conveyance for the water by 
using the little water firkins of the Kaffirs. By the 
help of brandy and opium all went fairly well for 
a day or two, when suddenly Mr. Skirving received 
orders to return forthwith. This was a bard trial to 
the sick and wounded, but worse yet was to befall 
them. On retniTiing to the Zand six of the waggons 
were taken away, and the sick and wounded were 
packed like sardines into the remaining five, and 
once more jolted off. Nothing daunted, Mr. Skirv¬ 
ing stuck to his work, and with unwearied patience 
finally reached the railway and safely deposited hU 
wearied ohaiges in a train, the boiling water of the 
engine being prmnptly taken over for the purpose 
of r^reshing the sick men with some much-needed 
hot soup. To feed, doctor, and nurse over sixty 
sick and wounded men for several days together, 
with no stores and no utensils, is a very heavy task 
for one individual, and Australia may well be proud 
of Mr. B. Scott Skirring, the late Consulting Sur¬ 
geon to the Aiutralian contingent. 


Quackery in Germany. 

The official records of the City of Berlin famish 
some carious information of the flagrant manner in 
which quackery and imposture are allowed to flourish 
inCrermany. Sixty percentofthearrantpretenders 
who, under the guise of benefaoting iTiii.Ti1rind, 
dupe the more than foolish citizens of Berlin are 
shown to have been ordinary day labourers. These 
impudent and ignorant “ healers,” ** bone-setters,*' 
and “ nature doctors ” base their claims to medical 
recognition on their assertion that th^ possess cer¬ 
tain mysterious virtues unattainable by qualified 
doctors. The usual nonsense is put forward that 
they heal where the medioal man only causes pain, 
and in that way they must be therefore more fit to 
practise medicine, midwifery, and surgery. Only 
40 per cent, of these quacks have had an elementary 
school education, and of the female portion about 
58 per cent, have been servant-girls. It is, unfortu¬ 
nately, only too true that if a medical man exposes 
these quacks the basest of motives are at once im* 
puted to him, and the thanks of the medical world 
are therefore especially due to Professor Tschlenoff 
of Bern, for his fearless attack on the increasing 
number of arrant impostors now infesting Germany. 
Individuals who see no barm in consulting quacks 
may be reminded that in Berlin, about 30 per cent, 
of these quacks have a criminal record. 

The Agitation against Expensive Asylums. 

Among the Wakefield Guardians, as elsewhere, 
there is persistent agitation against the extravagance 
which still continues in the erection of our new 
asylums. We do not say that this agitation is 
wrong, far from it, but we wish it were more 
rational and directed on better lines, and to some 
more sure and certain purpose. We fear, however, 
that most of it is mere froth, and that little good 
will come of it. The very men who agitate in this 
fashion would be guilty of the same wicked extrava¬ 
gance were the power put in their hands. If the 
money that has been wasted on showy buildings had 
been properly spent on good diet, liberal treatment, 
and the best means for the cure of the insane, it 
would not have cost the interest on the money 
which has been spent on these costiy piles of architec¬ 
ture, and it would certainly have been more likely to 
have added to the curative results. What our 
asylums want more than a pathological department 
is a clinical department, where schemes of collective 
investigation would be continually on foot, such as 
the treatment of epilepsy, the dietetic treatment of 
the insane, and so on. 

The Royal Commission upon Tuberculosis. 

The Government have appointed a Royal Com¬ 
mission to sift the question of the transmissibility of 
tuberculosis from the lower ftTiimstla to man. Their 
prompt action will command the approval of the 
medical profession. To the United Kingdom is 
generally conceded the front rank in practical pre¬ 
ventive medicine. It is fitting, therefore, that the 
Digitized ; 



294 ThS IflSIOAL PBX88. 


GERMANY. 


Sbpt. 11, 1001. 


reoenf' revolntionaiy doctrine annoonced bj Professor 
Koch at the Tnberculosis Congress in London should 
be forthwith investigated bj the leading scientific 
authorities in this oonntrj. The list of those 
appointed was published in the London Oaaette 
for September 3rd. It stated that the Kiog 
had been pleased to issue a commission under 
Ks Majesty’s sign manual, appointing the following 
members of the new commission: Sir Michael 
Foster, K.03., M.D.,F.B.S., Cambridge University ; 
Professor Sims Woodbead, Cambri^;^ University; 
Professor Sydney Martin, University College, 
London; Professor John MoFadyean, M.B., C.M., 
FJI.S.E., Royal Veterinary College ; and Professor 
Robert Boyce, University College, Liverpool This 
r e pr e s en tative commission is armed with full powers 
to secure fun evidence, and the result of tbeir labours 
may be awiuted with confidence. A jury of that 
stamp could hardly ^ to return a conclusive verdict. 
Their first sitting will probably be in October. 

Gelatin in Therapeutioe. 

Ik February of this year Geraldini published four 
cases of aortic aneurysm in which he had sub* 
cutaneously injected sterile solutions of gelatin with 
benefit. Though instances of the employment of 
gelatin in this manner have been reported in which 
no perceptible improvement has resulted, on 
the other hand, a number of observers have 
experienced more or lees favourable results, and 
the first practitioner who used gelatin as a st 3 rptio 
in the human subject was Br. Carnot, who injected 
solutions into the nose of a patient with severe 
epistaxis, with the result that the hemorrhage was 
immediately arrested, and he also was successful in 
the case of a deep razor cut of the hand. It must, 
however, be acknowledged that Carnot is credited 
with the bdief that subcutaneous injections are dan* 
geroxis, and that he prefers calcium chloride. It has 
been calculated that gelatin has been employed in 
about 500 cases, and the results have been encourag¬ 
ing if its employment in aaeur 3 r 8 ms is not taken 
into account. Hahn is reported {Munch. Med. Woeh., 
1900, p. 1,459) to have administered laige quantities 
of gelatin in a case of hsematuria, directing the 
patient to take it with aU the food that he ate during 
the day, and Dr. J. Sailer, in the Therapeutic Gazette 
for August, states that he finds patients prefer to 
take the gelatin warmed in liquid form. The credit 
of introducing tbe injection of gelatin for aneurysm 
rests with Lancereaux, of Paris. 

Mortality of Children. 

Such of our readers as take an interest in tbe 
mortality of children, especially in great cities, cannot 
have failed to notice how many deaths in childhood 
are uncertified. The significance of this fact is seen 
when it is known that the great majority of the un¬ 
certified deaths occur in children that are insured in 
one or more of tbe many burial societies. We ap¬ 
prove of insurance in childhood, and the system of 
small weekly payments is well calculated to pro¬ 


mote thrift. In principle nothing could be 
more praiseworthy than making provirion for the 
child’s future whilst the parents are capable of 
earning a wage in excess of the wants of their mode 
of life. But the principle, admirable as it is and 
fruitful in blessing, is so carried out that insurance 
becomes an evm*-present temptation to the parents 
to neglect the child. Eveiy visit of the coUector 
reminds them that the child is an expense, and that 
its death secures a sum oi money which to tiiem is 
huge, and at once ends the weekly payments, 
which are not always convenient. The remedy 
for such a condition of affrirs is to be found 
in requiring an inquest on the body of every 
infant whose death is not certified ty a phyeirian in 
at^danoe from the development of acute ^mptoms. 
As a further protection for these poor, helpless little 
ones no insurance money should be payable in any 
case in which the body gave evidence of n^lect. 
More than once we have seen every viscns in an 
infant's body healthy, and yet every limb and every 
viscns telling in silent eloquence of starvation. 
To some parents of a naturally oalloas nature 
insurance, without saf^oards, is a premium fM- 
killing their children — a reward for inflicting 
the most cruel of deaths, the most oowaidly 
form of murder—one in which they may pocket 
the reward of their evil acts without risking 
the neck in the gallows. Public health bodies, 
preventive medicine associations, medical societies 
generally should interest themselves on the question. 
We profess horror at the barbarous rites of Moloch, 
where for a few minutes the babe suffered its death 
agony, and we complacently live in the higher 
civilisation that allows inhuman parents to prolong 
the death agony of the babe for weeks or months, to 
listen with callous indifference to the cry of hunger 
day after day until the babe becomes too feeble to 
appeal for mercy and dies of exhaustion that 
inhuman parents may escape the death penalty. 
The law requires that parents should perform their 
duties towards their children. But it never occurred 
to our law-makers that a condition of affmrs would 
arise in which the neglect of the primmy duty of a 
parent of providing sufficient suitable food for the 
child would be rewarded with a money paymmit. 
We think too highly of our legislators to imapiie 
that they would tolerate the present condition of 
affrirs for a day if they knew the evils of the system. 
And we think too highly of thrir ability to imagine 
that they cannot find a remedy for this dreadful 
state of things. The cry—the hunger cry—of the 
starving babes calls on them to end this criminal 
state of affairs in the name of our common humanity. 

ft tmia ns. 

[FaoM OuB Own Coebbbpondbkt.j 

Bbbuv, Septamber 7th, ISOL 

Thb MonatKh.f. Pr. Dermat. 826 has an article by Pro¬ 
fessor Unna on 

Thb Tbeatstxnt of Cibcinoki. 

In it he groups together the chemical subetanoes that 

Di ■ ^ 



8pt. 11, IflOL 


AUSTRIA. 


Tn MiDicAL Pbxbb. 295 


Mpear to have a ipcoifio infloenoe on oudnoBai and 
wuok in chroaio oaaaa and in the oaae of patianti who 
draad oparatiTa meaaorw nia 7 ba racoauneaded. Tha 
write baa amplojad tbam with a oesrtaia good eflaaC, 
firafc of all in Inpna of the faoa, and than noeaaimianyin 
thanvw^»f^p*«iir aohorrlKBic 

warto and Inrth marks. First of all is the Paqaalin 
aantey, naad not for general eanteisatioa, but in a ' 
atea-lAa maanar, points with tha point of .tha 

osMitan {tha good affaet of thoaa appears to prooaad 
from w produotn giTon oflfreni tha tiaeoes burnt Ex- 
oallant raanlta ware also obtained.fiom xeaorain in snb> 
or in the form of pliurtsr as wall as appUoations 
with 6 per omit, resorcin sjdrit. Banioio aoid also, 
either alcma or in ooanbination witii resotcin in a 1 to 6 
per eent. solation, was eCcacions, eapecdally in 

rodent nicer. Ha has ate had good atfeots from an 
■ramir salfrjl. cranaahis gaosa plaster (add arson, 
eixt. oannabts orm C per cant, add sali^l. 20 to 1 m.) in 
eacoanoiiia of tha slu of Tarioos oripns. There has 
been base a similar atetrio aotum as in tiia simple 
plaafw rtn Inpn* Hmimw. The snspaotod 
tiasua nleeratao quickly; tha sound tiaone in between 
remains sound longer. 

In general. Prof. Unna first of all applies the resordn 
gansa plaster. If soma nodules renuununaiteotad they are 
priokaa with the Paquelin oautey, as are ate indoleat 
uloerated onrfaoes. Tha plaster is then reapplied 
strengthened with resordn powder. If the oarmnoma 
isaliee^ deeply oloeratad, tha oautey point is at ones 
applied, or tna ulceration furthered by the arsenio 
salicyL plaster, and the healing up waited for under 
the use d remroin plaster or reaordn bensoio aoid 
fumes. 

Hr. Boohner has published a diBsertation on tha 

TssATitBirr or Amm Middls Bau Sittpubation. 

On tiia basis of twenty-four cases treated in a garrison 
hoepitd, the author expresses a very favourable judg¬ 
ment on ^ di 7 treatment d the disease. Olsinfedion 
or dastruotion of tha axoration of suppuration is effeoted 
oithsr by injection d antiseptic solution through the 
external raiwsgrin or the enstehian tube, or by the in¬ 
sufflation of powder into the external passages or through 
the perforation opening. 

Catheterimtion in the Politser treatment by blowing 
in air dose hmm as often as good even when followed 
by temporary improvement in nearing. Too much inter* 
feresioa afte paraoantesis is oondemned. But as the 
secretim must ba removed and fresh infection must ba 
avoided dry treatment is recommended. Tha auditory 
passage mnirt be oarefnlly wiped with a probe armed wim 
sterilised wadding; astnp d ganxe is then to be passod 
in aa te on tbe t^pannm and the canal closed with a 
pladget d lint. As often as tbe wadding is soaked 
through with secretion or at least twice a day the ear is 
to he clssmsed afresh and fresh ganse introduced. In 
many oases a daily change d dressing is enough, sspe- 
<nally when a snffloient quantity d ganse is inteodno^ 
With such measnres sixty patients in the hospital have 
been disohaiged afte an average detention d twenty- 
two to twenty-three days, and oomplioation on tbe side 
of the mastoid i«ooem has only arisen in one case. 

8neh exoellent reenlts must oompel at least a oonside- 
ration d the metb<^ d treatment described. 


JlnBtm. 


[now OUB own ooBBssrownBirr.] 

ViznA. Bsptsmbar 7tb, IMl. 
Fbichotopoobapbt AMD Flschbio. 

BiAMcm is inclined to challenge Fleohsig with regard 
to his topography d ^e brain, and oonsiden many of 
his theories only an extension d other sseooisted fnno- 
tions, and not new areas as affirmed by Fleohsig in his 
anat^in'^* delimitation. 

Bianchi saj^mits his contention with experiments and 
froti, while Fleohsig demonstrate anatomioal 
flbrona relaticmsas prodd bisargnmmts. The anterior 
maty^ d ocmpto-parietal region is nndeniably 


visual in man, which is necessary for the higher fnn^ 
thm d reading. From the simple p er cept i on d light 
In the reriott d the flssnra oaloanna d the onnens, and 
the oooipital poles tha funotions may be inferred to be 
oonneoted wim the mote action d the eyebalL In tiie 
front d tills area, ngain, we have associated the graphic 
or symbolic sone. The intermediate space is ooonpled 
by w motor oentre d the upper arm, which makes the 
whole area a very complicate oombinatiMi to redtice 
to its several elements. Again, the third frontal oonv<^ 
Intion is oredite witii the motor d speech, which must 
stand in the same rtiation to the musdes d articolatiaa, 
mastication, phouation, and mimicry, aa the arm to the 
cmtie d gnmhio motkm or symbolism. Tbe archi¬ 
tectural plan of evohitiOB seoms to be in a dorso-ventral 
direction. 

This view is supported by tbe visual sene, whidi is a 
pr^rolandio development exhibited in the progrem d 
man, evolved from the senso-mote sone. The frontal 
lobes, physiologically speteng, may be considered the 
oonnectintt d lul sssasory and mote moveuieots in the 
grty matte d other parts d the loain, and therefore 
we oenfre d physiological fntion d psccepti<ma in the 
eonorete figure which mty be nltimaiely evolved. Con- 
sdousnsm and senmtioa, aa well as refiex, preside in 
the frontal eonvdaticOB. anA therdore, inhibitory 
action eannot be excluded. 

I Epilxpst AMO Hxkoet. 

Bonboeffsr drew attentiou to a case of epi to pe witii 
disturbed oonscioosnees, yet memoty perristed. The 
father was a ptyobotio and his brother snffeted from 
migishie. FromaehUdthepatiauthadsnffefedfromoon'* 
vitevetwitohings. He finally developed into an incen¬ 
diary with epuepcy, while his memory was good. 
Bonhoeffsr thou^t thisoorremoded to dreaming where 
tbe memory was quite vivid after the act. 

A Nsw Stwptow 1 m Epilbpst. 

Ceni observes that tiie normal tempsratura falls from 
86 deg. to 84 deg. oenA before aa attack sometimes in 
half an hour to aa hour bdore the attack. This hypo¬ 
thermia does Dot occur when restored to ooasciousnem 
again, althoogh it may be irregular and not so ooastant 
as the crisis. He oonsidert t^ strong prod in favour 
d the pnndmate cause being of an antetosio nature. 


yteratot. 


MONTI’S MOHXBN PATHOLOGY, (a) 

This work was awarded the [rise at the Fondairione 
Oagoola competition held in 1697 on tiie following 
thrae, propoite by the Soyal Lombard Institute, 
What laflnenoe has the docteine d the {uoliferatiou 
d oells b^nd the normal, ezeroased on the pathology 
d man P What has tiiat of the path(^;enio microhm P 
Contrast tbe two doctrines with others older. The 
advantages d both in the treatmoit of human infinni- 
tiss.'* 

Prdessor Monti shows in his book a verv full acquaint- 
aaoe with the pathological literature, both old and 
reosst, of his own and other oonntrisa. He tiaom the 
development of the tbecaries of oellnlar proliferation 
and d the pathogenic miorobm from their begianingB, 
and shows how in each oasa, great disooveries were 
generally preceded by vague intaltions d tbrir frnth, 
and bronght about by the discovery d improved 
^^laratua and improved teohniqua 
Tbe book consite of six ohaptera. 

Chapter I. treats d oellnlar pathdogy; the prolifera¬ 
tion of Oi^ and its resolta, hypertro^y, regeneration 
of tissnss and inflammation. 

In the section on ioflammation the soaroe of the 
elements of the exudation is well treated. 

Credit is given to Addison for having, in 1843, first 
formnlated the doctrine of diapedesis, usually attribute 
to Cohuheim. It is farther points out that **even 

(a) “The Foadunental Data of Modem Patholocr.’* Bjr Dr. 
Aot^e Monti. Tmnalated bj J. G. Ejm, New Sydenham Soctoty. 
London: H. K. Lewie. / • ^ ^ ^ I ^ 

D C .ooqIc 




296 Tbs Hbdioal Pbbss. 


COBEBSPONBEKOE. 


Sipr. 11, 1001. 


Cohnheim'8 famous expeiiment. to which so much import* 
Mioe is attributed as a proof of diapedesis, was per* 
formed by Augustas Waller in 1880, and was aooarately 
desMsribed, with all its details, in two notes published by 
him in 18M.” There is a ih^ aooount of the theories 
of the origin of tumours, and we may note that Pro* 
fessor Monti, in spite of all that has been written in 
recent years as to their parasitic origin, regards the 
question of the stiology of tnmonrs as s^l remiuning 
nnsolTed. 

Chapter II. deals with the doctrine of pathogenic 
microM. It begins with the statement, “The doomne 
of patlu^enio microbes was found by Agostino Bassi, a 
Lodcwian physician bom in 1778.” In support of this, 
Bassrs work on the parasitic nature of the mnscardine 
of silkworms and other writings of his are quoted. 
Thme is little doubt that Beesi did foresee the dis* 
ooveriee of modem times, though neither in his own day 
nor for many years afterwards were bis views accepted. 
The predisposing causes of microbial diseasos are sdso 
alluded to, and it is pointed out that fatigue, as well as 
atmospheric and other inftuencee which have been long 
recognised by ulini<hans as haring more or less oans^ 
oonimotion with disease, have been proved to have the 
effect in lower animals of rendering them liable to oer* 
tain microbi^ infections to which, nn^ ordinary cir* 
onmstanoes, they are immune. There are also short 
accounts of the toxins and of immunity. 

Chapters III. and IV. are historical, dealing with the 
doctrine which preceded those which form the chief 
snbieot*matter of the book. 

Chapter V. deals mainly with the hieto*pathologiosd dia* 
gnosis of neoplasm^ which is treated of very br^y. We 
agree genenmy with the statements made as to the 
scope and nsefnlnese of this method of diagnosis. In 
many cases which are clinically doubtful the hUtol<^oal 
straotnre of the diseased tissue leads to an absolntely 
certain diagnosis; but we think that in examination of 
this sort the pathologist may sometimes arrive at a 
wrong oonolnsion, uiuess he takes into account the 
history and clinioal features of the case. In referring 
to the so-called deoidno-cellnlar sarcoma it is stated 
that in this disease “the deoidoal elements left im¬ 
planted in the ntems vegetate and form tofts similar to 
chorionic villi.” 

We entirely disagree with this view. All modem 
opinion is opposed, and we believe rightly opposed, to 
the view that the decidual cells take any p^ in the 
formation of this condition, and, moreover, t^ts similar 
to chorionic villi do not occur in it. 

The sixth and last chapter deals with the doctrine of 
pathogeoio microbes in ite relation to the diagnosis and 
treatment of disease, and is, from tbe point of view of 
practical medicine and surgery, the most important in 
the book. 

The relation of the different pathogehio microbes to 
disease, and the methods of their recognition, are briefly 
stated. 

We cannot ^pcee that tbe recognition of diphtheria 
bacilli in cover-glass preparations from the membrane 
by their tendency to form gronpe or damps in which the 
individual elements are arraog^ parallel to each other, 
is so easy as tiie author states. Nor, inasmuch as this 
organism is frequently present in hedthy throats, can it 
be maintained that the discovery of the diphtheria 
hadllus is snffioientfor a certain diagnosis of diphtiieria. 

In his allusions to serum dii^^no^ of typhoid fever 
the author recommends a dilation of one in ten. This 
is, of oonrse, the dilation which was originally used in 
thiii method, but experience h** shown that a reaction 
in thiR dilation haa not at all as much diagnostic value 
as a reaction obtained with a dilution of one in &tty. We 
believe tiiat the latter is the dilution generally employed 
at the preeent time. 

With regard to the method of taking blood for exami* 
nation in pytemia, though we have sometimee succeeded 
in demonstnting OTganums in a single drop of blood, 
vre prefer, where poesible, to use a larger quantity, taken 
^ means of a sterile syringe from a superfloial vein. 
This is a method which preeenti little diffioolty, "6 


gives a better chance of suooees. There is less risk, too, 
of accidental oontamination than in taking blood by 
simple punotnre of tbe skin. The aooonnt of the 
malaria paraaitee is, considering the neoeeeary brevity, 
excellent and the same may be said of the sections on 
asepsis and serum therapy. As far as the narrow 
limits of the book lUlow, it deals vri^ ite subjeote in an 
admirable manner, and affords an excellent summary of 
our knowledgeof them at the date of ite appearanoe. 

There are oojidous and useful footnote referenoee to 
the literature of the subjeot. Altogether, the book is 
one worthy of high commendatum, and a valuable addi¬ 
tion to pathological literature, especially as to the parte 
which deal with history and critioism. 

We cannot commend the work of the translator, per¬ 
haps because the tianslation is too literal. For instsuioe, 
in the xeferenoe to pr^aration of material for histo¬ 
logical exaxmnatioas we read “ tiie inclusions are mad» 
in oelloidin.” Ac. We assume “ tbe inolusions are made”- 
is a literal tranelation, bat it is not an expression used 
in Bnglish. Other siaiilar iOstanoee oocnr throughout 
the book. . ■ , _• 

(ttorctsponiena. 

' [We do not hold oninelTss responsihle for the opinions of otw' 
oorreepoDdcDts.] 


THE TREATMENT OP GOUT. 

To the Editor of Thx Mbdioal Paass and Cibottlar. 

Bib, —The treatment of gout is a matter of intereet 
to everyone who practises medicine, whether general or 
special. As a factor in many skin diseases, every 
demartologist sooner or later learns to recognise the 
imporiAnoe of goat, both regular or irregular. It is not 
a little curious, however, to find that almost the whole 
pathology and treatment of gout furnishes the field f^ 
a host of conflicting theories and practice. Apart from 
the fact that the specific gouty deposit oonsiste of 
relatively insoluble sodium biurate, and that uric acid 
is an essential feature, the whole chemistry of 
the condition, including the very existence of 
the soluble quadriurates is full of doubts,' diffi¬ 
culties, and contradiction. If that be tbe. case 
with an exact science like chemistry what 
may one expect from an inexact science like that of 
me^cine, inexact, that is to say, in that much of its 
procedure is founded oo propositions incapable of proof 
on impeifeorly investigated phenomena. Tbe ohemista 
have tried to furnish uric stcid solvents in their labora¬ 
tories, bnt the claims of lithinm piperazine and a host 
of other et^oalled goat specifics have not withstood the 
test of ex^rience. We stand very much where Syden¬ 
ham did when called upon to treat aonte gout. 
Bo, too, with diet, every physician has his own 
dietory, and there is no scientifio law on the 
subject. As to alcohol, most medical men exolndo 
wines, and thereby, to my mind, lose a valuable remedy, 
inasmuch as the sufferer from (ffironio or advanced gout 
is often in a state of bodily debility* Hence ^e value' 
of a glass of sound port or sherry. The evil lies not in. 
quality but in quantity. 

It is ourions to see bow tiie writers of learned and 
voluminous treatises upon gout lapse into brevito when, 
tiiey arrive at treatment. So much remmns to be marned 
about the disease and its manifold ramifications that 
some of tiie bedside experienoee of your medioal readers 
oould hardly fail to be of value.—I am. Sir, yours traly> 

David Waxsh. 

Oroevenor Streep London, W., Sept. 7.1901. 

PASTEUR TREATMENT OP HYDROPHOBIA. 

To the Editor of Thjc Mbdical Pbbss and Cxscudab. 

Sib, —A letter from a medical man at Hove has been 
going tbe round of the newspapers. It is a violent 
attack upon the Pasteur treatment of hydre^hobia, and 
shows such lack of reaseming power as to merit your 
attention. The writer dearly thinlm that strong asser¬ 
tion of pers<mal opinion takM the place of argument;. 



Bxft. 11. 1901. 


CORBESPOTOKNOE. 


*rHa Msdioal Pbbu. 297 


«nd tiiAt formal poof iaonnecowtiy. Hia other logical 
method ia aimpV to attrihate to hia opponenta the 
worst possible motives. By a oombiaation of these on* 
enltared processes he produces a letter of abase worttiy 
of the iateUeotaal powers of a BUliningate fish pt^ter. 
nBe begias by sajiog that reports have appeared in 
the Faria papm this summmr of an alarmiog inoroaso 
of hydrophobia. The discrepanciee in these repoixe, he 
says, "are so glaring as to render them altogether 
absi^ and anTmiable.** This statement he gives mldly, 
without reference or i»oof. He then aaorilm their pro¬ 
bable origin to an attempt to create another hydro¬ 
phobia scare in the interests of the Paateur Inatitate. 
His next assertion is that it has been *' folly proved " by 
Latand of Faria, by Dr. Dolan, and others that Hie 
Fasteori an anti-tabic system ia uaelete and dangerous.’' 

One can only say that if a thing is “folly proved” 
it must be tme. It is impossible to believe, however, 
that the sdentiflo world has wilfully shut its eyes to the 
logical proof of an important matter that has been 
before it for some years. One would rather ask Hr. J. 
H. Thornton, for Hiat is Hie writer’s name, what he 
means by “fully proved.” Judging from the general 
tone of hia oommunioation, one wo^d imagine that in 
using the phrase he is simply besting the question by 
stattog as a fact what he should prove by the formal 
processes of logical reasoning. 

The rest of Us letter ia devoted to the accusation that 
the serum treatment of hydrophobia is simply kept 
alive because there is “money in it.” An innuendo of 
that kind could be oast at almost every discovery in 
therapeutics past and present. 

A praotioal training in the elementary methods of 
oone^ reasoning would prevent many a medical man 
from flaunting false oon^uaions in the face of the 
public. 

I am, air, yours truly, 

I^BCTATOB. 

Brighton, August 81st, 1901. 

[We have seen the letter alladed to by our corre¬ 
spondent and agree with him so far that its writer does 
not support hia strongly expressed views by any attempt 
at evidence. Neither does he act with dignity, in our 
opinion, by attributing sordid motives to the followers 
and supporters of so distinguished a scientific man as 
Pasteur. When a medical man writes to the lay neww 
papers the least he can do is to state hia facts and oon> 
elusions clearly and temperately, and to avoid person* 
alities that do not afleot the main issue. —Ed.] 


THE BIOLOGICAL TEST. 

To the Editor of Tax Mxdical Fbxss aao Oiroulab. 

Sib,—I did not wring my hands when I read your 
warning to anti-viviseotioniste. I smiled the smUe of 
the incredulous. A relative of my own was recentiy the 
subject of just such an obscure lung complaint as that 
which you use as an example. He consulted many 
speciali^: some diagnosed pneumonia, others tuber¬ 
culosis. A portion of his sputum was inoculated into 
guinea-pigs, and they died of tnberculosiB, it was 
declared. The disease progressed so rapidly that hope 
was abandoned. He went to the south coast to die; fell 
into the hands of a physician who disputed the dia¬ 
gnosis of tuberoulosis, notwithstanding the dead guinea- 
pigs, and treated him for pneumonia. In two months 
my relative was well. They say at the laboratory that 
by all the rules of medicine my relative ought to have 
died of tnbercnlosis as the animals did; if they did. 
Why should pneumonia be more easily dia^osed in a 
dying or deM mouse thu in Hie man from whom the 
disease was taken ? The bacillus of pneumonia (Fried- 
lander) says Sims Woodhead, “ tometimet givee rise to 
pneumonia in mice, guinea-pigs and dogs, but does not 
affect rabbits.” 

The diplooocons of pneumonia (Fraenkel), says Osier, 
is a widespread organism at times present in the mouth 
secretions of heal^y persons. So animals inoculated | 
with such secretions might die and lead one to suppose j 


I that the healthy persons who entertained the bacilli 
^re really the subjects of pneumouia. Dr. Hare 
in his “Fraotieal Diagnosis,” says that “while the 
promoe of tubercle bacilli gives positivs evidence, 
their absence in a given sample of sputum is not 
negative evidence of an absolute ohanmter, for that 
particular speoimmi may be free from or 

' they may uve escaped the staining or the eye 
I of the examiner.” I am not a bacteriologist, but I think I 
have read of sputa in which more than one form of 

E athoeenio organism has been found. A patient might 
ave the bacilli of tubercle in his lungs and th^ might 
escape the eye of the examiner of the sputum, but the 
secretions of the mouth might contain, as Osier tells ns, 
the diplocoooi of pneumonia, and so the physician 
might be misled into treating his patient for this disease 
instead of the tuberculoeis from which he was really 
suffering. The mice inoculated with the pneumonia 
bacilli might be killed by them instead of by the tubercle 
bacilli, wfaiob were not found. 

The olinicial signs of the various forms of lung disease 
are, in the vast majority of oases, quite sufficient to 
enable ns to make our diagnosis t where they are not so, 
it is my^ conviction that such experiments on mice or 
guinea-pigs are mote likely to hinaer than help us. 

I am. Sir, yours truly, 

Edward Bbbdob, L.B.C.F.(E.), M.B.C.S. 
September 6th, 1901. 

[We insert Hie foregoing letter, but at the same time 
must point out its oonfiioting internal evidence. The 
“ pneumonia ” spoken cf must clearly have been chronic, 
or Dr. Berdoe’s relative would not have had time to 
consult many specialists and go to the seaside. Chronic 
jmeumonia is another name for “fibroid phthisis,” and 
Hie only absolute meams of diagnosing Hie tuberoulons 
onset (s by proving the presence of the baoUlus either 
microscopically or by inoculation. We are at a loss to 
know how the special treatment of the chronic “pneu¬ 
monia ” could have ensured the salvation of the patient. 
What were the measures used that would not equally 
have applied to phthisis ? Dr. Berdoe seems to overlook 
Hie fact that tubercle bacilli disappear from lungs that 
recover. The presence of great numbers of pneumonia 
cocci in sputum, though not oonolnsive is yet strongly 
su^estive of a pneumonic origin. We still hold that 
not a few lung oonditions present the greatest difficulty 
in diagnoaie, and that the physician who refuses to avail 
himself of the evidence afforded by inoculation experi¬ 
ments in such oases is withholding fcom his patient the 
advantages of the most highly skilled modem treatment. 
—Ed. M. P. & 0.] 

Sanitary Inspectors’ Association. 

Thx Autumnal Conference of the Sanitary Inspectors 
Association was held in London last week, and during 
the meeting the members visited the Sewage Works at 
Crossness, and several factories of interest, including 
the new Limehouse Works of the well-known disin¬ 
fectant manufacturers, the “Sanitas” Company, 
Limited. On the previous day, by requeet of the 
Council, a paper on “Disinfection and Disinfectants” 
was commnuioated to the Conference by Ur. C. T. 
Eingsett, F.I.C., F.O.S., and the members were subee- 
quently afforded the opportunity of inspecting the 
processes of manufacture of the (everal disinfectant 
liquids and powders named “ Sanitas,” “ Okol,” 
“ Creooide,” “ Soldis,” and “ Formitas,” as also Hie 
patent Sulphur Candles and the various Formic fumi¬ 
gating, dr^ teetiog and other appliances which are 
produced by the “Sanitas” Company. The members 
of the Association were also entertained at a luncheon 
presided over by Sir James Crichton Browne, M.D., 
FH.S., who impressed upon Hiem the importonoe of 
their duties and of the proper employment of reliable 
disinfectants for preventing the spread of dinoapa 
L 


Mbdioai. Pmbs. XOnCBS TO OOBRESPOroKyTS. 


^totkes ta 

CotrtBponbtJite, glkort liters, *£. 

., Co»M»row»»»i» nqnirias % reply la thia oolamn an par- 
on of a dMiMftoe etpiwuun or 
iatnoM, and aroid the praotioe of eigainf themMlvee ** '• 

"Sobaolbet.” “Old 8abeariber.“ Ao. ITnoh ooafiuion will be 
■pond by atteotioa to thla rale. 

toraiart.—Beprinta of articlea appearii« la this Journal can be 
M at a reduced rate, providinj authors give notice to the pub- 
Ualw or printer before the tjrpe haa been distributed. Thla ahonld 
be done when returning oorreoted proofs. 

Owan raL Anncus or Limsa intended for publication ihould 

Mitten on one aide of the paper only, and must be authentioatod 

^th ^e name and address of the writer, not neoeaaarily for publioa 
aon, but as evidence of ideatitv. 

NOnCE TO HOSPITAL AND COLLEGE DEANS. 

Editor desires to thank those gentlemen attached to the 
vMl^ Medi^ Schools and Hospitals for supplying him with the 
information from which the foregoing pages have been composed. 
NOTICE TO Omt ETgAni nt ff. 

As this number is mainly devoted to information necessair for 
^dents intending to join one or other of the various Medical 
(^U^, and for thoee who, having paased their curriculum, are 
about to mtar the ranks of the profession, much ef the ordinary 
ma^ which usually ftUa our column# is neoeasarily defemd till 
next week. Shonld any of onr readers desire to present this 
number to a patient or friend who contemplates sending his sou to 
a medical college, our Publisher will be happy to supply him with 
a duplicate free of cost on receipt of address. 

DIBECT BEPBESENTATI^ ON THE QENEBAL MEDICAL 
COUNCIXie 

To the Editor of Tan Mnnicai. Paass aim Ciacotaa. 

^ vOTtw to ask yon to do me the favour of allowing 

entrusted their interests in the ConndUo 

lam, Sir, youratruly, 

WiLLUM Bacca, M.D., 

I>IngwalI. N.B.. Sept. 7.1901 

trial of antisyphilitlc remedies. 

patient to an instrument maker fer 

opinionuponthe resulting radiogram when t fl k ft n Tn^nctiVn ini.^r 
SlTin^cri'' advaSS^ thS?” h‘S^'’?;sHmonfiraV‘S 

is little wonder that the ansle-foint hn* »---- 
aes^yed imd» such circumstances, wd we thtok y^S 

A MODEL DAISY. 

Bridaet”wrfr?J!Sid “■* I yon for, Bridget ? 

wwtfor a confirznatiOD of diRimAaia. 
slMping or paying together when one is affected with diphtheria 

manner. A A qnnliflS^ntse 

SHiff • .ppltoa??^ «th 'n»?Sd 

wp‘Sd«“;”-pta.^ 5 ^ ,„T;op"tf M'sxs 

Es-sesij*«-“. 2 s 


8>pt. 11, 1901. 




' .1 A x« 4 AiAO AU r-nwgni 

-•« iss: 


I for <SrrtKBa I. ooc ~-Tini by pi 

I SSiShJ’ Th? ^’“•tion probably hingM u 

pollution of the dust of towns by the bow^acto 


ages upon the orgaaie 
l>aot«tla of the horse. 


^avxiatmt 


Bolahd a., L.E.C.P Lond. W s r a w t . 


^Acmtcits. 

Officer, under i6 jvat of m Salarv *? ,?* Medical 
the Medical Superintendent' to 

Esaminerahip in Medicine 

Boi o uo e. Annual emolumeBt ssn rinK^ <^ciae aiM 
January, 1902. (See adrA) ' commence in 

Gre^Nort^em Central Hoepital. London.-Vacancias for 

^ AUo J^' SSSfsi^^nrsiK h^ 

^hing ; and r^n-ieSffi iSS 

hpt i^iU^SSrs^of thl.2 

advertisemmit columns. «CM><ae# will be found in our 

Hospit^and School of Medicine, Cairo Ervot— 

Salary A150. 

Lon^a Hospital, Whi^hapeL—Surgical Begistrar. Salary Aiao 

HSr“^VeSrb 5 J ?2 

Ncrt^^em H^rtW for ChUd^ Medical Officer. 

L®“tio Asylum, Denbigh.-Second Assist. 

Military Bipedition, 

"ara ScSeta sa "S 


citoriaffcs. 


Church. John 

2.^“ V?’ “•?*^tab., & only son of the late William Brad¬ 
ford, Esq., of Moorbatb, Dorset, to HanMii i^mb INancvL 
ycungest ^whter of William Lowe Lawson, Esq., of Jersey 
E^CHAapsoir— Wallis,— On SepA 4th. at St. Fet^s Ckn^h 
Bex^ll-on-Sea, Gerald Nobm Biohardson, B.A Cantab, only 
surviving of Noble Eichardson, Esq., of Bombay 

w p?^4- daughter of the ^ 

a«J: ^■^^.^M.B.C.S., J.P.. ofBexhmand Etohingham 

^Pt- 5th, at George Lane Ooag««rtioiial 
'^®*“ Smith, M.B., M-B^^IamiiL. 
u S^nd Green, London, N., to Christina Cameron Maonab. of 
*^’*^*^ of ^te John Macnab, of Edinbunh 

S! v™<i ■ B.S.Lond., Ac., of Wandsworth Common, 

to^^^y Hilda, only child of the late William Green, of 

®** R^«7P^n-“^. 29th, at St. Margaret’s Church, 

Stephen. M.A., M.D.,of Loftus-in- 
•**«*•**«■ 


StsthB. 


ArsTLAiraKtc*..^nAB^29th,at Bishopsteinton. suddenly, 

A. L.Aust Lawrence, M.D., of Clifton, agedM years. 

® ■*‘®ft tilness, John 

Twnt^wtJw a^' *«•• of Stratford. Essex. 

^ F r H *t Goodwin House, DsaL John Thomson, 

I\C-8., eldest son of the late John ThomaonTW.!)., B.N., aged 


Di' 


.cockle 



®hf Medwal and Cimlat 



“8ALUS POPULI 8UPBEMA LEX.” 


VoL. CXXIII. WEDNESDAY. SEPTEMBER 18. 1901. No. 12. 


(Driginal 

SEASIDE SANATORIA FOB CHILDREN FOR 
THE PREVENTION AND TREATMENT 
OP SCROFULOUS COMPLAINTS, (a) 

By Sib HERMANN WEBER, M.D., 
F.R.C.P.Lond., 

CoamltiB? PhysiciAntothe Qerm»n Hoapital, London; and to tbe 
Mntioiul Bocpitnl for Consamption, Tentnor. 

In former times tbe so-called sorofulons diseases 
irere much discussed by the medical profession and 
^public, but comparatively little attention is paid 
to tbem at present, while tiie more fatal pulmonary 
tubercmlosis commands general attention. Yet there 
is good reason why scrofulous affections shonld in an 
equal measure engage our sympathy and attention, 
firstly, because they are likewise of tuberculous nature 
and intimately allied to other forms of tubercnlosis, 
and often lead to pulmona^ or to acute meningeal 
tuberculosis; and seconmy, because they cause 
infinite sufferine and misery to the patient and 
often cause dea& or invalidism or a crippled state 
for life. By treating scrofulous affections we there¬ 
fore not only endeavour to cure the existing diseases, 
but also to prevent pulmonary tnberonloeis. 

The principal means of cure are: Life in tbe open 
^ ; good food adapted in quality and quantity to 
the patient’s condition $ hydrotberapeutic measures, 
such as bathing in tbe open sea or in tepid sea 
water, friction of the body with cold water, &c.; 
active or passive exercise or rest in the open air, 
regulated according to tbe nature of the affection. 
Surgical treatment is required In some cases, and is 
more successful in the pure air of the seaside than 
in Inland towns; but the majority of diseases of 
bones and joints, of enlargements of glands and 
scrofulous ulcers, heal without active operative in¬ 
terference, though bandars are often indispensable. 

Such treatment cannot be carried out at the homes 
of the children of the poor, and frequently even not 
at tbe hospitals of large towns; but in tbe pure air 
of the seaside (and aim of inl^d places, especially 
at high elevations) tbe treatment if commenced 
early, almost always results in complete cure. 

Those who are rich can make the most necessary 
arrangements in private bouses or establishments, 
but the children of tbe poor have no chance except¬ 
ing in public sanatoria; and for the great majority 
of them, sanatoria at the seaside are preferable to 
those inland, on account of tbe more vivifying effect 
of the sea air, which undergoes constant changes by 
the reg^ular local currents of air and by tbe stronger 
^neral winds, and on account of tbe facili^ of bath, 
mg in the open sea or in tepid seawater. Experience 
shows that at the seaside the energy of the nervous 

(a) Abstnet of Psper read befon th« Britiih Congrau on Taber- 
enloRi, July, 1901. 


system, the appetite and digestion, and the whole 
oiganism are more rapidly improved than at inland 
localities. Inland sanatoria, nowever, can likewise 
be rendered most useful, and are, inde^, preferable 
in cases of scrofulosis complicated already with 
pnlmonary tubercnlosis, or in cases of polmonary 
tuberculosis alone, since most of tbem bear high 
winds badly. Localities sitoated at high elevations, 
as for instanoe Samaden, exercise a very beneficial 
influence, not only on pulmonary but on glandule 
affections, and on the so-called surgical tubercnlosis 
of joints and bones. This remark is, however, not 
to be understood as if we did not recognise that 
' great results can be obtained at well situated and 
well managed sanatoria in lower inland regions. 
Great and welcome lessons, for instanoe, are to be 
learnt from the benefit ^ected by tbe ” CEuvre 
d’Ormesson,” at Ormesson and Yimers-sur-Mame, 
near Paris. 

As the subject is so very large, we will confine our¬ 
selves at present to the sea-side sanatoria for 
children, as means ot prevention as well as cure. 
Although we must attend to diseases already de¬ 
veloped, we must, if possible, not wut till the sorofu- 
lons or tuberoulons disease is already fully estab- 
lisbedL, but must begin our treatment at tbe first in¬ 
dications, when we can gain in two months what in 
advanced oases barely can be effected in two years. 

Tbe poor children who are most benefited, and who 
specially require the sanatorium treatment are those 
affected wiA:—1. General weakness and deficient 
nutrition. 2. Tardy and imperfect recoveiy from 
various acute diseases, such as measles, whooping 
cough, scarlet fever, diphtheria, influenza, Ac. 3. 
Ansmia. 4. Rachitis. 5. Scrofulous and tuber¬ 
culous swelling of the lymphatic glands. 6. Scrofu¬ 
lous and tuteronlous inummation of the joints, 
including hip-joint disease and Pott’s disease. 7. 
Adenoid affections of the throat and nose. 8. Scro¬ 
fulous ophthalmia. 9. Scrofulous skin diseases. 

For the treatment of the m^ority of the cases it 
is not sufficient to use any oidinaipr house, hut we 
require a properly arranged sanatorium which must 
possess large rooms with abundance of light and air, 
with windows from the ceiling to the ground, 
through which the patients’ beds can be moved on 
the adjacent balconies or terraces; the patients who 
cannot walk most lie there from morning to 
night, and many with advantage also, with 
proper shelter, during the night in fairly good 
weather. Tbe rooms for meals and games 
must likewise be large and airy. Pavilions of mode¬ 
rate size, of one or two storeys only, are prefer¬ 
able to large blocks having two or three storeys. A 
pavilion for isolation of infectious cases is a neces¬ 
sity, and a well-arranged operating room is likewise 
indispensable, although in most cases, if taken early 
the necessity of operations can be avoided. Boys 
and girls ought to be in separate pavilions, when 

Di; . lOOg C 







300 The Midical Pb.88. ORIGINAL COMMUNICATIONS. 


older than fiye jears, bat may be in the same rooma 
up to that ace. 

There ought to he on the Eea^shore sheds open on 
two sides, with rotatory arrangement, for shelter 
against wind and rain, and to some degree also 
agunst too fierce a son. These shelters are especially 
necessary and must be numerous, if the becomes 
for lying out are inadequate, or far away from 
the actual shore. To these shelters the little 
patients who cannot walk must be carried on com¬ 
fortable kinds of bed-stretchers, and remain there 
during the whole day. 

There must be g<^ arrangements for bathing in 
the open sea and for tepid sea-water baths, to be 
used m winter as well as in summer. The resident 
m^cal officer must prescribe the diet for every 
single case, as also the nature and amount of walking 
and playing, and of Swedish or other ^mnastic 
manipulations, particularly for roine or jomt cases. 

The beneficiai effect of sea-side sanatoria can be 
greatly increased by providing each sanatorium with 
a hospital or sanatoiivm boat, arranged for the 
accommodation of the sick children, on which, in 
suitable weather, the invalids can be taken out to 
the open sea for shorter or longer periods of the 
day, since it is indisputable that the air on the high 
sea itself has a more powerful effect on the oi^;anism 
than that on the shore. 

The duration of the stay of patients at the ssna* 
torium ought not to be fixed by fast rules, but must 
depend on the nature of the case, and be left entirely 
to the judgment of the medical attendant. It may 
vary from a few weeks to a few years. To limit it 
to two or three months by the rules of the institution 
is absolutely wrong. If the patients are admitted at 
the beginning of ^e disease or at the first signs of 
the threatening, a short term will mostly suffice, 
while advanced cases of hip-joint disease or Pott’s 
disease may require years, and ought not to be dis¬ 
charged before the cure is as complete as the circum¬ 
stances admit. 

Another mistake which is made at many sanatoria 
is the restriction of the treatment to the warmer 
months of the year. Although the weather at the 
northern sea resorts is not always agreeable during 
winter and spring, the patients at seaside sanatoria 
are under infinit^y better influences than in their 
homes, or even in ordinary hospitals or infirmaries in 
crowded towns. The patients sent home during 
winter lose there often more than they had gained 
at the sanatorium during summer. 

The number of cbildien who require sanatorium 
treatment at the seaside is very large, and the 
number of beds available for them m England 
is very small. There are perhaps 300 beds 
in the seaside sanitoria of England, while 5,000 would 
certainly not be too many. Every hospit^ for sick 
children ought to have a seaside branch. It is almost 
incredible that there should be this strange defect 
in the hospital accommodation of England, especi^y 
when we reflect that the whole of the Unitea King¬ 
dom has such splendid sea-coasts, and when we 
further consider that England was the first country 
to awake to the great importance of this matter by 
establishing, on the suggestion of Dr. Lettsom and 
Dr. Latbam, tbe Genem Sea-batbiog Infirmary at 
Margate in 1791. The next country to move was 
Italy, which half a century later founded a sana* 
torium at Tiareggio (1841); and France followed in 
1847 by the sanatorium at Cette. While France has 
made great progress and deserves the highest praise 
for her enlightened philanthropy, England has re- 
mmned almost stationary in this matter. Tbe town 
of Paris alone maintains in its sanatoria at Berck- 
sur-Mer about 1,034 beds for scrofulous and rachitic 
children all tbe year round, and has also many b^ 


SsPT. 18, 1901. 

in several other seaside sanatoria on the French 
coasts. At Berck-sur.Mer, in addition, the benevcK 
lent Rothschild family gives perfectly gratuitous 
treatment to 1(X) children in the beautiful Hdpital 
Rothschild likewise, summer and winter. France 
has numerous other seaside sanatoria along her 
different coasts, mostly under the direction of tbe 
Assistance Maritime des Enfans Scrofulenx et 
Ehachitiques and I’CEuvre des Edpitaux 
Independently of these seaside sanatoria France 
possesses, as luready mentioned, the admirable inland 
sanatoria for tuberculous children at Ormesson and 
YiUiers-sur-Mame (CEuvre d’Ormesson). 

How is it that England, with its wonderful sea- 
coasts, and with its many excellent institutions for 
the sick, erected and maintained by private gifts, 
neglects this important matter ? We cannot uiink 
otherwise than that the crying need for help and the 
possibility of bringing this h^p, are unknown to the 
philanthropists of this countiy, men as well as 
women. If they were aware of tbe great sufferings 
which the poor children affected with Pott’s disease 
of the spine, with hip-joint disease, with caries of 
bones, or with tuberculous inflammation of joints, 
undergo in their wretched homes, and how large a 
proportion of them become consumptive later on, or 
cripples for life, or die after protracted misery ; and 
if they knew, at the same time, that the majority of 
them can be cured entirely, and that many of the 
others can be restored to such a condition that they 
can earn their bread and can enjoy life, provided they 
are sent early enough to seaside sanatoria, many 
philanthropic persons would surely assist in supply¬ 
ing means to round numerous such establishments. 
It may be difficult to obtain all tbe means required 
by pnvate benevolence, but tbe subject urgently 
demands also the attention of public bodies, such os 
the county councils and the Poor-law organisationa 
Associations like the trade unions ought likewise to 
feel the obliration to contribute their share towards 
tbe cure of ^e sick children of their members. The 
subject is so important and so large that I venture 
to suggest that an “ Association for the Erection o^ 
Seaside Sanatoria *’ should be formed, as a sub-divi¬ 
sion of the National Association Jor the Prevention 
of Consumption and other Forms of Tuberculosis, 


MEDICAL EXPERIENCES IN 
SOUTH AFRICA, (a) 

By JAMES B. COLEMAN, M.D,, F.E.C.PI, 
PhysicUn to the Bichmond, Whitworth, and Hardwicks Hoepitala 
Dnblln; aod to the NatioDal Hospital for Consamption for Ire 
land: late Physician to the Irish Hospital, South Afrioa. ISOO. 

It is now a matter of history that when the Boer 
Bepublios declared war in October, 1899, the forces 
which we were able to oppose to them were utterly 
inadequate. The pertonnel tnd matiriel of the Boyat 
Army Medical Corps were exhausted when two army 
corps were provided for, and the help of civil su^eons 
and private hospitals had to be invoked to supply 
medical aid for the additional forces which were put in 
the field. Accordingly the Irish hospital was equipped 
and sent to South Africa at tbe beginning of February, 
1900, tbrongb tbe generosity and patriotism of Lord 
Iveagh. Its staff consisted of Sir William Thomson, 
surgeon-in-chief; Dr. George Stoker, and Dr. Alfred 
Friel, surgeons; whilst I had the honour of being phyei- 
man. We had six dressers, including Dr. Couniban and 
Dr. Pounden, with Messrs. M'Dwaine, Stewart, Edwards, 
and Thomson, and between orderlies, drivers, servants, 
and artificers, our company nnmbei^ about seven^. 
When we were going to South Africa the War Office 
would not oonseut to nursing sisters accompanying ns, 

(a) Re^d in the Boyal Academy of H^cin« m Ireland. Hay 
17th, ISOl. 


8bft. 18» 1901. 


ORIGINAL COMMUNICATIONS. 


Thi Midioai. Pbbsb. 301 


bat at a later period Lord Ire^h sent out Miss 
MaoDoonell, matron of tbe Kiohmond, Whitirorth, and 
Hardvioke Hospitals, and Miss Walker, sister in charge 
of the Whitvorth Hospital, and their servioes only 
described as inralnable. 

We arrived in Capetown at the end of Febmary, and 
were at onoe sent to Naanwpoort, in the extreme north 
of Cape Colony. Here we reoeir^ orders not to set np 
oor hospital, bat to be ready to proceed to Bloemfontein 
when the railway line was repaired. 

No. 6 GBNBaAi. Hospital. 

Whilst the Irish Hospital was delayed at Naaawpoort 
awaiting the opening of the line to Bloemfontein in 
March, I volnnteered to do daty at No. 6 General Hos¬ 
pital, which was stationed at Naaawpoort, and was 
given chaige of seven marqneee, containing forty-two 
enteric cases. The hospital had a^nt 700 beds, and 1 
was astonished at the completeness of its eqaipment, 
eitnated as it was on the veldt, 500 or 600 mUes from 
Capetown. At that time a^at a third of the cases in 
hospital were enterics. They were all lodged in 
marqnees, there was no overcrowding, and they all had 
comfortable beds. There was no lack of medical com¬ 
forts, bat additional nnrses and trained orderlies would 
have been desirable, especifUly for night dnty. The 
medical staff of the hospital consisted of Lient.-Col. 
Somerville Large and four other B.A.M.C. officers, who 
were occapied with the work of administration, and 
sixteen civil sargeons, who attended to tbe treatment of 
the patients. In saoh a large hospital two senior 
medical officers would have been nsefnlly employed as 
consulting physician and surgeon respectively. There 
were no facilities for bacteriological and pathological 
work, which was often necessary for accuracy of dia¬ 
gnosis and as a guide to treatment. 

At Blobhfontbin. 

The Irish Hospital opened at Bloemfontein on April 
13th, 1900, our camp l^mg pitched on sloping ground 
to the north of the town, at the foot of a large flat- 
topped kopje. We had accommodation for 100 patients 
in large, square tortoise tents, and from the start it was 
pmcticslly a fever hospital. The patients were very 
comfortable. On admission they were washed, supplied 
with pyjamas or night-shirts, and pat into spring beds. 
They had everything that was necessary, except a 
sufficient supply of fresh milk, and for the latter con¬ 
densed milk m^e a fairly goc^ sabstitute. At first the 
nursing was done by our own orderlies, who displayed 
great devotion in tbe discharge of their arduous and 
often nnpleasant duties; but subsequently we had 
trained nurses, and their advent was a godMnd. Our 
patients at Bloemfontein were under favourable con¬ 
ditions, and in 150 cases of enteric in our hospital there 
we had nineteen deaths—a mortality of 12'6 per cent. 

Faou Blobuvontbin to Pbbtobia. 

In May 1 accompanied the mobile section of our boa- 

& ital in the march to Pretoria, Six William Thomson 
eing in charge. We were attached to the 11th Division, 
tbe efficient and courteous P.M.O. of which was Sur¬ 
geon-Colonel Magill, of the Coldstream Guards. We 
had ten ambulance waggons, and our equipment was 
reduced to the minimum weight. We carried tents for 
fifty patients, and mattresses or stretchers for the same 
number. It might be imagined that on the march 
with a large army through the enemy’s country the num¬ 
ber of wounded would predominate over tixe sick, hut 
the reverse was the case. Every day on arriving in 
camp we took cases of enteric into hospital, and when 
we entered Johannesburg we had sixty-nine patients, of 
whom two-thirds had enteric. Many of those cases had 
been carried in our ambnlanoe waggons day after day 
on the march, and they suffered very great hardships, 
bat there was no help for it, as it was impossible to leave 
them anywhere e» rouU, Fortunately we bad no death 
on tbe march, but I fear some of those patients must 
have died subsequently in the Johannesbu^ Hospital, 
where we left tbem, notwithstanding the good treatment 
they received in that excellent institution. 

At Pbbtobia. 

The Irish Hospital was under shell fire on Jane 4th 
outside Pretoria, and next day we entered the town. [ 


On the 10th we had 106 patients, induding sixty oases 
of enteric. We aooommo^ted them in marqneee and 
sqnare bell-tents on the veldt near the racecourse, but 
the patients were overcrowded, and nearly half of them 
were lying on the ground, whilst, to add to their dis¬ 
comfort, toe weather was cold and wet. In fact, the 
state of our hospital for about ten days after entering 
Pretoria was very nnsuitable for the treatment of grave 
medical cases, and it was impossible to treat toe enteric 
patients properly. But this state of things did not 
ooutinue, for Sir William Thomson applied to the 
military authorities for the Palace of Justice for 
use as a hospital, and they not only onsentod 
but allowed toe building to be fitted up and for- 
' nished luxuriously for toe reception of parients. 
Id this onerous undertaking invaluable assistance was 
given by the Hoc. Bupert Guinness, Mr. Murray 
Gutorie, M.P., and Mr. Leigh Wood. On June 19th we 
transferred our patients to this building, equipped as it 
now was with electric light, hot and cold baths, and 
good beds. Tbe rest of our staff arrived from Bloem¬ 
fontein at toe beginning of July, and the P.M.O. 
supplied additional nursing sisters and orderlies. A 
high standard of ezoellenoe was attained in the 
management of the Irish Hospital in the Palace of 
Justice, and it is no exaggeration to say that the 
patients were as well off as they would be in many a 
first-class civil hospital at home. We remained in the 
Palace of Justice in Pretoria until we left for home last 
October. 

Entbbic Fbvbb. 

Of the medical cases treated in the Irish Hospita^ 
first in importance comes enteric fever, which consti¬ 
tuted a terrible plague during the campaign. At the 
end of June, 1900, I^rd Boberts informed me that there 
had been 6,500 cases of the disease at Bloemfontein 
alone, with 1,800 deaths. At toe same place two 
general hospitals had nearly 8,000 cases at one time, and 
everywhere at the seat of war the same scourge afflicted 
our troops. 

In our hospital roister there are entered 672 cases of 
enteric, but I think the number treated was consider^ 
ably in excess of that figure, for in many instances tbe 
diagnosis in our register was taken from the admission 
forms, and was not afterwards corrected. For instance, 
many cases were sent in as "simple continued fever" 
whito were really enteric, but the former diagnosis 
appears in our returns. 

I had 260 oases of enteric under my care, and 
through tbe courtesy of my colleagues I saiv many of 
their cases. In general, the type of the disease did not 
differ from what we see at home. The d'l^^oais in 
doubtful cases was confirmed by a positive Widal 
reaction. In Bloemfontein I us^ the dead typhoid 
bacilli for the serum diagnosis, and I found they 
" clumped " satisfactorily with enteric serum. In Pre¬ 
toria I had the use of the Staats Laboratorium, which 
was carried on under toe able direction of Dr. 
Schmitz Dumont. Here I started fresh broth-ouUuies 
of typhoid bacilli, which I renewed from time to time, 
and 1 classed no doubtful cases as enteric in the absence 
of a positive serum reaction. 

Tbe temperature in our enteric cases calls for a few 
remarks. It was very high and very irregular. Twenty 
per cent, of my cases bad a temperature over 103** F., 
and two cases over 106'd^. Late in the disease there 
was extreme intermittence, so that malaria had been 
wrongly diagnosticated. 

Enteric spots were present in 85 per cent, of the cases, 
and a transient erythematous rash in 10 per cent. 
Diarrhoea, on the other hand, was not troublesome in 
more than 20 per cent, of the cases. 

Intestinsl hasmorrhage occurred in 9 per cent, of tbe 
patients. The spleen was enlarged and tbe abdomen 
distended in nearly every case. Deliiinm tras frequent. 

Lung complications were common, particularly bron¬ 
chitis (18 per cent.), pleurisy (3 per cent), pneumonia 
(2 per cent), and oedema of toe lungs. In two oases I 
saw Cheyne-Stokee’ respiration. 

Peritonitis and perforation occurred in less than 1 
per cent, of the cases and thrombosis in 6 per cent. . 



302 Th» Mbdical Pbibs. OBIGINAIi COMMTJKICATONS. 8bpt. 18, 1901. 


The lees freqoeot complications included epistaxie, 
meteorism, otorrhcea, nearitiB, laryngitis, tonsillitis, 
pskTotitis, orchitis, retention or inoon^enoe of nrine, 
albuminuria, bscmoglobinnria, cystitis, urticaria, boils, 
mania, syncope, and hyperpyrexia. 

Belapse or reomdescence was noted in about every 
fifth case. 

As to the mortality in enteric, we bad seveniy-nine 
deaths in 672 cases, teing a death-rate of 11‘7 per cent. 
This was much lower &an the general enteric mor* 
tality, but 1 make no invidious comparisons, as the 
conditions under which cases were treated were never 
alike. Eight of our cases died within forty-eight 
hours of admission to hospital, and four more within 
seventy-^two hours. For a month after the occupation 
of Pretoria the condition of the Irish Hospi^ as 
regards equipment. &o., was superior to other hospitals 
near the capital of the Transvaal, and for this reason 
we were sent an undue proportion of very severe cases. 
For instance, on June ^th we received a sick convoy 
of thirty oases of enteric, which were sent from a field 
hospital about twelve miles east of Pretoria. Those 
cases were selected as the most severe of 120 cases in 
the field hospital, and they were sent to ns as we had 
greater facilities for treating them. I regret to say 
that nine of these patients died, some of them being 
moribund on admission. 

The most frequent cause of death was heart failure, 
and this oocurr^ both early 'and late in the disease. 
Many of the fatal cases presented the picture of a 
severe toxeemia, and in such cases a pulse rate over 120 
was always an ill omen. Among the fatal cases bron* 
chitis and oedema of the lungs were very common, 
pneumonia was present in about 4 per cent., and per¬ 
foration in 6 per cent. In one case cardiac syncope 
occurred in convalescenoe. 

Post-mortem examinations were made in moat of the 
fatal cases, and the usual enteric lesions were found. 

The treatment adopted was expectant. For heart 
failure, stimulants and sbrychnine; for diarrhoea, 
restriction of the quantity of milk was usually all that 
was called for; for hsemorrhage, op''um and turpentine 
mixture; for pyrexia, sponging or cold compresses, and 
occasionally cold batba Wherever possible tiie use of 
the bed-pan was insisted on, and patients were not 
allowed to leave their beds for any purpose. During 
convalescence I endeavoured to increase the amount of 
the patients' diet as rapidly as possible, each case being 
toeated on its merits, and the general condition of the 
patient being considered in addition to the one symptom 
of temperature. 

Many of the troops were subjected to anti-enteric 
inoculation, and the value of the process has been much 
discussed. Whilst it cannot be described as an unquali¬ 
fied success. I believe it has been of use both as a pre¬ 
ventive and in modifying the attacks of the disease. 

Out of some sixty men of the staff of the Irish hospi¬ 
tal who had been inoculated six contracted enteric and 
one died. About 12 per cent, of all our enteric patients 
had been inoculated, and in the majority of these cases 
the attacks were mild and of short duration. Among 
the inoculated cases the death-rate was 6*2 per cent., 
as contrasted with 12*6 per cent, in the uninocnlated. 



Cases. 

Deaths. 

Mortatity 
pw cent 

Inoculated . 

... 80 .. 

.... 6 ... 

... 6-2 

Uninocnlated... 

... 692 .. 

.... 74 ... 

... 12-6 





Total. 

... 672 .. 

.... 79 ... 

... 18-7 


Too much should not be expected from inoculation 
when we consider that enteric may occur more than 
once in the same individual, and we cannot expect 
inoculation to produce stronger immimity than an 
attack of the dis^e confers. We had several patients 
who had had enteric before, in India or elsewhere. 

I have already remarked that many cases of enteric 
were sent to our hospital with the diagnosis of 
"B.C.r.” (simple continued fever). I quite satisfied 
myself that those oases were enteric. In many in¬ 
stances they presented the clinical symptoms of enteric, 
and autopsies were performed on fa^ casee, which 


showed typical enteric lesions in the intestines. Other 
cases, though very mild on admission, h^ undoubted 
enteric relapses; whilst in others the history was 
obaraoteristic. Finally, numerous cases which I exa¬ 
mined gave a positive Widal reaction. 

I believe that ambulatory enteric was common, but I 
do not contend that every patient with ill-defined 
febrile symptoms had enteric. I allowed the diagnosis 
of simple continued fever to stand in some cases, and 
influenza or febricnla accounted for others. 

The exaggerated intermittent temperature which was 
present towards the termination of an attack of enteric 
occasionally led to the mistaken diagnosis of malaria or 
" typho-milaria.” The effect of large doses of quinine 
in reducing such temperatures was adduced in favour 
of their being of malarial origin, but the temperature 
fell also in the absence of quinine. Further, I examined 
the blood of such cases for the plasmodium malarim 
always with a negative result, whilst the same blood 
gave a positive Widal reaction. 

Other Medical Cases. 

Medical cases other than enteric do not call for much 
comment. Dysentery was common, but the disease 
assumed a mild tyM, and the mortality was lees than 
1 per cent. failed to find the amtrba ooli in the stools, 
and in no case did I see an abscess in the liver. The 
catarrhal form of the disease prevailed. For treatment, 
rest, milk diet, and sulphate of m^^esia were efflcacions, 
whilst the administnt^on of ipecacuanha wae dis¬ 
appointing. The worst cases of dysentery which I saw, 
indnding two fatal oases, were chronic cases of the 
disease which bad been originally contracted in India. 

Diarrhcsa was very prevalent. Few men escaped a 
severe attack within a short time after landing in South 
Africa, and a certain amount of immunity resulted. 
The complaint was commonly known as " modders," 
from its supposed origin in drinking the Modder (a) 
river water. In some oa*es symptoms of severe enteritis 
or of gastro-enteritis were present. 

A number of patients suffering from catarrhal 
jaundice were admitted to hospital a^utthe time of the 
occupation of Pretoria. 

Comparatively few patients were admitted to the 
Irish Hospital with malaria. Basing the di^nosis on 
the presence of the plasmodium in the blood, I came 
across no case in which malaria had been contracted in 
the Orange Biver Colony or in the Transvaal south of, 
or in. Pretoria. Most of the patients admitted for 
malaria had ^e disease previously in India or in Egypt, 
or in Bhodesia, but in some instances it had 
acquired in the northern or eastern districts of the 
Transvaal. Simple tertian ague was invariably the 
form of the disease in the patients examined by me. 

Bheumatio fever was of frequent occurrence, oompli- 
cations being few. Some oases were much prolonged. 

Of pulmonary complaints the most serious was acute 
croupous pneumonia, whilst bronchitis and pleurisy were 
also prevalent. 

Acute or subacute Bright's disease was not of uncom¬ 
mon oocnrrecce, and a few patients were admitted with 
Bilharzia disease (endemic hajmatnria). 

1 saw many oases of “irritable heart*’ and tachy¬ 
cardia, and of the rarer diseases I may mention 
Addison’s disease and alopecia universalis. One case of 
diphtheria occurred in our wards in Pretoria. 

^fore concluding I would wish to emphasise the fact 
that the number of medical cases in the hospitals in 
South Africa was vastly in excess of the surgical oases, 
and the corollary is that physicians were more needed 
than surgeons. In the Irish Hospital we treated 2,748 
patients, of whom more than five-sixths were medical. 
Contrast our 672 cases of enteric with 114 cases of bullet 
wounds. In Bloemfontein in the large general hospitals, 
the enteric patients outnumbered the wounded in the 
proportion of twenty to one. Looking at the official 
lists of casualties, how often do we not see the state¬ 
ment at the top of a long list of deaths, “ Died of 
enteric unless otherwise stated " ? 

Consulting physicians would have been of incalculable 
service in all the large hospital centees at the seat of 

(a) Muddy. 












Sm . 18.1901. 


CLINICAL LECTUBBS. 


Ths Hkdical Pbbsb. 303 


wsr, and it is to be hoped that if. onhappily, the ooca* 
non arises again tiie sick will hare the benefit of the 
eerricee of a enffioient number of sooh physioians. 

I hare to express my thanks to my most efficient 
clinical <fierb, Messrs. Percy Stewart and John 
Mellwaine, to whom I am indebted for notes of my 
cm see. 


CUnicd 5terturc5. 


THE VOMITING OF PREGNANCY. 

By Prof. C. CBISTEANU. M.D., 

Profswor cf OTneeology in the UniTenlty of Bocbsrest. 
[sPECIAIiLT TBAN8LATED POU THB MEDICAL PBE8B 
AKD CIBCULAE.] 

Gestation, which is one of the most important 
functions of the hnman organism, can present, dur¬ 
ing its normal course, a series of complications, 
some of which are benign, while others have a bane¬ 
ful effect on the mother and the child, placing some¬ 
times the lives of both in great jeopardy by the 
violence of the morbid manifestations. Among 
these numerous complications, I beg leave to insist 
specially on vomitijig. This accident or complica¬ 
tion can be met with very frequently during gesta¬ 
tion, piesentiDg all the varieties, from the slightest 
sensation of nausea to the most grave forms, where 
the patient is unable to support any solid food or 
liquid. The continued denutrition and loss of 
strength resulting from this complete inanition 
constitute an immediate danger, not only for the 
existence of the fcetus, but especially for that of the 
mother. 

Authors have divided the vomiting into—slight, 
moderate, and grave, and this division suits all 
clinical purposes. The prognosis is dUHcult to 
determine, and the symptomatic treatment being 
uncertain, we are frequently obliged to provoke 
abortion to save the mother, and even then we are 
not always sure to attain our end, as 1 will show you 
further on. 

The epoch of the appearance of the vomiting is 
very variable; it is seen generally in primipara, that 
is to say, during only one pregnancy, the subsequent 
pregnancies running their course without complica¬ 
tions. It also happens, and frequently, that it occurs 
regularly at each pregnancy, placing the woman's 
life in danger. 

In the luge majority of the cases the vomiting 
appears in the half of the first month, and may con¬ 
tinue during the whole period, but it generally ceases 
at the end of four months and a h^. The causes 
are variable, and not well understood. Some 
authors attribute it to metritis of the cervix, others 
to uterine deviation, to gastric ulcer, cancer, tubercu¬ 
losis, tumours of the neighbourhood, worms, albumi¬ 
nuria, and even to varicose veins of the legs. 

Auvard asserts that where no apparent cause 
be detected, symptoms should be attributed to a 
modification of the blood produced by the retention 
of toxic products. M. Finard supposes intoxication 
resulting from bad function of toe liver, or perhaps 
by a toxine secreted under the influence of preg¬ 
nancy, and designates this state under the name of 
auto-intoxication. Kaltenbacb believes that he has 
found the canse in hysteria, yet cases are not want¬ 
ing where it was impossible to discover any stigmata 
of hysteria. For me, I consider that hitherto the 
true cause has been ignored, but on this 1 believe 
the following cases may be able to throw some 
light. 

Ten years ago I attended a lady of my family who 
presented the classical symptoms of incoercible 
vomiting. From the first month of her pregnancy 


the patient was seized with nausea and vomiting, 
which increased rapidly in intensity, becoming 
almost incoercible after the second month. She 
vomited at every moment, even withont taking any' 
thing solid or liquid, and was reduced to a state 
that, if her health had allowed it, abortion would 
have been provoked. The temperature rose slightly 
in the evemng. and the. emaciation was so great ths^ 
she could not leave her bed. The nrine secreted in 
twenty-four hours did not amount to more than than 
seven oimces, very concentrated, containing 
abundant salta. All kinds of treatment were em¬ 
ployed, without result. The vomiting ceased spon- 
taneoudy in the fourth month, the appetite returned, 
but the patient presented an irresistible tendency to 
sleep after dinner; she fell off immediately wherever 
she was, into a deep sleep, which lasted all night. At 
full term she was confined, and both child and 
mother did well afterwards. What appeared to me 
to be extremely interesting in the above case were the 
antecedents oi the family. The father had bad 
several attacks of^ut, and finally succumbed to an 
attack of angina pectoris. The mother had also the 
gouty diathesis. A sister died from congenital 
stenosis of the pulmonary artery. A brother suffered 
from articular rheumatism, while in the collateral 
branches hemicramia, chronic rheumatism, biliary 
calculi could be traced. 

This single case gave me light as to the relations 
which seemed to exist between heredity and the 
vomiting. All the family presented the same pre¬ 
dispositions, the same characteristics forming the 
classical manifestatisns of arthritism, or rather 
herpism (Lancereaux). Consequently I was obliged 
to admit a clone correlation between the incoercible 
vomitings and the herpetism inherited from the 
family. 

Lancereaux describes at great length in his clinical 
lectures the brusque apparition of symptoms and 
manifestations which are under the influence of the 
same cause: herpetism. Gestation is one of these 
causes; it modifies piDfoundly the organism of the 
woman, and bpr that awakens the arthritic or herpetic 
diathesis, diminishing on the one hand the disassima- 
tion of the products of combustion, retarding their 
elimination, with the consequence that toxic sub¬ 
stances are accumulated in the organism. The- 
necessity for the organism to eliminate at any price- 
tbese products, to compensate these toxic substencce 
by the gastric and buccal mucous membranes, leads 
as a natural consequence to irritation of these mem¬ 
branes, which react in their turn and produce the 
nausea and the vomiting esperially in the morning, 
sialon'hma, especially in the night and in the morn¬ 
ing, benign manifestations sometimes, and at others 
incoercible, probably caused by the local elimination 
of tbe products of incomplete combustion. It may 
be asked 'why all pregnant women do not suffer from 
vomiting. First, because those of a herpetic or arth¬ 
ritic predisposition are esp^ially predisposed to it, 
and, secondly, the same question might be asked under 
other conditions; why, for instance, all the patients 
who have a high temperature have not delirium P A 
predisposition is necessary, and this predisposition 
reacts according to each individual, and according to 
conditions which differ totally for each individual. 
Some present manifestations of the skin, others of 
varicose veins, others of haemorrhoids, others of 
vomiting, ptyalism, hysteria, mania, &c. These mani¬ 
festations can vary according to (Msnditions, but tbe 
cause is always tbe same, that is to say, the herpetism 
of Lancereaux. 

I will give briefly two or three cases which con¬ 
firm my opinion:—A woman, ast. 28, entered the 
hospital for incoercible vomiting. She was two 
months pregnant. The vomiting and ptyalism were- 


304 Thi Mbdio^ Pbbbs- 


CLINICAL LECTURES. 


Sift. 18, 1901. 


rei^ abundant. Traces of urea were found in the 
saliva. I instituted the following treatment:— 
Mixture of chloroform, water, coc^e, and twentj 
drops of tincture of helladona, gargles with Tichy 
water, warm baths, friction of the skin with aroma- 
tised alcohol, and one drachm of earbanaie of 
Hthia in a mixture given intemallj each 
day. Seven days afterwards the vomiting ceased 
and the ptyalism also. After ten days she left the 
hospital. A year subsequently she returned, two 
months pregnant, with the same symptoms; but, 
being in a very prostrate state she was unable to fol¬ 
low the medical treatment. Curettage was practised, 
and two days afterwards the vomiting ceased, while 
the urine, which had come down to 500 grammes, 
went up to 1.500. On the tenth d^ the vomiting 
returned with the same intensity. The urine fell to 
600 grammes and the ptyalism reappeared. The 
woman refused to remain longer in the hospital. It 
was evident that the vomiting was produced by 
another cause than that of gestation, as it should 
have completely ceased after gestation; and that 
cause was arthritism or herpetism. A third and 
fourth case entirely similar to the preceding were 
treated medically us indicated, and fifteen days after 
the patients left the hospital completely cur^. 


HYDATID CYST OF THE LIVEE, 

By Dr. D. A. MORAL AS PEREZ. 

Professor of the Faculty of Alediciso, Barcelona. 

[SPBCIALLT TRANSLATED FOE THE MEDICAL PRESS 
AND CIRCULAR.] 

In the beginning of February last, Joaquina M., 
st. 30, a native of Alcira, Yalencia, spinster, a 
dressmaker, and for some years resident in Bar¬ 
celona. The patient was thin, nervous, and had a 
peculiarly sad expression of face, which was heightened 
by an ictoric tinge of skin and conjunctivse. 

There was no history of any family complaint which 
would account for the sickness. When the patient 
was twenty years old she had an attack of typhoid, in 
which she nearly lost her life, but since that attack 
she has enjoyed good health. Three years ago she felt 
a pain now and then in the right side, under the free 
ribs. At first the pains were of little moment, but 
they gradually became worse, until they became very 
violent and were attended with vomiting and purging, 
for which she took the mixture of Riverio (a). 

The patient remained for some months under obser¬ 
vation, during which time she applied belladonna oint¬ 
ment and appeared to sufferlittlepain; but she noticed 
that the right hypochondriac region became swollen. 
She had found that medicines did not free her 
from the disease, and she came to consult me on the 
necessity of having an operation performed. 

Examination of the right hypochondriac region 
revealed a swelling which went from the right side 
to the middle line of the abdomen. The ribs were 
pushed forward, upwards, and outwards from the 
eleventh to the eighth. There was no clear evidence of 
fluctuation, but an obscure sense of it was felt, which 
appeared characteristic of sarcoma. It was plainly 
a solid mass. The skin was tense, limp, and almost 
translucent from the abuse of ointments and 
cataplasms. 

From the examination I concluded that there was 
an hydatid cyst of the liver and sarcoma. From the 
veiy first I felt inclined to the diagnosis of an 
hydatid cyst. 

After much hesitation the patient consented to an 
operation being performed, and was admitted to the 
hospital 

(a) The mixture of Riverio [Dice, de Jferf.) is u effervescent mix¬ 
ture of bicarbonate of potasiium and citric acid. 


I After she had had a saline pni^ and some baths 
the operation was commenced by cutting with a 
thermo-cauteiT, for fifteen centimetres, parallel to 
the border of the ribs, and tbrongh the most 
prominent part of the tumour. All the tissues were 
cut through, the right rectus abdominalis muscle was 
incised, and the epigastric arteiy was ligatured. 

When the bleeding was completely stopped the 
peritoneum was caught up by two forceps, and a bole 
cut in it, which was enlarged with a pair of scisBors 
this served as a guide to the left index finger, by 
which the convex surface of the liver was readily 
made out The peritoneum was sewn to the cutaneous 
surface, and the woimd closed with gauze and 
covered with surgical wool. The temperature 
remained normal, and the pulse did not exceed 72. 

During the night she had severe pain in the site of 
operation, and it became necessary to give her an 
injection of morphia and atropine which bad pre¬ 
viously been prescribed for her, should it be neces¬ 
sary ; the hypoderaic was well borne and gave her a 
night of tranquil sleep. 

On the third day she was given some food; the 
first day she had none, and the second day she was 
confined to milk alone. 

On the sixth day, 1 being ill, Dr. Jaumandrew on 
examining the wound found that the surface of the 
liver had become adherent to the edges of the wound 
and that the abdominal opening did not communi¬ 
cate with the peritoneal cavity. 

As I expected, the hydatid cyst was retro-hepatic 
and deeply placed in the tissue of the gland. 1 
ordered a special thermo-cautery bistoury with a 
blade nine centimetres long. On March 14tb, the 
patient being chloroformed, I proceeded with the 
second operation by plunging the incandescent bis¬ 
toury six centimetres into the liver, and no fluid 
escaped. I again decided to re-introduce the bis¬ 
toury, and having cleaned the blade of the stains of 
the cauterisation, introduced it. No fluid came, but 
there was distinctly a sensation felt of having 
entered a cavity. Withdrawing the blade I felt that 
the diagnosis was uncertain. Once more 1 intro¬ 
duced the knife, and at last opened the cyst from 
which a clear wateir fluid was squirted out, wetting 
I my assistants. Enlarging the incision two litres of 
fluid were drawn off, which on examination micro¬ 
scopically was seen to be hydatid fluid. A large 
drainage tube was inserted and kept in position with 
surgical gauze. The temperature remained normal. 

In three days’ time the gauze was saturated with 
bile, and the fsces were as if the patient had jaun¬ 
dice. This condition remained unchauged for some 
days. 

On April 15th the patient was able to get out of 
bed, the wound having gradually closed; there was 
no discharge of bile from the fistula for some days, 
the fteces were coloured as in health, the swelling 
had gone, and the patient was well. 

The case presents many features worthy of con¬ 
sideration. The patient had in her house a dog, 
which was a constant companion, and eat the residue 
of her meals. It is further of interest to note that 
one day when moving a machine she gave herself a 
severe blow on the right hypochondrium. The 
tetiology of hydatid cyst is well known; the germs 
of the txnia pass from the intestine and traverse the 
viscera, forming cysts in those that have been the 
seat of an injury. 

In countries in which dogs live in the dwellings, 
as in Iceland, hydatid cysts are very common. The 
same effects follow in Abyssinia, where tsenia solium 
is so very common as scarcely to be counted a 
disease, and the patients seek no other remedy than 
the indigenous one brayera anthclmintica, the 
use of which is handed down from prehistoric times. 



8«pt. 18> 1901. _ CLINICAL 

In many experiments which I hare performed for 
different purposes on dogs, I have found the tenia 
uAium in the intestines of ^e magoriij of them. 

The liver seems to be the most subject to hydatid 
< 78 ts, its anatomical relation to the duodenum, its 
Tascularisation, and its structure favour the passage 
of germs, and its site and size favour its being in¬ 
jured by blows and so forth. 

Statistics published by Herreon-Yegas and Daniel 
Cranwell, physicians, of Buenos Ayres, show that 
out of 952 hydatid cysts, 641 were situated in the 
liver, four in bones, and one in the breast. 

In the same article (Betnte de Chirurgie) the 
statistics of Neisser are quoted, which show 451 cases 
of hydatid cyst of the liver out of 983 cases ob- 
serred. 

The physicians of Buence Ayres ascribe this 
spread of the disease to want of personal cleanliness 
in those affected, and they quote the case of the 
butchers in that city who kill so many animals for 
consumption with impunity, though observation 
shows that of homed cattle 40 per cent, contain the 
echinococci, and of pigs fully 60 per cent. The 
rapid increase of the disease in Buenos Ayres has 
alarmed the authorities in Argentina. During the 
year 1877 there was but one case reported in the 
citj; in 1388 sixteen cases were admitted to hospital; 
and in the year 1898 there were 173. In Spain the 
cases appear to be getting more numerous than 
formerly. 

1 believe that in this country (Spain) it is highly 
probable that the echinococci pass their tem¬ 
porary stage in rabbits. These animals are very 
subject to infected by intestinal parasites, and the 
rearing of the rabbit is now a considerable industry, 
esp^laUy in Cataluha. Some years ago Dr. Colt, of 
Pujot, exhibited pathological slides of the intestines 
of rabbits, full of the germs of tenia. 

In reference to the method of operation, I may say 
I have twice operated in the same way. It has the 
disadvantage oi a large broad cicatrix, which cannot, 
however, equal the ever-present danger of an hepatic 
hydatid cyst. 

Some surgeons complete the operation at one sit¬ 
ting, suturing the hepatic opening to the cutaneous 
sui^ace; this method of operation I have not per¬ 
formed, and I prefer to complete the operation after 
an interval of a few days. I have also found it im¬ 
possible to draw out, as some profess to do, the whole 
cyst in such cases. And many of the post-mortem 
operations recommended in l^ks and journals I 
have found impossible of performance on the living. 

I have no desire to discuss the many surgical pro¬ 
ceedings enumerated in text-books on the subject, 
such as punctures, injections, electrolysis, and so 
forth, all of which have, in my hands, not been satis¬ 
factory. 

Before concluding, I desire to say that if when the 
viscus is penetrated i)y the blade of the knife to its 
depth and no cavity is reached, the blade should be 
withdrawn and again plunged in, when, if the cyst is 
opened, the contents of it gush out as from a foun- 
tuD. The blade should have a dull red colour, 
having been heated to a cherry-red colour and 
allowed to cool down. The knife may be intro¬ 
duced a second time into the cyst at a dull red 
beat to destroy the mother-membrane. 

A Nurse Cliarsed Wltb UbeL 

A Nirass called Clara Cooper is under remand at the 
Dawlish Police Court ofaa^^ with writing and publish¬ 
ing certain scandalous and defamatory libels in respect 
of Dr. Charles Newton Lovely, of that town, by means 
of letters and post-cards. 


RhiGOBtDS. Tkb Mbdical Pbbss. 305 

[ ^ecorba. 

PBINCE ALFRED HOSPITAL, MELBOURNE, 
AUSTRALIA. 

I'otol Oattuetony for CoreinortM of the Stomach. 

By Hswbt O’Haaa, F.R.C.S.I., 

Senior Hon. Sniyeon tothePrinoeAl/red Hoepitsl, Melbonrne. 

SiNCB Schlatter’s celebrated case of complete removal 
of the stomach, I have watched with mnch interest the 
reports of other gastrectomies performed by Favre, 
Brookes, Brigham, Richardson, McDonald, and BoeckeL 
The results have been so encour^ng that I determined 
1 to perform an operation on the first favourable case 
which presented itself. 

Dr. Weigall, of Cheltenham, kindly sent a patient to 
me with a very marked history of cancer of the stomach. 
Rapid wasting epigastric pain and vomiting after taking 
any food, and a marked cachexia. On examination a 
hard moveable tamoor, the size of a goose's egg, could 
. be felt in the region of the stomach, and the vomited 
matter was alkaline. On consuitation with my oolle^nes 
at the Alfred Hospital, it was decided to feed np the 
patient for a little while in the hope of getting him 
strong enough to stand the operation. The following 
notes and chart have been kindly supplied to me by 
Dr. Elvina, house surgeon to the hospital:— 

I R. P., Sit. 50. Patient complains of vomiting his food 
I after meals. Abont six months before admission he first 
noticed that he rejected his food. He did not vomit 
: nntU about one or two hours after a meal. He says the 
food seemed to settle for a while, and then came back in 
a liquid form. He suffered a good deal of pain in the 
epigastrium, noticed himself swelling np a good deal 
after food, eating or drinking, never vomited any blood. 
Appetite always good, bat conld never retain anything. 
Has been steadily losing weight; lost two stone weight 
in six months. 

On admission patient was in a very thin and emaciated 
' condition ; weight, 7 st. 4 lb.; height, 5 ft 7 in. Com- 
I plained of great pain in epigastrium. Above the region 
{ of the pylorus a large hard mass could be felt more or 
less distinctly. Stomach was greatly dilated ; its out¬ 
line conld be easily mapped out. Appetite good, in¬ 
clined to be Toraoions; bowels regular; heart and longs 
showed no sign of disease; urine, 1,025 acid, no albnmen, 
no sugar. 

Patient was put on liquid diet; very small quantities 
j at frequent intervals. Did not vomit much, but 
j vomited matter was dark coloured, not unlike ” coffee 
grounds," sour smelling, alkaline. Patient seemed to 
improve under treatment, vomiting almost entirely 
ceased, and he seemed to be able to digest fairly well the 
I small quantities of liquid food. He gained four pounds 
in weight in three weeks. As patient’s condition was 
mnch improved and as be was very anxions to have the 
operation performed, it was decided to explore. Accord¬ 
ingly, on January 1st, 1901, Mr. O’Hara opened the 
abdomen by a medium four inch incision and the mass 
was exposed. A large hard mass, apparently malignant 
in character, was found, involving the pylorus and ex¬ 
tending along the greater corvatnre of the stomach, 
and its interior wall for about two-thirds of the distance 
between the pyloiio and cardiac ends of the stomach. 

I No enlarged glands could be discovered. Clamps were 
placed on the cesophagus, and above the duodenam, 

: including the disease, and the whole mass excised. The 
large opening in the cardiac end of the stomach was 
partially closed by sutures through the mucous coat 
and a layer of Lembetfs sutures outside, all hemor¬ 
rhage being checked by ligatnres or torsion of vessels. 
A large size Allingham’s de^cifled bone bobbin was now 
insert^ in the cardiac orifice, or, more properly speaking, 
the sabdiaphragmatic portion of (esophagus, and fix^ 
there with a purse-string sntnre, the cut end of the 
dnodenmn was then palled over the other end of the 
bobbin and fixed in a like manner. The peritoneal 
surfaces being thus bronght in apposition were fixed 
there by a doable row of jUmberfs sutures. 
A portion (f the gastro-hepatio omentum was sewn over 
this anastamosis to make the union more secure. The 


306 Tn Hsdicai. Pbbsb. 


CONTINENTAL NOTES. 


Sbft. 18, 1901. 


■ibdoBiul 0 BTit 7 «m waahed out wiUx saline solation 
The aneatbetio used was ether, and oxygen was given 
during the lat^ portion of the operation. The time 
taken to complete the whole operation was a few 
minntee lees than one hour. About erne qTUtfter of an 
hoar before the operation the stomach was washed ont 
with boraoic lotion. 

A/ltr (rsotmenf.—The evening of the opmtion the 
patient's breathing became very laboured. Hypodermic 
injections of strychnine were ordered, m. v. of the 
liq. stryobnise every two hours, and oxygen inba1a» 
tionse very half hour. Breathing became much easier. 
Vomited dark brownish fluid several times. Temperature 
96-4. Pulse 136. 

On the 19th be was breathing much better. Com* 
plained of pain in the epimtrium. Had hypodermic 
injection of morphia gr. No vomiting, but had reten* 
tion of urine, for which catheter was passed; nutrient 
enema administered every four hours. 

The bowels were well opened several times on the 21st, 
the pain was much easier, and he slept well. 

Had the first food by the month since the operation 
on the 22nd—one teaspoonfnl of milk, brandy and water, 
or Brand's essence given every half hour. Nutrient 
enema stopped. 

From this time onwards till his discharge, the patient 
continued to improve rapidly, and with the exception of 
an occasional small rise of temperature and pulse, he 
made an uninterrupted recovery. Sixteen days after 
the operation the wound, which had been covered with 
collodion, was exposed for the first time, and was found 
to have united by first intention; the stitches were then 
removed. The growth proved to be carcinoma. On 
February 6th he had bread and milk, and was put on 
No. II diet, i.t., nineteen days after operation was able 
to take ordinary solid food. On February 18th he was 
discharged, feeling very well. 

Note by Dr. Weigall 

The patient was seen about a week ago (July 22nd) six 
months after the operation, he had gained nearly two 
atone, and expressed himself as feeling very well, and 
able to take any kind of nourishment. To ensnre a 
successful result for this operation, I consider the fol* 
lowing points most important:— 

1. The disease must be confined to the stomach, i.e., 
it must be inside the peritoneal lining of that 
organ, so that it can be completely removed without 
disturbing the important structures in the neighbour¬ 
hood. 

2. There must be a sufficient amonnt of cardiac end 
free from disease to complete the anastomosis with 
duodenum. There must Ira no dragging of the parts 
together, as the duodenum, if free from disease, can 
easily be loosened sufficiently to allow rf the anastio. 
mosis without any tension. 

If, then, carcinoma of the stomach is found to exist’ 
without being complicated with lymphatic deposits or 
other evidence of visceral metastases, and if emaciation 
the result of starvation and vomitin:; has not gone too, 
far in reducing the patient’s strength, I consider a total 
gastrectomy not only a justifiable operation, but one 
that gives the only chance of prolonging life under the 
conditions. 


€0ntincntal 


[raou j. a. wolfk, h.d., p.b.c.8.xd, late of 

OLABOOW.J 


ViEKSA, September 13th, ISOl. 

ON THE RESUSCITATION OF THE PARIS 
POST-GRADUATE MEDICAL SCHOOL. 

I WAS about to write some notes on the scope of the 
Vienna clinics as a post-graduate school in the various 
departments of medical science, when I noticed in 
this week’s issue of Thx Mxdical Press and Cibculab 
(August 28tb) a leading article on “The Parisian 
Medical School.” This article claims my first attention 


oonoeming which I venture to offer a few reuiarka. I 
am attached to the Paris Medical School by ties of 
deep gratitude. I was a post-graduate atudmit under 
Nelaton, Tronsseau, Vdpesu, Claude Bernard, and 
Desmarres, by whose brilliant achievements in ophthal> 
mio surgery I was attracted to that speciality. Being 
at that time the Paris correspondent of Tk« L»ne€t, I 
oame into friendly connection with these great^authori- 
ties. If I have contributed anything to medical science 
I owe it ohiefiy to these great masters, who, by 
their example and practice, have shown ns the 
manner and spirit in which scientific investigation 
shonld be condnoted. That was the golden age of 
medicine, when science was cnltivated purely and im¬ 
partially—free of school oliqnism and international 
jealousies, and Paris was the metropolis and centre 
towards which all eyes were directed, to read the last 
lecture of Tronsseau, and the last experiment that 
issued from Clande Bernard's laboratory. Now we are 
told that, “ dnring the past twenty years the French 
schools of medicine are being gradually deserted by 
foreign students, who now seek instruction in Vienna snd 
Berlin.” How is it ? We may well ask why it is that this 
beautiful city with its nnsnrpassed clinical material, its 
unrivalled anatomical institution at Clamor, its bright 
hospital people, its beautifol language and moderate 
living, how is it that all these advantages should have 
beeu abandoned by foreigners ? 

It oannot be owing to the want of attraction of such 
great luminaries just mentioned, for Vienna, at that 
period, was represented by men of exceptional celebrity, 
one need only mention Hirtel, Rokitansky, Skoda, 
Jaeger, Arlb, Hebra, Striioker, Billroth. Edinburgh, 
also, could at that period boast of an array of bright 
stars who illumined the medical horizon: Goodsir, 
Simpson, Syme, Christison, Miller, Bennet, Allison, 
Playfair—these were names to conjure with, to raise 
the prestige of a school. But then prophets do not live 
for ever, nor do medical celebrities; they train assistants 
who follow their example and methods, and their work 
is perpetuated. These assistants may even improve 
npon their teachers by bringing the subjects up to date. 
Thus the Vienna and Edinburgh schools, having grown 
in prosperity, added largely to the contingents of 
foreign students, and we might have expected not less of 
Paris, where the professorial chairs are filled np from 
the most saocessfol-from the pick of agr^ges, men who 
go throngh a oourse of thorough training for these im¬ 
portant offices from the very commencement of tkeir 
medical career. 

The condition complained of must have been prodneed 
by a strange apathy and waste of rich materiaL 
like an ” unweeded garden that grows to seed.” It is 
well, as your editorial informs us, that the city autho¬ 
rities have taken up the question and are dieoussing 
means of establishing a post-graduate school npon a 
sound basis: ” A municipal institute of practical medi¬ 
cine is to be established and supported at the expense 
of the city. Patients are to be drawn from all parts of 
French territory, the desire being to secure specimens 
of pathological states of rare occurrence,” Ac. The 
same, I presume, will be done for this mauidpal 
institution which Gambetta did for the Eye Cliniqne of 
Quinze-Viogts. There is every reason to expect tbst 
things will be devised on the moat liberal scale 

D, Goog e 




Sbpt. 18, 1901. 


AUSTRIA. 


Thi Msdioal Pbsss. 307 


and most oarefallj organised to do credit to the mnni« 
cipality. 1 most oordiallj join the editor of Th> 
ciL Passe AMD CtBCTTLAS in wishing tiie scheme snooeea. 
I may, bowerer, take the liberty to offer <me remark 
upon the closing sentence of the editorial, vis. 

**The home ^ Pasteur should be an attraotion to 
students, and our French eonfriru are well advised in 
foarhing Pasteur’s theories and demonstrating his teach¬ 
ing in Paris, and not relegating the duty to German 
professors.” 

There can be no doubt that Pasteur’s teaching is 
admirable, althoi^ I am unable to follow him in all the 
statistics and deductiona of his school.' Of the medical 
practitioners who resort to foreign schools but few, 
however, wish to study Pasteur’s theories; to the bulk 
of them Pasteur reads likes H^el or Spinosa. It is for 
the teaching of practical subjects that provision must 
be chiefly made. 


Jlnstria. 

[non oun owK ooBunspoirDBHT.] 

Visnri, Beptambar 14th, 1001. 

Facial Bonxs and Fabaltbis. 

Salonoxson showed two cares of a longstanding 
paralysis of the face to prove the fallacy of Schauter’s 
theory founded on experiment. 

The first case was that of a female who had suffered 
from facial paralysis for twenty-seven years; the second, 
a male, who had been afflicted forty-eight years with 
the same thing. The bony structure of the cheek was 
in no way reduced or softened, but on the contrary, was 
full and firm, which is to be expected from the remoTal 

the mnsoolar pressure on its surface, which would 
reasonably retard the development of the bone, 

" PUBOATOL,” A K*W LAXATTVB. 

Db. Wbnhabdt Janos introdaoed this new cathartic 
in a lecture to his dass at the University Clinic, Buda¬ 
pest It is a synthetic glucoeide endowed witii the 
natural properties of purgation. It is claimed for it 
that it is a drug the effects of which can be eisily esti* 
mated; it is tasteless; passes through the stomach un¬ 
changed, and, therefore, does not disturb the digestive 
function. It is given in doses of from 05 to 1*0 gramme. 
It produces no griping, tenesmus, do., and is useful in 
the purely functional constipation of neurasthenia. 

Axsokvalxsation. 

Enlenburg has been experimenting with high tension 
intermittent currents, and finds tiiat there is a steady 
increase in the blood pressure when measured with a 
large solenod and Basoh’s spbygmo manometer. The 
previous experiments on animals with a cannula in the 
carotid connected with a mercurial manometer gave 
no particular change. Alcmg with the high arterial 
tension the depth and frequraoy of the respirations are 
increased, the absorption of nitrogenous products 
augmented, and the elimination of carbohydrates 
doubled. In the case of local arsonvalisation there is a 
decided reduction in the perc^tion of cold, heat, and 
p re ss ure, not so mnch that of pain in the particular area 
acted on. Later, however, there is hypenssthesia for 
odd and heat, often associated with hyperalgesia, which 
can be relieved by local analgesics, ansssthetios, or anti- 
pmrigenous drugs. This form of electric application 


has been found useful in acne faciei and lichen ruber 
French authors speak highly of it in functional neurosis 
and morbid assimilation. 

Sbftic Endocabditib. 

Septic endocarditis may be aonte or chronic in its 
course, or, as in some oases, it may take both courses 
In addition to the purulent cocci, or staphylo- or 
strepto-coooi, tiie pneumo-cocci, or more rarely the 
gonno-coooi, may be the exciting cause. 

According to Lenharts, twelve oases of septic endo¬ 
carditis occurred in old cardiac lesions, five times in the 
puerperal condition, four times at the onset of gonor- 
rhcea, and seven times from injury to the urinary tract 
after the passing of a catheter, bougie, or other instru¬ 
ment. 

The bacteriological examination gare staphylo-oooci 
eight times, pneumo-cocci nine times, strepto-oocoi ten 
times, and one only contained gono-oocoi. 

The chronic form of the disease is slow and insidious* 
seldom occurring with rigors. The form is a 

feeling of lassitude, weariness, and exhaustion, with 
aching in the joints; sometimes there is great pain in 
the neighbourhood of the joints and aponeurosss. These 
dangerous symptoms gradually increase in severity, 
with the ai^>earanoe of a murmnr and great in¬ 

crease in the sise of the spleen. There is nothing patho- 
gnomcmio in the temperature as many have no rigors 
whatever, while in others it may be erratic, with an 
iotermitting or remitting curre. The prognosis is 
always grave, as is shown by the fact that out of thirty- 
eight oases he had only four recoveries. 

Spboitic Blood Chanobs aptbb Ubinb Injbotion. 

The serum from animals treated with the urine of men 
and goats acquiree an aggiutinating property. This phe¬ 
nomenon is most marked in man. The blood serum has no 
power of this nature when acted on with the urine of a 
horse, haring neither hsmolytio nor agglntinative pro¬ 
perty. *' Predpitine ” and anti-complemente ” are 
not to be found in the serum of the animal that has 
been inoculated with the urine of a goat. The oaseis very 
different when the serum contains the active principle 
of the guinea-pig, or when acted on by the inactive 
senun of the goat, where great quantities of "anti- 
complemente” and " precipitine ” are formed, while 
"hemolysins” is absent, but agglotinine is sometimes 
present. 

Tbbathbnt 07 Motob Aphasia. 

The therapy of cerebral aphasia, or aphasia after 
cerebral disturbance, is more hopeful than is generally 
believed if a systematic course of treatment be followed. 
Careful tuition, according to Vidal, should be carried 
out on truly physiological lines, which in his hands has 
given wonderful results, when the case is purely motor 
aphasia; but the case is very different in prognosis when 
combined with amnetio aphasia. Treatment under the 
latter conditions is very unsatisfactory and imperfect 
in its results. 

Cholbdochotoht. 

To obviate the operation of choledoohotomy Rose 
proposed and carried into practice the sounding of the 
gall passage from the duodenum with a considerable 
amount of snooess. Agmn, Erug has demonstrated the 
practicability of passing che sound and removing 
ooncretions from the common duct. Krug thinks ohol^ 
doohotomy should never be performed whme a oaloulus 

Dir lized by Google 



308 Thb Mxdioal Pbcss. 


GERMANY. 


Sbpt. 18» 1901. 


emipl 7 blocks the passage, as this can easily be retnrned 
to tite gall-bladder by the aid of the sound, thus prov¬ 
ing the valae of the simpler operation. 

Where the itone is encapsnled this simple application 
will not succeed, and the case will consequently require 
the majoroperationof choledoohotomy. 

Cbtstallinx Ikhunibino Pboduct. 

The crystalline immunising substance which Buchner 
named "globulite" turns out to be a barium sulphate 
of albumen. The barium seems to have been present 
E iihne peptone or other altered form of blood, in the 
serum. 


Germans. 


[Fbom Oub Own Cobrkbpondxnt.] 

BuLts, September Uth, 160L 

Ik the Btrliner Klinilt, E. 156, Br. E. Felix has an 
article on 

Adenoid Veoetatioks. 

This disease was first thoroughly described by W. 
Meyer in 1888. It occurs most frequently between the 
fifth and fifteenth year of life, but cases have been ob¬ 
served very early in life and also in old age. The fre¬ 
quency of the affection is very varied as regards locality 
and race. It is more common in the north t>»wi in the 
south. 

Although one is generally inclined to consider hyper¬ 
plasia of the tonsils to be the result of inflammation, 
this cannot always be proved. According to Fraenkeb 
adenoids are to be looked upon as an anomaly of growth, 
and nutrition. In the etiology of the affection the 
infectious diseases—scarlatina, measles, diphtheria, and 
whooping-cough - play a part as predisposing factors. 
According to Zeim, suppuration in the neighbouring 
cavities also bring about adenoids. Another question 
that has disturbed authors during recent years, is that 
of the connection between hyperplasia and tuberculosis. 
This question has not yet been satisfactorily settled. 
From the histological standpoint Dansac has distin¬ 
guished three forms, the scrofulons, the lymphade. 
nitio, and the syphilitic. From the symptoms Curciller 
divides them into three groups, the respiratory, ^e 
auricular, and the mixed. 

Digital examination leads to a correct du^;nosis 
when the soft masses can be felt. Ozena is often pre¬ 
sent, which disapfeais on removal of the growths. 
Obstinate bronchial catarrh which resists all treatment 
is often associated with the condition. By swallowing 
the pus secreted, disturbances of nutrition are often 
caused. 

The treatment is surgical, but supported by prepara¬ 
tion of iodine, cod liver oil, sea-bathing, and hydro- 
therapeutics. The earlier the operation is undertaken 
the better. Tender age is no contra-indication. Even 
children at the breast thrive remarkably after successful 
operation. With bleeders one must be very careful, and 
it is better generally with such not to undertake sur¬ 
gical operations. If acute inflammation is present it is 
best to wait until it subsides. The best instrument for 
use is the one to which the surgeon is most accustomed. 
Many use the finger only, armed or not. The author 


prefers Gottstein’s ring knife to all others. As regards 
anesthetic^ cocaine may be used, and chloroform is not 
more dangerous than in other operations. The compli¬ 
cation most to be feared is hemorrhage in hemophiles 
and in women who are menstruating. Hsmorrh^^ 
may come on immediately after the operation. Amongst 
unpleasant sequences of the operation may be mentioned 
tonsillar inflammation, mastoiditis, purulent middle ear 
inflammation, adeno-phlegmonons and retro-pharyngeal 
abscesses. Becurrence may take place even after com¬ 
plete rskdical extirpation. 

Saloohinike. 

Salocbinihx, or saloqninine, is one of the esters of 
quinine, the quinine ester of salicylic acid. According to 
M. Overlach in the Ch. f. tnnen Med. saloqninine 
possesses the following advantages over quinine itself. 
It is first of all absolutely tasteless. It produces no 
dis^reeable head symptoms, such as singing in the ears, 
headache, or deafness. It exerts no irritating effect on 
the mucous surfaces either in lai^ doses or after pro¬ 
longed use. Two grammes of saloquinine are equiva¬ 
lent to one gramme of ordinary quinine. As an 
anti-neuralgic, the author places it in a front rank in 
sciatica as well as in other neuralgias. The doses must 
not be too small, however. In the case of adults be 
gives two grammes for a dose once or more times a day. 
In the case of sciatioi he gives the two grammes towmrds 
evening. If the pain gets worse the third night he gives a 
second dose in the night. This dose does the work and the 
onward course is satisfactory. For typhoid be gives 
saloquinine in preference to other drugs, and gives 
two grammes just before the bath. 

A further advantage of saloquinine is that it can be 
employed as a base for other acids than those generally 
employed for quinine. Two groups of salts are formed, 
the acid, and the neutral. The acid salts have such a 
horrible taste that they are useless, but the neutral 
salts, on the contrary, are quite tasteless and non¬ 
irritant, and they afford the practicability of using 
useful acids along with the quinine base. A very im¬ 
portant combination is that with salicylic add, and 
named, on account of its almost specific action in 
rheumatism, " rhenmatine." It is a salicylate of salo- 
quinine. The anti-rheumatic action of the combina¬ 
tion is excellent. The rapid relief of cardiac pain 
is especially noticed. He places it above all other anti- 
rheumatic remedies. For the three first days of treat¬ 
ment he gave three grammes in one gramme doses. 
The fourth day a pause is made, and after that it is 
given in one gramme doses four times a day for four days. 
A welcome advantage of this drug is that it is absolu¬ 
tely tasteless; it is neither sour nor bitter nor sweet, 
and it does not disturb either digestion or the head. It 
is also useful in the gonorrhoeal form of the disease, in 
neuritis, muscular pain from over-exertion or injury, 
and in the lancinating pains of tabes. 

The DeuttcK Med. Zeitueg contains an extract from a 
paper by Dr. Bose, of Strassburg, on 
The Coubse of Tubebculous Pebitonittb Without 
Operation. 

The observation of such a case, and still more of a 
series of such cases, is at the present time one of such 
rarity as to make it extremely interesting. The chief 
result of the author’s observations is to the effect that 

Dir tized by Google 




Bmt . 18, 1901. 

a third of all oases of taberoalous peritonitiB would ze- 
ooTSr without operation and much more frequendj than 
has been assumed. The question as to whether laparo¬ 
tomy does most, or a oonserradon and wasting oourse, 
has not yet been decided, and will not be until the work 
of a large number of hospitals has been tabulated. Cases 
requiring operative treatment must be distinguished 
from Buoh as do not. If the fever and swelling sub¬ 
side under conservative treatment, and the general 
condition and strength improve, the patient has been 
spared a serious, if not dangerous, unneoessary opera¬ 
tion. But when there is a purulent exudation or a 
purulent cavity the patient’s strength should not be 
allowed to run to waste before sending him to a sur¬ 
geon. The difficulty here lies in that of an exact dia¬ 
gnosis, and the case is sometimes left until the opera¬ 
tion is done in desperation. Without operation the 
patient dies; with operation he does generally, but now 
and then such a case can be rescued, especially when 
the exudation is enoapsuled. There ace also those cases 
in which the indications for laparotomy ace occa¬ 
sionally intestinal stenoses, ileus, fistula, tuberculous 
tumours of the female pelvis or genital o^ans. It is 
different, however, in the dry fibrous with fibrous asoitio 
forma that form the main contingent of the cases 
recovering after laparotomy. According to all appear¬ 
ances these cases recover just as well without it. 

The same journal has a reference to the 

So&oiCAi. Tbxatwxnt or Aboitbb rw Atbofhic 

CONTBACTION Or THB LtVBB, 

by Dr. Koeiowskt. 

The first case was that of a drunken woman, at. 46, 
who had been ill two years. Fourteen months ago she 
was operated oc, when the liver was found to be con¬ 
tracted; it was small, nodular, and hidden under the 
ribs, and could only be felt with difficulty. There were 
no complications on the part of other organs. The 
omentum was stitched into the wound in such a way 
that it was in contact with both the peritoneum and 
the subcutaneous coimeotive tissue. Recovery was 
undisturbed. On the eleventh day after operation 
paracentesis was performed, but was not repeated. 
Now there is a pronounced network of veins run¬ 
ning to the cicatrix. Two months ago fiuid 
collected i^ain, but it was absorbed without punc¬ 
ture. The patient is now perfectly well and able to per¬ 
form her domestic duties. The second case was that of 
a countiryman of 40, who had been ill for fourteen years. 
Alcoholism was denied. At the operation performed in 
1899 the liver w as found to be enlarged and to reach to 
within an inch of the navel. On the sixteenth and 
twenty-first days after operation the abdomen was punc¬ 
tured on account of rapid return of fiuid. The patient 
lived seven months after the operation without further 
puncture being required. A third case was that of a 
countryman of 45 who had been ill two years. There 
was enormous ascites. After removal of the fiuid the 
abdomen rapidly refilled to the extent of a litre a day 
At the operation the liver was found to be whilst 

the spleen was enlarged to three or four times the 
normal sine. Evmr after the operation no improvement 
took place, so that the steadily recurring aadtes had to 
be relieved once a week by abdominal paracentesis. 


Thb Mxpical PBBsa 309 

theatres. 

WEST LONDON HOSPITAL. 

Two Casxs op Nsphbbctoict. — Mr. Bzdwbll 
operated on a mac, at. 29, who had previously been 
operated upon for the removal of a renal calculus. Three 
weeks previously he had been admitted into the hos¬ 
pital with considerable swelling and tenderness in right 
loin, and with some sigiu which pointed to a sub-phrenic 
abscess. There was some dulnem and crepitation at the 
base of the right lung. The temperature was 103^, and 
there was redness and cedema just below the last rib. As 
theseatof the suppuration was not certain an incision was 
made in front below the costal aroh. It was then found 
that the swelling was due to pyonephrosis, and on open¬ 
ing this a large quantity of pus escaped, and a calonlns 
the sise of a hasel nut was found blocking the opening 
of the ureter. A drain^^ tube was placed into the 
kidney and the rest of the wound closed. Progress was 
uninterrupted for the first week; the temperature being 
normal; when one morning he had a severe attack of 
hamorrhage from the wound, the whole bed being 
soaked with blood. The wound was plugged by the 
house su^feon and the bleeding stopped, but he con¬ 
tinued to pass a large amount of blood in the urine. 
From this date the temperature began to rise, going up 
to 10S° and not going below 101^. He also had one or 
two slight attacks of bleeding when the plug was re¬ 
moved, but declined any further operation until the day 
before, when he had another and more severe attack of 
hamorrhage. The ordinary incision was made in the 
lumbar region, and the kidney exposed. It was found 
to be very soft and friable and in parts there were some 
foci of suppuration. It was removed after ligaturing 
the artery, veins, and the ureter separately. It was 
then found that the kidney had been surrounded by a 
very large blood clot, which was now breaking down, 
and was evidently septia Several handfuls of this 
were removed from beneath the diaphragm and the 
wormd irrigated. Two large drainage tubes were 
inserted and the rest of the wound closed. 

It is satisfactory to state that this patient mode a per¬ 
fect and uninterrupted recovery. 

Cabb 2 .—A man, at. 40, who was admitted into the 
hospital having been knocked down and stamped on by 
a horse. There was a fracture of the tenth and eleventh 
ribs on left side. The abdomen was rigid and board¬ 
like, and did not move at all on respiration. The 
patient could not pass water, but on passing a catheter 
almost pure blood was drawn off. The patient was in 
great p»ain and was vomiting, and had a feeble, rapid 
pulse. The kidney was exposed by the usual incision, 
and on opening the transveraalis fascia a large amount 
of blood was found surrounding the organ. The kidney 
was brought outside the wound, and on examination it 
was found that there was a deep rent in its posterior 
surface, extending into the pelvis, there were several 
tmiallftf rents, from all of which there was free 
bleeding. Attempts were made to ligature the bleeding 
points in the kidney, but the parts were so friable that 
no ligature held. Very free hamorrhage continued and 
was not controlled by plugging. The patient then 
became very faint, and the anosthetist wished the 
operation concluded as soon os possible. The pedicle was 
therefore clamped and the kidney out away. The pedicle 

Di-! ^ 


THE OPERATING THEATRES. 



310 Te> Midioal Pbmd. 


LEADING ARTICLES. 


Sbpt. 18, 1901. 


was then ligatured with strong silk, and before remoT- 
ing the damp a ligature was applied to the renal artery* 
The damp was then remoTed, and immediately there 
was a gosh of blood showing that the ligature on the 
pedide had slipped. Fortunately the renal artery had 
been secured previoasly so the bleedingwas only Tenons. 
The Teasels were picked up with some diffionlty and 
tied. The wound was dosed after uniting the musdes 
in two layers with silk sutures, and a small drain was 
left in the posterior part. 

It is satisfactory to state that this patient also made 
a perfect reooTery and had no further bleeding. 

Mr. Bidwell remarked that the operation of nepbreo« 
tomy was a Tery successful one, and was indicated in 
all cases of pyonephrosis; in the first case, howeTer, the 
condition of the patient at the time of the first operation 
made it necessary to do as little as possible. He would 
not like to do such an operation as nephrectomy, which 
left BO large a oarity and opened up lymph spaces so 
fredy on a patient who was suffering from pyonephrosis 
accompanied by perinephritis. In such case the course 
followed was preferable, namdy to drain the pyone> 
phrosis first and then when the infiammation had 
subsided to remoTe the kidney if necessary. The acci¬ 
dent which occurred after the first operation, namely, 
hnmorrbages, was a most unusual one, and but for the 
prompt plugging of the wotmd might hare proTed fatal. 
It is interesting to note that the plugging was followed 
by a large collection of blood in snbphrenio space, and 
it was the suppuration of this blood clot which produced 
the high temperature. With regard to the traumatic 
cate, Mr. Bidwell remarked that he would not feel 
inclined to remoTe an injured kidney unless the pelTis 
was extensiTely lacerated, since most eztensiTe wounds 
in the kidney substance healed readily; when the 
laceration extended into the pelTis the Teesels 
dirided were so much larger that it was difficult to 
control the bleeding by plugging alone; in this case 
as the ligatures failed to hold, and the patient was 
getting faint, nephrectomy was decided on. In order 
to saTe time, the pedicle was ligatured cn morse, but this 
was not his usual custom, since in nearly erery other 
case of nephrectomy he had done he had ligatured the 
artery, Tein, and ureter separately. Mr. Bidwell men¬ 
tioned that he had carefully noted the effect of 
nephrectomy and the amount of urea secreted. Im¬ 
mediately after the operation the amount of urea was 
found to be increased, but on the second day it de¬ 
creased in quantity and did not become normal till the 
end of a fortnight. He, therefore, recommended that 
patients should be kept on a low diet for the first fort¬ 
night after a nephrectomy. 


The practice of allowing unqualified persons to 
minister to the medical requirements of paupers and 
casuals is one which cannot be too strongly con¬ 
demned. In a case recently inTestigated at Derby, 
it was elicited that an inmate of the Belmont Bo^ 
Workhouse complained of feeling ill, and was giren 
a pill by one of tne male nurses, and died on the fol¬ 
lowing morning without having been seen by the 
proper medical officer. If an inmate is ill enough to 
require medicine, he is Ul enough to see the doctor, 
and nothing can justify the intervention of an un¬ 
skilled official, even to the extent of giving an un- 
prescribed pill. 


BeSISTSIBP TOB raSMBKIBSIOll abboau. 

^\a jatiiicd jprtjEsa mh ®irnilar. 

Pnbliab«d vrvrj Wednasdsy momios, Frioe 5d. Pett tree. Bid. 

ASYSKTISBIllUITS. 

f OB 0»B iBSBBTiOB t—Wliole Paso, E6 Ob, Od.; Half F>SSi 
£S 10b. Od,: Quarter Pace, £16s,; One-ei^th, ISa. Sd. 

Poa A Bbbbb or Ivsbbtiobs Wbola Pare, thlrteea inaeitknu 
(weekly, fortnirhtly, or monthly), at £8 lOa, Od. j twenty.^ 
insertions (weekly or fortnirht^) at £9 Sa. Od.; ftfty-two 
Inaertiona (weekly) at £8 eaoh. Half Par*, thirteen iaaectlOBa 
at S5a.: twenty-aix at SSa.; fifty-two insertioas at SOa. eaobi 
Qaarter*pare, thirteen inaerUons at Ifia. twanty-aiz inaertioiii 
at ISa. I fifty-two InaertionB at 16a each. 

Small annonneementa of Pxaetioes, AaBiatanciea,yaoanciea, Books, 
fto.—Seven lines or onder, 4*. per insertion { 6d. pec Use 
beyond. 


%)xt frwe anD Circular. 


8ALU8 POPULl BUPBEMA LEX.” 


WEDNESDAY, SEPTEMBER 18, 1901. 


THE PSYCHOLOGY OF ASSASSINATION. 

The assassin—the executive apostle of anarchy— 
has again been busy among the most prominent, if 
not the most “ truly great ” ones of the earth. The 
selection of the latest victim of the levelling-down 
principle presents a new feature of most striking 
philosophical, as well as political and social, interest, 
inasmuch as President McKinley was the beloved 
and admired leader of the more advanced party of 
the most advanced and most expanded democracy 
that the world has yet seen. It is another of the 
terribly instructive incidents which must make the 
unprejudiced observer seriously doubt the success of 
the g^reat experiment of “ government of the people 
by the people for the people,” of which another o* 
its pilots, and subsequent victims, used to speak so 
exultingly. It furnishes another item of proof of what 
bus probably always been evident to thinking men, at 
least to that section not actively engaged in politics, 
that every system of government devised by man 
must be strongly tinted with the hues of human 
weakness. Another startling example of the meet¬ 
ing of extremes in all our terrestrial affairs is 
offered by the fact, which the history of the last 
quarter of a century goes to prove, that the respective 
heads of the absolute despotism of Russia and of the 
unlimited democracy of the United States of America 
occupy the most unsafe positions of any public men. 
The ingenuity expended upon the preparation of 
weapons of destruction has also contributed to in¬ 
crease the danger of a prospective victim to popular 
hatred or indignation. The death-dealing revolver 
/»jLTi effect the object of its owner, where the stiletto 
or bodkin could not. And a more widely-diffused 
knowledge of the structure of the human body is 
utilised by the educated murderer of the present age 
to minimise the chances of failure of bis deadly 
design. For the “ pen-knife scratch ” of the weak- 
minded and weak-bodied Ravaillac, the nineteenth 

Dr- ^^8 ^ 


Sbpt. 18, 1901. 


LEADING ARTICLES. 


TeV MbSICAL PBB88. Sll 


centaiy eobetituted the oarefoUj-rehearaed dag^r- 
throat of Karl Ladwig Sand, ^is latter poUtioo- 
religioos enthxiBia8t*had meditated hie act a whole 
jear before ite execution, continually prayed for the 
aesietanoe of God in carrying it out, and died exult- 
ingly “ for hie own conviotione ’’ fourteen months 
after ite perpetration. During the year of incuba* 
tion of hie design he had frequently attended anato> 
mical demonstrations in order to make sure of the 
position oi ti)e heart, wrote the most affectionate 
letters to his parents, was a most lovable companion 
to his felioW'Btudents—who objected to him only on 
the score that he was always trying to improve their 
morals and elevate their religions sentiments—and 
while under sentence of death always stated with 
calm dignity that he only “did what it was his duty 
to do." Although we learn from the pages of Holy 
Writ that the Jews of ancient times emphasised 
the importance of smiting an enemy under the 
fifth rib, this evident mm at the seat of car¬ 
diac impulse does hob display the appalling 
subtlety of skill displayed by the assassin of the 
Empress of Austria, who planted his deadly weapon 
a step higher and a step nearer to the breast-bone. 
The thickness of the left ventricular wall may render 
the infliction of a wound “ beneath the fifth rib '* com¬ 
paratively triviaL Wounds of the beart-^usually 
so rapidly fatal—are by no means necessarily so, as 
popular faith assumes. We have long adopted a 
triple classification of wounds of the central organ 
of circulation: (1) non penetrating, (2) those so small 
as to deserve the name of eelf-cloeing or collapting. 
such as needle-thrusts, and (3) valvular, which pass 
so obliquely through the cardiac wall as to be closed 
by muscular action during systole, and by the pres¬ 
sure of the blood from within during diastole. The 
thinness of the wall of either auricle almost excludes 
the first and third of these groups, and tiie choice of 
the assassin’s weapon practically always excludes the 
second. These facts explain the much smaller 
recovery-rate in cases of wounds situated at the base 
of the heart. Even suicides do not usually employ 
needles, and this fact, combined with the others 
above stated, goes far to justify strong scientific 
scepticism regarding the description furnished by 
the “ authorities ” concerned regarding the death of 
Admiral Yilleneuve. Even Karl Ludwig Sand 
missed his own heart, although he had been so suc¬ 
cessful in his experiment on Kotzebua Death in 
cases of wounds of the heart is, of course, in 
the vast majority of cases, not due to hsemor- 
rhage in the ordinary way, but to the mechani¬ 
cal obstruction offered to the movements of the 
01 ^^ by the blood which has escaped into the peri¬ 
cardium. In this connection the wound and conse¬ 
quent symptoms in the case of the late Empress of 
Austria furnished what may be looked upon as a 
typical experiment. There can be little doubt 
that the assassin of President McKinley also 
aimed at the heart, “ in a general way,” in bis first 
shot, and, less definitely, in the second. The pene¬ 
tration of the stomach—before the days of the anti- ^ 


septic revolution—almost as surely fatal as that of the 
heart itself, only much more slow, and infinitely more 
painful—has, aocordicgly, been substituted. But, 
even now the advant^es of asepsis and amesthesia 
cannot wholly neutralise the effects of a prolonged 
abdominal operation up<m a patient already in a state 
of complete collapse. Then the use of the Rbntgen 
rays, although giving in so many cases a gratifying 
confidence in the search for an imprisoned bullet* 
retains, in such a case as the one now before us, the very 
serious element of danger from prolonged exposure in 
various positions of the body. And behind the whole 
history of such deplorable cases lurks the moral of 
the “Tanity of Human Wishes,’’ the hitherto com> 
plete failure of establishing up<m earth a reign of 
complete “ Peace among men.” Poverty, misery, and 
discontent will as surely be met with in the most 
advanced democracy as in the most absolute mon¬ 
archy. So will their consequences, physical and moral. 
The materialism and utilitarianism of the present 
age have aimed, and with a oonmderable amount of 
Buccess, at stamping out all the higher emotions, as 
their features and results were visionary and un¬ 
practical. Superstition and even faitii were to be 
extinguished, as enemies to reason and physical 
truth. The frequently unsatisfactory results of 
medicine and surgery drew off the confidence of that 
advanced section of the community which must see 
and feel everything before believing. Passion of 
every kind must be eliminated; emotion must be 
absolutely controlled; faith must submit to physical 
tests. This programme has been worked with in¬ 
creasing demonstrativeness during the last half 
century, and the opening of the twentieth century 
has at least shown that, with the rapid growth of 
physical science and the daily inroads on the 
mysteries of nature, the human race as a whole is 
still unsatisfied, white its most advanced and most 
materialistic sections are probably the most miser¬ 
able of all. The emotional longings for higher 
things than those of earth will not be exterminated; 
the hankering after the mysterious and the un¬ 
attainable—in fact the human characteristics which 
most truly distinguish man from bmte^are still 
living in the human heart. Their volcanic explo¬ 
sions assume forms ridiculous, preposterous, insane, 
and even criminal. Medical men should recognise 
the position and contribute what they can to the 
education of the public. It is of greater interest 
and importance to them than to most sections of the 
oommuoity to keep continuously in touch with the 
advanced guard of thought. Unsatisfied longings 
and disappointed hopes have on one side created a 
cosmopolitan brotherhood of Anaichists; on the 
other a crusade of Christian Science healers. 


THE ROYAL COMMISSION ON 
TUBERCULOSIS. 

Thb promptitude with which the Government has 
seceded to the popular demand for a Royal Com¬ 
mission, to inquire into the validity of Professor 
Koch’s conclusions in regard to the non-identity of 

Google 


Die ■ - 



312 Thb Medical Pbbbb. 


LEADING ARTICLES. 


SlPT. 18. 1901. 


hiimftn and bovine tubercnloBis, has elicited univereal 
commendation, and the composition of the Gommis* 
eion is certainly not open to criticism. We must, 
however, be on our guard against that blind confi¬ 
dence in commissions of inquiry which leads one to 
regard them as a ready, if somewhat costly and cum¬ 
bersome, means of remedying shortcomings in our 
knowledge regarding a given subject. Doubtless this 
method of inquiry answers very well when the subject 
to be investigated is one to be elucidated merely by 
collecting evidenceof fact from heterogeneous sources, 
and when the task before the commission is merely to 
sift the statements made and to apportion their 
value. It is quite otherwise when the object is to 
obtain scientific data, the lack of which is more or 
less acutely felt. Scientific problems do not often 
admit of solution at will in this way. But too often, 
as in the present instance, the discovery of fresh 
methods of investigation must be the indispensable 
prelude to satisfactory conclusions, and the initiation 
of these methuds may baffle the most diligent and 
skilled of observers. Of what possible use, for in¬ 
stance, would be a Royal Commission on cancer P 
Would it add one tittle to our knowledge 
or diminish one iota our ignorance in re¬ 
gard to its stiology and pathological nature P 
We trow not, and it remains to be seen whether even 
this highly qualified body of experts will be enabled 
to carry our knowledge of tuberculosis beyond the 
point where Koch and others have left it. True they 
may repeat and confirm or invalidate his experiments 
bearing on the non-transmissibility of human tuber¬ 
culosis to cattle, though we doubt if the result will 
be more than to show that, though possible, such in¬ 
fection is of rare occurrence. The question whether 
the disease in man and animals is one and the same, so 
far as it is based on morphological considerations, 
must be largely a matter of inference, and no conclu¬ 
sion will command assent unless it is borne out by 
experimental and clinical experience. After all, the 
principal question which the Commission is called 
upon to decide is the transmissibility of tuber¬ 
culosis from animals to man which is of far 
greater import than its transmissibility from 
man to animals. Professor Koch was unable 
to decide this question simply because no 
experimental data were procurable, and he was 
fain to fall back upon statistics which, under the 
circumstances, are notoriously untrustworthy and 
even misleading. We do not see what means of in¬ 
vestigation are open to the Commission which were 
not available to Koch, and although we do not 
despair of our ultimately acquiring authentic data 
on this point we cannot but wonder what fresh line 
of inquiry the Commissioners c.an devise with this 
object in view. Medical literature teems with clinical 
observations and scientific disquisitions based on a 
more or less slender foundation of ascertained fact, 
but on a close scrutiny we find that the absolute gain 
to science is miserably small. Will the Commission 
avail itself of the assistance of volunteer victims ” 
should any such present themselves, or will they 


leave Nature to perform the experimente and merely 
seek to chronicle the results P The worst of Nature’e 
experiments is that they are very slow and they are, 
moveover, carried out under conditions which are 
not of our choosing, and of which we are not neces¬ 
sarily cognizant, so that the premises are usually 
too uncertain to admit of conclusive deduc¬ 
tions. Then, too, there is always a margin of diffe¬ 
rence between experimental resnlts and what may be 
termed accidental innoculations, which adds to the 
difficulty of determining the truth. It is evident, 
therefore, that the data which we are so anxious 
to obtain are procurable only at the price of 
long and painstaking inquiry, on a scale, we fear, 
beyond the reach of any specially-appointed body of 
experts, hampered by the obligation of formulating 
a report within a reasonable period. In any event 
it is idle to look for a report for a long time to 
come, but in the cicrumstances the Commission is 
entitled to disregard our impatience in order to 
arrive as far as possible at resnlts which will com¬ 
mand the assent of the scientific world. 


A PROPOSED CANCER CLINIC. 

Thb general newspaper press of the United 
Kingdom naturally enough keeps a finger on the 
pulse of the public. Of late it has adopted a pro¬ 
gressive, if not always severely scientific, attitude 
with regard to the prevention of tuberculosis and 
enteric fever and other infectious diseases. The 
general spread of knowledge, it may be reasonably 
inferred, has, therefore, to some extent included the 
principles that govern the or^n and spread of 
specific infectious fevers. Indeed, such information 
may be said to form part of the intellectual stock-in- 
trade of every well-educated layman. For instance, 
such a man would certainly know that malaria is 
spread by mosquitoes and consumption by means of 
tubercle bacilli. This state of affairs is distinctly 
encouraging, inasmuch as the national administra* 
tion of preventive science cannot advance far beyond 
the average standards of popular belief. As regards 
prevention, it is to be hoped that the present 
diffusion of knowledge may be the dawn that precedes 
the full and brilliant light of day. At the same time, 
it will be wise for the medical profeesion to keep a 
watchful eye upon the popular enthusiasm, in order 
that its energies may be directed into the 
proper channels. So far as tuberculosis is 
concerned, the results bid fair in practical im¬ 
portance to equal almost any great advance 
hitherto made in public health. Stimulated by this 
success investigators in other branches of scientific 
medicine are beginning to urge their claims for 
similar support. In this way appeals have been 
made recently to the public to establish a special 
clinic for the investigation of cancer. The proposal 
is in itself sound, but before it is accepted there are 
a good many common-sense considerations that will 
occur to most medical men who are not cancer 
specialists. Everyone will agree tiiat cancer is a 
terrible disease, the prevention and cure of which 

D "Oog e 


SxpT. 18, 190L _H0TE8 Oy OUBBENT TOPICS._ Th« M«dical Pbibb. 313 


would 1)6 a vast triampb of medical skill, and would 
confer an nnspeakable benefit upon hnmanitj. At 
present, however, the causation of cancer presents 
problems of stiology as obscure as anj within the 
whole ranji^ of modem scientific medicine. It is onlj 
quite recently, indeed, that there have been signs of 
possibility, not to say probability, of tracing the 
^timate origin of this scourge of mankind. By all 
means let the nation endow science with the means 
of investigating cancer in the full light of modem 
scientific knowledge. On the other band, however 
let XU remember that there are many everyday die* 
eases that kill hundreds of oxir fellow-countrymen 
every year where cancer can reckon its victims 
only by the score. In some of these diseases, 
as in enteric fever, the cause is definitely 
recognised in a specific bacillxu. Why should 
not the popular fury, so to speak, be directed 
against enteric fever P Or why, arguing on 
similar lines, should not a declaration of war be 
made against diphtheria, which has increased 
BO greatly in incidence during recent years. There 
be no reasonable doubt that the eradication of 
both enteric fever and diphtheria could be accom¬ 
plished by a body of scientific medical men if 
armed with full powers at all points. That money is 
not gmdged by the public when spent in preventive 
directions is amply proved by the lavish expenditure 
that goes on year after year by the Metropolitan 
Asylxims Board in order to provide for notification 
and isolation of the infectioxu sick. But the machinery 
is still imperfect, becaxue it has not succeeded in 
stamping out, or, at any rate, in reducing to a mini¬ 
mum aU the infectious diseases that come within its 
operation. The point is whether the public woxild 
not spend their money to better advantage in per~ 
fecting the preventive system at their doors instead 
of mnning after every alluring proposal that is drawn 
across their path. If the amount of money forth¬ 
coming for the endowment of scientific research 
be sufficient to embrace all sorts and conditions of 
disease, so much the better for everyone concerned. 
One note of warning may be raised, and that is to 
keep so-called “ specialists ” within their own sphere, 
as men whose range is necessarily more or less limited, 
In the case of cancer, all the special knowledge 
attainable should be in the hands of any competent 
surgeon of experience. The problems of cancer will 
probably be solved ultimately in the pathological 
laboratory, whither, indeed, we must look for many 
of the future triumphs of practical medicine and 
surgery. 

JloUs on (Enrrmt ^opica. 

Small-pox in the Metropolis. 

AxTHOUOH it is satisfactory to be able to record 
that the outbreak of small-pox in London is now 
well in band—the total number of cases up to 
date being 142—the very fact of its occurrence is 
sufficiently disquieting in view of the very large 
amoxmt of inflammable material always present in 


this hnge aggregation of human beings. There is a 
large floating population, largely recruited from 
foreign countries, in respect of which legislation for 
ensuring vaccination is, and must be, inoperative. 
Moreover, the unprotected belong, ‘to a great extent, 
to the poorer classes of foreigners, who are xin- 
familiar with the godliness of cleanliness, and live 
xmder conditions which are at variance with the most 
elementary laws of hygiene, a fact which this outbreak 
bas once again brought to light. The propriety of 
compelling the vaccination of all xmvaccinated aliens 
on their arrival in this country is a question the ex¬ 
pediency whereof is well worthy of consideration. 
Another usefxil measure would be to refuse admis¬ 
sion to public schools failing the production 
of a certificate of successful vaccination. Medical 
practitionera in this coxmtry have few oppor¬ 
tunities of becoming familiar with the appear¬ 
ances during the initial stages of the disease that 
there is a serious risk of early cases being over¬ 
looked, thus rendering nugatory the elaborate pre¬ 
cautions taken to secure the prompt isolation of 
infected persons. Even post-graduate classes are 
unlikely to remedy this lapsus, for obvioxis reasons, 
and a very considerable proportion of medical men 
can lay claim to never having seen a case. We should 
hesitate to encourage men engaged in active practice 
to visit small-pox hospitals for the purpose of 
gaining the requisite practical knowledge, for that 
would entail the unavoidable risk of their spreading 
the disease; moreover, the patients whom they 
would see woxUd, in the vast majority of instances, 
have passed the stage at which diagnosis pre¬ 
sents much difficulty. The only solution that we 
can see is that in periods such as the present 
every practitioner should refresh bis memory in 
respect of the symptomatology of small-pox in its 
earlier stages, and be on the look-ont for suspicions 
signs. Attention should be aroused by the abrupt 
onset, the high fever, and the early appearance of 
the characteristic shotty papxiles, which may be felt 
on the skin on the inner side of the cheek as early as 
the third day after the supervention of the fever. 
It must not ^ forgotten that various erythematous 
or measly eruptions may make their appearance 
during the interval which normally elapses between 
the onset and the eruption peculiar to the disease, 
but as a rale it is sufficient to have clearly before 
one the possibility of the disease being small-pox to 
enable an approximately correct diagnosis to be 
arrived at, and the medical officer of health is there 
to afford assistance in doubtful cases. 

Ether v. Chloroform. 

We are so accustomed to the idea that in America, 
the birthplace of ether ansBstheeia, that drug is 
almost exclusively used as a general anssthetic, it is 
with no little sxirprise that we leam from a recent 
paper by Dr. Frazier, that be and many of bis col¬ 
leagues in Louisville are ardent advocates of chloro¬ 
form. The reasons which he advances for this pre¬ 
ference are, however, with one exception, not very 

Dr- ^ 



NOTES ON CURRENT TOPICS. 


Sift. 18. 1901. 


314 Thi Midical Pbbsb. 


ccDTincmg. If tLe aneesthetist imderstandB the 
methods of administering the one drug and not the 
other, undoubtedly it will be safer for the patient 
that he administer that drug with whose action and 
usage he is familiar. Such considerations can have 
no weight in deciding the general question as to 
which is the more dangerous drug for general use* 
The one point of cardinal importance which must 
always be kept in mind is that chloroform is at least 
seven times a more powerful nerve poison than ether, 
and consequently the margin of safety under it is 
correspondingly reduced. It is a striking fact how 
other figures in relation to the two drugs bear out 
this proportion. Thus, speaking roughly, we find 
that we use as many ounces of ether for a given 
length of anffisthesia as we do drachms of chloroform* 
The percentage mortality of the two drugs is also 
very instructive. If we combine the statistics col¬ 
lected by Drs. JuUiard and Ormsby, we find that 
ether is roughly five times as safe as chloroform 

Anesthetic. Total number of Total Death-rate, 

administra- number 
tioDS. of deaths. 

Chloroform... 676,767 ... 214 ... lin 3,162 
Ether ... 407,653 ... 25 ... Iinl6.302 

In the face of these figures there can be but one con- 
elusion, that the routine ancssthetic for general 
surgical purposes should be ether. While as a 
general working principle this position is unassail¬ 
able, it should not for a moment be allowed to inter- 
feie with the specialist or limit his privilege to select 
that drug which under the circumstances he con¬ 
siders most suitable in a given case. As, however, 
we are apparently far from that time when the 
administration of anessthetics will be considered of 
sufficient importance to demand proper instruction 
and efficient knowledge, and as such papers as Dr. 
Frazier’s are addressed to general medical practi¬ 
tioners rather than to specialists, we feel it a duty to 
enter a strong protest gainst the conclusions which 
he arrives at. 


Typhoid Baoilluria. 

It is only recently that the possibility of enteri^ 
fever being spread by the urine of those suffering 
from that disease has been recognised, and even yet 
the full significance can hardly be smd to be properly 
appreciated. In the September number of the 
Edinburgh Medical Journal Dr. C. J. Lewis contri¬ 
butes a very interesting paper embodying the results 
of his investigations in the subject. If the bacillus 
typhosus is found in the urine in an active state it 
becomes a matter of the greatest importance that 
this should be sterilised as carefully as the fesces if 
we are to prevent the spread of the disease. The 
condition is not easily recognised, since, as a rule* 
there are no symptoms connected with the urinary 
apparatus. In a typical case of typhoid bacilluria 
there is little or no frequency of micturition, no dis¬ 
comfort in the region of the bladder; the urine is 
acid when freshly passed, and contains large numbers 
of typhoid bacilli in pure culture with some pus cells 


and no albumen. The condition' is rarely pre¬ 
sent in the early stages of the fever, usually not 
appearing till the third week, and then may continue 
for a varying length of time sometimes even till well 
on into convalescence. Occasionally it does not 
begin till convalescence is established, and then may 
last for a long time. The question of the 
frequency of its oocurrenoe is far from settled, some 
writers estimating it at 25 per cent., others at 6 per 
cent, or less. As regards diagnosis the only method 
is careful and frequent examination of the urine. 
Any cloudiness of acid urine, especially if it appear 
suddenly, should excite suspicion, and microscopic 
examination will demonstrate actively motile bacilli 
with some pus cells if the organisms be present. If 
fresh acid urine, examined directly it is passed, is 
found to contain organisms, then bacilluria may be 
fairly certainly diagnosed. As regards the treatment 
Dr. Lewie recommends urotropin in ten-grain doses 
three times a day for two or three days, since this 
drug is supposed to be excreted by the kidney as 
formalin, which has a powerful germicidal action. 
The best method of disinfecting the urine after it is 
passed is by heat, but carbolic acid 1-20 or percbloride 
of mercury 1-1000, if thoroughly mixed with the 
urine and allowed to stand for half an hour, is said 
to be efficient. 

The Public and the Medical Profession. 

The ordinary layman has pronounced ideas on 
the duties of the medical profession; ideas begotten 
and fostered by the self-denying ordinances that the 
members of the profession so generally adopt and 
practise. It has come to be looked upon as a part 
a doctor’s duty to incur expense, personal trouble* 
and to undergo hardships without looking for any 
reward. Knocked up at night to go to some sufferer 
who had been ailing all day, and whose friends post¬ 
poned calling in assistance until the small hours of 
the morning; roused without any compunction 
from his well-earned sleep, the doctor is called 
I upon to go with them. An accident occurs, and 
I the local practitioner is expected to be promptly 
I present. Any delay, any grumbling, is quickly re¬ 
sented by the compassionate public, not one of 
whom would incur the expense of a fee for the 
medical visit. But the doctor is expected to 
not alone visit, but to bestow bandages, dreesings, 
medicine, and so forth, as the case may require, at his 
own expense. At a recent case in the West of Ireland 
a lay Coroner had the temerity to lecture a local 
practitioner for not travelling twenty miles with a 
wounded man. The journey to the infirmary could 
be made by ra^i, the accident occurred on the rail¬ 
way, the local practitioner applied some first-aid 
dressing to the patient, and sent him to the hospital. 
At the inquest there was no word of censure for the 
railway company for not employing the surgeon to 
make the trip with the woimded man; no thanks 
given the surgeon who visited the patient and did 
what he considered best for him. But, on the con¬ 
trary, the Coroner hoped that “ in future, when a 

Di Google 



8»Pt. 18, 1901. 


NOTES ON CURRENT TOPICS. 


Thx Mxdioal Prsbs. 315 


ca»e of such gravity occurs, doctors will not view it 
with the callousness which is begotten of long asso¬ 
ciation with life and death.” We emphatically deny 
that the members of the medical profession become 
callous to human suffering. On the contrary, they 
become more and more sympathetic with suffering. 
Knowledge and experience makes them calm and 
self-contained in the presence of danger. They 
leam to act quietly, quickly,skilfully, in the presence 
of alarming accidents—a very different condition 
from the callousness begott^ of indifference. 


Mushroom Poisoning. 

It has been smd with great truth that in all 
probability the most dangerous feature concerning 
the risk of eating of mushrooms is the belief that 
the teste usually employed in the household are 
trustworthy. The average housewife is of opinion 
that she can infallibly detect an edible mushroom 
by the odour, especially if the particular species of 
fungus does not blacken a piece of silver while 
cooking. As a matter of fact the only compara¬ 
tively trustworthy tests are the botanical cha¬ 
racteristics of the fungi. It cannot safely be 
assumed that the majority of the individuals who 
gain a precarious living by gathering mushrooms 
are possessed of this somewhat unusual botanical 
knowledge, and the reason why more cases of 
poisoning do not happen is no doubt because the 
market supply is furnished by people who confine 
their harvest to a very few varieties of fungi which 
they know by experience can be eaten with impunity. 
The supply of mushrooms provided by cultivators 
of these fungi is in the nature of things beyond 
question. The individual most to be feared is the 
amateur or casual gatherer of mushrooms, and 
under these circumstances it is well to bear in mind 
the method followed by market-women before any 
doubtful fungi are prepared for food. The stem is 
scraped, the gills are removed, and the upper part 
of the cap is peeled. The fungi are then boiled in 
salt and water and finally steeped in vinegar. Any 
toxalbumin that may be present in them is removed 
by the boiling and the dangerous alkaloid muscarine 
is rendered innocuous by the vinegar. If one may 
judge from the full notice that this subject has 
received in the last volume of Sajons’s Annual, the 
occurrence of cases of mushroom poisoning have 
attracted considerable attention in America of late. 
It is certainly not very comforting to know that 
Mr. Colville, of the Botany Division of the United 
States Department of Agriculture, considers that 
“there is no single test and no safe series for 
poisonous mushrooms,” There is only one rule to 
be followed in avoiding poisonous mushrooms and 
that is to make sure that the particular variety is 
safe because it has been eaten with impunity. 

The Nutritive Value of Alcohol. 

Two experienced investigators have lately given 
to the world their conclusions on the subject of the 


nutritive value of alcohol, and unfortunately the two 
conclusions are absolutely contradictory. B. U. 
Neumann, in the issue of the Munchener Jfedian- 
I iscke Woehensehri/i of July 2nd, considers that there 
' can be absolutely no question as to the nutritive 
value of alcohol, and, in bis opinion, alcohol is a 
true food. On the other hand, H. J. Beyer, in the 
Boston Medical and Surgical Journal of August 
22 nd, proclaims his conclusion that alcohol has no¬ 
nutritive value whatever, but, on the contrary, that 
it causes an abnormal destruction of the proto¬ 
plasmic constituents of the body. He recommends 
its use only for the sake of its temporary stimulant 
effect in cases of extreme fatigue. Beyer bases his 
findings on the experience he had with five battalions 
of infantry and 2,300 coolies manoeuvring under a 
tropical son in a country infested by malaria, the 
issue of alcohol having been withheld-throughout 
the duration of the expedition, which lasted five 
months. The conclusions of Neumann are founded 
upon the results of certain experiments to which he 
submitted himself. The results of his experiments 
were practically the same, demonstrating that 
alcohol is a true food, although not capable of 
taking the place of fat in every respect. From an 
examination of Neumann’s experiments it is difficult 
to deny the albumin-saving property of alcohol, and 
his views have received full support from some per¬ 
sonal experiments carried out by Clopatt, and set 
forth in the Scandinavian Archives of Physiology, Nos. 
5 and 6 of this year. It must be clearly understood, 
however, that, although, according to Neumann and 
Clopatt, alcohol has an alimentary r6le, it must not 
be recommended for use as such, because it is also a 
poison when taken in what in ordinary language is 
termed moderate quantities. There are a sufficient 
number of scientific arguments against the abuse of 
alcohol without absolutely denying that alcohol is a 
food, because, in the face of modern research, this 
woul i certainly appear to be proven. 

Laohnanthes and Consumption. 

The Times correspondence in reference to Mr. Ala- 
bone's vaunted remedy for phthisis, is still dragging 
its slow length along. Some of the recent develop¬ 
ments have been hardly calculated to add to the 
dignity of legitimate medicine in tbeeyes of the public 
One of the leaders of the profession, as readers know, 
wrote to disclaim all knowledge of Alabone and his 
professed cures of consiunption. He further 
declared that he never heard of the drug called 
“ Lachnanthes,” the weirdly named medicament with 
which Alabone professes to exorcise the demon of 
tuberculous disease. We publish elsewhere a letter 
from an eminent authority on materia medica, in 
whose mind familiarity with this drug appears 
to have bred contempt. One thing must be 
evident to all candid men who have a grasp of the 
principles of modem pathology of tuberculosis, 
namely, that cure is not to be looked for from any 
specific drug or combination of drugs. In order 
that the mind of the public should be relieved 
D,. ^ 




316 Thx Mkdioaii Pubs. NOTES ON CURRENT TOPICS. Sxpt. 18, 1901. 


of anj impression that Mr. Alabone Las not 
been fairly dealt with by the medical profession, we 
herewith publicly invite him to declare the nature 
of his cure for consumption. If so simple a remedy 
as a preparation of a common American plant can 
cure consumption then it is clearly the duty of a 
medical journal to afford every facility in its power 
to the diffusion of that knowledge. For reasons 
already given we question the curative powers that 
are claimed for“ Lachnanthes." At the same time we 
shall be glad to subject Mr. Alabone’s reputed 
cures to scientific scrutiny. We may remark 
incidentally that after the recent correspondence 
from leaders of the profession no complaint can ever 
reasonably be brought against lesser lights of the 
profession who wish to air their views, wishes 
thoughts, knowledge, and aspirations, professional 
and otherwise, through the medium of signed com¬ 
munications in the public press. 

Poor-law Nursing. 

The Birmingham Gazette of August 31st contains 
some severe comments on the inadequacy of Union 
nursing at Walsall. It speaks of the disclosures as 
“ one of the most startling announcements that have 
been beard of late years in connection with Poor-law 
administration.” If the editor of the enterprising 
journal had haply been a reader of The Medical 
Press and Circular he would have found repeated 
comment and exposure of abuses of a precisely 
similar nature. The attention of the Walsall 
Guardii^ns was drawn by their medical officer 
to the fact that a probationer night-nurse in 
the infirmary bad under her charge two wards, in one 
of which were ten men in a critical condition. The 
chaplain had a still more “ startling ” story to tell of 
a probationer in charge of four wards, one of them 
containing three delirious patients who kept getting 
out of bed. The whole thing binges on the parsi¬ 
mony of guardians who understaff the nursing de¬ 
partments of their infirmaries. The Gazette, how¬ 
ever, need not go to Walsall for examples of that 
kind of thing. If we are not misinformed their oain 
large and palatial Poor-law infirmary is managed 
on strictly economical lines, and a single probationer 
may be found in charge of three or four wards, some¬ 
times in separate blocks, and holding a certain pro¬ 
portion of acute, dying, and delirious cases. At any 
rate, we understand that was the state of affairs not 
many years ago. We shall be glad to have the 
assurance of the Gazette to the effect that the 
responsible duties of night nurses are now 
reduced to safe and reasonable limits. The editor 
might with advantage make some inquiries as to the 
opinions of the Local Government icspectors upon 
the matter. 

A Departure in Mental Hospital Work. 

Like all other organic diseases, there can be no 
doubt that mental maladies might often be arrested 
or cured if brought under medical treatment at their 
outset. So far as insanity is concerned, the know¬ 


ledge of the ftilly*deveIoped condition has now 
reached an advanced position, but a vast deal 
remains to be learned as to its earlier manifestations. 
That state of matters is readily explained by the fact 
that the insane come under systematic medical 
supervision, as a rule, only when they have attained 
the asylum stage. Some years ago the energetic 
Medical Superintendent of the Morpeth County 
Asylum, Dr. McDowall, attempted to reach 
sufferers in the earlier stages by opening a 
department in the asylum whither persons supposed 
to be suffering from incipient insanity might 
be taken for advice. The experiment proved a dead 
failure, because persons afflicted in that way would 
shun the idea of approaching an asylum for any 
purpose whatever. Accordingly Dr. McDowall has 
secured the support of the managers of the Royal 
Infirmary, Newcastle-upon-Tyne, to another plan, 
whereby a special out-patient department is opened 
for the particular class of individuals in question. 
He himself has been appointed the first honorary 
physician, and attends weekly. This departure is 
likely to be of considerable value in filling up the 
gaps of medical knowledge as regards the early and 
sometimes curable stages of insanity. The pro¬ 
blems or causation, both predisposing and excitant, 
still require a great amount of investigation in the 
cure of mental maladies. 

Nail-bitiog and Neurosis of the Skin. 

Some discussion has taken place in medical cir¬ 
cles concerning a Continental professor’s contention 
that biting the nails was not merely a bad habit but 
was also a symptom of local asphyxia of the extremi¬ 
ties—that is to say, biting the nails was an outward 
and visible expression of certain pathological changes 
in the body. This question has been once more 
brought forward, in the Mediteinskoe Obosrenie, of 
June, 1901, by Pospieloff, who holds that nail-biting 
is a result of a peculiar venous stasis in the ends of 
the fingers in people so affected, and the gnawing of 
the nails is only a means of relieving the numb and 
heavy feeling in the finger-tips. We are not con¬ 
vinced, however, that nail-biting is therefore to be re¬ 
garded as a neurosis of the skin, but it is certainly 
worth noting, as Pospieloff points out, that intclli 
gent persons who are addicted to this habit explain 
that they are impelled thereto, especially when under 
the stress of emotion, by a feeling of weight and 
fulness at the finger-tips. It is further advanced in 
favour of this view that some medical students were 
observed to be addicted to the habit of biting their 
nails only when studying hard just before examina¬ 
tion, and cases are also reported of patients suffering 
from Raynaud’s disease who exhibited this peculiarity 
in common with their children, as in one instance 
where the habit obtained in a woman and in her ten 
children. All the phenomena in connection with 
Ra3maud’B disease have not yet been fully worked 
out, and until further advances have been made in 
this respect it would certainly be somewhat prema- 
tui'e to dogmatise on a matter of this kind. 

Di - sOOg c 


SsPT. 18, 1901. 


NOTES ON CURRENT TOPICS. 


'fSB MXDIOIL PbB88. 317 


St. Petersburg and Sanitation. 

Accobdiko to tbe well>known Russian physician, 
Dr. Yakovleff, the sewerage system of the Russian 
capital is rery defective in all hygienic respects; in 
other words, things are about as bad as they well 
can he. It is a considerable time since Peter the 
Oreat controlled tbe destinies of Russia, hut the 
wooden drainage canals furnished to St. Peters* 
burg by that ruler are still employed for the dis¬ 
posal of sewage. Alt water-closets and sinks drain 
into these wooden pipes of ancient construction, and 
the natural result is that not only the soil, hut also 
tbe air, of the city more or less reeks with gaseous 
abominations. It is therefore scarcely to be won¬ 
dered at that the annual mortality rate of St. 
Petersburg is about 30 per 1,060 of the population. 
Apart from this, it can scarcely be a pleasant city 
to live in since the tabulated results of a series of 
experiments demonstrate the continuous presence of 
sulphuretted hydrogen and other gases in the air 
at the level of the cellars, and also in dwellings six 
storeys in height. Samples of the air from the 
streets and courts and alleys furnished similar 
results. The quick transit of modem times has ren¬ 
dered the sanitary conditions of all large centres of 
population of importance to this country, and one 
cannot but look forward with impatience to tbe time 
when some effort to render St. Petersburg less of 
a menace to the health of surrounding nations will 
be made. 

Glycosuria and Cigars. 

Ik the early months of this year the view was 
advanced (ct) that the habitual or excessive use of 
tobacco not merely determined an exacerbation of 
existing glycosuria but also, though less frequently, 
that it might actually set up this condition. The 
constituent of tobacco smoke, considered to be the 
causative factor in this relation, was not nicotine, 
but the carbon monoxide resulting from imperfect 
combustion; and it was further noted that this 
tobacco glycosuria was only observed in cigar 
smokers. The publication of this etiological study 
of glycosuria has directed a considerable amount of 
attention to the question, and it has been suggested 
that the variations in the results of Krebl’s examina¬ 
tions made on certain beer-drinking students at 
Jena (b) are capable of explanation if tbe existence 
of a tobacco glycosuria be admitted. The dis¬ 
crepancies in Krehl’s conclusions have hitherto 
been ascribed to different individual dispositions to 
exhibit glycosuria and to the various kinds of beer, 
bat the whole investigation may have been com¬ 
plicated by the fact that some of the students who 
were the subjects of observation may have affected 
pipe-smoking, and others may have indulged in 
cigars. When tbe increase in the habit of smoking 
is taken into account it will be readily seen how 
necessary it is to arrive at some certain knowledge 
m this connection with so serious a malady as 
glyooeuria. _ 

<<i) H. Stem. Rtcord, April 22, 1901. 

(b; Ktehl, CentnUb. f. limeM Ued. Ko. 40,1807. 


The Medical Congreea at Cairo. 

Fbom many points of view the forthcomin g 
Medical Congress at Cairo shonld he of considerable 
intereet to the medical profession. The capital of 
the most ancient land of Egypt is a fitting place 
wherein to hail the teachings of modem science, for 
it was there that some of the earliest observations 
were made that have laid the foundations of the 
marvellous modem superstmcture of modem medi¬ 
cine. It is interesting to note that the 1902 Cong^rees 
at Cairo will be the first held in a really Oriental 
country. The increasing relationship of Egypt with 
the Far East has opened up a more direct interest 
in tbe transmission of many Eastern epidemic 
diseases. Under such circumstances discussions 
upon plague, malaria, abscess of the liver, cholera, 
dysentery, ophthalmia, and other specific infections 
that are mainly of tropical habitat cannot fail to be 
fruitful. Our knowledge as to the setiology of 
tropical diseases has made enormous advances during 
recent years, owing chiefly to the development of 
modem methods of research in bacteriological re¬ 
search. A vast fund of clinical observation must be 
at the command of Egyptian medical practitioners, 
and it is to be hoped that much valuable matter will 
be published at Cairo. Tbe Ehedive of Egypt has 
consented to take tbe movement under his patronage, 
and by his infinence has secured to tbe promoters of 
the Congress the solid encouragement of a Govern¬ 
ment grant. 

The Parent’s Right of ^feto. 

The parent is universally conceded a right of veto 
in respect of an operation on his children when cir¬ 
cumstances allow of his being consulted, and it is 
perhaps right that this should be so. Tbe parent, 
however, who, from prejudice or misdirected affection^ 
refuses surgical aid to his child and thus precipitates 
a fatal result, is morally guilty of manslaughter, 
although the law is somewhat ambiguous on 
the exact degree of bis legal responsibility. 
If medical aid be withheld and death ensues 
tbe parent is prosecuted, and it is not easy 
to trace any technical distinction between the 
conduct of a parent who refuses medical attend¬ 
ance and one who declines surgical assistance. This 
point was brought out at an inquest held by tbe 
coroner for Cheshire last week on the body of a girl 
who had a growth in the throat for which an opera¬ 
tion had been advised and refused, with the result 
that spasm of the glottis speedily caused death. The 
jury could do no more than censure the parents for 
their heartless conduct, and there the matter rests; 
but to all right-minded persons the feeling of having, 
even involuntarily, brought about the death of a 
child would entail unspeakable anguish, and this 
may be deemed punishment enough. 

Midwife and Medical Attendant. 

The contemptuous attitude of many midwives 
towards their duties and responsibilities could hardly 
be better illustrated than by the facts disclosed at a 

Di;....zed : 'OO^ C 


318 Tbb Hbdxoal Pbbbs. 


NOTES ON CURRENT TOPICS. 


recent inquest in London. The evidence showed that 
a woman was delivered bj a midwife of a child, 
which lived about ten minutes. It was not until 
three hours later, however, that the midwife thought 
it desirable to call in a medical man. The latter 
stated that so far as he could judge from the marks 
on the face of the child the birth was not normal. 
The jury censured the midwife severely for her re* 
missness, and there the matter ends. There is a 
moral, however, to the incident so far as the medical 
profession is concerned. If these things are done in 
the green wood what may we expect in the fully grown 
tree P In other words, now that the midwife has her 
status certified by an imposing document shall we not 
find her superior to the whole race of qualified prac* 
titioners P It is to be hoped that the coroners will be 
able to keep a tight hand over the midwife, otherwise 
a most insidious danger may be introduced into the 
heart of the community in the shape of a new branch 
of unqualified pi'actice. 

Suicides in the French Army and Navy. 

Thb tendency to self-destruction is peculiarly 
strong among the Latin races, and is more marked 
among the men undergoing military serrice than in 
the civil population. In the French Army suicide 
accounted for fifty out of every thousand deaths from 
all causes during 1900, and this figure represents 
twenty-seven suicides annually for each hundred 
thousand men under the flag. This proportion is 
slightly lower than usual, but is well within the 

limits of oscillation.” As might perhaps be ex¬ 
pected the number of snioides is proportionally 
greater among the marine than among the land 
forces, rising to sixty-nine per thousand deaths, and 
per hundred thousand on active service. Among the 
various native races serving in the French marines 
the proportion of suicides is much smaller—only 
about twenty-four p>er thousand deaths (fifty-nine 
per hundred thousand on service). In the Navy 
proper there are only twenty-six suicides per 
thousand deaths, equal to seventeen per hundred 
thousand sailors. 


Hospitals at the Front. 

The interesting communication which we pub¬ 
lish fiom the pen of Dr, J. B. Coleman em¬ 
bodying bis very extensive experience of medi¬ 
cal service at the front is, on the whole, 
pleasant reading after the violent denunciations of 
which the Army Medical Service has of late been the 
object: indeed, it is difficult to believe that he is 
dealing with the same campaign. It is obvious that 
the shortcomings so bitterly complained of by certain 
critics were not characteristic of ^e hospital adminis¬ 
tration throughout. The importance of disease in 
weakening forces in the field is but too apparent, the 
sick outnumbering the wounded in the proportion of 
twenty to one. The author’s remarks on the value of 
inoculation as a protection against typhoid fever are 
worthy of note. His returns show a mortality twice 
as great among the uninoculated as among the in- 


SXFT. 18, 1901. 
^onlated, but we must remember that his statistics 
only bear on a comparatively small number of cases. 

Orthomtrophenylpropiolic Acid. 

Acgobding to the authority of Dr. G. Ruini, th& 
following is a successful method of determining the- 
presence of glucose in the urine. Dr. Ruini has used 
the reaction for two years, and recommends its adop> 
tion. The reagent used is a ^-lOths per cent solu¬ 
tion of orthonitropbenylpropioHc acid in 10 per cent 
soda solution. Ten drops of the urine to be tested 
are boiled with 5 c.c. of the reagent. If the liquid 
turns dark blue 5-lOth per cent, of glucose or an 
equivalent quantily of reducing agents are present. 
A green colour is observed if smaller quantities of 
glucose are present, and a bright red colour is seen 
with excessively large quantities. Albumen has no 
effect on the reaction, and it is said that the reagenb 
keeps indefinitely unchanged. Fall details are given 
of this test in the Beforma Medica of June 25th. To 
define the reaction more sharply, Dr. Ruini adds 
chloroform to the cooled liquid, and shakes the test- 
tube well, with the result that after standing the 
colour reaction is more marked. 


Bonesetters and Quacks. 

A WIDE publicity has of late been given to the 
exploits of a certain notorious bonesetter, and hie 
friends have taken .advantage of the opportunity to 
boom his attributes to the utmost. One fact is 
obvious, viz.f that the so-called educated classes are 
as gullible and as prone to faith in unauthenticated 
cures as their, educationally speaking, less favoured 
brethren lower down in the social scale. Patent 
medicine vendors confidently rely to a very great 
extent on a clienUU derived from the upper strata 
of society, and their confidence is not belied. There 
is nothing in this that should cause surprise. Edu¬ 
cation does not per ae confer intelligence, which is a 
congenital quality, improved but not created by edu¬ 
cation. The wish which is father to the thought is 
as potent in the breasts of the educated as in those 
of the unlettered, and credulity is by no means the 
exclusive appurtenance of any social status. 


Royal Army Medical Corps. 

The following officers of the R.A.M.C. are 
“ specially mentioned ” by the Commander-iu-Chief 
in connection with services rendered in South Africa: 
—CoL J. A. Clery, Col. R, Exham, Lieut.-CoL T. R. 
Lucas, Lieut.-Col. F. A. B. Daly, Major S. Westcott, 
Major B. Kirkpatrick, Major R. J. Geddes (attached 
East Kent Begt.), Major 0. R. A. Julian, Capt. S. G. 
Moores (attached Scots Guards), Capt P. Smith 
(attached Wiltshire Regt), Capt H. J. Parry, Capt. 
J. H. £. Austin (attached Grenadier Guards); Capt. 
E. M. Pilcher, Capt. W. A. Ward, Lieut G. G. Delap 
(attached G. Battery Royal Horse Artillery), Lieut 
O. Challis, Lieut. L. N. LLoyd (attached Royal Dub¬ 
lin Fusiliers), Lieut T. C. Mackenzie (attached High¬ 
land Lt. In.), Lieut. T. E. Fielding (attached 
Mounted In.) 

Google 


Dl:-' ‘ - 


Skpt. 18. 1901. 


NOTES ON CUBENT TOPICS. 


ThB MbDIOjil Pb188. 319 


Medical Reform. 

The interest which is felt b; a large proportion of 
practitioners in the cause of medical reform is 
evidenced by the copious correspondence in the 
TariouB oi^ans of professional opinion. We regret 
that considerations of space prevent our publishing 
a very thoughtful commimication from Dr. Angus 
Macphee, of Glasgow, on this important subject, 
wiiich, however, appears in full in several of our 
contemporaries. Dr. Macpbee insists on the unsatis¬ 
factory way in which the General Medical Council 
discharges its duties as the medical parliament of the 
kingdom—witness the chaos in medical education as 
a possible result of the half-hearted manner in which 
tlie dispute with the London colleges has been con¬ 
ducted. He complains, not without reason, of the 
inadequate control exercised bj the Council over 
certain departments of medical students’ education. 
Saving described tbe Council as the " medical par* 
liament ” Dr. Macpbee proceeds to argue as if the 
Council possessed the legislative attributes of 
such a body, which is, unfortunately, perhaps, 
not the case. He suggests, for instance, that 
ibe Council shoidd inaugurate the “one portal” 
system, a step which would be in excess of its statu¬ 
tory powers. The Council might, it is true, frame a 
Bill to put down quackery, but what chance would 
the Bill have of becoming law? Dr. Macphee is 
doubtless in the right when he attributes tbe halting 
^it of the Council to the overwhelming preponder* 
ance of the nominees of qualifying bodies on the 
hoard. We would suggest to him that an alternative 
to the withdrawal of these representatives, in whole 
or in part, would be for them to be elected by the 
constituent members of the licensing bodies instead 
of, as is now the case, by a “ ring ” of office holders. 
In this way we should obtain in large measure tbe 
advantage of direct representation while still keeping 
the bodies in touch with tbe Council. We agree with 
our correspondent that it is time the various medical 
societies of the kingdom took action in the matter. 
It is only by concerted and collective pressure that 
we can hope to achieve this measure of reform which 
is a necessary prelude to the oi^nio measures which 
our correspondent advocates. 

The Death of Mr. McKinley. 

In spite of tbe sanguine tone of the ante-penulti* 
mate bulletins, our anxiety was maintained with 
regard to the ultimate fate of the unfortunate 
Btatesman whose death we all sincerely deplore. 
Although a few brilliant achievements in this direc¬ 
tion show that recovery is possible after operation, 
especially if promptly performed, the fact remains 
that perforated wounds of the stomach are, in tbe 
majority of instances, unavoidably fatal. The gravity 
of the injury is vastly increased when the victim is 
past middle life, especially if the kidneys are working 
with a narrow margin. The fatal result in tbe case 
under consideration appears to have been due to 
uraemia, precipitated, in all probability, by a lacera¬ 
tion of one organ caused by tbe bullet. Tbe tissues 


failed to display the tendency to heal which the sur- 
geons in attendance had a right to expect, and no 
attempt at repair had apparently taken place in the 
wounds. The nrsemic process amply acooonte for the 
prostration and cardiac failure which heralded the 
fatal dinotiement. and which no medication could pos¬ 
sibly hold in check. 

A Good Kxample. 

The Rev. Richard Wilson, of St. Angnstine’s* 
Stepney, is an enlightened advocate of vaccination. 
A case of small-pox having occurred in some hop 
fields with which be is concerned, he came to the 
very sensible conclusion that as many as possible of 
the hop pickers should be at once vaccinated if an 
epidemic among them was to be averted. Accord¬ 
ingly every evening in a large marquee at Five Oak 
Green a concert was given, while in an adjoining tent 
the vaccmationofficer was bard at work vaccinating all 
of the audience who could be persuaded to undergo 
the operation, he himself setting the example. We 
commend the rev. gentleman’s example to thoseof his 
fellows who have the physical as well as the moral 
advantage of their flocks at heart. 

Medical Practice at the Cape. 

Fiftt-sbvbn medical practitioners applied for 
registration of their diplomas at the Cape of Good 
Hope dnring 1900, tbe number being slightly below 
tbe average. Thirteen dentists applied for registra- 
■ tion, and three were refused owing to their failure to 
satisfyihe Council’srequirementsastoprevioustrain- 
ing and qualifications. A warning having been issued 
to “ dentists and other registered persons ” against 
advertising, it is reported that all the advertisements 
complied of have been withdrawn, proceedings 
having been found necessary in only one instance. 

A Statue to Dr. Armauer Hansen. 

A STATUE has been erected in the garden of the 
Bergen Museum to Dr. Armauer Hansen, tbe dis¬ 
coverer of the bacillus of leprosy, on the occasion of 
his sixtieth birthday. It is not often that a medical 
man attains this dignity during his lifetime, but his 
fellow-countrymen determined not to defer this 
public recognition of tbe scientific merit and profes¬ 
sional attainments of their distinguished compatriot, 

PERSONAL. 

It is announoed that Mr. Oeorge Lambert is on the 
point of rejigning the post of Director of Greenwich 
Hospital, after forty years* service. 

Db. C. F. £. UuBBAT has been appointed an addi¬ 
tional member of the Cape of Go^ Hope Colonial 
Medical Council, under the provisions of the Medical 
Connoil and Pharmacy Ao*> Amendment Act (1899). 

Db. J. E. Huohss, Medical Officer of Health for the 
Aberystwyth District, has been presented with a silver 
cabinet by 1,170 friends and patients on his retirement 
after 25 years practice in Llanilar. Presents were also 
made to Mrs. and Mias Hughes in token of appreciation 
by tbe donors. i 

D Cjoogle 



320 Mkdioal Prxbb CORRESPOyPBNQE. 


Lixvt.-Colonxl Knox, of the Boyal Army Medical 
Corps, who has been chief medioal officer in chai^ of 
the Cambridge Hospital at Aldershot since the com¬ 
mencement of the war, baa just retired after thirty- 
three years’ service. He was specially mentioned for 
Benrioes daring the Afghan War. 

Da. Astlkt CLAnxi and Mr. Hy. J. Blakesley. 
P.B.C.8., have been appointed Hon. Physician and Hon. 
Snrgeon on the staff of the Leicester Royal Infirmary, 
vice Lrs. Neale and Clarke, recently deceased, a resoln- 
tion expressive of r^ret and condolence witii the 
relatives of deceased being passed at last week’s 
meeting of the Board of Governors. 

Scotlunii. 

[fboh ocb own cobbxspondsnt.] 

SANITARY ASSOCIATION OP SCOTLAND. 
Tbk twenty-seventh annual Congress of the Sanitary 
Assooiation of Scotland was held at Paisley, seven miles 
from Glasgow, on September 6th, 6tb, and 7th, and was 
attended by snch a lax^e number of members and dele¬ 
gates that the accommodation of the lectare-ball 
in connection with the Free Library and Mnsenm 
was taxed to its atmost when the presidential 
address was delivered by Dr. Robert Farqaharson, 
M.P. Among those attending the meetings were 
Lord Dali^mple, C. B. Benahaw, M.P., Provost 
Cowan, Paisley; ex-Provost Clark, Paisley *, Professor 
Glaistw, Glasgow; Bailies Steel, Dick, and Dnnlop, 
Glasgow; Dr. Chalmers, M.O.H., Glasgow; Drs. Dnnosn, 
Dewar, and Richmond, Glasgow; Dr. Robertson, M.O.H., 
Leith; Dr. Robb, M.O.H., Paisley; Dr. Mnnro, M.O.H., 
Renfrewshire, Ac. Dr. Farquharson, the president, took 
for the snbject of hi) address '* Domestic and Official 
Sanitation.” H» referred to the theory put forth by 
Koch recently at the London Congress on ^beronlosis, 
with regard to the non-commnnicability of bevine tuber- 
onions disease to man. He believed that a diseased 
beast was a focus of infection which should be notified 
and isolated, and therefore he took exception to Koch’s 
views as expressed recently in London. 

Rkcxption Honexs. 

Professor Glaister (Glasgow) introduced a discussion 
on reception houses. He dealt in detail on the law re¬ 
garding them, their obj'>cts, the treatment and super¬ 
vision of those received, as practised and as proposed, 
and the proper situation of such booses. An animated 
discussion followed, in the course of which Bailie Water- 
ston, Edinbut^h, said that he looked upon such houses as 
intended for isolation only. He made reference to 
medical men not always doing what they preach, as 
they went in and out among patients of all kinds. He 
thousht there should be no mixing with the public. 
Mr. Fyfe, Chief Sanitary Inspector, Glasgow, said recep¬ 
tion houses should be centrally situated, instead of being 
on tbe outskirts of a city. Several other gentlemen 
took part in the discussion. 

Consumption. 

Among many interesting papers read was one by 
Councillor Mallinson, Edinburgh, ou "The Duty of 
Local Authorities with Regard to Consumption.” He 
said that recent discoveries as to the nature and origin 
of consumption have completely changed the attitude 
of medical men and the public toward the disease. He 
believed that if tbe disease is to be fought and con¬ 
quered, as it can be, more specific mtans must be 
^opted in the future than ^ve been in the past. 
He advocated compulsory notification, the establiebment 
of bacteriological laboratories by municipal authorities, 
the distribution of leaflets to all classes, giving informa¬ 
tion as to how the disease is spread, and explaining tbe 
extent of its ravages, tbe establishment of sanatoria 
by municipalities, and of hojipitals for cases where the 
patients are bed-ridden and there is no accommodation 
in tbe homos for isolation, and, lastly, the oompulsory 


SxpT. 18, 1901. 

disinfection of all rooms in which consnmptive patients 
have di^. A disonsdon followed in which Dr. Dnnoan 
(Glasgow), Dr. Russell (Paisley), and others took part. 

On the kind invitation of the Provost and msgistratea 
of Paisley, a party of from 200 to 800 were driven to 
BarrheM, where they visited the Corporation Sew^e 
Pnr^oation Works. The company was photographed 
here. Provost Heys, of Barrhead, kindly entertained the 
company to light refreehments in the Burgh Hall. 
Following the oonclnsion of the business the whole 
company, on the invitation of the Provost, magis¬ 
trate, and Town Council of Paisley, drove in breaks 
on the Satnrday to Bridge of Weir, where the well-known 
" Home ” of Mr. Qnarrior are situated. After being 
shown over the "Home” and" Sanatoria for Consump¬ 
tive,” the company was very hepitably entertained by 
Mr. Qnarrier, wbo was heartily thank^ for the same 
on the motion of Dr. Farqaharson, M.F., seconded by 
Lord Dalrymple. 


dBtrtspfmbfitta. 


[We do not hold oorselvestesponsible for the opinione of oar 
oorrespondents.] 


LACHNANTHES TINCTORIA. 

To tht Editor of Thx Mxdicxl Fnxe and Cikcular. 

Sib, —The plentifnl lack of knowledge of the literature 
of materia medica exhibited by many writers in tbe 
Times in the reent controversy on tbe merits and pro¬ 
perties of Laohoantbes affords conclusive proof of the 
sad neglect and state of deoadenoe into which the study 
of pharmacology and the physiological action of drugs 
has fallen in this oonntry Lachnanthee is a remedy of 
no importance; it is far more frequently employed by 
the pnblio than prescribed by the medical profession; 
bat it is neither wise nor expedient to ignore its exist¬ 
ence and to have to confess that even its name ii un 
known. It is humiliating to have one’s deficiencies in 
this respect supplied by some casual chemist or unortho¬ 
dox pn^tioner. A want of knowledge of the teohnicsU- 
ties, even of the trivialities, of one's calling is an offence 
not readily condoned by the lay mind. In saying this 
I am not refieoting on any parincolar set of 
iadividoals, hot am simply pointing ont that 
materia medica is no longer cultivated with the same 
oire and attention to detail as is devoted to, let us 
say. pathology and bacteriology. And this, I think, is 
a pity, for it is difficult to disabuse patients of the idea 
that one, at all events, of the fuaetions of a physiciaa 
is to cure or alleviate disease, and to make himself 
acquainted with tbe actions and uses of drugs. 

What, then, ought we to know about Lachnanthee, 
and where can this information be obtained ? A fairly 
comprehensive account of its origin and reputed powers 
is given in King’s well-known " American Dispensatory,*' 
18tbedition,third revision, (1900)Yol. IE..p. l,112,a work 
which, if I mistake not, was favonrably reviewed in The 
Medicxl Pbrbs and Cibculab only a few weeks ago. 
In this comprehezuive treatise it is stated that the 
botanical name of the plant is Laehtianthes tinc» 
toria, and that it belongs to the N.O. Hmmoderaose. 
Its popular names are “red root” and "spirit 
wood." It is a native of the United States, and 
grows abundantly in sandy swamps and on the borders 
of londs near tbe Atlantic coast, from Rhode Island 
to Florida. It fiowers in July, and the root is nsed as a 
dye. A saturated solution of the whole plant is pre¬ 
pared. In large doses it dilates the pnpils, impairs 
vision, produces dizziness and "other unpleasant sym¬ 
ptoms,” from which I gather that it is a kind of weak 
belladonna. As is usual with this partioalar class of 
remedy, it is reputed to be an unfailing specific for 
pneumonia, nervous and typhns fevers, diseases of the 
brain and spinal cord, delirium tremens, wry-neck, laryn- 
i geal cough, tinnitus aurium, and nervous bead-aohe. Tbe 
dose is two minims every three or four hours, and for some 
inscrutable reason, it must be given well dilated with 
water. Its pharmacological action has not been investi¬ 
gated, and no active principle has been obtained from it. 
It has been landed as a specific for consumption, and 



Sift. 18, 1901, 

people talk wildly of the Laclinanthee Cure.” I am 
not aware, however, of any anthenticated caee, and by 
I mean a case pnblished, with eome approach to 
accanay of detail, in which it has proved beneficial. 
Some seven years ago I tried it, fortunately on a small 
scale, and obtained absolutely no effect from it even in 
large and frequently-repeated doses. There is no more 
reason for employing it in phthisis and other diseases 
of tuberculous origin than there is for prescribing the 
thousand and one other drugs which are describe in 
every herbal and dispensatory with equal accuracy and 
minuteness. I have been familiar with the drug for the 
last twenty years, and have frequently refeired to it 
indden^ly In my lectures at the Westminster Hospital. 
1 have no hesitation in asserting that far better results 
would be obtained in a case of phthisis from a single 
week's inhalation of some efficient antiseptic, snoh as 
formaldehyde, than from the administration of gallons 
of snch an inert preparation as tincture of lAOhnanthes. 

I am. Sir, yours truly, 

Welbeok Street, W., William Musrbll. 

Sept. 16th. 1901. 

THE SCHOOL-BOAKD AND VACCINATION. 
To the £diior of Tbk Midical Press and Circular. 

Sir,—I suppose most medical praotitiouers would 
gladly accept Dr. Garrett Horder’e suggestiou that no 
ehUd ahould be admitted to a Board school unless a 
certificate of successful vaoclnation is produced. Were 
this made a rule and strictly enforced the proportion of 
unvaccinated ohildren woidd be reduced to vanisbiug 
point, and the spread of small-pox would receive a 
wholesome check. It is indeed a matter for surprise 
that no snoh regulation should hitherto have been put 
ioto force. This country, I believe, etamis alone in not 
exacting proof of vaoclnation from intending scholars— 
a circumstance which is. to say the least, remarkable in 
the land where vaccination was discovered. 

If the School Board authorities all over the country 
would adopt this elementa*y precaution, the other 
scholastic establishmects would doubtless follow suit. la 
Frsnee, where vaccination is not compulsory, there are 
but few unvaccinated persons owing to the rule in re¬ 
gard to school children, and in respect of the males, all 
are revaodnated when they enter on their military ser¬ 
vice, a lesson which was well rubbed in duringthe Ftanoo- 
German W ar. 

We are told that School Boards have no legal power to 
insist on vaccination, an assertion which is open to ques¬ 
tion in view of the extensive powers conferred upon 
them in the management of their schools. In any event 
we can hardly imagine that so obvious a saf^^ard would 
be refused by the Legislature. 

I am, Sir, yours truly, 

M. 0. H. 

THE BIOLOGICAL TEST. 

To the Editor of Tbb Medical Press and Circular. 

Sir,— Mr. Edward Berdoe asks, with some prima facie 
ebow of reason: “ Why should pneumonia be more 
easily diagnosed in a dying or dead mouse than in the 
man from whom the disease was taken,’* from which I 
apprehend he means that the bacteriological test in man 
should suffice. Although I know little of bacteriology 
and less of vivisection, I venture to guess as to the 
former that bacteriolog'sts recognise the non-infallibility 
of their expeiimenta, and the case of Mr. Berdoe’s 
relative won'd appear to confirm this ; therefore in 
doubtful cases they think it advisable to inoculate a 
lower animal as a further test, and sapposing no disease 
is set up in the lower animal from such inoculation, 
negative evidence would be thereby procured, and 
their conclusions fortified, and of course this would be 
an argument in favour of vivisection. 

With regard to vivUeotion itself, about which, as I 
have said, I know very little, although as I believe, 
broadly speaking, the objectors base their views on 
two fundamental principles, vis., the inhumanity, and 
secondly the inutility, of the system. With regard to 
^e former, supposing that to be their sole objection— 
in other words that the lives of the lower 


The Mrdical Panaa. 321 

should be bracketed with and as equivalent in import¬ 
ance to our own, which may be a matter of opinion— 
morally speaking, we are all bound to become vegeta¬ 
rians. With re^ud to the latter, viz,, its inutility, 
that is to say, if their proposition is that vivisection is 
no aid to scientific research—it appears to me for oue 
mongtrous. I remember reading many years ago in 
Eirke's Physiology ” an experiment perform^ on two 
dogs with the view of testing the sustaining proper¬ 
ties of a purely nitrogenous diet, one dog 
being fed on tea and the other being 

supplied with no food at all, and the one fed on beef 
tea perished first from starvation. Would Mr. Berdoe, 
or any of his disciples, contend that apart from chemical 
analysis the result of the said experiment served no 
useful purpose ? If so, 1 will suggest to them that it 
might be of inestimable valne in pointing out in a sick 
room to the school of that or any other day how much 
reliance ought to be placed on b^f tea as an article of 
diet in sicknees, and surely this must be a matter of 
public benefaction. 

I am. Sir, yours truly, 

130, Queen's Uoad, Peckbam, 8.E., Clement H. Serb. 

September 13th, 1901. 


THE TWIN ICE BAG. 

To the £d\ior of The Medical Press and Circular. 

Sib,—H aving been informed that there was no special 
bag on the market for applying ice to the thorax or abdo¬ 
men of a restless patient, and in my practice having felt 
very ranch in need of such an apparatus, I gave Ueesrs. 
Arnold and Sous full instructions (dimensions included) 
to make me what I have termed the Twin Ice Bag, of 
which a sketch is given herewith, and have found it to 
answer admirably. 



It is made entirely of plain rubber, straps included; 
it is thereby not iojuriously acted upon by the secre¬ 
tions from the body. Having given it a good pract'cil 
trial I have found it to give complete satisfaction, and I 
can confidently recommend it to the profession. 

The advantages I claim for it are:— 

First.—In ite application to the thorax back or front; 
reatiesaness of the patient does not interfere with its 
perfect action. The ice or ice water, owing to the two 
separate compartments, cannot gravitate from the aide 
on which it is required to act. It can be emptied or filled 
with very little disturbance to the patient, if the night 
dress is put on ao that its opening corresponds to the 
seat of the ice bag, namely, on either the anterior 
or posterior surface of the Iwdy. It will be seen that 
on loosing the shoulder straps (not interfering with the 
waistband) whilst the patient lies on bis side and 
allowing the upper portion of the bag to hang down, 
removing the stopper, aud slightly pressing on Uie bag, 
the contents can be emptied into a dish and refilled, 
with a minimum of disturbance to the patient. If the 
patient is not too ill to sit up in bed, it will be easier 
still to empty and fill the bag. The openings in the ice 
bag are so placed that they are very unlikely to press 
on the patient, but, if they happen to do so, they are 
within snch easy reach of the patient that he can place 
them just as be likes. 

Di> 


CORRESPONDBNOB. 


} 




322 Tss MssiciL PBBae 


MEDICAL NEWS, 


SSFT. 18. 1901. 


The application of ioe in pnettmonia I believa to be 
the most satisfactory treatment, eepeoially from its 
effect in controlling the temperatiire. 

Secondly.—In its application to the abdomen, as will 
be seen, the shoulder straps can be made nse of ronnd 
the thighs, and the appliwoe in this situation has all 
^e adrantages claimed in its application to the thorax. 
On the abdomen it is not only useful in oases of inflam* 
matory troubles situated in this oarity, bat simply as a 
gener^ temperature reducer I have found it to act 
▼ery beneflcially. I see no reason why this bag should 
not be applied to the head as well, in oases of rmraotory 
patients, using the arm straps under the armpits, and 
the waistband under the chin. 

I am, Sir, yours truly, 

Mabtih J. Cuxtxbb. 


(Dbituarg. 


Wb r^ret to hare to chronicle the death of Dr. John 
Louis 'William Thudichnm, whose death took place at 
his residence, 11, Pembroke Gardens, Kensington, on the 
7tb inst. Dr. Thudicbum was of German origin, and 
graduated as M.D. at the University of Giessen as long, 
as fifty years ago. He came to this country and took 
the diploma of memb er of the Boyal CoU^e of Surgeons. 
After passing several years in general practice he became 
a member (1860), and later a Fellow (1878) of the Boyal 
College of Physicians of Jiondon. Dr. Thndichnm's 
attention was early directed towards what is now known 
as chemical pathology, the changes produced by 
disease in the chemical activities of the human body ; 
and, his work in this direction having been brought 
under the notice of Sir John Simon, then Medical 
Officer to the Privy Council, he was employed to con* 
dnct a series of researches for the Government, the 
results of which were published in Sir John Simon’s 
successive annual reports for the years 1866-72, 
under the title of " Sports on Chemical Besearohes 
to Promote an Improved Identification of Disease.” 
At about this time Dr. Thudichnm began to turn bis 
thoughts towards the chemistry of wine production; 
and, in conjunction with Dr. DuprS, he published in 
1871 a volume of 700 pages on this subject, which 
attracted considerable attention and hostile criticism. 
Dr. Thudiohnm's next departure was in the direction of 
the employment of electricity as a curative agent; but 
he never lost sight of organic chemistry, and published 
a treatise on the chemical constitution of the brain so 
lately as in 1886. He was at one period lecturer on 
pathological chemistry at St. Thomas’s Hospital, and 
from time to time held several professional appoint¬ 
ments of secondary importance. Dr. Thudichum had 
for many years an extensive private practice, and was 
much estmmed by a lai^e circie of friends; but his 
activity in the domain of science somehow never 
realised one’s expectations. He was a man of inde¬ 
fatigable energy and a strikingly original tom of mind. 


literature. 

ltACNAUGHTON-JONBS’3 PRACTICAL 
GYN.i:COLOGY. (o) 

This excellent book has now reached its second edi¬ 
tion. Its efaaptors are reprints of a series of communi¬ 
cations which appeared in the Edinburgh Medical Journal, 
which were written for it by the author at the request 
of the editor. Practically the entire domain of gynee- 
cology is dealt with. It is written in the author’s beet 
style, and its value to the consultant is much mihanced 
by the full reports of interesting oases. This is 
especially so in the chapter on ” Some Pitfalls in Gynffi- 
colc^cal Diagnosis,” which is, perhaps, one of the best 
in the book, and will well repay reading. In the 
chapter on *' Some Points in Gyniecological Asepsis ” he 
labours heavily to out-Herod Herod in bis methods and 
technique. He has succeeded in confusing methods in 

(a) "Points o( Practical Intsrest ij Ornnecolory.'' By H. 
Hacnauxbton-Jjoes, U.D., M.Ch., O.H.I. With Twelve Plates. 
London; BailUere, Tiadall, and Cox. 1901. 


a manner that is perfectly bewildering. Having read 
the chapter, one is at a loss to know what particular 
method the author reaUy follows. We hardly think 
it necessary in cases of curettage to follow the author’s 
directions in fuU “ the vagina is thoroughly prepared 
the day before and the vulva shaved.” Why shaved ? 
The therapeutics of disorders of menstruation he treats 
under the beads of hygiene, me^oine, and operation. 
His hints are very valuable, eepeoially to the busy prac¬ 
titioner; his advice as to the selection of Continental 
spas is good; we are sorry he did not include and show 
a preference for our home waters and spas, the medicinal 
properties of which are equal if not superior to those 
found on the Continent. 

The feature of the book is the new chapter on retro¬ 
version ; it raises the level to a high standard, and in it 
be justly recognises the value of the teaching of Prof. 
Sbnitz in bis book on “Displacements of the tTtorus.’* 
an excellent translation of which, by Dr. Arthur Moen, 
late Master of the Rotunda Hospital, was brought out 
in the year 1688. Dr. Jones’s conversion to the te^hings 
therein we gladly recognise. Many beautiful platM 
adorn this edition, and we warmly congratnlato the 
author on his interesting contribution to gynseoologicat 
literature. The book is at once interesting, sound, and 
practical. 


dftcbiwl (^ctos. 

Inianity in the County of London. 

Thx twelfth annual report of the Asylums Committee 
of the London County Council, which has just been 
issued, gives a clear view of the general oondition of 
the insane during the year ended March 31st last. On 
January 1st, 1901, the Council had under its chai^ 
21,369 insane persons, or 24 less than at the same period 
of the preceding year. The total was composed of 
6,482 males and 8,842 females who were certified pauper 
lunatics in asylums and licensed houses; of 2,689 males 
and 2,878 females who were imbeciles in the asylums of 
the Metropolitan Asylums Board; of 151 males and 
206 females who were lunatios in workhouses; and of 
62 males and 110 females in the care of their own 
friends. There was an increase of 213 in the number of 
the certified pauper lunatics in asylums, and of 31 in the 
number of lunatics in workhouses, with a decrease of 
203 in the number of imbeciles, aad of 65 in the number 
of lunatics imder the care of friends. A decrease in the 
total number appears for the first time since the 
operations of the Council were begun, the aven^ 
annual icorease since 1890 having been 603; so that 
there appears at first sight some probability that the 
progress of insanity in the county has at last been over¬ 
taken by the provisions mode for dealing with it in a 
satisfactory manner. The statistics in question are, 
however, to some extent vitiated by the number of 
lunatios chargeable to the county who are boarded out 
in other asylums, and the same observation applies to 
the numbers or ratios of deaths or disebarges. In the 
London asylums themselves the total percentage of re¬ 
coveries was 36‘28 on 3,531 admissions, 903 on the 
averse number resident, and 7‘33 on the total number 
under treatment. The percent!^ of deaths on this last 
number was 7‘56. The report contains a larg;e amount 
of detail with regard to each of the eight asylums under 
the control of the CouncU, and an intereeting report 
from the pathologist, Dr. Mott, F.R.S., whose work and 
that of his assist^ts appears to offer increasing proba¬ 
bilities of new light upon the causes and treatment of 
insanity. 

Ptomaine Poisoning. 

Thx death has taken place, from ptomaine poisoniag, 
of the Rev. John Driver, refident priest at St. Joseph's 
Roman Catholic Church, Bishop’s Stortford. Father 
Driver was seized with illness after eating tinned 
salmon, and lingered in great agony for a week. 

St Thomas's Hospital House Appolntmenta 
Thx following gentlemen have been selected as House 
Officers from the present month; — 

House Physicians: L. H. C. Birkbeok, B.A., H.B., 
B.Ch.Oxon.; Y. S. Hodson, B.A., M.B., B.Ch.Ozoa.; 

Dir lO X C 



Skpt. 18, 190L 


MEDICAL NEWS. 


Ths Mbdicu Pbbss. 323 


J. E. H. Sfcwyer, M.A., M.B., B.Ch.Oxon. (Extension) ; 
J. L. Look, M.A., MB., B.C.Cantab., L.R.C.P. 
M.B.C.S. (Extension). 

Assistant House Physicians: W. M. G. GlanTille, B.A., 
MB B.Ch.Oxon} T. W. 8. Paterson, M.A., B.C. 
Cantab., L.R.C.P., M.B.C.8. 

Honse Surgeons: C. A. R. Nitcb, M.B.Lond., L.B.C.P,, 
M.E.C.8.; W. H. O. Woods, B.A., M.B., B.C.Cantab.; 
8. Hunt, L.R.C.P., M.R.C.S.; A. S. Grimwade, L.R.C.P., 
M.R.C.S. 

Assistant House Surgeons: G. A. C. Shipman, M.A., 
■M.B., B.C Cantab , L.E.C.P., M.B.C.S. j W. Hill, B.A. 
Cantab. L R C.P., M.R.C.S.; T. W. H. Downes, L.E.C.P., 
M.RC.8.; P. J. ChUd.M.A.,M B,B.C.Cantab.,L.R.C.P., 
M.R.C S. 

Obstetric Honse Physicians: (Senior) H. S. Stannus, 
IjR.C.P., M.R.C.S. ; (Junior) Z. Mennell, L.E.C.P., 
M.B.C.8. 

Ophthalmic Honse Surgeons : (Senior) H. S. Harris, 

L. RC.P., M.R.C.S.; (Junior) P. B. Skeirett, B.8o.Lond., 
L R.C.P-, M.R.C.S. 

Clinical Assistants in the Special Department for 
Diseases of the Throat : H. T. D. Acland, L.R.O.P., 

M. B.C.S.; A. D. Hamilton, L.R.C.P.. M.R.C.S. Skin: 
F. Clarkson, M.B.. B.S.Durh.; J. L. Timmins, M.A., 
B.C Cantab. Ear: H. Spurrier, B.A.Cantab., L.R.C.P., 
M.B.C.S. 

Clinical Assistants in the Electrical Department: H. 
T. D. Acland, L.B.C.P., M.R.C.S. 

The Incorporated Dental Hospital of Ireland. 

Wk r^ret that Dr. C. E. Boyce’s name was 
accidentally omitted in the list of aniesthetiets for the 
above hospital published in our " Educational Humber " 
last week. 

Belfast. 

Tub serious outbreak of typhoid fever which has 
occurred in Belfast has already been noted in these 
columns. The following table, which was presented to 
a meeting of the City Corporation held on September 
1st, by Alderman J. Graham, M.D., shows the serious 
increase iu frequency in the occurrence of thia disease 
which has taken place during the past three years. 
With a record of 505 cases for one month it is impera* 
tive that the Belfast sanitary authorities should take 
etepe to ascertain and to combat the cause of the out* 
break. 


Month. 

1889. 

1900. 

1901. 

January 

94 

42 

68 

Februi^ 

54 

48 

81 

March 

61 

84 

79 

April 

40 

95 

90 

May 

56 

... 177 

... 129 

June 

190 

... 227 

... 247 

July 

182 

... 206 

... 605 

August 

258 

... 209 

... 345 

September .. 

248 

... 223 

... — 

October 

278 

... 280 

... — 

November .. 

103 

... 127 

— 

December 

54 

90 

... — 


The Army and Indian Medical Servlcea 
Tbb following official despatches have been Gazetted. 
Tbe first is from Lord Rol^rts, dated September 4th, 
in oontinnation of that of April last, containing a 
further list of officers, non-commissioned officers, and 
men serving under his command in Sonth Africa who 
had rendered specially meritoriona service. The names 
of the following medi^ officers occur in it:— 

Grenadier Gnards : Surgeon-Major E. H. Sheldrake. 
Coldstream Guards: Surgeon • Lieutenant - Colonel 
J. Magill, Surgeon-Major W. R. Crooke-Lawless. 

Soots Guards: Surgeon-Lientenant-Colonel G. S. 
Bobinson, Surgeon-Major W. C. Beevor. 

Royal Army Medicu Corps: Colonel J. A. Clery, 
Colonel R. Exham, Lieuteuaut-Colonel T. R. Lucas, 
Lieutenant-Colonel P. A. B. Daly, Major S. f^estcott, 
Major R. Kirkpatrick, Major B. J. Geddes, Major 0. B. 
A. Julian, Captain 8. G. Moores, Captain F. Smith, 
Captain H. J. Barry, Captain J. H. E. Austin, Captain 
E. M. Pilcher, Captein W. A. Ward, Lieutenant G. G. 
Delap, Lieutenant O. Challis, Lientenant L. H. Lloyd, 
Lieutenant T. C. MacKenrie, Lieutenant T. E. Fielding. 


Indian Medical Service; Major W. H. W. Elliott, 
M.B., First-Class Assistant-Surgeon J. Moore, Third- 
Class Assistant Surgeon R. H. W. Hart, Assistant- 
Surgeon F. de Santos. 

Imperial Yeomanry : 3rd Battalion—Civil Snrgeon H, 
A. Lowndes, Medical Officer ; 4th Battalion—Captain R. 
M. Wilson, Medical Officer; 5th Battalion—Captain E. 
Davidson, Medical Officer; 6th Battalion - Captain W. 
J Haismith (Surgeon-Lieutenant-Colonel Ayr Imperial 
Yeomanry), Medical Officer; 7th Battalion—Captmn F. 
Wellford, M.B., Medical Officer (since died of wounds); 
12th Battalion—Civil Surgeon H. Manden, Medical 
Officer; 15th Battalion—Surgeon Captain E. Hopkinson, 
Medical Officer; 16th Battalion—Captain G. H. 
Reynolds, Medici Officer; 20th Battalion—Captain T. 
Wicot, Medical Officer. 

Volunteers: Elswick Battery (Ist Horchumberland 
Volunteer Ariillery), Snrgeon-Captain J. Wreford, 
Medical Officer; City of London Imperial Volunteers, 
Snrgeon-Captain R. R. Sleman (20th Middlesex Volun¬ 
teer Corps); Field Battery, Snrgeon-Captain A. Thome, 
M.B. (2ad Middlesex Volunt^r Artillery Corps); 
Colonel Lumsden’s Corps, Surgeon-Captain S. A. Powell, 
M.D. (Surma Valley Light Horse Volunteers). 

Colonial Corps.—New South Wales: Major W. L'E. 
Fames (New South Wales Army Medical Corps), 
Honorary Major A. MacCormick (New South Wales 
Army Medical Corps), Lieutenant B. J. Newmaroh 
(New South Wales Army Medical Corps), Lieutenant J. 
A. Dick (New South Wales Army Medical Corps), 
Lieutenant A. H. Horsfall (New South Wales Amy 
Medical Corps), Nursing Sister E. Nixon. 

Civil Surgeons: Mr. W. H. Brodie, with hospital 
ships; Mr. O. Carre, with prisoners, Simonstown; Mr. 
Denyer, attached ^yal Horse Artillery; Mr. Engel- 
bach, killed in action; Mr. £. T. E. Hamilton, with 
hospital ships; Hr. T. Kay, attached 6th Battalion 
M.I.; Mr. R. O. Moon, attaicffied 2ad Battalion Man¬ 
chester Regiment; Mr. Perkins, Mr. A. Ricketts, 
attached 12th Brigade Field Hospital; Mr. A. E. 
Stephens, attached Bearer Company 19th Brigade ; Mr. 
Willis. 

Civil Staff, Kimberley: Dr. Smart. 

In conclusion (Lord Roberts writes) I wish once 
more to draw attention to the great civil hospitals in 
Sonth Mrica, which did so much to alleviate suffering 
and to moderate the strain thrown on the Royal Army 
Medical Corps, and to the patriotic efforts of Sir John 
Fnrley, Lieutenant-Colonel G. 8. Ryerson, Commissioner 
of the Canadian Bed Cross Society, and Major W. G. 
Maopherson. Royal Army Medical Corps, and the B^ 
Cross Society; and finally to bring to your notioe the 
following names, in addition to those previously sub¬ 
mitted, of persons who helped to raise and equip these 
hospitals, and maintain them in a state of efficiency:— 
Irish Hospital: Lord Iveagh, the Hon. Rupert Guin¬ 
ness, Drs. G. Stoker and Coleman, and Captain W. T. 
Mould, Royal Army Medical Corps. 

Yeomanry Hospital: Drs. Stonham, Green, Evans, and 
Sheen; Major G. £. Hale, D.S.O., Royal Army Medical 
Corps. 

I^ngman Hospital: Mr. J. L. Langman, the donor of 
this hospital, and his son, Mr. A. Langman; Drs. C. Gibbs 
and H. Scharlieb. 

Welsh Hospital: Sir John Williams, Bart., M.D.. Drs. 
Lynn Thomas, P.R.C.8., and R. H. Mills Roberts, 
F.R.C.8.E. 

Princess Christian’s Hospital: Mr. Alfred Moseley, 
Major H. B. Mathias, D.S.O., Royal Army Medical Corps. 
Edinburgh Hospital: Dr. Francis D. Boyd, M.D., 

F. R.C.P.E., Major Sir James Clarke, Bart. 

Scottish National Hospital: Deputy Surgeon-General 
, H. Cayley, Honorary Sni^eon to the King (retired Indian 
Medical Service). 

Van Alen Hospital: Mr. Van Alen, 

Portland Hospital: The Duke of Portland, Drs. E. Q. 

G. Calverley, C. Wallace. 

As this despatch is in continuation of my despatch 
dated London, April 2nd, 1901,1 would request that all 
the mentions herein made may be considered as bearing 
the same date—November 29th, 1900—80 those in that 
despatch. 


I 




324 Th» M.DIOAL Pbmf. NOnOBS TOCORRBSPONDBNTS. 


SsPT. 18. 1901. 


^toticee to 

(ItorrtBpnnimte, Sthxrrt %siitxe, Ac. 

iV* COMXirovDiHTB TOquiriof » rsplj in this oolnma are pu- 
timUrly reqnocted to make bm of a dUtinetiv$ litmatur* or 
iaiMoff, and avoid the pniotioe of aiffnin? tbeneelTea “ Reader,’* 
'*Sabeorfber," "Old Snbaorlber," Ac. Vnoh oonfuaion will be 
apared bj atteotion to thia role. 

BepuRTa.—Beprinta of articlea appearinjr is thia jouroal can be 
had at a redoced rate, providing authors give notice to the pub* 
Usher or printer before the tfpe has beeudiatributed. Thia abould 
be done when returning corrected proofs. 

OaioiBAL ABTicxsa or LaTrana intended for publication ahould 
be written on one aide of the paper only, and must be authenticated 
with the name and addreM of the writer, not neceamrily for publica¬ 
tion, but as evidence of identitr. 

8pe 8 (Exeter).—Our correspondent will find that formalin is 
the best. 

ToBBRCULoars.— We have ascertained that the work baa been 
lookout of print, but doabtlcM a search amonr the second-ban d 
book shops would result in a copy bein? prociuuble. 

HOPEruL. -It is impossible to carry out n research of the kind 
without beinff near a lat^ reference Ubrary, such as that of the 
Boyai College of Surgeons (Eng.) 

YoPHO Uepico. *- Three months’ introduction we ahould consider 
sufficient under the circumstances, bat this our correspondent 
should claim. 

THE PUFF OBLIQUE. 

A cosaEBPOSDiBT senda os a market copy of the Iiarn$’ey 
ChronifU for September 14th containing a fulsome notice of a 
pamphlet written hr Dr. Sykes, of that city, on '' The Feeding of 
Infants.'* If it cotud be ahown that this was done at the Instance, 
or with theassent, of the author we should not hesitate to describe 
such conduct as professionally reprehensible, since it would amount 
to advertising. It often Imppens, however, that over zealous 
friends do medical men theae ill'toms, much to their annoyance, 
and we should be glad to know that this is the explanation in the 
present m«tance. 

Ha. J. BEsan (Bradford).—We hope to have spsioe for yonr com- 
mnnlcation in onr next. 

Ha. C. L. T. - Boston).—We will look into the matter and report. 
Thanks for information. 

EDitiBnaoB Stodbbt.—W e understand the new edition of the 
work in queetion is a reprint of the lavt with a few necessary oorrec* 
tiODB; the book met with such a rapid sale that the anthora were 
not given time to do more than oorreot trifling errors. 


Abdebsob, Wk. a., H.B., O.M.Ed., Assistant Hedical Officer to 
tbePlvmouth Borough Asylum, Ivybridge, Devon. 

Abdbew, Hbkbt, L B.CiP.Lond., HB.C.8., Hedicil Officer to the 
ExetW Bo/al Albert Hemorl^ College. 

Clabze, AsTLBT Vavasoob, B£D.. B.C Cantab., Physician to the 
Leioeeter Infirmary and Fever House. 

COMPTOB, Alwtbb T., HB.C.S.Eng., L.B.C.P.. Second Asaisiont 
Hedical Officer to St. Han, lalingtoa, Infirmary. Highgate 

Daxib. Thomas B., H.B.C S.£Dg., L.&C.P.Lond., District Medical 
Officer of the Qlanford Brlgg Union. 

OoBBALL. J. OuEST.H.A., H.B., D.P.H.Cantah., Hedical Officer of 
Health of the County Borough of Warrington. 

Hallam, a. R., H.B., Ch.B.Edin., Junior AsaMantHouse Sargeim 
of the Sheffield B-'yatlnflrmarv. 

Hipwell, Harbt, M.D.Brux., H.R.C.S.Eag.. L B.C.P.Lond., Dis¬ 
trict Hedical Officer of the Banbury Uoion. 

Hauobab, H H., L.B C.P., L.B.C.Sal.i Hedio^ Officer to the Dub¬ 
lin Me ropolitan Police Aid Association. 

Htles, F. j., H.B., B.Ch., Hedical Beferee nndsr the Workmen’s 
Compensation Acts, and 1900, for the County of L-mgford. 

Peaz^ Abtuob E.,H.B.C..'3.Eng., L.B.C.P.Lond., District Hedical 
Officer of the Henley Union. 

Stevbbbob, Boland A.,L B.C.P.Lond ,H.B.C.P.Eng., Junior Resi¬ 
dent Hedical Offl'^er at the London Open-air Sanatorium, Fine- 
wood, Berkshire. 

Wbittimoham, Georoe H. T., H.B.C.S.Eng., L.BC.P., Assistant 
Hedical Officer of the Wandsworth and Clapham Union. 


Iftcandts. 


Conw^ Aaylnm, Hickleover, Derby.—Senior Assistant Hedical 
Officer. Salary £130 rising to £150 per annum, with famished 
apartments, board, washing, and attendance. Applications to 
the Hedical Snoerintendent. 

Boat Bidiiw of Yorkshire.—Coonty Hedical Officer of Health. 
Salary £400 per annum, rising to £500 per annum, with cert^n 
allowanoee. Applications, on fo'ms to he obtained from the 
Clerk, to be sent to the Clerk of the County Council, Counir 
Hall. Beverley. (See advt.) 

Essex County Aaylnm, Brentwood. — Junior Assistant Hedical 
Officer, under 36 years of age. Salary £140. Applications to 
the Medical Svp^ntendent. 

OIswow University.-Additional Examinership in Hedicins and 
Science. Annual emolument £30. Duties to commence in 
January, 1903. (See advt) 

Guy's Hospital Hecioal School Gordon Lectureship in Experi* 
mental Patholosy. Salary with fees app-oximately £250 per 
annnm. Particulars of the Secretary, Guy's Hospital, London, 
S.E. 

London Hospital, Whitechapel —Surgical Begistrar. Salary £100 
per annum Applications to the House Governor Wore 
October 3rd. 

Hancbester. Owens College.—Junior Demonstrator in Fhjrsiology, 
teltfy £100 per annum, riAing to £150 per annum. Applici- 
tions to the Begistrar, from whom further pirticulm maybe 
obtained. 

Margate Boyai Sea Bathing Hospital.—Beeident Surgeon. SUary 
£130, per annnm. with board and reeidenc*. Applications to 
the Secretary, Boyai Sea Bathing Hospital Offices, 30, Charing 
Cross, London. 

North Wales Countiee Lnnatio Asylnm. Denbigh —Second Asrist- 
ant Hedical Officer. Salary £1S0 per annnm, rising to £160; 
with board, residence, and washing. Applications to the Clerk 
of the Visiting Committee. 

Boyai London Opbthalmlo Hospital. City Boswl—Curator and 
librarian. Ssjary £120. Applications to the S*cretary. 

Somerset and Bath Luiiatic Asylnm, Cotford, TanntM.—Assistant 
Hediral Officer. Salary £1M per annum, rising to £150, with 
famished apartments, b-'ai'd, and washing. Applications to 
the Hedical Superintendent. 

Worcester County Asylum, Powick.—Third Assistant Hedical 
Officer. Salary commencing at £120 rer annnm, increasms to 
£140, with hoaid, residence, Ac. Applications to the Hedical 
Snpenntendent. 


ftrthB. 

Elliot.— On September 9tb, at Warwick Square, London, S.W., the 
wife of Norman B. Elliot, H.D., H. B.C.P.Lond,, of aeon. 

FxaoaeoH.—On September Itth, at 26, Woodland Bead. New 
Southgate, N.. Ae wife of B. Brace Ferguson, H.A., U.D.. 
B.C.Cantab.. of a daughter. 

Hall. —Ob September Stn. at Eletowe House, Southampton, tho 
wife of Ed. 8. Hall, HB.Lond.,H.B.C.S.,of a daughter. 

Hewitt.- On September 8th. at Qneen Anne Street. Cavendish 
Square, London, W.. the wife of Frederic W. Hewitt, HD., of a 
son. 

Ladchlah.— On September IStb, at 43, (Hapham Boad, 8.W.,the 
wife of Charles A. Lauehlan, L.B.C.P.. of aeon. 

Pamcxridoe.—O n September lltfa. at Petersfield, Hants, the wife 
of W. P. Panokri^, H.B.Lond., H.B.C.S., L.B C.P., of a md. 

Smith.— On September 11th, at High Dewn, Hindhesid, Haalemsre, 
the wife of Gilbert Smith, H.D., F.B.C.S., of adaoghter. 


FoRTURH-EBBinDT.—On September 6th, at 01«sgow, Ernest 
George Fortune, H.B., C.H, F.R.C.S.E., to Sophia Farl^, 
fourth daughter of Thomas Kennedy, Esq. 

Hall—Gilmobe —On September 5th. at St. Hary'e. Great Baddow, 
E. George Hall, H.B.Lonl., to Ethel Mary, daughter of the 
UteBev. John Gilmore. H.A. 

Uacabtmet—Fisher.— On September 7th. at St Margaret's, Lee, 
Edward Kendnck Hocartney, M.B.C.S., L.B.C.P., to Eleanor 
Hand, daughter of Frederick Fisher. 

Hiddlemist -Clack. —On September 1 Ith, at Holy Trinity Church, 
Exmouth, George Edwyn MiddJemist H.B., of Hoiwtonhamp- 
stead, fifth son of the late Bev. B. Hiddlemist, HA., to Habsl 
Elphinstone, daughter of the late Bev. W. C. Clack, rector of 
Moretonhampste^. 

Hilleb- Gilbbbt.— On September 7th, at the Church of St John 
the Baptist Eii^ton Vale, Putney, G W. Hiller, H.B., Ch.B., 
to Lome, daugb W of H, Gilbert. 

Smith—WE irLB.— On September 11th, at 8t. Catherine’s Church, 
Colwyn, N. Wales. John Smith, H.D., HK.C.S,, Bryceball, 
Kirkcaldy, N.B., to Beatrix Alice, younger daughter of CoL 
Whitle, J P., Gian Hafod, Colwyn, N. WfJea, (late of Duke of 
lAncaster's Own). 


Bndford Boyai Infirmary.-Honee Physician. Salary £l(X) per 
annum, with board and residence. Appiioations to the Secre- 
taiT, Boyai Infirmary, Bradford. 

British Hedical Temperance Association,-Assistant Secretary 
Hast be a qualifle^iBctitioner, a total abstainer, and able to 
speak in public. Salary £150 per annum, with lecture fees 
and board and reeideace. Appiioations to the Hon. See., Dr. 

Bidn, Carlton House, Enfield. (See advt) 

Cork Street Hoepitat and House of Recovery.—Assiatant Lady 
Superintendent and Matron. Salary £40 per aanum, with 
hoard and nnlform. Applications to be sent to J. Hsrshall 
Day, BcMtrar and B.U.O. (Seeadvt) 

Connty Anlum, Bnrntwood, near LicMeld.—Junior Assistant 
Hedical Officer. Salary £ 50 per annum, increasing to £2(X), 
with board, lodging, attendance, and washing. A r'plications to 
the Hedical Superutendent 


SeathB. 

Halfobo.— On September 12th, at 48, Olenthorne Boad, Hammer¬ 
smith, Edward Halford, HD., in the 8:^ year of his age. 

Holland. -On September 3rd, at Cheadle, Cheehiie, Joseph Hoi- 
land, F.B.C.S.Eng., aged 88 years. 

Jackson.— On September 6tb, at bis realdenee, Ulverston, Lancs., 
Fox T. Jackson, HB.C.S., L.B.G.P., aged 35 ysara 

Bobbbta -On September fith, at 28, Feel Square, Bradford. Wil¬ 
liam Lake Boberts, H.&.C.S.Eng., in his 56th y^ar. 

Thudichcm,— On September 7th, at Pembroke Gardena, Kensiiig. 
ton, John L. W. Tlindichum, HD., F.B.C.P., H.B.C.8., aged 
78 years. 

Tract.—O n September 10th, at Crescent Bjsd, Alverstoke, Hants, 
Samnel Jora Tracy, H.B.C.S., L.B.C.P., aged 88 years. 



ibe Hidiat Wtm andi tfMar. 


*‘SALUS POPULI 8UPBEMA LEX.” 


Voi. CXXIII. WEDNESDAY, 


(Original Cmnmunicatume. 


THE 

DIAGNOSIS AND TREATAIENT 
OF METRITIS 

AKD 

ITS RELATIONSHIP TO MALIGNANT 
DISEASE. 

By JOHN CAMPBELL, M.D., F.RC.S.Eng., 

Senior Phyelcinn to the Semnritnn Hospital for ^'omcn, Bel/ast^ 

Ths Diaokosis of Mitkitis. 

In coneideriog the iDflammatory diseases of the 
aterua,ta bee, or OTaries, it is essential to bear in mind 
that all these organs are in the closest relationship, both 
fanctionally and physically, and that an affection of any 
one of them is boond to influence the rest to a greater 
or less d egree. Hence in metritis we hare to reckon 
with a simple nterine condition in only a minority of 
the cises, the adjacent tissues and organs being in the 
mijirity also involved, and the diagnosis of metritis 
being dependent on the fact that the affection oi the 
nterns is the most prononnoed lesion we csn detect, any 
others present being subordinate or secondary to it. A 
grasp of this elementary principle is essential to an 
intelligent discussion of the subject^ and has an import¬ 
ant betting on the question of diagnosis in particular, 
since errors may arise from the marked prominence of 
one symptom, which overshadowing all the others, pre¬ 
sents a false picture to the mind. 

1. Pre/naruy .—Banking foremost among the condi< 
tiotts which may be mistaken for metritis, we have early 
pregnancy. When the metritis has produced oonsider- 
able enlttgeuieut and congestion its resemblance to 
early pregnancy is a close one. The flattened form of 
the metritic uterus as compared with the globular 
shape of the pregnant one forms one of the best distin¬ 
guishing marks. Equally valuable is ^e recognition of 
the relative consisteoce of cervix and body. In the 
inflamed utems there is a comparative sameness in con¬ 
sistence between these two parts, both being relatively 
Arm. In the pregnant womb, on the other hand, we 
notice tbat the softening process affects the body much 
earlier than it does the neck, leaving the former soft 
and somewhat ill-defined, while the cervix remains firm 
and definite in outline, and, as it were, hinged upon the 
corpus. If riieee signs leave any lingering doubt the 
lapse of time will soon dispel it. 

2. Canetr .—The character of the discharge iu metritis 
may present a superficial resemblance to cancer, and 
the appearance of the cervix may also temporarily 
deceive the observer. The muco-pnrulent and viscid 
discharge of metritis contrasts with the red, serous, and 
foul-smelling flux of cancer. In cases of metritis the 
edges of the raw surface of the cervix are not hardened, 
while in cancer they are hard and irregular, and the 
surface itself presents yellow points. Furthermore the 
nodular feel of the cervix in metritis can be got rid of 
by puncture of the Xabothian foUioles and glycerine 
d^ssings, while the nodules of cancer remain in spite 


SEPTEMBER 25, 1901. No 13. 


of such treatment. Finally the extreme friability of 
the canoerons tissue forms a marked contraet to the 
resistance of the products of inflammation, and gives n» 
the best guide we hare for bedside diagnoiis. Iu 
malignant oases the sharp curette will remove plugs of 
tissue, even at an early stage, but will get mere shreds 
in cases of metritis. The examination of portions re¬ 
moved and prepared for the microscope is of uss only 
as a confirmatory test. It is too cumbrous and uncer¬ 
tain a method for practical clinical use. Whether the 
disease be in the cervix or body of the nterns, the 
curette gives the most trustworthy information we can 
get, and leaves all other methods in the position of mere 
accessories. 

3. IneompUte Abortion may simulate metritis, and 
can only Iw distinguished with oertaiuty from it by 
curetting and discovering thus the characteristic 
plaoentsJ tissue. 

4. .Fibroidi and Intrauterine Fibroid Polypi form a 
class of cases which may often be distinguished from 
metritis by the irregular feel of the uterus on bimanual 
examination. At other times dilatation, followed by the 
introduction of the finger into the uterus and careful 
palpation of the uterine walls between the two bands, 
may be essential to discover small intramural fibroids or 
intrauterine polypi, and in the case of the latter is much 
more satisfactory than the use of the uterine sound. 

6. may cause symptoms like those of 

metritis, and may co-exist with a Bec:>ndary metritis or 
be secondary to an endometritis. Careful vaginal and 
rectal examination will reveal the tubal nature of the 
case. 

6. Cystitii may simulate some of the symptoms of 
metritis or may be conjoined with it. 

7. Proctitis, with tenesmus and the so-called “anal 
leuoorrhoea” and spbiucteralgla may be due to metritis, 
or symptoms of metritis may be due to a rectal polypus 
or other condition. 

8. Refiex Disturbances .—Different groups of reflex die- 
tnrbances may be set up by metritis, and may mimic 
other diseases. Thus cough, shortness of breath, and 
progressive wasting may simulate pulmonary tuberon- 
losis; or lose of appetite, vomiting, flatulence, and 
dilatation of the stomach may suggest disease of that 
organ ; or aneemia, palpitation, prsecordial anxiety, and 
vascular murmure may arouse fears of heart disease; 
or pains simulating neuralgia may be present; or 
nervous conditions like hysteria may depend npon the 
state of the womb. In all cases where the cause of 
symptoms is obscure the gynssoologist should avoid 
attaching undue importance to the condition of the 
uterus, and should carefully and repeatedly examine 
all other accessible organs ; but he should edways bear 
in mind that the uterus should be examined in all cases 
where a woman persistently complains, no matter of 
what nature that complaint may be; that disease of the 
uterus and appendages should be treated at the same 
time tbat the symptoms are being attended to, and that 
the uterus and appendages should not be treated unless 
signs of real disease are present. 

ThS TaXATVINT OF MXTBITIB. 

Prophylaxis.—The importance of prophylaxis against 
inflammation of the uterus is so well recognised that it 

Dir:.zed byCjOOglC 






326 Ths Mbdioal Pbbss. OBIQIITALj COMMUNTCATONS. Sift. 25, 1901. 


leqmres no adrocaoj at the present time, when the 
neoeesitj for care as to the cleanliness of instroments 
and hands, as well as of the Taginal and nterine canals, 
is admitted by all who perform operations, major or 
minor, on women. The management of cases of labour 
and abortion, howoTer, still leaves room for improre* 
ment. The circumstances under which these oases have 
frequently to be undertaken, as well as the reluotanoe 
of the patient and her medics! attendant to regard them 
as essentially operative, are responsible for this, leading 
as they do to the neglect of a cardinal principle of 
nterine surgery, namely, that when you have once 
entered an aborting uterus you should never leave it 
until it is thoroughly cleared out Failure to do so is 
not infrequent, and is partly to be attributed to an 
antiquated error which um bmn handed down through 
the generations by the writers of obstetric text* 
boohs. I refer to ^e classical description of cleaning 
out an aborting atoms with the forefinger. Such a 
feat is, I believe, impossible, as, even under ansss- 
thesia, the finger cannot reach and scrape every 
comer of a uterus enlarged by pregnancy, and, 
without anesthesia, can only make the most futile 
attempts to do so. Those who remove early placentee 
in this way as a rale never get beyond the internal os. 
They are, in fact, removing placenta which are already 
in the cervix and do not require removal at all, and are 
in many cases mistaking the contracted inter^ os for 
the fundus. No man’s finger is long enough or supple 
enough to thoroughly clean out an aborting uterus. 
Whenever, therefore, it is necessary to introduce any* 
thing into such a uterus a sharp flashing ou*ette 
should be used, and the whole endometrium carefully 
scraped. 

The patients who suffer from metritis as a result of 
imperfect evacuation of the uterus at labour or abor¬ 
tion are but a few, though I have mentioned them first 
on account of the facilities we have for averting their 
sufferings. For the larger number who owe their 
disease to indiscretions daring mf-nstruation we can do 
but little in the way of prevention beyond advising 
mothers to warn their daughters against too active ex* 
ercises at the periods, especially such as involve much 
abdominal movement, and insist on the use of some good 
absorbent pad while the flow continues. To the great 
army of women who snffer from gonorrhceal metritis we 
have no preventive to offer. They seek our aid when the 
uterus is already involved. They are subject to repe ited 
re*infections. So far as prophyl^is goes they are beyond 
our reach. The prevention of metiitis is, therefore, a 
matter over which we have but a limited, though an 
important, amount of control. In spite of our best 
efforts the disease will remain with ns, and the question 
of its treatment will exercise the ingenui^ of the pro¬ 
fession in the future, as it has done in the past. 

1. Obnkbal TaiaTMKNT. 

There can be no question about the utility of immo¬ 
bilisation of the uterus by an abdominal belt, so far as 
tiiat is possible; about ^e avoidance of fatigue and 
strain; about avoidance of sexual intercourse; about 
the use of laxatives and dieting, or of glycerine or 
water enemata or of glycerine suppositories to aid 
evacuation of the bowels; or about the advantages of 
general tonics and of the natural medicinal waters, the 
ferruginous for the ansmio oases, the alkaline for 
dyspeptic patients, and the indifferent and sodium 
chloride waters for the neurotic. 

2. rouehes are undoubtedly useful, but rrquire to be 
used more energetically than they mostly are. The 
amount of water should not be lees than two quarts for 
each douche; the duration of its application at least 
twenty minutes; the temperature should be gradually 
raised from 100“ F. to 120“ F., the frequency should be 
at least twice a day; theposition of the patiant should 
be dorsal with the^hipe well raised, and the residue 
should be carefully evacuated from the vagina after 
each douche. To gain any real effect from them hot 
douches need to be continued for months. Hip bat^t 
are also of some service, especially when a bath 
speculum is used, but are inferior to douching properly 
done. 


8. Tatnpov$. —The advantages of the tampon have 
been much overestimated, whether they be soaked in 
plain glycerine or in solutions of ichtbyol or other 
medicament in glycerine, appears to be immaterial. In 
any case to be of use they require to be incerted much 
more fr^uently than is customary. In fact, a daily 
application is necessary. 

4. Local Bleeding is. in some cases, beneficial, espe¬ 
cially where the cervix is chiefly involved. It is best 
done by puncture followed by warm douching, and 
needs to be repeated every second day until the conges¬ 
tion has decreased. 

The application of letchea is quite infurior to puncture. 

6. /ntra-tt'sr/iie Medication is of more importance than 
any of the foregoing methods, and includes (1) the 
application of antiseptics, and (2) the application of 
caustics to the aterine cavity. 

6. The “ galvano-cantery," the thermo-cautery,” and 
the ” actual cautery *' deserve no commendation. 

7. Neither does *' atmo-cansis,” for the application of 
steam to the endometrium is an unnecessarily severe 
and dangerous proceeding. 

8. Cweiting is, of all the methods of treating 
metritis, sdmitt^ly the best. It is, however, not 
generally recognised by the profession or by the public 
that the mere scraping of the uterus is not in all cases 
sufficient to effect a cure or even a marked amelioration 
of symptoms. The fact that metritis is often a very 
chronic and intractable complaint is lost sight of, and 
the patient is encouraged to hope that the operation 

will make her right.” 

Frequently it does not do so, and the operation or the 
operator is discredited. Now the truth is, that in most 
oases of chronic metritis the curetting is merely the 
Jirat ttep in a course of treatment which ought to be 
sufficiently prolonged to materially iofluence the 
disease. Curetting, therefore, requires to be reinforced 
by one or several of the other methods, as well as by 
the removal of complications if such exist. As at present 
carried out, the operation is preceded by o'eansiog of 
the vaginal and nterine cavities by antiseptic lotions, 
and foUowed by the application of caustics or s^ptice 
to the uterus for a comparatively short time, according 
to the views of the operator. My contention is that 
patients should be taught to expect more prolonged 
Bubaequent treatment, both general and local; tlut, 
in fac^ the treatment, like the disease, should be some¬ 
what “ ohronia” Besides this question there are some 
others worthy of disonssion, as they give scope for some 
difference of opinion, such as the " curette ” to be used. 
Opinion as to whether it should be blunt or sharp still 
varies. The sharp one is, 1 think, to be preferred. 
With it a greater or less effect can be produced acced¬ 
ing to the amount of force used. The operator has thus 
a chance of using his discretion, which he has not when 
the instrument is blunt. The time at which the ope¬ 
ration is done is, perhaps, not of much importance. 
Undoubtedly dilatation is easier immediately after a 
period, but on the other band, in cases of bsemorrhage 
or dysmenorrhcea, a good deal may be gained by cur^ 
ting a week or ten days before the ^riod. Certainly 
the latter time is the best fox oases in which sterili^ 
is an important factor. 

The question of anesthesia depends on the amount of 
dilatation needed, as well as upon the nervousness of the 
patient. The dUatstion and not the scraping is usually 
the painful part, and some relief can be obtained by 
cocaine in 10 per cent, solution applied to the oerrix 
and cervical canal for ten or fifteen minutes beforehand. 

Preliminary vaginal antiseptics in the form of 
thorough douching night and morning with 1 in 2,000 
sublimate solution or other efficient agent, and two 
fingers in the vagina is essential to safety. This can 
only be done by a specially trained nnrse. Neither the 
patient herself or an ordinary trained nurse can give a 
proper cleansing douche. 

The operation may be performed with the patient on 
her left side, but the advantages of the dorsal position 
are so great that it should be universally adopted. It 
renders the operation both easier and safer. The steps 
of the operation afford little scope for controversy. 




8mpt. 25, 1901._ ORIGINAL COMMUNICATIONS. Thi Medical Paws. 327 


Wheit the patient ha« been placed in position the 
Tagina is ecrnbbed with soap and water and a tooth* 
brash, green soap which h^ been sterilieed by heat 
being ue beet. An antiseptio douche follows this. 
The speenlnm is then introduced, the cervix lowered 
by a Tulsellnin, and the sound pawed to asoer* 
tain the direction and size of the uterine cavity. 
If the canal is wide enongh the curette may be us^ 
without dilatation. If not, the dilatation is b^ accom¬ 
plished by long-handled dilators, such as Duncan’s, 
beoauee the len^h of the handle and the curve enable 
the instrament to be introduced with lew disturbance 
of the uterus than the shorter ones like Hegar’s give 
rise to. Extreme dilatation is unnecessary; indeed, in 
most cases dilatation beyond No. 16 of Duncan’s instru¬ 
ments is accompanied by laceration, and should only be 
resorted to in cases of uncertain diaraoeis where the 
introduction of the finger is essenti^ Dilatation is 
followed by flusbing of the cavity with an antiseptic 
aolution, 1 in 2,000 sublimate being tbe best. The 
oorette is then applied, and with a sharp instrament 
the force must be modified to suit tbe state of tbe case 
in hand. The dibrit having been washed away through 
a double-channelled uterine catheter, the cavity is dried 
ont with a strip of sterilised gauze and swabbed or 
injected with percbloride of iron or some preparation of 
iodine according to the amount of bleeding. Irrigation 
of the utenu and vagina follows this, and then a vaginal 
plag of iodoform ganze is inserted and allowed to remain 
tor two or three ^ys, when it is removed and vaginal 
douches given night and morning for a week. After 
this farther treatment is unnecessary in cases of catar¬ 
rhal metritis, but in the grann’ar form intrauterine in¬ 
jections of iodine every second day for eight or more 
timw will be needed. 

The danger of tbe curette nowadays is very slight, 
bat certain accidents may occur. Perforation appears 
to be rather frequent. A good many instances have 
been published, and tbe accident baa happened to most 
men who have peiformed the operation many times. 
It is most likely to occnr when tiie exact carve of the 
nterine oavify is not continnally borne in mind during 
tbe operation, hence the necessity for carefully passing 
the sound before commencing to dilate or cnrette. Tbe 
Accident is practically free from danger when the 
opeontor recognises what has occnrred and desists from 
tnrther treadnent. Hemorrhage seldom follows the 
operation in cases of metritis. It is more likely to sno- 
oeed an imperfect curetting than a thorough one. Its 
importance lies in the fact that tbe possibility of its 
oocnrrence should deter ns from being too ready to 
oorette in our consulting rooms. Peritonitis will only 
-occasionally follow the operation when it is done 
intelligently. 

10. SUctrolynit is a tedious method of attaining ends 
which can be better coopassed by other means, and 
has little to commend it. 

11. Among the more recent things which have been 
sased for gonorrhoeal metritis and vaginitis the " Yeast 
Method" deserves mention: 10 c.o. to 20 o.o. of fresh 
beer yeast mixed with a small quantity of beer is in¬ 
jected every day or every few days into the vaginal 
fornix, the vagina having been previously cleansed and 
-dried. A tampon is subsequently introduced. Its effi- 
oaoy depends on the antagonism of certain mioro- 
OTganisms. It is no improvement on other plans of 
treatment. 

12. In chronic cases, where there is evidence of old 
venereal disease, the application of mercurial ointment 
to tbe uterine cavity may be beneficial. It is applied 
apparently with advantage to the male urethra in oases 
of intractable gonorrhoea with small urethral ulcers, and 
possibly it might be equally serviceable in the uterus. 

Tbiatkint or Complications and Sboubl^. 

The treatment of certain complications and sequels 
of metritis demands a passing notice. 

1. Mucous polypi of the cervix may require removal 
by forceps or curette, with subsequent application of 
perohloride of iron or of the thermo-cautery. 

2. The so-called “ulcerations’ of the cervix often 
require prolonged toeatment even after the ntems has 


been curetted. When they are recent, and there is not 
much thickening of the cervix, they will yield to curet¬ 
ting, followed by solid nitrate of silver for a few times, 
and subsequsntiy by borio acid dressings. This pro¬ 
duces a rapid change in the condition, and is superior 
to such remedies as tincture of iodine, weak nitric acid, 
chromic acid, chloride of zinc, acetic acid, pyroligneona 
acid, Ac., on the other hand, for old standing eroeions 
with much chronic thickening canstios are worse tbim 
useless. In such oases the excision of the diseased por¬ 
tion, followed by tbe noion of the vaginal to the 
nterine mnoous membrane is the best treatment 
(Sobroeder’s operation). 

8. A third set of oases includes those in which these 
are lacerations as well as erosions. According to the 
amount of thickening present these will demand repair 
of the lacerations in the leas hypertrophied examples 
(Emmet’s operation) or amputation of the cervix when 
the enlargement is more pronoonced (Schroeder’e 
operation). 

Vabixties of Mxtbitis BxQDiaiNo Modified 
Tbbatmbnt. 

Two varieties of metritis are deserving of special 
attention as regards treatment, namely, tbe hsemor- 
rhagic and the chronic painful metritis. For the 
htemorrhagio form the recumbent position, hot douches, 
and the administration of the liquid extract of ergot, or 
still better the fresh iDfusion, or ergotiue, are unques¬ 
tionably nsefnl. Hydrastis canadensis is of doubtful 
value, and digitalis is effective only in cases compli¬ 
cated by heart disease. Laminaria tents and plng- 
giog toe vagina for nterine bsmorrhage are 
obsolete. Of the more active measures the injection of 
perohloride of iron, or still better onretting followed by 
the injection of perohloride of iron, together with the 
repair of lacerations and removal of other complica¬ 
tions, yield the best results. But even such ene^tio 
treatment will have but a temporary effect unless it be 
followed by repeated injections of iodised phenol and 
the prolonged use of ergotine. In bod cases plugging 
toe ntems with plain sterilised ganze or with iodoform 
ganze may be required nntil tbe patient rallies enough 
to be able to stand the curetting, or plugging with 
gauze Boaked in 50 per cent, ohloride of zinc solntion 
may render curetting nnnecessary. 

Chronic painful metritis is one of the most trouble- 
rome forms of toe complaint. In it a certain amount 
of benefit will be derived from scarification and punc¬ 
ture, followed by toe use of glycerine and iodioe or 
glycerine and iohthyol tampons. The virtues of iohthyol 
are, I think, very doubtful. The so-called “ Columni- 
sation ’’ of tbe vagina by filling it with cotton wool or 
clay or sheep’s wool has some good effect, especially if 
sheep’s wool soaked in glycerine be the agent used. 
Hot doQches are partioularly serviceable in these oaees. 

Ignipunotnre gives no permanent good reenlt. 

Electricity is uncertain, as is a^ message of the 
nteros. 

Among operative measures amputation or repair of 
the cervix may be required, bnt removal of tbe ovaries, 
or of toe ntems, with or witoont the ovaries, yields poor 
results, owing to the neurotic tendenoiee of most 
patients tons affected. 

Tbe SxLATioNSHip of Metritis to Malignant 
Disease 

The relationship between metritis and cancer of tbe 
cervix has not so far been demonstrated beyond ques¬ 
tion, bnt the evidence in favour of its existence is strong. 
The connection between metritis and cancer of the body 
of the uterus has been definitely settled. We know 
certain facta about cancer which have a bearing on this 
subject, e.g., cancer is more common in women thin in 
men. This freqnency manifests itself between puberty 
and tbe menopause, especially between forty and fifty 
years of age. The ntems is the oi^an most often 
affected. The cancerous tendency is infiuenced by race, 
whites being more liable to it; by heredity, thongh evi¬ 
dence on this point is open to qu^lon; by age, and by 
the stmggle for existence, including want, worry, and 
painful emotions, and everything calculated to depress 
the general bealto. About these general considerations 

C 



328 Th* Msdical Prbbb. OBrlGINAIi COMMUNICATIONS. Sspt. 26, 1901. 


there can be no doubt. We are now. however, more con- 
oemed with local influences. Cancer of the cervix 
appears to be prediepoeed to by lacerations; by cervical 
metritis, especially of gonorrhceal origin, and by fre¬ 
quent parturition, factors which are largely dependent 
on one another. The proof of their influence is the 
relative immunity of nullipaiffi from cancer of the 
cervix. We have no direct evidence that the typical 
glandular proliferation or “simple adenoma” passes 
into the atypical proliferation or “ malignant adenoma," 
in other woi^s, into an epithelioma of the cervix. 

Cancer of the body of the uterus, which is a disease 
both of the parous and nnlliparouB, has had its connection 
with metritis more thoroughly worked out. The trans* 
formation from endometritis to cancer has been fol¬ 
lowed step by step at successive cnrettings. (1) A 
alight glandular endometritis when aggravated becomes 
(2) abenign adenoma, t.e., a typical glandular endome¬ 
tritis, with a single layer of epithelium and normal 
interglandular tissue which degenerates into (3) 
malignant adenoma, an atypical growth with a single 
layer of epithelium and the interglandular tissue gone, 
and this is the first step towards cancer, where the 
glands form solid cylinders filled with cancer cells. The 
recent observation that the uterine glands in their 
deepest ends normally contain solid masses of cells is 
rather disconcerting, as glands blocked by proliferation 
of cells can be no longer regarded as evidence of com¬ 
mencing malignant disease. Primary cancer of the 
“ body ” is special to women who have passed the meno¬ 
pause, and, on that account, bsmorrbage in them calls 
for the immediate nee of the curette as a diagnostic 
instrument. 

In this connection it is important to remember that 
epithelioma and chronic metritis may exist in the same 
uterus. Hence the necessity for examining many 
pieces of scraping before making the diagnosis. 


Otlinual future 

ON 

THE PRESENT STATE OP 

OUR KNOWLEDGE OF AUTO¬ 
INTOXICATION. 

By Dr. JOSEPH KOVACS, 

Senior Assistant at the Principal Clinic of Budapest. 
[specially reported POE THE MEDICAL PRESS 
AND CIBCCLAR.] 

It is generally known that Bouchard was the first 
to call the attention of physicians to the fact that 
under certain circumstances the urine contains some 
toxic constituents, and from this fact he has drawn 
the conclusion that these toxic matters must be 
circulated in the blood, where they are also formed. 
French and Itelian physicians investigated the ques¬ 
tion with the greatest accuracy, and endeavoured to 
explain these phenomena on chemical grounds. This 
elucidated the fact that not only during the normal 

t >roce88 of digestion, but also in certain patho- 
ogical conditions, various chemical substances are 
formed in the stomach and intestines (phenol, strep- 
totoxin, volatile fatty acids, alkapton), which bodies, 
when injected into the bloodstream of the animal 
experimented upon, gave rise to very striking and 
characteristic constitutional symptoms. 

These phenomena are similarto those of poisoning, 
and, on account of the poison being in the organism 
itself, the group of symptoms thus arising received 
the name of ” autointoxication.*' 

Later on it was elucidated that the toxic matters 
which have such a deleterious effect upon the tissues 
of the organism, can be also formed in other parts 
of the organism. Especially is this true regarding 
the intermediary and final products of metabolism 
(aceton, diacetic acid, lactic acid, oxjbutyric acid, and 
amylobutyric acid). The last-mentioned source of 


autointoxication, being formed by the metabolism 
going on in the tissues themselves, the pathological 
symptoms arising therefrom were given the name 
histogenetic or inie-'tiitial autointoxication. This 
much therefore is certain that among the different 
phases of metabolism chemical substances are pro¬ 
duced, which have a deleterious effect upon the 
organism by virture of their chemical toxicity. 

Now the only question remaining undecided is 
what may be the catise of the fact that the toxic 
materials, permanently present in the organism, are 
in one case active and in another abaolntely inactive. 
The explanation may be: first, that these chemical 

f )roductB being very changeable, are decomposed, and 
ater on unite with other products of metallism and 
in such a way they are harmless; secondly, that the 
organism has under its command certain bodies that 
defend, it which hold the enemy in check, and so 
these poisons are eliminated from the organism. 

It is evident, however, from the preceding that- 
whilst demonstrating the chemical ground of auto¬ 
intoxication no light had been thrown on the dimly 
lighted territory of pathology. 

In the first Internal Clinic of Budaijest, Koranyr 
Sandor initiated extensive investigations for the 
de'ermination of the osmotic relation of sick and 
healthy men (1893). From these investigations it 
became clear that the molecular concentration of the 
normal blood is strikingly constant (0'56). and so 
we were justified in supposing that the functions of 
single organs are best cairied on by this physical 
state of the blood. On the contrary, it was evident 
that in diseases in the course of which autointoxica¬ 
tion occurred in its most striking form, the osmotic 
pressure of the blood was increased to the highest 
point 

Particularly we found this great physiological 
alteration of blood in the various forms of nephritis, 
also in several cases in the course of the development 
of urmmia. Similar results have been afforded by 
investigations carried on on chlorotic patients. 
These led me to the conviction that the physical 
alteration of the blood of chlorotic patients was very 
closely related to that taking place in nephriiics, and 
at the same time, under the influence of these 
diseases, symptoms very much resembling the 
unemic signs of nephritis have set in. In a contri- 
butiun, published at a corresponding period, I 
described the results of my investigations on this 
subject, calling attention to the fact that the charac¬ 
teristic symptoms of ansemia and chlorosis can be 
traced back to autointoxication. 

On the other band, nothing was more natural 
under such circumstances than to suppose that the 
autointoxication stands in a close relation to tee 
changed physical alterations of the blood and of the 
juices of the organism, and acting on this supposi¬ 
tion we have laid the foundation of the further 
study of autointoxication. For in order to decide 
this question more accurately I made some further 
investigations, in which I twk into consideration 
the osmotic relations as well. I injected the urine 
of chloroticB (having a low molecular concentration) 
and the urine of patients suffering from heart disease 
(possessing a high molecular concentration) into 
bares. Similarly I used in several cases hsemoglobi- 
nuric urine. With the urine of ehlorotics I could 
not produce any abnormal symptoms on hares, 
but, on the contrary, with the urine of patients 
suffering from heart disease I observed the well- 
known symptoms of autointoxication. Furthermore, 
it was striking that from btemoglobinurio urine I 
succeeded more easily and rapidly in producing the 
symptoms of intoxication. 

* I am, therefore, justified in concluding from these 
experiments that the osmotic pressure nndoubtedly 



SXFT. 25, 1901. 


OKIGINAIj communications. Th> Medical Fbess. 329 


has some conneotion with the urotozicitv, but I had to 
keep in view that other factors most aim play some 
ri)U in this matter. For instance, among the con- 
stituents of the hsmoglobinuric urine the potassium 
salts prevailed; therefore, 1 believe that these salts 
haye a great influence upon the degree of nrotozicity. 
The results of my numerous investigations closely 
t^ed with the experimental results Kordnyi Sandor 
attained on uramic patients. In some of his oases 
too tbe osmotic pressure was proved to be very high, 
but there were a^ others that showed the reverse. 

Hy investigations, with regard to nrotozicity, I 
had to then abandon owing to many calls on my time 
in other directions, but later on, in 1900, 1 agmn 
commenced to deal with this question. This time 1 
could carry out my experiments far more easily. 
The starting-point of these last investigations was 
that there exmts some connection between osmotic 
pressure and tbe nrotozicity of the urine. For my 
experiments I used bares and mice; I injected the 
ui^ of pneumonicB (in an unchanged condition) 
and tbe urine of pneumonics and others previously 
rendered isotonic, together with isotonic salt solu¬ 
tion. and finadly isotonic salt solution, together with 
unchanged pneumonic urine. By these experiments 
I hoped to be able to prove undoubtedly the efficacy 
or inefficacy of the osmotic pressure. The result 
attained on mice 1 cannot put forward as trust¬ 
worthy, because most of the animals suffered severely 
from tbe injections, although this much is certain, 
that under the injections of salt solution none of the 
animals died, whilst fifteen to thirty minutes after 
the injection of unchanged urine of pneumonics all 
the animals died. It is important also to note that 
tbe urine of pneumonics after the crisis proved to be 
much more toxic than during the course of the 
illness. 

The fluid injected into the animals was equal to a 
third part of their weight. 

And now, after reviewing my experimental data, 
whilst searching for the active agents of urotoxicity, 
and supposing these urotoxic agents (evacuated in and 
extracted from tbe urine) to w circulating in tissue 
fluids, my conclusion is justified, that the osmotic 
pressure, as well as the chemical constitution of these 
agents have some influence upon the production of 
autointoxication. It must be remembered, however, 
that there are aleo other active agents, such as 
potassium ualts, and no doubt others as yet unknown. 
Besides tbe supposition is that these agents can 
support each otner in their effects; tny experimental 
data at least seem to prove this cooperation. It seems 
sure that each of the above-mentioned components aid 
in the production of autointoxication. What cannot 
be demonstrated is what share they respectively 
take in tbe phenomenon. 

Tbe efficacy of the osmotic pressure is proved by 
tbe experimental fact that the red blood corpuscles 
seem to be extraordinarily sensitive to osmotic pres¬ 
sure. 

I think the following case is a very instructive one, 
rendering good service in the explanation of this 
nebulous question. 

Two months ago a patient was admitted into our 
hospital with the following symptoms:—On the first 
two days headache, uncontrollable vomiting, great 
prostration, tbe pupils wet's contracted and reacted 
very sluggishly; respiration normal; pulse beat 90; 
temperature tending to subnormal. Partly on 
account of these symptoms, partly by means of ex- 
dusion, we thought we had to dead with uraemia. 
Tbe examination of the urine did not verify this 
supposition (k per cent, albumen, kidney epithelium 
being present, but without cylinders). Exami¬ 
nation of the blood demonstrated, that tbe, 
freezing point had sunk to 0*72. Fatieot was 


soporous, and later on comatose. On a second 
examination of blood and urine the results were 
similar; therefore, we thought it necessary 
to administer an enema of physioTogioal salt solution; 
this was followed by striking improvement, which 
lasted forty days; then periostitis has set in. and 
also pneumonia with endocarditis and fever (39 and 
40^ C.). Daring the feverish condition albuminuria 
was present just as at the time of the admission of 
the patient. Fourteen or fifteen days after the onset 
of the fever tbe patient died. The autopsy showed 
no nephritis, hut parenchymatous degeneration of 
the kidney; evidently it was a case of uraemic in- 
toxication with an expressed clinical image, with 
uraemic blood without nephritis. It is impossible not 
to observe here the connection between the high 
osmotic pressure and the expressed pathologi^ 
image of autointozioation; and although this case 
cannot be used for tbe decision of the question as to 
whether tbe matters, kept back on account of tbe 
renal insufficiency, poisoned tbe organism bv reason 
of their osmotoxicity or by their chemical effect; 
yet the supposition can almost be excluded that 
chemical or biological toxins that bad accumulated 
to an extent corresponding to this high molecular 
concentration, would be able to cause the intoxication 
of tbe organism. It can be more easily understood, 
that here not a single, but different protoplasmio 
poisons were acting, among which ^e excessive 
osmotic pressure must certainly have a certain role, 
and this can with facility be brought in accordance 
with the above-mentioned experimental facts. 

Posner and Vertun sought the source of urotoxicity 
and autointoxication almost purely in tbe osmotic 
pressure, this being gathered from their communica¬ 
tion published in 1890 in the Berliner Ktinische 
Wochenscrift. Tbe Paris School, and especially tbe 
pupils of Bouchard, described the result of their in¬ 
vestigations in the same year, and they likewise 
apply the name of “ Tosmotoxicit^ ” to the toxic 
effect of the osmotic, pressure. 

The autointoxication, therefore, which during the 
last decade constituted the most diligently cultivated 
part of pathology started at first from our Cliuic, 
and being carried on also at other clinics it gained 
a new foundation by showing the existence and 
aHion of autointoxication, without, however, the 
older hypotheses being cast off. There are in pro¬ 
gress, however, still more recent investigations from 
which, as seems indicated, we can expect further 
light to be thrown on this verv occult question: I 
mean the seai'cbing after toxic matter, which are 
the products of internal secretion. 


ON TIME-SAVING METHODS OF 

TREATMENT IN PHTHISIS, 

WITH A PEBLIMINABT NOTE ON THE “ SILVER 
TREATMENT” OF PHTHISIS BY INTRA- 
INJECTIONS OF PROTARGOL. (o) 

By WM. EWART, M.D.Cantab.. F.B.C.P., 

Senior Physicim to St. Oeonre's Hospital, London, ud to the 
Belsrrave Bospitol for Children. 

It is now recognised that phthisis is curable by 
the open air if sufficient time be allowed. Our next 
effort should be to shorten the cure, and this com¬ 
munication is an endeavour to promote the search 
for more expeditious methods, without which the 
complete realisation of the scheme of State-aided 
relief cannnot be carried out owing to the vast num¬ 
bers to be dealt with and to the costliness of the 
necessary accommodation and of the treatment and 
diet. Much, therefore, would have been achieved 

S Abstract nf pnp«r read before the British Conxreas on Tuber- 
da, Aoguat, 1901. - 



330 The Medical Pbbsb. 


ORIGINAL COMTJNICATIONS. 


Sept. 25, 1901- 


if the mdividiial stay at State sanatoria could be 
shortened; and this achieTement is claimed as poe* 
sible if the cases of phthisis (excluding always hope* 
less oases) were to oe provided with adequate pre* 
liminary treatment su^ as to fit them to secure 
from Sanatoria the maximum good in the minimum 
time. 

Quite recently strong claims have been put for¬ 
ward in favour of various methods of tr^tment. 
Special notice would seem to be due to those with 
pretensions as *' specifics," most of which probably 
do some appreciable good, even though not fulfilling 
their entire promise. A strong plea must therefore 
be entered in the interest of we rate paying public 
as well as of the patients for an adequate inquiry 
into the comparative capabilities of the various 
“cures”now available. It is clear that we cannot rest 
satisfied with our present system, however great its 
advance upon previous conditions. 

The “Thorough Treatment" or “ Hoajnial Treat- 
meni ’’ as a preliminary to Open Air or oanatorium 
Treatment. —Early and mild cases in strong subjects 
are practically self-curable with an open-air life; but 
with the large group of pyreiial, sub-pyiexial, or 
more or less chronic phthisis, the open-air treatment, 
at any rate in this country, and also the climatic 
treatment, so it would seem from Alpine experience, 
is not the shortest way to a cure. Nay, many cases 
are at first ill-suited for it. In these cases pro¬ 
gressive tuberculosis is perpetuated by the catarrh. 
A great deal of the latter is remediable 
by what may be termed the hospital treat¬ 
ment, or " thorough ’’ treatment, the object of 
which is to rid the case as soon as possible of its 
dangerous complications—bronchitis, catarrh, casea¬ 
tion, and suppuration-—whilst utilising the period of 
unavoidable confinement in bed, in the ward, or in 
an even temperature, for the application of every 
therapeutical influence which in toe individual case 
may be profitably resorted to. This idea has been 
recently carried out with an encouraging degree of 
success in a limited number of ca^es. The favour¬ 
able results obtained have demonstrated to my satis¬ 
faction the advantage of not sending the patients to 
the open air prematurely, but only in a convalescent 
state. 

The Direct Pulmonary Methods, including the 
Intravenous. —In addition to serum therapy, which 
belong to the future, these include the intratracheal 
injections, which are not sufficiently recommended 
by their results: the inhalation treatment, well 
known to all in its more familiar applications, but 
specially elaborated into definite methods by Cervello 
with only partial success as the formaldehyde sys¬ 
tem, and more recently with every promise of prac¬ 
tical usefulness by Dr. George Stoker as the 
continuous nasal oxygen inhalation method; and, 
lastly, the intravenous injections, which in some 
form, perhaps quite different from any at present in 
use, are likely to prove the most active and rapid 
agency. Landerer s sodium cionamate treatment 
has bad a fair trial, and the bulky injection method 
which we owe to Dr. Maguire's labours is now being 
tried. I am not acquainted with the latest develop¬ 
ment of the formuldehyde injection treatment, but 
some of the results obtained with the original method 
were very favourable, although neither by this nor 
by any other method has a permanent clearance of 
the bacilli from the tissues been obtained. 

I was led to substitute protargol for formaldehyde 
by the conspicuous success of the administration of 
nitrate of silver in pneumonia (Caccianiga) and of 
its subcutaneous injection in phthisis (M^s) Pend¬ 
ing the discovery of some better remedy I have pro¬ 
visionally adhered to it in preference to formalde¬ 
hyde because of its more decided, of its more rapid, 


and of its more lasting action. The clinical effects 
resemble those obtained by Dr. Ma^ire with formal¬ 
dehyde—viz., a remarkable subjective feeling of im- 
provemmit coinciding with manifest improvement in 
aspect and in stren^h, a rapid diminution in the 
cou^h and in the expectoration, and a more or less 
rapid change from ^e dense sputum of phthisis to 
simple catnrrhal sputum and mtimately to hyaline 
mucus, Ac. 

The ultimate effect is to lower the temperature, 
but meanwhile the level may be disturbed by eleva¬ 
tions incidental to the treatment. More often than 
not the injection is followed after one hour by a 
chilliness or even a rigor and a sharp rise lasting 
about half an hour. After this has passed off the 
patient feels and continues to feel remarkably well; 
no untoward symptoms of any kind have followed 
the rigors. A short attack of nephritis occurred in 
one patient, but this seems to have been occasioned 
by a chill. Pre-existing albuminuria of long stand¬ 
ing was much reduced in one of my cases; in 
another the first injection succeeded in stopping a 
rebellious hemoptysis. 

The Technique.— The details of the operation are 
given in the paper. The injection consists of forty 
cubic centimetres of saline solution containing It 
to 2l G^ins protargol, and this is preceded and fol¬ 
lowed by an injection (through the same needle) of a 
few cubic centimetres of pure saline solution to 
obviate leakage of irritating fluid into the tissues, 
which is £mt to lead to considerable pain and 
swelling. From twelve to fifteen injections generally 
suffice. It is best to administer them at intervals of 
one day, but in some cases they have been given daily. 

The Systematic Treatment. —The protargol injec¬ 
tion method has yielded by itself satisfactory 
results, but it does not claim to be more than the 
first and most important instalment in an extensive 
system of active treatment. My present practice is 
to combine with it, as soon as the case has lost all 
acuteness, general massage, gentle exercise, and par¬ 
ticularly respiratory exercise for the expansion of 
the lung, strong diet and nutrient adjuncts, local 
and general treatment of (he skin, and suitable in¬ 
ternal remedies, among which I have obtained 
specially good results from ichthyol, originally re¬ 
commended by Wertheimer. This combined treat¬ 
ment, a full description of which cannot be briefly 
given, has enabled some patients with originally 
un'avourable prognosis to become, after a few weekb’ 
stay in the hospttiU, quite suitable for the open-air 
treatment, and to return, after a short period in the 
country, ereatly improved, and with a promising 
forecast of ultimate recovery. 

Drugs may have been too much discouraged owing 
to the superior virtues of “ open air." Our know¬ 
ledge of the latter should not paralyse, but stimulate 
our therapeutical activite. A place is still to be 
found for the old remedies, not anr longer as the 
sum of our treatment, but as useful or necessary 
adjuncts. Expectorants, antipyretics, tonics, and 
sedatives may all have their temporary uses. Bat 
there are new remedies from which greater help may 
be derived, particularly when judiciously combined. 
Good combinations have been sacrificed to the desire 
to prove any one system to be a specific cure. The 
continuous inhalation of oxygen, for instance, is. 
compatible with various hygienic helps, and with 
most useful forms of medication. The same is true 
of the hyper-nitrogenous alimentation advocated by 
Bicbet (raw meat treatment), and by Harper (urea 
treatment). 

Wertheimer’s ichthyol treatment consists in the 
administration after meals of a few drops of ichthyol, 
say, in peppermint water, with a daily iocrease of 
one minim till ten minims are taken—some of my 

e 


o 


8spt. 26.1901. 


ORIGINAL COMMUNICATIONS. Th» Midiwl Pbw. 331 


patienta have taken twenty minims with advantati^e. 
A diminution in the coagh and expectoration, and 
a change in the character of the sputnm are percep¬ 
tible in a few days. Mj own experience endorses 
Wertheimer's most encouraging reports, and for the 
present I have no hesitation in recommending ich- 
thyolas the remedy which will mcst favourably and 
most rapidly influence the catarrhal complication, 
eren when administered singly. But this or any 
other medicine found to be superior may be used in 
combination with intravenous injections; and 
it is my belief that such a combination 
would help us to effect a rapid change in 
the condition of the lung, and to subdue the catarrh 
sometimes within two to four weeks, and thus pave 
the way for a rapid improvement under the " open- 
air** treatment. 

Conclusions .—In this system of treatment there is 
nothing final. On the contrary, all its details are 
provisional and merely the beet that existing oppor¬ 
tunities afford. Its resolts, hitherto, seem to justify 
a hope that yet better things are in store, and that 
well-sustaioed efforts in the direction indicated will, 
at no distant date, bring about a considerable reduc¬ 
tion in the total duration of the cure of phthisis, and 
in the minimum period to be spent at Sanatoria. 

The cases treated have all been hospital cases, and 
therefore illustrate the possibilities open to the State 
for the treatment of phthisis among the poor on 
a considerable scale, if Poor-law infirmaries and 
Sanatoria were thoroughly organised for carrying 
out a well-conceived systematic treatment. In all 
its details, and in special connection with the intra¬ 
venous injections, the general scheme which has been 
proposed could be more easily conducted at public 
institutions than in private. 

So long as no better remedies are forthcoming, 
those which have been suggested may be used with 
safety and profit; but it is urgent, in view of the 
important issues at stake, that a systematic inquiry 
should be undertaken into the comparative value of 
the various forms of treatment elaborated by indi¬ 
vidual efforts, and for some of which important 
claims have b^n advanced. 

THE 

PRINCIPLES OF TREATMENT 

OF 

TUBERCULOUS LARYNGITIS, (a) 

By StCLAIB THOMSON. M.t)., M.K.C.P.Lond, 
F.E.C.8.Eng., 

Fbjiiclaii to the Throat Bospita], Qolden Sqaare; Snrgeon to the 
Boyal Ear Hot pita], London. 

Thb statistics of tbe pathological department of the 
Brompton Consumption Hospit^ show that the larynx 
is sffe^sd in over 60 per cent of the cases which buo- 
enmb to pnlmonary tuberculosis. As 70,000 persons die 
annually in the United Kingdom from this disease, at 
least 36,000 of them would bare claimed our help in 
diminishing their sufferings from tuberculosis of the 
larynx. The statistics of averages warrant ns in saying 
that there are in this country at least 76,000 who require 
our aid in arresting or easing tbe progress of tubercu¬ 
losis of the larynx. The wide-spread character of this 
disease is therefore in itself a claim upon our attention ; 
and when we remember the long drawn-out sufferings 
which may accompany it, and the youth of the majority 
d its victims, our humanity is keenly stimulated on 
their behalf. 

Tbe moment seems opportune for briefly reviewing 
the principles which may guide us in the treatment of 
tnbmu’osis of the larynx, for not only must we re¬ 
adjust older views to the modem light which has come 

(t) Paper read before the British Coagresi on TsbercnloeiB, July, 
190L 


upon tbe scene, but such an occasion as tbe present con¬ 
gress rarely occurs for supplementing the experience of 
tlte laryngologist by that of the genera physician and the 
pathologist. That this review is very necessary has 
been impressed upon me by the perusal of a large 
number of the most receut text-books on laryngology, 
few of which contain any reference to the treatment of 
laryngeal tuberculosis by modem hygienic methods. 
The frame of mind of many laryngologiste is reflected 
in a recent paper by Dr. Johann Sendziak, in which he 
makes mention of tbe “rational—that is, the surgical— 
treatment" (o) of this disease, as if any method of 
treatment short of surgical was not worthy of being 
denominated as reasonable, and as if hygiene and rest 
were of no avail, and the tn's nedieatrix vaivrm a myth. 

Our principles of treatment are guided by clinical ex¬ 
perience, but, when available, are based on pathological 
knowledge. The pathology of tuberculous laryngitis is 
rendered difficult by the complexity of the anatomical 
arrangement of the larynx. 1 he varieties in tbe strac- 
tnre of the mucous membrane and sub mucosa, tbe 
functions it performs, the proximity of tendons, liga¬ 
ments, muscles, cartilages and joints, the disposition of 
lymphatics and vess^, the occasional movements 
required in deglutition and theconstantihythmioaotion 
of the vocal cords in respiration, are all points which 
have to be taken into consideration. While the morbid 
histology of tuberculosis can be so readily studied in 
the larynx that Virchow recommended it as one of the 
best opportunities for observing the process, yet the 
complicated nature of the larynx renders an investiga¬ 
tion of the anatomical conditions an equally important 
part of our task. 

Tuberculous affections of tbe larynx have been olsesi- 
fled under four categories:— 

(a) Superficial ulceration commencing from the sur¬ 
face; 

(b) Inflltration, followed by 

(o) Ulceration; and 

(d) Tumour formation, or tuberculoma. 

Tl^ olaesifloation is of coarse somewhat arbitrary. It 
is seldom that two or more of these forms are not oom- 
bired when a case first presents itself. As there is 
little doubt that in the large majority of oases inflltra¬ 
tion precedes every other process, it is deserving of par¬ 
ticular study as to its situation. It commences in the 
snbepithelial layer, and when it takes place in regions 
where the mucoiu membrane is closely adherent to 
deeper tissue, and partioolarly to cartil^e - as in the 
epiglottis, vocal processes, and arytenoid—it is very 
apt to spread to deeper parte, leading to periobondritis 
and necrosis of cartilage. Although the mucous mem¬ 
brane of the vocal cords is closely attached to the 
underlying tissue, the abeence of subjacent oartilsge 
renders i^ection of this part of the la^nx a less 
rapidly destructive process. On the ventricular bands 
there is still less danger of immediate spread to 
adjacent cartilage. 

Of all the various situations in the larpnx the most 
frequently attacked is that of the arytenoids and the 
neighbouring inter-arytenoid sjraoe. Lake found this 
part affected twice as often as the vocal cords, and 
three times as often as the epiglottis and venericnlar 
bands, (b) 

In the euly stages of such cases the vocal cords not 
only show a want of tonsion, but careful inspection will 
show that their movements are impaired both in adduc¬ 
tion and abduction. This tendency to remain in the 
natural cadaveric position (i.s., the position of rest), the 
inter-arytenoid tbiokening.and tbe coDseqaentdysphonia 
or aphonia, have inclined W. Fowler to look upon tuber¬ 
culous laryngitis as chiefly a joint disease. He snpports 
his view by the record of between forty or fifty 
autopeies of tuberculous laryngitis, and as bis know¬ 
ledge as a laryngologist helped te render these examina¬ 
tions very complete, I think the results deserve careful 
consideration. “ In every oase," he writes," the greatest 
seat of the mischief was in the immediate neighbourhood 
of tbe orioo-arytenoid joint, and the joint itself was 

ogle 


(a) Jovmnl of Ijorynuotogy. Haj, 1901. 

(b) “LaiTiiseal Pbthisis,’'London, 1901. 



332 Thx Hbdio^ PkB88> 


OB1GINA.L CUMMTTNIOATIONS. 


Skft. 26. 1901. 


always implicated. The deepest pan of the nicer, when 
nloeration existed, wae always immediately in front of 
the joint, and the joint not only oommnnioated with 
the floor of the idcer, bat was also more or less 
disorganised. In many cases the arytenoid was a loose 
piece of dead cartilage.” (a) 

The patiiolt^ of laryn^al tnberonloeis reqniree still 
further study, bnt in any case we seem warranted in 
assuming that, as in other parts of the body, the first 
process is one of infiltration. Universal ex* 

prrience and pathological observations concur in 
•establishing the fact that in a large majority of oases 
this infiltration first takes place in or about the 
arytenoid joints. Other parts are occasionally attacked 
primarily; the epiglottis less frequently than any 
ether. 

Leaving now for a moment the pathological aspect of 
the subject, let us consider it from the result of treat* 
ment. 'Writing in 1880, Morell Mackenzie observed. 
” It is not certain that any oases ever recover” (p. 
883), and he states that he only knew of four in whiem 
he bad reason to believe that the disease was entirely 
arrested. (6) 

This view has been somewhat modified in the suc¬ 
ceeding twenty-one years by the work of Moritz 
Schmidt, Krause, Hexyng, and others. Their work has, 
unfortunately, divert^ attention too exclusively to the 
possibility of exterminating the disease from the larynx 
Dy knife and caustic. K^veries have, indeed, been 
claimed under various treatments, but we must re¬ 
member that arrest will take plaM in the larynx as 
elsewhere without any local tieatment whatever. When 
reaction and resistance of neighbouring tissues are 
sufficiently vigorous the advance of infection is checked 
by the fibroid change, which is the natural and desir¬ 
able process of oure. In many cases the recovery is 
deceptive ; partial cicatrisation of an ulcer may take 
place in one part, or retrogression of an infiltration occur 
in the region visible in the mirror, while the process 
may be spreading in the depths of the tisRuee, or in 
sncdi parts as the ventricles of Morgagni and the sub- 
glottic region. Besides, the foreshortened image we 
see in the mirror is a very unsatisfactory picture of the 
posterior laryngeal wall—the most important region in 
tuberculosis—and is always inadequate as regards the 
parts lying below the cords. Everyone who performs a 
laryngo-fissure, or opens a larynx on the post-mortem 
table, is prepared to find disease invariably more exten¬ 
sive than it appeared in the laryngoscope. 

But what remains to us of all the various methods of 
local treatment which have from time to time been 
vaunted as curative of laryngeal tuberculosis ? Their 
very number is eloquent of their inefficiency, and 
although some cases may have recovered under treat* 
ment, and many may have been locally relieved, yet we 
need hardly stop to consider whether the various sprays, 
pigments, insufflations, submucous injections, or intra* 
tracheal injectiocs, had more than an alleviative effect, 
or whether, in the majority of cases, the irritation and 
reaction they produced did not far counterbalance any 
possibility of good. 

None of the numerous methods which have from time 
to time secured some attention have ever appeared to 
me sufficiently rational to make them worthy of an 
extended trial. On the other band, their disadvantages 
and uncertainties were only too apparent. I have, 
therefore, been compelled to appeal to the experience 
of others on this matter, and in doing so will only refer 
to what we may term the Isotic acid and the surgical 
methods of treatment. 

Applications of lactic acid to the tnberoulous larynx 
have obtained such a vogue in the last ten or twelve 
years that the method has been applied d tart tt d 
iraveri, practitioners in many cases persevering with it 
while the patient was being prevented, through its 
effects, from improving generally, or even steadily 
deteriorating in health. In many cases I have known 
of its being applied over nnbroken mneons membrane, 

(a) " IntercolooisI Modioil JoaiDtl of AuitiftlasU,” Oetober 20tl)| 
1698. 

(b) Diseuea of the Throat and Nose," vol. 1, p. &SS. 


covering deep infiltrations, or evident perichondritis, the 
surgeon apparently not stopping to ask himself how this 
superficial caxutic could affect these deep processes, or 
do more than distress Ihe patient and hnrry on the pro¬ 
gress cf the disease. And now Frendenthal, who need 
it freely, states frankly that'* it ought to be dispensed 
with as antiquated and barbarous torture of the 
patients.” (a) 

In 1809 Fiendenthal subjected twenty-nine oases to 
ani^oal treatment without being able to record one 
single onre. (b) He then treated his oases of tubercu- 
lons laryngitis without ooretti^, and after a year’s 
observations he wrote, " I believe my patients are just as 
well and perhaps better off than they would have been 
with the operation.” (c) 

The extensive and trustworthy experience of Jonathan 
'Wfight has led him to the following statement:—“The 
permanent radical cure of the local lesion of tuberoulons 
laryngitis is not materiaUy hastened by the varions 
methods of treatment in any but an insignificant num¬ 
ber of cases.” 

That a certain number of apparently permanent cures 
have been effected is nndcnbt^. I have myself verified 
such a case both before and after treatment, which was 
shown by Dr. Lack to the Laryngological Social of 
London, (d), bat the chief point to realise is that even 
the most enthusiastic supporters of eurgical treatment 
of tnbercnlons laryngitis admit themselves that the 
majority of cases are unsuitable even for attempting 
operative measnres. We must also remember tlmt in 
this small minority of cases tbe method is painfnl and 
distressing; it cannot but react unfavourably on any 
general condition, and tbe result is extremely donbtful. 

It seems to me that the treatment of the last decade 
has been based too exolnsively on tbe baoillns as the one 
and only [etiological factor, and that dne regard has not 
been given to more general considerations. 

In indicating the slight and unsatisfactory results 
which have been gainM from the direct treatment 
of laryngeal toberc^osis I must be understood as only 
deprecating much of the treatment in so far as it has 
been regaled as affecting a local core. Where the 
progress of the disease—in the longs and in the larynx 
—is not stimnlated by local interference then many 
measotes are available for symptornatio treatment, and 
we are well equipped nowadays for soothing laryngeal 
irritation and cough, easing pain, facilitating swallow¬ 
ing, and thus contributing to the general treatment 
and the possibility of core. 

We must look elsewhere at present than to surgical 
measures for a prospect of progress in the treatment of 
tnbercnlosis of the larynx. This progress is ready to 
hsnd in the making of an earlier diagnosis of local infec¬ 
tion. Tbe present is hardly the occasion, even if time 
permitted, for me to enlarge on tbe symptoms of tbe 
early diagnosis of laryngeal tuberculosis. Besides, tbe 
most detailed description of the laryngoscopic appear¬ 
ances could hardly portray a condition whi^ would be 
recognised by any bnt an expert, so slight are the early 
changes, and so varionsly are they combined. “In 
general,” says GtUnwald, “ it may be said that it is 
impossible to teach anyone theoretically how to make a 
diagnosis from the picture in any given case, because, in 
order to arrive at a decision, one must first learn the 
development of many socoessive pictures by long per¬ 
sonal observation. Not the picture of to-day, but that 
of yesterday, and that of to-morrow, must decide for or 
against laryngeal tuberculosis.” (a) But it is not only 
from the laryngoscopic appearances that a diagnosis of 
early local tnbercnlons infiltration, or of even pre- 
tuberculouB laryngitis, be made. We must make a 
careful and thorough examination of the entire body, 
and pay carefnl attention to such symptoms as ansmm 
anorexia, dyspepsia, loss of weight and strength, bnrried 
pulse, and evening rise of temperatore. The previous 
history of the patient, particularly in regard to hasmo* 
ptysis and pleurisy, must be taken into consideration, 

а) Joum. oftht Amer. Med. Aivoen., Uareh 16tb, 1901, 

б) PhiiadeljAia Med. Joum , March S5ih, 1899. 

(e) Medical A’tw*, New Vwk, Jan. iSth, 1901. 

(d) " Tnwe. Laryngol. 8oc., LoiidoB." 

c 


o 




S»PT. 2S, 1901. 


CLINICAL RECORDS. 


Tss Hssioai. Pbbs8. 333 


and the family hiatory ahoold not be forgotten. Thera : 
are many other indications of early tuberoolosiB, and | 
these, together with the indications for the employment I 
of tnberonlin as a diagnostic test, I must at present 
leave ont of consideration. In this way evidence can 
often be obtained which will complete the du^nosis of 
a laryngeal condition which might otherwise m treated 
as a simple catarrh. In the absence of positive con¬ 
firmatory symptoms, and of other adequate explanation 
of laryngeal symptoms, we mast treat snspioione cases 
by measures &at we know now will avert a condition 
which, once well established, is almost always incurable. 
In doing this we are but working along the lines and 
making the same plea for early diagnosis which has 
been so forcibly advanced in recent years in the subject 
of pulmonary tuberculosis. 

Once the early diagnosis is made the treatment is 
exactly the same* as that now employed in pulmonary 
phthisis - the sanatorium treatment in what should 
practically be the open air, with rest, hygienic 
surroundings, and good food. To this must be Mded, 
more or less, strict insistence on voice rest. This is 
found to be beneficial in many cases, even when the 
larynx is not affecied. It must be mooh more so in 
laryngeal cases, when we realise that in the majority of 
instances the focus starts near or in the orico-arytenoid 
joints. 

The treatment of catarrhal or obstructive affections of 
the nose and throat, and of any interourrent conditions 
of the larynx, must, of course, receive careful and luitable 
treatment, and it is, therefore, very desirable that those 
in medical charge of sanatoria should be skilled in prac¬ 
tical Imryngoscopy. But the important principle to 
bear in mind is primum non nocere, for even a cluiuy 
examination of tiie throat may produce more irritation 
and hium than any treatment can counterbalance. ^ 
Briefly recapitulated, the principles to bear in mind in 
tuberculosis of the larynx are as follows:— 

1. Patholc^ and clinical experience show that in the 
majority of oases the focus of infection is near or in the 
crico-arytenoid joint. 

2. Many cases only present themselves at a stage 
when the possibility of effecting a cure by local measures 
is quite untenable. 

3. The principle of pntnum non nocere should be con¬ 
stantly kept before us, as many measures which have 
been tried in this affection have only distressed the 
patient and biutened the disease. 

4. In the light of present knowledge and therapeutic 
resources, the most rational principle is to attempt to 
make an early diagnosis of the disease while in an 
indpient stage. Any persistent or suspicions laryngeal 
catarrh should be treated seriously on even a presump¬ 
tive diagnosis. 

5. Once diagnosed, the patient should be treated on 
the prindples laid down in the modem method of sana¬ 
torium treatment. 

6. Symptomatic treatment should be directed to any 

irritative, catarrhal, or obstructive condition of the air 
passages. . 

7. In addition, silence should be enjoined, the disuse 
of the voice l^ing proportionate to the degree in which 
the focus of infiltration approaches or interferes with 
the arytenoid joint. 

8. In cases where the situation or extent of disease do 
not warrant sn expectation of complete arrest of the 
process, treatment should be symptomatic, and in many 
such cases the sanatorium treatment is uncalled for. 


Cltnital ^ccorbs. 

A UNIQUE CASE OF GENERAL EMPHYSEMA 
FOLLOWING TRACHEOTOMY. 

By Gxobg* Fot, P.R.C.S., 

Snrgeon to the Dmmoondra HospiUl, Dublin. 

Oni of the least common of pathological conditions is 
general emphysema. Of the 43,610 wounds of the neck 
and thorax recorded in the Federal Service during the 
Civil War in America there was not a case, though there 


were eight cases of jtartial emphysema. In the Con- 
federate StaUt there is cot a case of general emphysema 
in the old Medical and Snrgieal Journal, though there 
are two cases of partial emphysema recorded. Heenan 
never came across one, neimer did Guthrie. Longmore 
has not recorded one. Withal every military surgeon 
appears to expect it. MouUns, Wiseman, Chese^n, 
John Bell, B^n Larrey, i^e younger Larrey, and 
McGuire, who all have seen great numbm of 
throat and chest injuries, have but one case on record, 
the oft-quoted Lsrrey's light dragoon. 

Incivilpraoticeafewcasesarereoorded. Wilks,in 1868, 
tells of a boy in whom a perforating ulcer of the trachea, 
occurring as oomplication of typhus, caused general 
emphysema. Somewhat similar is the Zenker and 
Grenosen case, in which an ulcer, of the size of a lentil, 
perforated the larynx, and gave rise to an emphysema 
that gradually during the course of some days became 
gene^. Schreger reports a case from fracture of the 
thyroid cartilage. 

A unique case of the disease has, however, just been 
published by Dr. EUett in the Atlanta tTbsmsI Record of 
Medicine. The patient, a boy, et. 2, had his trachea 
opened for the remov^ of a foreign body—a water¬ 
melon seed. The incision extended from the bifurca¬ 
tion of the trachea to the larynx. The wound was 
closed with three layers of oatout sutures, one in the 
trachea, one in the muscles, and one in the skin and 
fascia, and the dressing applied. Following recovery 
from the anesthetic the child began to cry, forcing 
air ont of the tracheal wound, and thence along the 
layers of cervical fascia. The child swelled to an 
alarming d^ree, the emphysema being at first^ con¬ 
fined to the left side of the body and the right side of 
tbe head, but soon involved the snhcutaneons tissue 
of neck, face, scalp, (diest, abdomen, and scrotum. 

The case was reported at the Memphis Medical 
Society in Augnsti 1898, and in the discussion that fol¬ 
lowed Dr. Sale mentioned a somewhat similar case, in 
which partial emphysema, extending over the neck and 
chest developed as a oomplication after an operation.^ 

The possibiUty of emphysema of the neck following 
on tracheotomy is referred to by Allen Bum. 

But so far Dr. EUett's case is the only one recorded I 
«»a.n find; it is the fifth case of general emphysema, and the 
only one occurring in so young a patienh During the 
Peninsular war piisoners on both sides, who were 
malingerers to secure moie comforts skilfully produced 
partial emphysema of the head and neck by perforating 
the tissues of the cheek from within the mouth to the 
cutaneous surface, and dilatsd the subcutaneous tissue 
by blowing through a fine cannula. 


ftermang. 


[fbom ocb own cobrkspondxnt.] 

BssLiir, September 81st, 190L 
Hxtol in Lartnobal and Pulmonabt 
Tubbscclosis. 

A PAPBR on this subject appears in the B-rl. JTlia. 
Woc\., 27/1901. The paper is really a report by Dr 
Guttmann on tbe subcutaneous use of the drug in the 
PoUclinio for nearly a j ear and a half. Referring fiist 
to the literature of the subjeot he remarks first that 
the majority of obeervers have noted improvement 
of the subjective symptoms soon after commencing tbe 
treatment. Both cough and expectoration were favour- 
ablyinfiuenoed. Night sweats diminished or disappeared. 
The effect on the appetite was striking. The body 
weight increased in correspondence with this. No 
injurious bye-effects were observed. Tbe treatment 
could be carried out on out-patients with moderate 
care. Cases were suitable for polyclimo treatment in 
which there was absence of fever, and the condition as 
to nutrition was moderate. Cases in which there was 

dk. jogie 


(fl) OnmwAld on " Diseases of tbe Laryna,” 1898, 


334 Tbs Midical P&sae. 


AUSTRIA. 


SsFT. 26, 1901. 


lasting fever, qoiok decline, disturbance of bowels, and 
hamoptysis were unsuitable for outdoor treatment. 

In the Policlinic (Prof. Krause’s) oontinuous obserra- 
tions were carried out, and the material employed was 
grouped in two series. The first series comprised 
twenty>eight oases, the whole of which at first 
appeared to Landerer himself as unfavourable. The 
period of treatment lasted from December, 1899, to 
Angxut, 1900. The second series began in October, 1900 
and lasted to April, 1901. In the majority of the cases 
there was laryngeal tuberculosis in addition to that of 
the lungs. The carrying out of the treatment was after 
the method proposed by Landerer. The solution used 
was a 1 per cent, solution of cinnamonic acid kept in 
coloured glass, kept clear in appearance, and either 
neutral or slightly alkaline. Before use it was sterilised 
by five minutes’ immersion in boiling water. A properly- 
sterilised syringe was used. The needle was very 
sharp, so that a minimum of pain should be caused 
by the puncture. The needle and syringe were both 
kept in absolute alcohol, boiled before using, and 
washed out with sterilised 0*7 per cent, saline solution. 
Before making the injection an elastic ligature was 
placed on the left upper arm near the elbow. The 
region of the cephalic vein was then washed, first with 
ether and then with sublimate solution. After the air 
babbles had all escaped from the syringe the needle 
was passed into the cephalic vein. The dose at com¬ 
mencement was half a milligramme of hetol. After the 
injection sterilised lint was placed over the site of punc¬ 
ture and fixed in position. According to the patient's 
condition the dose ranged from half a milligramme to 
eight milligrammes. The injection was repeated three 
times a week, the two arms alternately. The treatment 
was not continued in the presence of nephritis or 
diabetes. 

Of the thirty-three cases treated, one recovered, ten 
improved, nine were treated without result, eight died, 
five withdrew themselves from treatment The re¬ 
porter designates hetol as a valuable remedy in the 
complaint, but denies that it is a specific, i.e., that it 
possesses any antitoxic or bactericidal properties, but 
it has the property of supporting the organism, and 
in many cases may assist in bringing about a recovery. 
Care must be taken as to dosage. la^e doses ap 
pear to be unnecessary. Taking the matter as a whole 
the reporter recommends the treatment in the early 
stages of the disease. 

Alcohol and Tubebculosis. 

The Berlin Med. Woehen. has an article on this sub¬ 
ject by Dr. Hammer, of Bmnn. From observation made 
on three oases the author is inclined to support the view 
of Koranyi to the effect that as in the liver and kidneys, 
in the lungs also aa active development of connective 
tissue can be brought about by alcohol, which has the 
power of shutting off the diseased part from the surround¬ 
ing healthy ones, and of thus leading to recovery. This 
observation was made in the oise of three individuals 
who drank to exoecs, but whether similar results may 
be expected in other oases is not stated. 

At the Niedersohen Gesellsohift fur Natnr and 
Heilkunde Prof. Sohiefferdecker communicated a note 
on the 

PaSBEBVATlON OF BoDIBS BT CbINOSOL. 

Completely satisfactory preservation coold be effected 


by 60 grms. of ohinosoL The 60 grma. are dissolved in 
three litres of water, and after this is injected into the 
body, half a litre of water is added to assist in forcing 
the solution mote effectively into the great vessels of 
the body generally. The iojeoUon is beet made by 
means of an irrigator, and is very simple. The colour 
of the organs is in no way changed, both the blood and 
the muscles show their usual red colour. The brain, 
however, appears to take on a slightly yellow tint. By 
this in jeotion both the bowels and the skin are efficiently 
disinfected and preserved. With the quantity used and 
equally distributed into all parts of the body each 
part will contain one per thousand or one per fourteen 
hundred, quite enough to kill off all fungi. It is also 
probable that infeotion from the body would no longer be 
possible. For disinfection of the hands a 1 in 500 
solution is regnlarlf used. When the body has to be 
kept for any length of time before being used it will be 
well to wrap it in cloths soaked in chinosol solution. 
Bodi^ which already smell badly when they arrive 
should first be washed with chinosol solution whereby 
the smell is mu-ih diminished. If bodies have already 
been opened cavities should be washed with the eolation 
and cloths soaked in it should be allowed to lemain in 
them. 


Jiustria. 


[raOB OUB OWN oobbbbpondxnt.] 

ViEKSA, September SUt, 1901. 

Ekubbsis in Childbxn. 

Thixbbch gives it as bis opinion that enuresis is not 
a symptom denoting a local disease, but rather a general 
neurosis resembling hysteria. His reason for coming to 
chis ooDOlnsion is that most of the parents of such 
children suffer from a neoropathio disease of some kind, 
such aa hysteria, Ac. This may account for the epi¬ 
demic form of enuresis that frequently attends our 
hospitals, which is often asoribed to other causes. 
Another ground for his belief in a neurosis is the 
ineffectual efforts of medicine to give speedy relief, 
onureeis being so obstinate to the potency of all 
medicaments to remove or alleviate the discomfort of 
the patient. The treatment that is most efficacious is 
that preferred in the restoration of the neurotic state, 
such as faradio treatment, injections of strychnine, Ac. 
The suggestive treatment is not without its votaries, 
whioh also meets with a certain amount of success. The 
most powerful meMure to adopt in the cure of enaresis 
is to remove it from the surroundings where the disease 
first commenced, or, more properly speaking, isolation. 

Gblatinc as a Hemostatic. 

Gmnow's experiments still confirm the opinion that 
gelatine, when auboutaneously injected, is a powerful 
styptic. His injection ii two grammes of gelatine in 
a hnndred grammes of a physiological aolntion of com- 
men salt injected into the thigh, side of the thorax, or 
abdominal wall. This treatment has been in his 
bands most effioaoious in many cases of internal htemor- 
' rhage. The gdatine appears to rapidly act as 
a powerful ^ent in producing coagulation of the blood, 
and thus arresting the general diapedisis. There is one 
weak point in bis experiments that militates against its 
success whicdi he frankly admits. He tells us that soms 


Dir tized by 


GoogI 


c 




SjgT. 25. 1901. _ THE OPERATING THEATRES. Thi Medical Pbiss 335 

©ptraimfl ‘theatres. 


of kia cases required a combination of drags to eff »t the 
ksemostatio action. 

Thb Radsohbbsnd BaoiLLi. 

Sobattenfroh and ixrasberger have for some time past 
been engaged ni experimenting with the Bansohbrand 
bacilli, and conclude that they are genaine butyric acid 
producers in the presence of carbohydrates, and that 
sporification is carried on in the granular substance of 
the germ, although they acknowledge a double form of 
development b; germination. The former have long, 
active flagellse; the latter have none. 

The cultivations exhibit both forms of generation j 
the chemistry and pathogenicity are unquestionable 
evidence of the presence of the microbe. Both gene* 
ration forms are interchangeable. 

Chanoss in thi CasTBAL Nbbvb Ststbm aptbb 
Ttino thb Thtboid Vbssbls. 

Huas in his experiment on dogs, tells us that there ig 
a decided morbid change in the spinal cord, both longi. 
tndiually and transversely after tying the vessels of the 
thyroid, particularly in the posterior column, a lees 
degree in the anterior column, as well as the posterior 
part of the lateral column. In the ganglionic cells of 
the gray substance as well as the spinal cells no morbid 
or degenerative changes can be observed. In the brain 
itself degenerated fibres can be found in the posterior 
bundles. In one dog. forty-eight days after tying the 
vessel, there was present a decided change in the pyra¬ 
mids extending from the pons to the cerebral convolu¬ 
tions. The longer the dogs lived after the operations the 
more decided the morbid changes. 

Dblibiuk Tbihbns. 

Bonhoeffer, in dtscussing the complications in deli¬ 
rium tremeu), thinks the first important change is acute 
congestion of the lungs and next ofthe stomach. Injury, 
direct or indirect, such as fatty emboli, is more imaginary 
than real, which may properly be said to hasten the pul¬ 
monary changes. The epileptic attacks may be properly 
relegated to a toxic source, and may be ascribed to ex¬ 
cessive drinking and malautrition. 

PuBBPBBAL PsTOaOSIS. 

Meyer, of Tubingen, records 1,104 cases of mental 
disease that have come into his clinic from 1894 to 1901, 
and finds that 61,or 46 per cent, became affected during 
the puerperal or lactation state. To be more accurate, 33, 
or 2*9 were affected during the puerperal period and 
18 or 1-6 per cent daring lactation. Out of the 61 
puerperal and lactation psychosis, 11 were of the melan¬ 
cholic type, 4 periodic melancholia, 3 circular psychosis, 
6 were paranoic, 9 acute mania, 14 catatonia, 2 
epiphrenia, 2 epileptic, and one suffered from hysterical 
psychosis. Meyer found nothing that would lead him 
to believe that there was any specificity in the aetiology 
ci puerperal as such mental changes might ooonr under 
any other momenta. 

Bibthdays. 

Next month come two notable bir^days, for which 
great pr^)arations are bring made. The first is that of 
Virchow, st 80, of Berlin, on the 11th; the second 
is that of Professor Nothnagel, tst. 60. A committee, 
with Lorens, Uanoabei^, and Brewer at its head, has 
bemi appointed for the banqnet-addresses which will be 
namerona and reprooontstive. A varied and inter- 
national gathering is sheeted on October 16th. 


WEST LONDON HOSPITAL. 

NbPHBKCTOHT fob HtdBONBPFBOSIS FOLLOWINO A 
Nbphbopbxy. —Mr, Swinfobd Edwabdb operated npon 
a young woman, set. 22, who had nnde^ne fixation of 
rile right kidney a month previously. This had been 
undertaken for what was evidently a luxated kidney, and 
which had troubled her off and on for years. Three 
days after this operation the patient complained of oou- 
siderable pain in the abdomen. The temperature rose 
to 101°, and an area of dulness was discovered extending 
from the wound down to the iliac crest. After tbi8,the 
temperature fell, and she experienced some relief. Ten 
days ago a rounded tumour could both be seen and felt 
in the right lumbar and iliac regions, which was dnU 
to percnsston, elasttc to palpation, and a wave could be 
made out suggesting fluid contents. Hydronephrosis was 
diagnosed. The amount of nrine passed had fallen from 
forty ounces before the operation to twenty or thereabonts. 
Mr. Edwards commenced the operation by excising the 
old scar. On cutting down into the kidney he came 
across several silk sutures, after the division of which a 
tense, elastic, blnish sac presented. This was incised 
and gave exit to qnite a pint of urine. The kidney was 
next isolated, and the incision into what proved to be an 
enormously extended pelvis.was extended. The calyces 
and renal papillte were now distinctly seen, but the 
nretsral opening was found with difficulty, bein^ awklII 
and quite out of its usual position. Moreover, inutead 
of being infnadibnliform in shape it opened abruptly 
into the distended pelvis. A probe was passed with 
ease into the bladder. It was therefore evident that a 
kink into the ureter had cansed the hydronephrosis, 
which kink was obliterated on drawing the kidney ont 
on to the loin. The kidney sabstanoe lay alto, 
gether in front of the distended pelvis, and was 
thinned. The operator, thinking that mere drrinage 
with refixation of the kidney would probably lead to a 
permanent urinary fistula, decided to remove the organ. 
This was accomplished by first dividing and ligaturing 
the meter, the stump of which was oarefoUy swabbed 
with carbolic acid. The remains of the pedicle were then 
transfixed with a blunt needle armed with silk some¬ 
what thinner than is nsnally used, and tied with two 
interlocking loops. After excision of the kidney the 
branches of the renal vessels were tied separately on 
the distal side of the pedicle ligatures, and the opera¬ 
tion completed in the usual manner, a drainage tube 
being inserted. Mr. Edwmds remarked that 
hydronephrosis following nephrorrh^hy was not 
nnknown, thongh he personally had not met with 
this accident in his series. He thought the 
cause of it might possibly be that sni^eons were 
not snffioiently ovrefnl in replaoii^ a loose kidney 
before anchoring it. It is, of course, a much easier 
proceeding to stitch a kidney to the mnscles and fascia 
in the loin, well bolow the last rib, than it is to 
stitch and maintain the organ in its proper position, 
which is with the upper half on a level with the lower 
two ribs. Mr. Edwards elected to remove the kidney 
on two grounds. First, on account of its attenuated 
and seemingly atrophied condition, and secondly be¬ 
cause in these cases nephrotomy and drain^e is apt to 
be followed by a permanent fistula for the core of which 

bv O' 



336 Ihi MsDICAL 


LEADING ARTICLES. 


Sbpt. 25 , 1901. 


an ultimate nephrectomy would probably hare to be 
undertaken. 

ST. THOMAS’S HOSPITAL. 

Excision of thb Hpfib Jaw.—‘Mr. Battls operated 
on a married woman, Est. about 47, who bad been sent 
to him tor a tumour of tiie right noetril. The patient 
had noticed discomfort in the right nostril for about 
three months, and she had attended a special hospital 
for it. Here it was ascertained that she was suffering 
from a growth probably arising in the inferior tur¬ 
binate bone. A portion of this was rentored for ex¬ 
amination, and proved to be carcinoma. On admission 
to St. Thomas’s Hospital there was a tumour which 
blocked and distended the right side of the noetril and 
projected as a fleshy mass through the opening. The 
enlargement of the nostril extended up to, and indeed 
involved part of, the bony wall above. The nostril 
was completely blocked. There was some blood¬ 
stained discharge from the nostril, but no pain. 
There were no enlarged glands to be felt. The 
palate, the anterior wall of the antrum, the 
orbital plate, and the alveolar process appeared normal. 
There was no impairment of vision and no epiphora. 
The patient having agreed to the removal of the tumour, 
it was decided to take it away with the whole of the 
upper jaw, so as, if possible, to completely eradicate the 
site from which it was growing. The operation was 
done by Eergusson’s method, and the whole of the 
upper jaw, including the orbital surface, removed. The 
incision was made through the centre of the upper lip, 
skirting the ala of the nose, along the side of the cheek 
to the inner angle of the orbit, and outwards along the 
lower margin of the orbit to the outer angle and for a 
short distance along the zygoma. The flap'was reflected 
backwards, but in this case it was necessary to divide 
the nostril in order to permit of the better separation 
of the nose from the tumour; this incision on the nostril 
rendered complete removal much easier, but was not 
one, as Mr. Battle pointed out, that was frequently 
necessary, and should be avoided if possible. The bone 
was divided into the orhit by a keyhole saw in 
front of the attachment of the masseter muscle, and 
then from the nose into the orbit at the inner angle. 
The soft palate was separated from tiie hard, and an 
incision made through the mucous membnme of the 
hard palate forward to the socket of the incisor tooth. 
The saw was then placed in the right nostril, and the 
alveolar portion of the jaw divided in the same line as 
the incision in the mucous membrane. Bone forceps 
were inserted along the line made by the satr, and the 
separation completed. Lion forceps were then used, 
and the bone levered from its bed. It was found that 
the growth had not only invaded the anterior two thirds 
of] the inferior turbinated bone, but bad also spread 
upwards along the nasal duct almost to the oanthaB,and 
to quite the upper part of the nostril, so that it 
was surprising epiphora had not been a symptom. 
The curious point in the case, Mr. Battle said, 
was the presence of a growth, presenting a similar 
appearance, on the septum, opposite to the original 
tumour of the outer wall. The upper part of the growth 
had to be removed with a scraper as it could not be 
followed with a knife. The flap was sutured in position 
by means of multiple sutures of fish gut, and a plug 
placed in the cavity from which the jaw had been re. 


moved. It was a matter for regret, Mi. Battle aaid, that 
the operation bad not been performed directly after the 
growth had been diskgnoeed, but for some reason or ano* 
ther the patient was difficult to coavinoe of the seriousness 
of her condition. Microscopical examination of the growtii 
showed it to be columnar oelled-oaromoma. 

The patient suffered from a good deal of shock but 
recovered sat’sfttotorily. 

Beoistkbbd roa raABSiusaioN Abboad. 

JHtbtcal fre«0 anb (itircttUr. 

PubUshed evsry Wednesday morning, Price 8d. Post free, (fd. 

AOVEKTISEMEirTS. 

Fob Oim Issbetio* !—Whole Pegs, Oe. 0d.{ HsB Pige, 
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at 86a. i twenty-ai* at SSa.: flfty-two inaertiona at 80a. each: 
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Jfttbkal fttss anb ^xttvdst. 


SALUB POPULI BUPSBMA LSX.” 

WEDNESDAY, SEPTEMBER 25, 1901. 


THB TEACHING OF MATERIA MEDICA. 

It may safely be said that medical edncatiou is 
still in ita tentative stages, and that in spite of 
recent admirable advances there remains behind 
much that requires readjustment The eubject is 
certain sooner or later to arrive at a more perfect 
state of evolution, but that reflection should not 
hinder the attempt to hasten the day of salvation. 
Becent signs of the times tend to show that radic^ 
reforms are needed in medical training and examina¬ 
tion. The high etandard examinations demand a 
wtart crammed to the muzzle with a blunderbuss 
charge of details in every subject that enters into the 
curriculum. As a rule he is examined by men 
who are specialists in each branch, and who demand 
a detailed knowledge that would be more appropriate 
within the covers of a book of reference than as a 
fragment of the hastily-acquired and speedily for¬ 
gotten information of the high standard student. As 
everyone knows, education may be regarded from 
two distinct points of view; first, that teachii^ 
which aims simply at developing the intelleotual 
faculties, such as memoiy, reasoning, imagination, 
and observation; secondly, that which furnishes facts 
and knowledge necessary to the future career 
of the scholar. Medical education falls miunly 
within the second or technical category, although 
it is obviously impossible to dissociate the 
two by any absolute line of cleavage. It is diffi* 
cult to say on what grounds it would be possible to 

D!: 'zed by sOO^ C 



Skpt. 26, 1901. 


LEADING ARTICLES. 


Thi Midical PsBsa. 337 


defend a vast deal that the student ie forced to 
learn by the examiners, who practically pnll the 
strings of medical edacation. Let the examiners 
Bay that a candidate mast know the minutiae of some 
highly technical subject, say the electrical pheno¬ 
mena connected with muscular structures, and woe 
to the man who presents himself for examination 
without being fully charged with curious information 
upon the particular point in question, especially if one 
of the examiners happens to have hatched a pet 
Uieory of his own bearing in that direction. The 
fact of the matter is that both medical education and 
medical examination are left far too much in the 
hands of specialiste. The value of ladnnte and 
laborious research in the advance of science is vital 
to all progress, but the student is concerned more 
with essential principles and with a grasp of essen¬ 
tial facts and a practical training that will enable 
him successfully to face the battle of professional 
after-life. Materia medica affords a concrete example 
of the useless lumber of knowledge that the student 
ie obliged to take aboard. He has to acquaint 
himself with a vast mass of details as to the 
botany, chemistry, and physiological action of 
a myriad agents for which the ingenuity of man has 
found a place among medicaments. 'When the stu¬ 
dent becomes a practitioner he will confine himself to 
a score or so of drugs, and dismiss perhaps 95 per 
cent, of the remedies whose inner history and 
vaunted virtues he has so laboriously committed to 
memory. In materia medica a wise pruning of 
dry and withered branches would go far towards 
reviving the interest of medical men in what 
is still an important part of medical education. 
There can be little doubt that the advances of 
Bui^ry and our more exact knowledge of the 
setiology and pathology of morbid processes 
have greatly lowered the relative importance of 
materia medica in the field of modem scientific 
medicine. Yet neither teachers nor examiners show 
any signs of relaxing their standards so far as the 
student is concerned. A short while since one of 
the leaders of the medical profession confessed in 
the columns of the Times that he bad never heard 
of a drug which is found in the American Fharma- 
copceia. In a private capacity that lack of informs- 
tion was quite excusable, inasmuch as the virtues of 
the remedy in question appear to have no proved 
basis. At the same time it seems clear enough 
that a leader of the profession who enters into a 
public discussion in the columns of a lay newspaper 
should at least have taken the trouble to inform 
himself about the drug he was condemning. The 
fact that the drug figures in the American Pharma¬ 
copoeia on the strength of empirical experience need 
cause no surprise. Our own Pharmacopoeia pi*esent8 
a veritable chaos of unsupported theory and dog¬ 
matic assertion, which the student ie nevertheless 
required to master before he can pass the ordeal of | 
examination. The best man probably both to teach 
and to examine in materia medica would be a well-in¬ 
formed physician who is not a specialist in the subject. 


By sU means let ns have onr special researches by 
the best men obtainable and let them have ample 
means at command, hut the exolnsion of specialists 
at any rate from the examination table would pro¬ 
bably inaugurate a sounder era in the teaching of 
materia medica, and, cceteris paribus, in other 
branches of the medical onrriculum. 


PERFORATION IN ENTERIC FEVER. 

In the zymotic death-rate of this country, at all 
events, enteric fever still holds a high place in spite 
of the improved methods of modem treatment. The 
fact that this mortality is due, not so mnch to the 
fever itself, as to the complications to which it is so 
peculiarly liable, makes the matter all the more diffi¬ 
cult to deal with. Of all the complications perfora¬ 
tion is that which is most feared, and one which until 
lately was almost always fatal. As Professor Osier, 
writing in the St. Louis Medical and Surgical 
Journal, says, “until within a comparatively few 
years in the presence of this disastrous event we 
folded our hands and murmured that all was over.” 
That we should be forced to adopt this attitude in the 
presence of a complication which occurs in be* 
tween four and five per cent, of all cases may 
well account for the bigb mortality, and it is 
most satisfactory to think that a new era 
has dawned, and no longer will it be necessary for 
the physician to stand passively by and await the 
death of his patient If by the aid of surgery we 
are enabled to materially lessen the number of 
deaths from this grave accident, not only shall we 
have the satisfaction of considerably reducing the 
mortality of the disease as a whole, hut we shall also 
save the lives of many who otherwise were doomed 
to a certain death. The figures which Professor 
Osier gives are certainly most encouraging. IJp to 
January Ist of this year eleven cases of perforation 
had been operated on in bis wards, five of which re- 
covered, or 45 4 per cent.; five additional cases are 
recorded, one of which recovered, making a total of 
sixteen cases, with six recoveries, or a percentage of 
37 5. In this as in all cases of perforation of the 
intestinal tract early diagnosis is essential to success, 
and on this subject Professor Osier has much 
to say that ie both interesting and instructive. 
The time-honoured picture of perforation with 
the Hippocratic facies, the feeble mnning pulse, 
the profuse sweat, the distended motionless 
abdomen must be erased as a picture not of 
perforation but of peritonitis, or, as Professor 
Osier aptly calls it, “a rough draught of death.” 
For surgical aid to be of use, and that it can be of 
use is shown by the figures quoted above, the dia¬ 
gnosis must be made before general peritonitis has 
developed, and thus it becomes the duty of every 
physician to study carefully the symptoms by which 
it may he recognised. The first essential is that 
every serious case should be carefully and constantly 
vUited at short intervals by one who is competent to 
quickly grasp the changes in the patient’s condition 
and who in such cases is hourly in collusion with 

. ’8 ^ 


338 Thi Medical Press. 


LEADING ARTICLES. 


Sept. 26, 1901. 


bU snr^^ical colleague. The complication occurs, as | 
a rule, in severe cases and during the height of the i 
disease, and those cases with diarrhcea and tympanites 
are more liable to this accident. As the majority of 
cases of enteric fever have no abdominal symptoms ' 
whatever it ir not so difficult for the attendant 
to be on his guard. Professor Osier has 
drawn up a schedule of instructions which 
will well repay careful study. (1) Nurses must 
at once notify the physician of any complaint 
of abdominal pain by the patient, of hiccough or 
vomiting, of a special rise of pulse or respiration, of 
sweating, or uf any signs of collapse. (2) The 
physician must note the character of the pain both as 
to onset and locality, particularly whether it is vio¬ 
lent in paroxysms oi merely an aggravation of the 
slight abdominal pain already present. (3) The con¬ 
dition of the abdomen both as to shape and the 
presence of respiratory movements. Percus¬ 
sion and palpation may also afford valuable 
information. (4) The condition of the patient as 
to the presence or not of sweating, vomiting, 
or hiccough, and any alteration in the facies, 
pulse, temperature and respiration must all be care¬ 
fully noted. (5; In the majority of cases there is a 
marked and early rise in the leucocytosis present 
which should be looked for as it affords an important 
clue. The whole subject is one which demands the 
most careful study, a study too which can only be 
made at the bedside of enteric cases, making oneself 
familiar with the changes which take place in the 
coarse of the disease from day to day. 'When we 
think that out of a total of 20,000 cases of enteric 
fever which occurred in the Spanish American War 
only about 60 per cent, were diagnosed by the regi¬ 
mental or hospital surgeons, and that out of 25,000 
cases in the South African War there was a mortality 
of 20 per cent., there is ample evidence of the 
necessity of a more careful study of the disease. 


THE ABUSE OF SCIENTIFIC LITERATURE. 

Fob some years past a wave, or rather a current, 
of scientific and medical literature has made itself 
manifest in the shape of a perfect deluge of books, 
to say nothing of repeated avalanches of more 
ephemeral literature, such as magazines devoted to 
one or other special department of science and 
medicince, monographs, transactions and proceed¬ 
ings of societies, and hospital reports. Personal 
vanity is unquestionably the most important factor 
in this exaggerated production. In spite of the 
ample opportunity for publicity afforded by the mul¬ 
tiplicity of medical journals all over the world 
every medical society, be it never so provincial 
and never so insignificant, conceives a journal of its 
own to be indispensable to its corporate dignity, much 
to the disadvantage of ita contributors whose papers 
are thus buried alive, reaching as they do but an 
infinitesimal number of readers. Even less useful 
are the ornate and costly reports whioh every hospi¬ 
tal which respects itself inflicts upon medical 
humanity at stated intervals. Instead of rendering 


what is original and useful in their reports acoessible 
to the professional public in journals of wide circu¬ 
lation. The difficulty of classifying and properly 
housing the ever increasing output of medical books 
is severely felt by those in charge of public libraries 
apart from the onerous requirements entailed in the 
matter of space accommodation. The mere index- 
ing becomes a burden too grievous to be borne, and 
the copiousness of the indexes adds immensely to the 
task of reference. It is obvious that a very large 
proportion of the works which issue with uninter- 
mittent flow from the publishers' shelves are more 
or less ideotical in subject matter and treatment^ 
and it goes for a good deal if the various authors not 
only duly acknowledge the source of their informa¬ 
tion but take the trouble to veiify their references. 
One manifest drawback of this multiplicity of works 
is that the underlying facts, comparatively few in 
number, run the risk of being hidden in the mass of 
verbiage: in fact, one may well exclaim that “ we 
cannot see the forest on account of the trees.’’ Of 
late the United States has headed the list in this 
direction. The medical journals published in that 
land, flowing with ink and money, baffles enumera¬ 
tion. It is a noteworthy fact that whereas twenty 
years ago American works on medicine and surgery 
attracted little attention and commanded hut a very 
limited sale on this side of the Atlantic, now they are 
to be found on the shelves of all medical libraries 
with any pretensions to comprehensiveness. The 
striking progress in medicine and sui^ry due 
to the originality and ingenuity of American 
physicians and surgeons fully explains and jus¬ 
tifies this change of front, but it intensifies 
the plethora of the book market and adds 
to the burden of readers and librarians. It is 
idle to appeal to prospective authors to reduce their 
output to “ the greatest possible minimum," as a 
contemporary expresses it. Their motives for writ¬ 
ing are tangible enough to render them deaf to any 
such suggestion. Inasmuch as the writing of books 
and articles is the only form of self-advertisement 
open to medical men who respect professional ethicsi 
they are not likely to forego so valuable a means of 
keeping their names before the public. Real honest 
literary work, the outcome of prolonged observation 
and attentive study, will always be welcome, but to 
what a very small proportion of the works which 
throng the reviewer’s table can this description be 
conscientiously applied P 


OR (Durant topics. 

Empyema of the Antrum of Highmore in 
Infonts. 

The antrum of Highmore attracts the interest of 
specialists in many differmit lines of medical science 
and practice. Anatomists, surgeons, dentists, 
ophthalmolog^te, rhinologists, physicians in fever 
practice, and others. Anatomical descriptions of if> 
formaUon seem to leave much to be desired; it 
appemv, however, to be pretty well eetahlished tiiat 

Google 


Di'- ‘ - 


SXFT. 26 , 1901. 


NOTES ON OITERENT TOPICS. 


’rsa Msdig^ Pbs86 339 


ihft cavity of the antrom exists at a much earlier 
date than was at <nie time believed. It is not easy 
to understand the difficulty fdt by some in accept* 
ing the diagnosis in most of the published cases of 
empyema of the antrum in young infanta. There 
have been but few such cases published, and it has 
been held by Avellis that the condition was really 
one of necrosis of the superior maxillary bone. Dr. 
Emil Mayer, of New York, in the Medical Record 
for August lOtfa, records a case which came imder 
hie care, of a female child, aged 21 years, which was 
brought to him in consequence of a fistulous opening 
having developed in the right cheek from which pus 
exuded. An eversion of the lower lid and fcetor 
from the nostril were also present The pre¬ 
vious history was to the effect that the child 
six weeks before had been attacked with scarlet 
fever, with pneumonia, and, shortly afterwards, 
diphtheria, principally nasal, had appeared. 
Careful examination led Dr. Mayer to the conclusion 
that the condition present was empyema of the 
antrum of Highmore. A case of Dr. Platts, of Balti¬ 
more, is given in exteneo, in which the infant was 
only five months old. Pus was discharged, not only 
through a sinus on the cheek below the orbital mar¬ 
gin, but also through a sinus opening on the gum 
“ iu the I'egion of the second molar tooth,’’ from 
which a rudimentary tooth was removed. Infection 
with gonorrhoeal pus was believed to have taken 
place during birth, but why this opinion was formed 
does not seem clear from the report. The first case 
on record is more remarkable still. It was that of 
an infant, aged two weeks, reported by G. A. Rees 
in 1847. The eyeball was protruded to such an 
extent that the lids could not be closed; the palate 
was depressed and the cheek prominent. One of the 
rudimentary molar teeth being apparent was ex¬ 
tracted, and a director passed easily into the antrum 
and allowed the escape of a “ considerable quantity 
of thick matter.” On the next day an abscess near 
the inner canthus was opened, and.water injected into 
the antrum from below came out on the cheek. 
Bees believed that the pressure of the arch of the 
pubes on the cheek caused the mischief. Other 
cases are quoted by Dr. Mayer and commented on, 
and points in dispute are ably discussed. Perhaps 
most interesting of all is the consideration of the 
infection of the antrum in infectious diseases. From 
the evidence produced of the pathological conditions 
frequently found in the antra in fatal cases it is 
reasonable to believe that infection commonly occurs 
also in cases which recover. 


Blue Eleotrio Light. 

Ybbt extensive therapeutic effects are to be de¬ 
rived from the use of blue electric light, and if the 
favourable experiences recorded by Dr. A. Y. 
Minine in Vratek of June 23rd ore confirmed by sub¬ 
sequent investigations, a great advance in the art of 
h^ing has been made. Dr. Minine has found that 
while blue light produces an anssmia in the parts ex¬ 
posed to it, white light causes the tiseuee to be filled 


with blood. The chief advantage claimed for blue 
electric light lies in its action on the vaso-motor 
nerves. A further benefit to be secured by the use 
of this blue light is that it has a very marked anes¬ 
thetic effect, and Dr. Minine has employed it in the 
suturing of wounds instead of cocaine. Bums and 
scalds heal rapidly and painlessly without any local 
application being necessary under the influence of 
this new method of treatment. It appears that the 
removal of stitches can be carried out without caus¬ 
ing any pain by utilising the action of this light. In 
purpuric patients it is claimed that the general con¬ 
dition of the patient, the appetite and the sleep are 
greatly improved. If a contusion be exposed to this 
light the occurrence of ecchymosis or of abmmatoma 
is thereby prevented. In the history of medicine it 
is not unknown that the advocates of particular 
methods have in perfect good faith claimed more for 
their therapeutic measures than has afterwards been 
found to be the case. But if only a portion of the 
favourable results recorded as ensuing from the use 
of the blue electric light are capable of being utilised 
by the ordinary practitioner, the treatment of many 
puzzling conditions will be greatly simplified. 

M^ifitrates and Conscientious Objectors. 

The spectre of the conscientious objector appears 
to deprive magistrates of their common sense in 
some instances, witness the strange case which was 
recently adjudicated upon at the Thorpe Police 
Court. The soi dieant conscientious objector alleged, 
as-the ground of his conviction, that his mother had 
died ” after vaccination,” and on this he based his 
claim of exemption for his child. It was pointed out 
to the bench that the lady in question had been vac¬ 
cinated when a baby and had lived to be a grand¬ 
mother, yet the plea was favourably entertained and 
the objector obtained his exemption. Some one 
might have pointed out to these sapient justices that 
if one does not die before vaccination one must 
perforce die after, death being on hereditary com¬ 
plaint. 

The White Cross Leagrue. 

The education of the public in regard to sexual 
matters is admittedly one of the crying necessities 
of our epoch. Incalculable harm is wrought by 
ignorance, which passes for innocence, on this sub¬ 
ject, and the White Cross League is unquestionably 
rendering a public service by placing at the disposal 
of those who are willing to learn, such advice as is 
contained in the pamphlet just issued on " The 
Duties and Besponsibilities of Married Men.” The 
married state is regarded by many as an authority 
for unlimited self-indulgence, the results whereof 
are detrimental not only to the parties immediately 
concerned, but also to generations as yet unborn. It 
is well that married people should be made to under¬ 
stand that marriage has its duties and its restric¬ 
tions, as well as its privileges. The pamphlet is vir¬ 
tually an amplification of the sage precepts embodied 
in the marriage service. It points out marriage affords 

D;. oog e 



340 Thb Hbdical Pbbsb. 


NOTES ON CURRENT TOPICS. 


Sept. 25, 1901. 


tmparalleled opportunities for self-control and self- 
discipline, the sacrifice of which entails a lowering 
of the moral fibre and the risk of much physical and 
social unhappiness. Incidentally it teaches the 
lesson that although procreation is the object and 
aim of marriage, this function, like all others, ought 
only to be exercised within certain limits. The 
health of the mother and the physical well-being of 
the offspring impose certain limits which prudent, 
parents will observe. The regulation of the sexual 
appetite, especially by the married, is a high ideal, 
an ideal to which possibly few may aspire with con¬ 
fidence, but in this respect the teachings of theolo- 
g^ts and physiologists are in accord. 

Small-poz in London. 

Rbcbnt correspondence in the daily press con¬ 
firms our contention that some systematic control 
in respect of vaccination over children attending 
elementary schools should be put in force. The Rev. 
J. J. Coxhead, in a letter to the Timet, states that 
forty out of 170 school children had not been vac¬ 
cinated at all, and the closure of the schools simply 
means that for six weeks to come 700 children will 
be running about the streets. Incidentally this cor¬ 
respondent mentions that there are, in the district 
of St. Pancras, which has an unfortunate reputa¬ 
tion for indifference to sanitary precautions, “ houses 
badly drained, uncleanly, with underground kitchens 
inhabited in contravention of the law*’ to which he 
has repeatedly called the attention of the sanitary 
authorities, apparently in vain. Under these cir- 
cnmstances it can be no matter for siu^rise should 
small-pox attain the dimensions of a foi’midable 
epidemic, and we can only hoi>e that the School 
Board authorities will take such steps as are in their 
power to check its spread. To ensure the protection 
of the inflammable material in their schools is a 
step of vastly greater importance than merely closing 
the schools in the affected districts, since the latter 
leaves the children ready victims to infection. There 
is nothing, so far, to justify serious apprehension, 
the increase in the number of patients under treat¬ 
ment being only what one must expect under the 
circumstances, but since there is abundant evidence 
to prove tbatsmall-pox cannot obtain a foothold in 
any well-vaccinated community, it is urgent to adopt 
measures having for object to protect the com¬ 
munity against anything in the nature of a wide¬ 
spread epidemic.- 

The Medical Offlcership of Health at 
Southampton. 

The good folk of Southampton have had a smart 
family squabble over the appointment of a new 
medical ofBcer of health. The combined salary of 
that and other posts reached £500 per annum, with 
a yearly tenure of office. There were thirteen can¬ 
didates, and disappointment was expressed in the 
council chamber that a larger number had not been 
forthcoming. Three candidates were chosen by the 
Sanitary Committee, namely, the gentleman who for 
the last three months had acted as assistant medical 
officer at Southampton; a medical man who has 


practised in the town for the last eight and 
a half years; and the assistant medical officer 
of Leyton. The second of these gentlemen 
was selected by a large majority. He had, 
until recently, been a member of the Town 
Council, and it was stated that a number of votes 
had already been pledged in his favour. To that 
local influence and to the smallness of the salary 
one of the speakers. Dr. Eliot, attributed the fact that 
the list of applicants was unsatisfactory both in 
quantity and quality. How any town council can 
expect to secure the exclusive services of a first- 
rate medical officer of health for such a salary is 
beyond conception. How is he to live and maintain 
a family upon such a salary in a manner befitting 
the importance of his position, not to mention 
the insecurity of tenure? In many respects the 
officership of a great port like Southampton is 
one of the most important in the United Kingdom. 
It is to be hoped that the miinicipality will sooner or 
later rise to a sense of the responsibilities and the 
needs of the situation, and will materially increase 
the salary offered to their medical officer of health, 
while they at the same time do away with the 
faintest suspicion of parochial jobbery. 

Scarlet Fever in the Midlands. 

Bibminoham is increasing its hospital accommo¬ 
dation for scarlet fever, in view of the gradually 
extending epidemic. Last week there were 471 
patients under treatment in hospital, as compared 
with 456 in the preceding week, and 324 in the corre¬ 
sponding week of last year. These figures had not 
been reached during the past five years, and one 
most unpromising feature is that the seasonal maxi¬ 
mum is not due to arrive until November, so that 
there appears to be good groimd for the fear of the 
local authorities that the worst period of the epidemic 
is yet to come. In a densely crowded industrial 
population like that of Birmingham the control 
of communicable diseases presents a problem 
of peculiar difficulty. So far as the isola¬ 
tion hospitals are concerned it is interesting to 
note the popular prejudice runs altogether in favou' 
of those institutions. In these days of rapid and 
free international transit an Infectious outbreak in a 
great town has a bearing on the whole community. 
It has been shown again and again that epidemics of 
enteric fever, small-pox, cholera, and other specific 
infective diseases have been started in whole dis¬ 
tricts by the advent of a person hailing from an 
infected town. There were twenty-eight cases 
reported last week in Birmingham from enteric 
fever, a number that is surely too large in view of 
our modem knowledge of the origin of that disease. 
There are also about fifty or sixty deaths weekly from 
diarahcea, another preventible malady. 

The “Ti”an8action8'’oftheThirteenthIntemation8l 
Congress of Medicine have just been issued, and mem¬ 
bers who have not received copies thereof are 
requested to apply to the Editors, 120, Boulevard St 
' Germain, Paris, before December 31st. 

d : Google 


SlPT. 26, 1901. 


NOTES ON CURRENT TOPICS. 


Ths Hbsical Pbxbs. 341 


Medico-Literary Advice. 

An American contemporary relates the story of a 
certain novelist who called in his family physician to 
assist him in disposing of one of his snperfinous 
characters, lifach to his sarprise he was favoured 
by and bye with a bill for services rendered, which 
be nuvely admitted appeared to him “ somewhat 
extraordinary." It says little for the author’s 
perspicacity that he should have failed to recognise 
the value of the advice. We can call to mind quite 
a number of romances which would have gained 
hugely in likeliness had their writers taken the 
trouble to get their medical advisers to supervise the 
symptomatology. We should not hear of heroes 
being reassured by feeling the pulsation returning in 
the heroine’s femoral artery, rascals would ceue to 
throw their victims abruptly into unconsciousness 
by waving a handkerchief soaked in chloroform 
before their faces for a brief Auction of a minute, 
and many diseases would run a course more in 
accordance with text-book descriptions than is at 
present the case. We can imagine that Rudyard 
Ripling, in The Light that Failed," must have 
enlisted the criticisms of a man skilled in ophthalmo- 
logical work, for his description of the onset of optic 
atrophy is as good as a clinical lecture. 

Public Baths and Eye Affections. 

Resort to public swimming baths is a not 
unlikely source of infection in various ways, and it 
is stated that in Philadelphia numerous cases of eye 
disease, presumably of the nature of ophthalmia, 
are under treatment at the hospitals as a result of 
this practice. It is not so much the management of 
the particular baths as the system itself which is at 
fault, for although great care is taken to secure an 
ample supply of fresh water, contamination by a 
large number of bathers is inevitable. The remedy 
suggested is the substitution of shower baths for 
swimming pools, and the most recently built bath 
there has been constructed on this plan. 


The North India School of Medicine for 
Women. 

We have received an appeal on behalf of the Lud¬ 
hiana Hospital and Medical School for funds to 
enable this institution to provide an adequate teach¬ 
ing staff and laboratories with the object of affilia¬ 
tion to the University of Lahore. The students will 
then be eli^ble for university degrees in medicine 
which will enable them to treat the native women 
who are debarred by religious scruples from accept¬ 
ing the ministrations of doctors of the opposite 
sex. There is a great dearth of native girls of good 
family to fill the posts of bouse surgeons, ansssthe- 
tists, and nurses, and the object in view is to open 
the portals of the profession to such students. The 
school is already recognised by government, and 
is in a posirion to secure a sufficient number of 
students. We note, not altogether with approval, 
that "besides alleviating bodily suffering it may 
reasonably be hoped that the influence of 


the medical students will aid the progress of 
Christianity in India.” We hold very strongly to the 
opinion that medical work should not be made a 
means of proselytism. The knowledge that these 
students are virtnally missionaries as well as doctors 
cannot but prejudice the natives against them. Let 
them preach the Christian virtues by example by all 
means, but the operating theatre and the sick bed 
are not, in our opinion, sites of election for dogmatic 
instruction. 

The Effect of Heat on Blood Stains. 

We referred some time since to the method 
devised by Wasaermann and Schutze for ths identi¬ 
fication of the origin of blood stains, a method 
which enables us to ascertain conclusively the source 
of ibe blood in a given case, a discovery the im~ 
portance of which in medico-legal work is obvious* 
It remained to he seen whether the value of this dis¬ 
covery might not be impaired by accidental circum¬ 
stances, such for instance as the action of heat 
An Italian observer has instituted a series of experi¬ 
ments in which blood was submitted to the action of 
beat before being tested, and he found that blood 
which had been exposed to a temperature of 130^ C 
for an hour, or a less period in proportion to 
the rise of temperature, failed to give the cha¬ 
racteristic serum reaction. The formation of 
hmmin crystals, however, is not prevented by 
these temperatures, so that, though the sauguineons 
origin of a given stain may be proved by the forma¬ 
tion of these crystals, the specimen may not give a 
precipitate with the serum of an animal immunised 
by the blood of the species from which the blood 
stain is derived. The action of heat may be sas* 
pected by the changes which blood-stains undergo in 
this event, viz, the diminished solubility, their lighter 
. colour, and the special form of the hsmin crystals. 
This observer also calls attention to the fact that the 
serum of an immunised aninxal loses its properties in 
the course of a fortnight or thereabouts, so that it is 
essential to make use of a fresh serum in carrying 
out these experiments. 

The Influence of Spices on the Stomach. 

Although the use of spices for the purpose of 
heightening the flavoxu* of food is almost universal, 
it is generally recognised that their influence on 
digestion is detrimental, hence dyspeptics are warned 
to avoid " spiced and made dishes.” Some experi¬ 
ments recently carried out by a Polish physician. 
Dr. Korczynski, tend to prove that while spices 
stimulate the motor function of the stomach, they 
progressively impair the secretory functions, and, in 
the long run, inhibit the production of hydrochloric 
acid. On the whole, therefore, the ingestion of 
spices hinders, rather than accelerates, digestion, 
thongh an exception may be made in respect of 
persons in whom slowness of digestion is 
due to a deficiency of muscular activity on 
the part of the stomach, and also possibly 
of the victims of hyperacidity. Opiates, as is well 
known, tend to increase the acidity of the gastric 



NOTES ON CURRENT TOPICS. 


Sept. 26, 1901. 


342 The Medical P&esb. 


juice, hence they are contra-indicated in oasea of 
hyperaciditj, and alkalies merely neatralise the 
excess of acid without benefiting the disordered 
function to which the excess is due. It may be in¬ 
ferred that for persons whose digestion is normal 
the employment of sauces and spices is undesirable. 
A witty Frenchman once described Worcester Sauce 
as an English device for giving the same taste to all 
kinds of meat, and there is no doubt that the habit 
of tickling the palate by the addition of various con¬ 
diments is one to be deprecated. 

Micro-organisms in Glrowing Vegetables. 

Gbowino vegetables absorb the inorganic consti¬ 
tuents of the soil and convert them into organic 
compounds. This process of plant-digestion of 
course takes time, and it follows that until the vege¬ 
table cells have been enabled to carry out the transfor¬ 
mation, the contents of the vessels retain whatever 
pathogenic properties the original soil possessed. 
Along with the inorganic constituents of the soil 
various micro-organisms find their way into the 
plant, and repeated bacteriological investiga¬ 
tion has proved that certain of these organ¬ 
isms may, and do, retain their virulence. These 
results are confirmed by a series of experiments 
recently made public by Wurtz and Bourges 
who found that typhoid and anthrax bacilli could be 
recovered in the leaves for three weeks after the in¬ 
auguration of the experiments. These facts have an 
important bearing on the importance of cultivating 
vegetables intended for food as far as possible on a 
pure soil. This is specially important in respect of 
vegetables of a kind usually eaten raw grown on 
sewage farms, indeed, pending careful observation of 
the bacteriology of plant-growth under these condi¬ 
tions it would appear desirable to avoid the cultiva¬ 
tion thereon of salad plants and of all vegetables to 

be consumed raw. - 

The Dangerous Zone for Intragluteal 
Injections. 

Semsobt and motor disturbances have been 
observed to follow mercurial injections made in too 
close proximity to the sciatic nerve, effects which 
have, reasonably enough, been attributed to the 
infiammatory reaction in the nerve trunk excited by 
the presence of the mercurial salt. The " dangerous 
zone ” may be outlined by drawing a line passing two 
fingers' breadth outside the posterior superior iliac 
spine, terminating at the point of intersection of the 
gluteal fold and the central line of the posterior 
aspect of the thigh. The region to be avoided is 
contained within lines drawn parallel to the above 
at a distance of an inch and a quarter on either side, 
between the posterior superior spine above and the 
gluteal fold below. In making the injections it is 
desirable to direct the point of the needle away from 
this zone. The safest spots in which to make the 
injections are the retrotrochanteric area or at the 
intersection of a horizontal line passing two fingers’ 
breadth above the great trochanter and a vertical 
line passing from the junction of the internal and 
middle thirds of the buttock. 


The liOoal Oovemment Board and Vac¬ 
cination Prosecutions. 

The Local Government Board has caused to be 
forwarded to boards of guardians a circular dealing 
with certain questions which have recently arisen 
under the Vaccination Acts, 1867 to 1901, in connec¬ 
tion with proceedings taken with a view to procuring 
an order for the vaccination of a child nnder section 
31. It is laid down that notices may be served by 
prepaid letter, without registration, and that such 
notices need not be served personally upon the parent 
or other person in charge of the child. Proceedings 
under section 31 of the 1867 Act do not necessitate 
proof that the public vaccinator has given notice of 
his intention to vaccinate the child, or that he has 
actually visited the child’s home for that purpose. 
The actual notice need not be produced, nor a copy 
thereof, verbal evidence of its contents being sufficient, 
but vaccination officers are nevertheless advised either 
to use printed forms or to keep a carbon duplicate of 
the notice for production at the hearing. 

The Magnet as a Means of Removing 
Metallic Foreign Bodies ftom the Eye. 

The value of the magnet in removing splinters of 
iron from the eye is now fully recognised, but the 
extraordinary strength of certain electro-magnets 
recently devised has in some oases proved to be a 
cause of additional injury. In some cases reported 
by Dr. Holstrom the attractive force of the instru¬ 
ment was such that the splinter was dragged out 
with so much violence as to determine further serious 
injury on its path. He infers from his experience 
that a very powerful electro-magnet is an instrument 
to he used with prudence, and he finds it preferable 
in many cases to draw the foreign body into the an¬ 
terior chamber by the aid of Hash's powerful instru¬ 
ment, completing its removal with one of less 
strength. 

Cedron Seed. 

An official report dealing with Jiminez, Costa 
Bica, contains an interesting announcement from 
Dr. S. H. Hodgson, the Government physician 
stationed at that place- His attention was drawn to 
the remarkable antitoxic properties possessed by the 
tincture of “ cedron seed.” This tincture is in use in 
certain parts of Central and South America as an 
antidote for snake bites and for the stings of venomous 
insects of various kinds. It occun-ed to Dr. Hodgson 
to try the effect of cedron seed in the treatment 
of ye low fever, and after observing the results of 
its administration in a number of cases he arrived 
at the conclusion that it has as specific an action in 
yellow fever as quinine has in malaria. Every case 
that was treated with the tincture recovered, and the 
method of its exhibition was by hypodermic injec¬ 
tion of twenty minims three times a day. The 
immediate improvement that ensued was most note¬ 
worthy, the headache was relieved and the nausea 
subsided, whilst in cases in which the injections were 
commenced early the congestive phenomena were 
very slight. Considering that these very promising 


Sbpt. 26, 1901, JlOTES ON CDKItENT TOPICS. Tb* Mxdicaii Pbbss. 343 


remits were obtained by Dr. Hodgson under the 
most unfayoorable circumstances, the report would 
appear to furnish grouude for believing that the 
investigation is one worthy of being followed 
up. The patients were native labourers on the 
country farms, and they were nursed under the 
most unfavourable and insanitary surroandings. 
The only nurses available were dirty, igno¬ 
rant natives absolutely devoid of the most 
elementary ideas of what was required, and the 
tincture was home-made, by no means guaranteed to 
be antiseptic, and of very uncertain strength. Any 
advance in the therapeutical treatment of such a 
fatal malady as yellow fever is sure to be received 
with gratitude by those whose duty it is to deal with 
this insidious foe, and we can only hope that the 
happy experiences of Dr. Hodgson will be confirmed 
in the practice of other physicians. 

Phototherapeutios. 

One result of the great success achieved by Pro¬ 
fessor Finsen, of Copenhagen, in the treatment of 
lupus by means of rays from the ordinary arc light 
has been to stimulate scientific inquiry in the direc^ 
tion of phototherapy, and it is now stated that Dr. 
Sophus Bang, one of Professor Finsen’s assistants, 
has devised a new lamp which possesses ten times 
greater bactericidal power than the ordinary arc 
lamp. The special electric lamp invented by Dr 
Bang is reported to possess but feeble illuminating 
powers, but for phototherapeutic purposes it is ex¬ 
tremely active, owing to its richness in actinic rays, 
the poles being made of metal instead of carbon. An 
important consideration in respect of Dr. Bang’s ap¬ 
paratus, from the point of view of expense, 
is that it effects a great economy, a fact 
that will enable this remedial measure to be 
more generally employed. In connection with 
the question of the expense of working the Finsen 
apparatus, and the cost of the necessary nurses. Dr. 
Gaston has lately described in certain French 
medical journals an ingenious and inexpensive 
apparatus, manufactured for him by IfM. Lortet 
and Genoud, of Lyons, which simplifies very much 
the application of Finsen’s method of treatment. 
Briefly described, the advantages claimed are the use 
of a lamp of lower voltage, the reduction in the time 
of exposure, the increase of the surface area affected, 
and the saving of a great amount of electric current 
A distinctive feature in this apparatus is the arrange¬ 
ment for focussing the rays; this is made up of two 
rock crystal lens, separated by a current of running 
water. 

Leprosy. 

In the recently-published international periodical, 
entitled Lepra, it is stated, on the authority of 
Ehlers, that the Guber springs, in Bosnia, have an 
unmistakable curative influence on leprosy. These 
springs, we are informed, have been credited from 
time immemorial with healing powers of the kind 
snggeeted, and it is satisfactory to find that after a 


very full and complete examination by Eblers, 
he declares himself “amazed and delighted” at 
the successful results he has himself seen and 
studied. This favourable report is fully borne 
out by the independent researches of Professor 
Glueck, whose experience covers a series of cases 
that have been cured at the Guber springs. 
It has, of course, been long recognised that in cer¬ 
tain conditions of leprosy a permanent cure is not 
impossible, but it is nevertheless exceptional, to say 
the least, to have definite medical testimony that 
under a course of Guber waters, internal and ex¬ 
ternal, leprous ulcerations heal with subsidence of 
the nodules and other objective and subjective sym¬ 
ptoms. The only weak point in this otherwise 
pleasing report is that the permanency of the results 
in the cases described as cured is not very accurately 
determined in the accounts so far to hand. 

Anal Pruritus. 

The treatment of cases of that refractory condi¬ 
tion, anal pruritus, generally taxes the patience alike 
of the sufferer and of his medical attendant, and it 
is worth noting that Dr. Siebourg {Centralhlatt /. 
Cryn., June 27th, 1901), of Bremen, reports great 
success in the relief of obstinate cases from the use 
of local subcutaneous injections of a very dilute 
solution of carbolic acid. From the description 
given it would not seem to matter much what the 
exact nature of the fluid is, the important factor 
appears to be that the injection must be in sufficient 
quantity to lift the skin, and to cause sufficient trac¬ 
tion on the nerve terminals to bring about numbness 
to the extent of abolishing the pruritus. This grati¬ 
fying condition of ease is said to last for a week or 
longer, thus giving time for other local treatment. 

An Ophthalmological Curiosity. 

The following exceptional incident is describtdby 
Dr. Strawbridge in the Archivee of Ophthatmo- 
logy as having occurred in the course of his exami¬ 
nation cf the right eye of a patient who had leceived 
^ a blow on the right temporal region; the lids were 
I very gently opened, when, to the astonishment of Dr. 
Strawbridge, the eye suddenly slipped out of its 
orbit and remmned fast in this position with the 
lids in close apposition behicd. This extraordinary 
dislocation was reduced by steady pressure, the lids 
being held apart, the return of the organ into its 
place being marked by a distinct click. A few days 
afterwards the eye was carefully examined and found 
to be normal and free from symptoms of irritation. 

Medical Begn^ation of Marriage. 

A Biix to regulate marriage is now under discus¬ 
sion in the State of Colorado. The proposed regula¬ 
tion is to render it impossible for any couple to be 
united in holy matrimony until the candidates have 
been duly passed by a board of medical examiners as 
mentally sound and free from the taint of tubercu- 
loeis, cancer, syphilis, and other diseases. The 
punishment for daring to be married without under- 

DiL-'-^ed b) ‘OO^ C 


344 Thb Mbdical ±^Be. 


SOOTL^D. 


Skit. 25, 1901. 


going medical examination is described rather raguelj 
as “ heavy penalties,” and they will have to be very 
heavy indeed to enable such a law to become really 
operative. The Bill apparently enforces this exami¬ 
nation on women as well as men, and this under pre¬ 
sent conditions is lihely to render well nigh insuper¬ 
able the already grave difficulty of working such 
an Act. — ■ - 

The Treatment of Epilepsy. ' 

A suoaBSTiOK is made by Balint (Berlin 
Klin. Woch; June 10, 1901), to replace sodium 
chloride in the diet of the epileptic by a bro¬ 
mine salt. This method is to be thoroughly 
carried out, and it is recommended that bread 
for the use of epileptic patients should be 
made with a bromine salt instead of sodium chloride. 
The first objection that is naturally raised against 
thia plan of Balint is that bromism must 
surely result, but it is stated that this was not ob¬ 
served in any of bis twenty-eight cases. This is a 
complete answer so far as it goes, but the number is 
too small to justify us basing any absolute conclu¬ 
sion. Certainly the plan seems a very agreeable 
way of administering bromide. A fair share of 
credit in the success observed in the twenty-eight 
cases should no doubt be ascribed to the increasing 
amount of bromide administered. The treatment 
has been found in practice to require its being carried 
out in a suitable institution, and this mirst unfortu¬ 
nately decrease its value. A really satisfactory 
solution of the treatment of the epileptic at home 
has yet to be found. 

A New Tract in the Cord. j 

Db. Purves Stewart, of the Westminster Hos¬ 
pital, has discovered a new tract in the spinal cord. 
It is a descending tract in the cervical region, situated 
ventro-extemally to the crossed pyramidal tract and 
separated from the latter by a distinct interval at a 
plane corresponding to the tip of the lateral horn of 
the gray matter. It does not extend below the 
level of the eighth cervical segment, and somewhat 
resembles in shape, but differs in position, from cbe 
tract desciibed by Helwey and v. Bechterew. It 
was first made out in a patient at tbe West¬ 
minster Hospital who sustained a dislocation of tbe 
vertebral column between the bodies of tbe fifth and 
sixth cervical vertehne, crushing the spinal cord at the 
upper part of the seventh segment for a vertical 
extent of about half-an-inoh. Tbe patient, it is 
interesting to note, survived for ten weeks after tbe 
injury. The new Purves-Stewart tract is exciting 
mnch attention, especially among German neuro¬ 
pathologists. 

Pulverised Bone Aeh. 

The injection of pulverised bone ash prepared 
from the femur of a steer, in distilled water and gum, 
has been used for the purpose of procuring union in 
a case of ununited fracture of the ulna and radius 
in a robust adult suffering from delirium tremens. 
The bone ash in gum water to the amount of 10 c.c. 
was injected every four weeks. When this treat¬ 


ment was commenced no callus at all bad been 
formed, but after tbe sixth injection union of a firm 
and lasting character was obtained. (CentralbleUt. /• 
Ghir. June 29,1901.) It is stated that the reason 
for not submitting the man to a surgical operation 
of some magnitude was that the restlessness asso¬ 
ciated with his condition precluded this being done. 

PERSONAL. 

Colonel A. B. B. Mtbbb will take tbe chair at the 
ftTiniiitl dinner of past and present students of St. Uary’s 
Hospital, at the Whitehall Boomr, Hotel Hetropdle, on 
the 8rd prox. 

Ms. Chables Stonham is to preside at the anTinal 
dinner of past and present students of the Westminster 
Hospital, which is announced to take place on October 
4th at the Hotel Cecil. 

Mb. Alprbd Coopbr, F.B.C.S., President-Elect of the 
West London-Medico Cbimrgical Society, will open tbe 
Winter Session on Friday evening in next week with an 
Inaugural Address. 

Hb. Hcohxs, of Llanilar, Aberystwith, has been pre¬ 
sented with a valuable cabinet of silver, containing 
upwards of two hundred pieces, on the occasion of his 
retiring from practice. 

Oua Vienna correspondent refers in another column 
to the preparations being made to celebrate next month 
the eightieth birthday of Professor Virchow and the six¬ 
tieth of Professor Nothnagel. Long may these brilliant 
stars illumine the medical firmament for the behoof of 
mankind. 

Da. Button, Principal of the Fifth Malarial Exptdi- 
tion sent out by the Liverpool School of Tropical Medi¬ 
cine, left Liverpool on Saturday last, with bis party in the 
mail steamer Arim for the West Coast of Africa, where 
every assistance is offered the expedition by tbe Gover¬ 
nor of Gambia, Sir George Denton. 

Wb understand that Dr. Tellowlees has already re¬ 
signed, oris about to resign, the important and lucrative 
post of medical Buperintendent to the Gartnavel Asylum, 
Glasgow, which he has held for a great number of years 
in connection with the Leotnresbip on Insanity at tbe 
University of Glasgow. There are expected to be a con¬ 
siderable number of candidates for the vacancy. 


Scotlanb. 

[fBOU OUB own COBBXSPOKnXNT,] 

Thb Bbitish Association fob tbb Advancxbxnt 
OF SciBNCB.— Glasgow has been honou^ with the 
presence of the members of tbe British Association, to 
the number of nearly 2.000, during tbe past week. Tbe 
meetings hare been held in the University, which served 
tbe purpose moat admirably, the various class-rooms 
being used for the sectional meetings. Many members 
of the medical profession have attraded tbe meetings, 
and a goodly number read papers of considerable 
interest to tbe profession. Prof. MoKendriok, at 
President of the Physiological Seotion, delivered an 
address on tbe advances in pb^iology daring the last 
twenty-five years. Papers were read on *‘The Use of 
the Telephone for investigating the Bhythmic ^eno* 

Dir tized by CjiOO^ C 



SsPT« 26| 1901« CORRESPONDEJNCR* Tm Msdical Pbbss. 345 


mena of Mnsolee/' by Prof. Sir J. Bordon-SandereoD ; 
“ Experimente on tbe Brain of the Ape,” by Prof. 
Sherrington; end Dr. Robert Kennedy rei^ an intereet* 
ing paper ' the Beetoratiott of Voluntary Movemente 
after Alteration of the Nerre Supply by Nerre-oroseing 
or AnastomoBis.” Papers were also read by Prof. 
Cleland, Glasgow : Dr. Sutherland, Deputy Commis¬ 
sioner in Lunacy, Scotland; Dr. J. F. Gemmell, Glasgow, 
and oihers. ^of. Sims Woodhead, Cambridge, who 
was also attending the meetings, gave an address, on the 
19th ittst., in connection with the meetings of the In¬ 
ternational Assembly, which held their meetings in the 
lecture-room of the Art Galleries. His address was a 
very interesting one on preventible diseases. By means 
of the lantern he showed the micro-organisms of a 
number of diseases, such as diphtheria, cholera, plague, 
tetanus, do., pointing out the distingnishisg features of 
each. The ^dress was much appreciated by those 
present. 

Ths Nbw Anatomical Schools, Glasgow Dnitbe- 
81 TT. —Glasgow UniTersity can now boast of haring a 
well-equipped anatomical department. Instead of the 
galranised iron sheds which were such an eyesore for a 
number of years, standing as they did in front of the Uni¬ 
Tersity in a rery conspicuous position, there are the new 
and handsome bnildings which hare just been finished, 
thanks to the generosity of the trustees of the late Mr. 
Thomson, shipbuilder. The buildings are rery complete 
and offer every facility for teachers and students en¬ 
gaging in their work profitably and at the same time 
very comfortably. At the opening ceremony, which was 
largely attended. Professor Cleland took the opportnni^ 
which presented of magnanimously handing over to the 
University for all time his large and varied collection of 
anatomical preparations, for which be was heartily 
thanked. Lord Lister, Sir William Turner, Principal 
Story, and Lord Provost Chisholm took part in the in- 
tererting proceedings. The company thereafter, on the 
kind invitation of Professor and Mrs. Cleland, partook 
of afternoon tea. 

Gabtnavbl Abtloh, Glasgow—Thb Mbdical 
S npBBiNTBNDENT. —We bave just been informed that 
Dr. Tellowlees, lecturer on insanity iu Glasgow 
University, and physician sui^erintendent of the above 
asylum, has resign^, or is on tbe eve of resigning, the 
important office whii^ he has held for a long period 
of years in connection with Gartnavel Asylum. Tbe 
office is a responsible one, but at the same time it is, 
from a pecuniary standpoint, a very lucrative one, as 
it carries with it a handsome salary, free house, with 
concomitants, a carriage and pair of horses, and last, 
but not least, the liberty of private practice or consulta¬ 
tion work in mental diseases. Already the names of 
one or two who are likely to be applicants for the 
vacancy have been mentioned. There is a gentleman 
of outstanding ability at present oocnpying a similar 
position, although it is not snch a valuable one, who 
it is generally thought will succeed Dr. Tellowlees, who 
has discharged the duties of the office so creditably. 
The gentleman we refer to was a very distinguished 
student of Glasgow University. That said, however, 
the vacancy is snch an important one that it will 
probably call forth applica'ioos from various quarters. 
Tbe gentleman appointed will succeed to a remarkably 
snug position. 

(Eorrwponbnta. 

[Wado sot hold oarBalTeatesposaible for the opisions of oar 
oorreapondents.3 

THE PASTEUR TREATMENT OF HYDROPHOBIA. 
To ihe Bdiior of Thb Mbdical Pbxss and Cibculab. 

Sib, —For the information of your correspondent 
“ Scrutator,” 1 quote the following paragraph which 
appeskred in the Olobe, the Westminster Oazeite, and the 
Svening News of August 15th ” The figures published 
by the sanitary anthorities especially demonstrate the 
inorease in hydrophobia in the French capital, and show 
the alarming proportions to which the malady is rapidly 


growing. The deaths are said to have reached the 
enormous total of 8,079 ! ” 

Surely no further evidence is required to prove m 7 
assertion that these reports of the increase of hydro¬ 
phobia in Paris are absurd and untrustworthy. 

The following paragraph from The British Medical 
Journal of September 7tb shows that the manufacture 
of “ serum ” is a very profitable business :—” In 1895 the 
Pasteur Institute, Cbarkoff, sold 69,267 doses of auti- 
dipbtberia serum at a profit of nearly ^2,600. The 
exj^nses of the Institute amounted to about X4,200, 
while the income was about £6,680.*' 

For evidence of the truth of my statement that the 
I Pasteurian anti-rabic treatment is useless and dangerous, 
1 refer ‘‘Scrutator” to Dr. Dolan’s work entitled 
” Pasteur and Rabies,” to Dr. Charles Bell Taylor's 
article," Pasteur's Prophylactic,” in the National Review 
for July, 1890; to the writings of Dr. Lutaud of Paris 
(translated and published by the London Antivivisection 
Society), to my paper ' On Rabies and Hydrophobia ” in 
7 he Medical Brief for June, 1901, and to the published 
opinions of Dr. Spitzka, of New York, Dr. Charles Dulles, 
of Philadelphis, the late Professor Peter, of Paris, Pro¬ 
fessor Colin, of Alfort, Professor von Frisch, of Vienna, 
Professor Zienitz, of Warsaw, Dr. Abate, of Naples, the 
late Sir B. W. Richardson, and many others. This evi¬ 
dence, though too often ignored, has never been csontro- 
veitei, andl challenge ‘'Scrutator” to ref at) it if he 
can. 

I am. Sir, yours truly, 

J. H. Thobnton, M.B., B.A. 

Dy. Surgeon-General, I.M.S. (retired)^ 
Hove, Sussex, September 17th, 1901. 

THE BIOLOGICAL TEST. 

To the Editor of The Medical Press and Cibcdlab. 

Sir,—T he biological test in my relative’s case had a 
rositive and not a negative result. Tbe animals inocu¬ 
lated died of tnberciUosis. But as you, Sir, said in your 
note to my letter, the ciase was evidently one of chronic 
pneumonia, and if the biological test had any value ah 
all the animals should have died of that disease. We 
have recently read of two deaths at Guy’s Hospital 
from “ tetanus,” following subcutaneous injections of 
gelatine. But was tetanus the cause of death ? Was 
the suspected gelatins tried on animals and did they 
suffer from tetanus ? If it was so tested and the animals 
escaped are we at liberty to say that the patients in the 
hospital did not die of tetanus as the medical eridencse 
seemed to prove ? If they did so die it proves that tbe 
most elaborate precautions taken to sterilise the ap¬ 
paratus and material for inoculation are futile. Quite 
apart from the question of vivisection I am opposed to 
the biological teit because I consider it extremely liable 
to mislei^ the practitioner who puts faith in it. As a 
matter of fact, and altogether apart from laboratory 
theories I do not bslieve that many practising physicians 
value it more than I do. Your correspmdent—Mr. 
Sera—need hardly tell ns that he knows very little of the 
auti-viviseotion question. It is not the lives of the 
animals that most of us are concerned for, it is the 
torture, the infiiotion of auvere and continued pain upon 
them, against which we protest. The majority of anti- 
vivisectionists are not vegetarians; they believe they 
bave the right to kill animals for food if it be done 
mercifully. As to tbe question of the utility of vivisec¬ 
tion, I believe that, compared with tbe suffering it 
entails, its value to practical medicine is infinitesimal ^ 
but were it ever so valuable we should condemn it on 
the principle that we must not do evil that good may 
oome. The world had better be sick than pitiless. Mr. 

. Sers’ illnstratioD about beef tea is an example of very 
I poor reasoning. In the first place I deny that properly- 
made beef tw is valueless as food for invalids. The 
practice of tbe medical profession is against him, and I 
need not waste your space in refuting his proposition. 

' The experiment on the dog is beside the question. Our 
patients are not dogs, but human beings. Kemmerich 
(I bave read somewhere) discovered that he could kill 
dogs by injecting into their stomachs extract of horse- 



34>6 Thi Midical Pbs88. 


CORRESPONDENCE. 


fleeh; they died with all the appfatanoes of cardiac 
Mralysis. I bare uot read of any haman beincfB who 
hare suffered the like from the ingestion of meat 
extract. 

I am. Sir, yonrs truly, 

Edwabd Bbrdok, M.S.C.S, &c. 

September 19th, 1901. 

TOTAL GASTRECrrOMY. 

To ihg Editor of Thb Medical Pbbss and Cibculab. 

Sib,— In your issue of September 18th there appears 
an article by Mr. O’Hara, of Melbourne, on ” Total 
Gastrectomy for Carcinoma of the Stomach.” 

I think a protest should be made against the misuse 
of the term “ total gastrectomy.” It is quite clear from 
Mr. O’Hara’s description that only a portion of the 
stomach was removed. He writes: ” The large opening 
»n the cardiac eni of the etomach was partially closed,” 
Ac., and i^ain “^ere must be a sufficient amount of 
cardiac end free from disease to complete the anasto- 
mosia with the duodenum.” In complete gastrectomy 
the specimen removed should show cesopb^rns at the 
one end and duodenum at the other, as in Schlatter's 
case. 

Mr. O’Hara is not alone in bis nufonnded claim to 
hare performed " total gastrectomT.” I bare carefully 
read all the records of cases so reported, and it is quite 
clear that in some of them a portion of the cardiac end 
of the stomach was left. 

If Mr. O'Hara’s description of the growth be accepted, 
of its extent along ” about two>thirds of the distance 
between the pyloric and cardiac ends of the stomach,” 
and ’ if the stomach was “ greatly dilated,” it is im> 
possible to see any adequate leason for a “total 
gastrectomy,” Mr. O’Hara was therefore quite right in 
not performing one. 

I am. Sir, yonrs truly, 

B. G. A. Motnihan. 


Sbft. 25, I9ui. 


LACHNANTHES TINCTORIA. 

To the Editor of Thb Medical Pbbss and Cibculab. 

Sib.— If among the readers of the Mbdical Pbbss 
AND Cibculab there bare been included any sufficiently 
ingenuous to bare cherished the faintest hope that after 
all there might be “ something” in the above-named 
*' remedy ” for consumption, the hope must hare been 
shattered by the able letter of Dr. Murrell which 
appears in the Medical Pbbss and Cibculab of to-day, 
August 18th. To the man of the world, being also a 
medical man. Dr. Murrell’s eridenoe was not necessary 
to prove the character of the “ cure ” in question. 
Every medical man of the world would hare pre¬ 
viously been willing to pledge himself that no 
solid scientific data would be forthcoming to estab¬ 
lish the claims put forth for the “ Lachnan^es treat¬ 
ment,” and that the only evidence adducible would 
consist in “ testimonials from grateful patients ” of 
exactly the same value as those which bear witness to 
the power of Holloway’s pills and ointment to lOot out 
the totally distinct causes of several score of totally 
diverse diseases. Our knowledge of the physiology of 
the lungs is no doubt not absolutely perfect, and our 
acanaintance with the progressive morbid phenomena 
following tuberculous infection is no doubt not complete, 
but surely we have enough solid scientific fact to enable 
us to distinguish between rational therapeutical mea¬ 
sures and procedures the success of which could only be 
accounted for as a miracle. It would certainly be some¬ 
thing like a miracle if advanced tuberoulosii of the 
lungs were curable by internal administration of Lao- 
nanthes combined wj th inhalation of any form of vapour 
derived from that herb. The whole correspondenoe 
on the subject has no doubt been calculated to make 
the cynics sneer, especially those who detest the medical 
profession and the scientific methods by which medical 
progress slowly fights its way. In those who have 
sympathy with human misery the injury to which the 
correspondence has given rise will excite the reverse of 
a smile. The effect of the world-wide advertisement 
afforded by The Timet has been to raise false hopes in 


the hearts of a vast number of wretched patients to their 
ultimate injury or destruction. For this result Colonel 
Le Poer Trench is primarily responsible, although per¬ 
fectly innooentof any but the purest philanthropic pur- 
^Perhaps by this time he perceives how much 
wiser it would have been if be had placed himself in 
the bands of advisers having a knowledge of science. 
No one would wish him the punishment which realisa¬ 
tion of the harm he has done would surely inflict upon 
him. 

I am, Sir, yonrs truly, 

September 18th, 1901. TTbique. 

To the Ed%tor of The Medical Pbbss and Cibculab. 

8ie,~I Bee yon have fallen into the same mistake so 
many lay people have - that Mr. Alabone’s treatment of 
tuberculosis cousiets of the administration of ”lach- 
nanthes ” alone. Laohnanthes is only one of the drugs 
he recommends in his treatment, which is carried out 
chiefly by daily inhalations. He has perfected 
a comminutor for inhaling, by which 20 to 
30 per cent of formalin with other inhalant* 
can be used. I can only say that for the last ten 
years I have recommended no other treatment for 
phthisis, when combined (as far as is practicable in our 
climate) with the open-air treatment, and I have btd 
the good-fortune of seeing patients who have been given 
np as absolutely hopeless cases recover, and remain in 
good health. 

Mr. Alabone has to my knowledge explained to many 
medical men every pai^cular of hit treatment, and 
more than one medical man has placed his sons and 
daughters under hie care wi^ the happiest results. 

I think, too, it ought to be mentioned that Mr. Ala¬ 
bone’s name was taken off the Regietrar solely for a 
laudatory article and sketch which appeared in Ifoon- 
thine in 1886, similar cartoons having apneared week by 
week of the late Sir Andrew Clark, Sir £. Qaain, and 
other eminent medical men. 

1 trust that Colonel Trench’s generous offer of £1,000 
towards the expenses of having the above treati^t 
” officially tested ” may be carried out, and that I msy 
live to see the day. 

I am. Sir, yours truly, 

Hbnbt J. Buck, L.B.C.P.E,, Ac. 

Clapton Common, N.E., 

September 23rd, 1901. 

MEDICAL BEFOBM. 

To the Editor qf Thb Mbdical Pbbss and Cibculab. 

Sib, —Under this beading in your editorial of last 
week you referred in favourable terms to a oommnnlos- 
tiott on the subject sent by me for publication. I r^ret 
that owing to its length yon were unable to find spam 
for it, for a perusal of the letter would have made several 
of your references to it more easily understood. The 
main object of my letter was to point oat the great dis¬ 
proportion in numbers between the representatives ia 
the General Medical Council of the qualifying bodies on 
the one hand and the medical practitioners on the other, 
and to emphasise the fact that this unfair distribution of 
representation is largely to blamefor the uusalisfactory 
position in which medical affairs stand at the present day. 
I stated that while twenty members of Council are elects 
by the eeventeen qualifying bodies, toe 30,000 meffioal 
practitioners in the kingdom can elect five members 
only. In Scotland five qualifying bodiee return seven 
members, while toe 6,000 practitioners there return one 
member. My letter also showed that under the existing 
system certain evil results were to be feared from the 
quantity of qualifications by seventeen independent 
bodies pecuniarily interested in such granting and 
having different and in some cases inefficient btindards 
of examination, and it was in dealing with this point 
that I referred to the one-portal system, indicating that 
a uniform State examination would be a good substitnte 
for the seventeen varied examinations above described. 
My references to the one-portal system and to a Bill for 
putting down quackery were mere asides, but you seem 
to have misunderst^d this. Though I refored 

.OOglt 


SxpT. 25, 1901. 


LITEBATTTBE. 


Tes Mkdical Pbbm. 347 


to it as the Medical Parliament, my remarks were 
not in any way intended to imply that the Oeneral 
H^ical Coun^ was acttully a leffislatire body. But 
while of itself enable to legislate, there is no donbt that 
a strong representation on any medical snbjeot from 
tile Medical to the Privy Council wonld have % very 
good chance of becoming law. It is certain that the 
wneral Medical Council has power, by such representa¬ 
tion, to increase the number of direct representatives, 
and this is the main point for reform in the meantime. 
If the medical societies throughout the kingdom will 
petition the Medical Council to request from the Privy 
Council an increase in the number of direct representa¬ 
tives the increase will be given. 

Tour suggestion that the electorate of the licensing 
bodies be enlarged is good and reasonable, and if the 
constituent members took up the question vigorously 
they could make out a very good case for admission to 
the electors’ roll. Would it not, however, be a better 

E lan to reduce the number of representatives for these 
censing bodies by giving one representative to the 
several groups of colleges, universities, or other bodies 
which have much alike in their constitntions, their aims, 
and their general modes of procedure. Snob an arrange 
ment would benefit the financial department of the 
General Medical Council. 

I am. Sir, yours truly, 

Anoos MacPhxs, M.B. 
Glasgow, September 22nd, 1901. 


inbcntiouB. 


A PEEFECTED GAS FI BE. 

In discussing the advantages and drawback of gas 
fires some time since, we insisted rather emphatically on 
the noise which characterises most of the stoves in the 
market, and upon their almost universal tendency to 
light back.” Since thun Messrs. Fletcher, Eussell 
and Co., Limited, of Wsrrington and London, have in¬ 
vited onr inspection of their various gas firM, and we 
have availed ourselves of the opportunity to go 
thoroughly into the matter. 

We were struck by the fact that none of the stoves 
inspected could be accused of ” roaring in fact, if the 
gas supply be properly regulated, they bum in absolute 
idlcnoe. More than this, thanks to an ingenious device, 
lighting back is an impossibility, as we have ascertsin^ 
for ourselves. In view of the perfection to which these 
gas fires have been brought, one can only wonder that 
&ere is any sale for the ordinary gas stove, with its 
manifold inconveniences. Those mannfa(^red by 
Messrs. Fletcher, Eussell, and Co. throw out an nnnsnally 
large proportion of the heat generated, and this without 
any disagreeable or other odonr due to charring of the 
organic dnst of the air. 

We are fain to admit, therefore, that the objections 
which we raised on a previous occasion to gas fires in 
general do not spp’y to these, and we on conscientiously 
recommend them as highly ornamental and thoroughly 
efficient. 


Ifitfiratturc. 


MUNSON'S MILITAEY HYGIENE, {a) 

Tun difficulty the reviewer finds in dealing with this 
great work is to convey some idea of its value in the 
space at his disposal. Aa a text-book of military 
hygiene it is far and away the best we have ever seen. 
We know no book to compare with it in fulness of in¬ 
formation, excellence of arrangement, or clearness in 
writing. Of its one thonsand octavo pages there is not 
one lesf of padding, and every line tells how deeply the 
author has studi^ bis subject out of his practical 
experience. For the reader he brings things new and 
old from the treasury of his knowledge. 

His systematic arrangement is admirable. He oom- 

(a) “ Tb« Tbeor 7 *od Practice of Militarj Hy^eoe." By Edward 
I,. Muruos, A M., M.D.. Captain. Medical Department, United 
States Army. Illustrated by Efgbt Plates and ue 'rly 400 En^ravinsi. 
lK>ndon : Bailliere, Tindall, and Cos. 1901. Price 328. 


menoes with a chapter on the selection of the recruit, 
and shows that “ The ineffective man weakens tne ranks 
he was intended to strengthen. He eerves but to fill 
the hospitals, load the timns on the march, consume 
supplies, and require the care of the effective and able- 
bodied to minister to his infirmitiee.” He reminds Army 
surgeons that the strength of the Army is determined 
by the number of rifies in the field rather than the 
number of names upon the rolls. Lord Kitchener has 
recently been re-echoing these opinions. Napoleon in 
1813 felt this, and in calling for recruits Mter the 
retreat from Moscow desired men, not boys, who 
served only to encumber the hospitals.” 

Passing from the selection of the recruit Be considers 
the devMopment of the recruit, and remarks; ” It is 
false economy on the part of the nation, and crnelty 
to the men to expose them to the privations of war, and 
the fatigue iocident to campaira, without fortifying 
their COD stitntions and providing that reserve of strength, 
vitality, and endnrance upon which they must draw, and 
without which they will break down.” He considers the 
infinenoe of exercise on the muscnlar system, the nervous 
system, upon the heait, and in relation to the chest and 
lungs, and fully discusses the subjects of exhaustion, 
overtraining, and proper physical proportions from a 
fulness of knowledge acquired by practical experience. 

The march in campaign is next dealt with under the 
headings Prepiration, The Step, Work Done on the 
March, Position on the March, Length, Meteorological 
Conditions, Terrain, Equipment, Forced Marches, Night 
Marches, Delays, Bests, Use of Fluids, Straggling, Con¬ 
valescents, Mouth Breathing, Mental Occupation, Acci¬ 
dents of the March, Blisters and Excoriations, Pud 
force. Heart Strain. Health. We ennmerate these 
headings to show the thoroughness with which the 
author does his work. 

Chapter IV. is devoted to the important subject of 
“ Water,” its quantity, sources, storage, and supply. 
For hospitals he thinks the supply should be praotic^y 
unlimited. For stationary camps the minimum amount 
of water for each soldier shonld be five gallons. Sepa¬ 
rating tanks and filters are illustrated and receive very 
fall notice, and details of Norton's tube wells and their 
method of being sunk are given. These wells were first 
used in the American Civil War, and since then have 
been generally adopted in foreign military fervice. 
Drinking water in its relation to disease, and the 
methods employed for the determination of its quality, 
together with the article on the pnrifioation of drinking 
water, are of such great value that we would like to see 
them read by all students of medicine, military and 
civil. The author's description of how water may be 
contaminated and the evils that arire from the use of 
such vater, and how the water may be purified is a 
masterful exposition of onr knowledge of the whole 
' subject. 

The soldier’s ration in relation to work, the deter¬ 
mination of the real nntritive wants of the body, the 
selection of the to d, the association of foods, the 
proper cooking of the food, and their jost distribution 
are all considered. Much stress is laid on the quality 
of the ration, and in this connection be dwells on the 
storage of perishable articles and the examination of 
such before use. Wastage of rations, savings from, 
and additions to, have not escaped notice, and a number 
of illustrations show the many varieties of field stoves 
in use. Beef, cattle, their weight, age, condition, 
health; the inspection of dressy beef, its age, sex, 
quality; the transmissible diseases of cattle; oysticems, 
tuberculosis, anthrax, actinomycosis, and other diseases 
are passed under review, aod the reader wonders can any¬ 
thing more be said of beef, mutton, pork, or bacon, when 
the author commences on horseflesh, and passes on to the 
consideration of healthy slaughter-houses and the pre¬ 
servation of meat, refrigerated and frozen, desaicated, 
sun-dried, smoked, and canned—nothing escapee notice, 
and instructions on salting and cbemi^ preservatives 
come in for their due measure of description. 

The general principles involved in the cooking of food 
are coi sidered, aod trailing, stewing, roasting, broiling, 
baking, and frying are told in a series of artiolee that 
would form a good text-book for a cookery class. Fish, 


348 Tab Mbdical PBBSfe 


LITERATURE, 


Sept. 25 , 1901. 


fresh and dried, pickled and canned, next demands 
attention, and then bread and vegetables. Of bread 
we are told everything, from the examination of the 
floor to the fioiebed loaf, not omitting the many bacilli 
which may be fotind both in the raw material and the 
cooked ration. The illnstrations of the bacilli are 
alarming looking, but we soppoae their bideonsness is 
drawn from natore. 

Tea, sugar, coffee, and oondimente are then discussed, 
and of sugar he ^opts Sobumberg’s conclusion that 

sugar in small doses is well adapted to help men to 
perform extraordinary muscular labour,” and he recom¬ 
mends chocolate as the best medium. He gives an 
excellent receipt for making coffee, which many house¬ 
keepers might read with advantage. 

So far Dr. Munson has merely dealt with the ordi¬ 
nary rations, and he afterwards discusses emergency or 
reserve rations very fully. 

Some fifty pages are devoted to military clothing 
and equipment. We are sorely tempted to quote his 
article on the head covering, and his account of the 
infiuence of colour in protecting the soldiers from sun¬ 
stroke, but space will not allow of it. 

This chapter practically ends the first part of the 
book, and chapter eight commences with the general 
principles that guide the military sanitarian. Com¬ 
mencing with camp sites and camps, he considers 
topography, soil, moisture, water, soil temperature, 
bsicteriology, and vegetation. Those of our readers 
who have studied the sani'ation of the recent American 
campaign in Cuba and the French invasion of Mada¬ 
gascar will recognise the importance of the subject, and 
those who have read Snxgeon-Qeneral Lsid's account of 
the Spanish Army in the Cuban War will recognise 
somewhat of the difficulties that beset tbe military sur¬ 
geon in choking his hospital sites. Numerous illustra¬ 
tions in the article “ Camp ” greatly aid the reader in 
following the descriptive letterpress of the plan of the 
camp, its area, bivouacs, cantonments, shelter-tents, 
bospitsl tents, and tents in general. The military 
authorities, as well as the general public, have come to 
recognise that disease kills more than either the rifle or 
the sword in modem wars. 

He oouimences bis chapter on posts, harracks,qn<irters, 
and hospitals by accepting Parkes’s well-known require ■ 
ments for a besdthful habitation ; and tbe article is pro- 
fa«ely illustrated, to the great comfort of tbe reader, 
who has no difficulty in recognising the different plans 
that varying circumstanoes call for daring war. Venti¬ 
lation is next dealt with, ite influence on health, drafts, 
intakes, and so forth, with descriptions and illustrations 
of its many methods, occupies some fifty pages. 

Heating and lighting naturally follow, the relative 
value of the different fnels is considered, and the many 
methods of local and general heating described and 
illustrated. 

Fifty pages follow on the disposal of excreta, sewage, 
and refuse. He deals with the advantages and dis^- 
vantages of the cesspool system, the pail system, the 
dry-earth system, and the Gonse system. Sewers, their 
sanitary value, their construction, their site, the 
velocity of their flow, their gradient, their discharge, 
and sewer-air all come in for treatment by tbe author. 
Tbe technicalities of drainage and plumbing, sewer 
pipes, latrines, and the disposal of sewage secure due 
consideration. He next t^es up the question of the 
personal cleanliness of the soldier, and opens chapter 
thirteen with the statement, which we heartily endorse, 
“ The maintenance of personal oleanlioess is even more 
essential in tbe military service than under the ordi¬ 
nary conditions of civil life.” 

Military mortality and morbidity and diseases of the 
soldier are disouseed in 160 pages; of the military 
surgical records from the Memoirs of Baron Larry to 
Senn’s Beport on the Spanish-American War, we know 
DO book so full, so clear, so trustworthy a guide on these 
subjects as tbe work under notice. Disinfection is next 
considered, and we recommend this description of 
chemical and other disinfectants to all health officers, 

articularly to those having charge of infirmaries, 

ospitals, and such-like boildinga. 


' Tbe habits of tbe soldier, under tbe headings alco¬ 
holism, tbe canteen system, venereal disease, the use of 
tobtcco, tattooing, bis amusements, insanity, and 
suicide, tbe hygiene of hot and cold climates, of the 
troopship, sanitary inspection, and the disposal of the 
dead, conclude this great work. 

Great in its fulness and accuracy, its clearness of in¬ 
formation and excellence of arrangement, and great in 
the mastery of his subject that tbe author displays. 

Written for military surgeons, tbe book is withal in¬ 
valuable to public health officers, medical officers of 
infirmaries and workhouses, for surgeons in charge of 
segregated bodies of men, for headmasters of public 
schools, and for all who take an interest in preventive 
medicine and practica’. hygiene. 

CLAEKE’S NEW THERAPEUTICS, (a) 

This work has reached a sixth edition, so that pie* 
BOmably there is some demand for it. It may be 
described as a catalogue of diseases, with indications 
for treatment. We will take an example. Under the 
heading of Enteric Fever we find : “ At the very com¬ 
mencement when it is not absolutely certain whether 
it is true typhoid or low gastric fever, Se/'i c^min.'' 
We must admit that we have never met with such a 
case, and are not very clear what is meant by “low 
gastric fever.” “Low Fever” and *'Slow Fever" are 
somewhat antiquated synonyms for enteric fever, and 
the term “ Gastr'c Fever ” is sometimes met with in the 
works of the older writers, but we do not remember to j 
have seen a case of “ low gastric fever ” in the wards of 
any hospital, and we were r.ot aware that it was a com¬ 
plaint likely to be confounded with interic fever. 
Possibly tbe author might find Widal's reaction an aid 
to diagnosis. At all events, should there be an epi¬ 
demic of such cases, septicmmin is the appropriate 
remedy, and it should be given “ 80-200, 4b.’' Whether 
this would cure the patient or kill him outright we are 
not informed. There seems to be some mystery about 
septicffimin, but from another part of the work we gather 
that it is an abbreviation for septicseminum. What is its 
origin and how it is prepared we are not informed, but 
possibly that might be ascertained from a study of the 
author's “ Practical Materia Medica.” Other remedies 
suggested for enteric fever under various circumstances 
are “agar,” “ecchin,” and “pyrogen.” "Agar” is 
probably agaricua muscarius, a drug with which we are 
familiar; “ ecchin ” we find is ecobinacea augustifolia; 
whilst ’pyrogen” is another name for sepsin. This is 
all very well as far as it go«s, but we should like to 
know how a medical man brought up on such pabnlam 
would conduct an ordinary case of enteric fever. It 
seems to us that his knowledge of the etiology and 
pathology of the disease would be utterly thrown away, 
whilst the condition of tbe patient, if these drugs have 
any action at all, would be critical. Supposing as a 
complication the patient were to develop tympanites or 
peritonitis, or perforation or hyperpyrexia, is it at all 
likely that “ agar," or “ ecchin,” even with the mystic 
symbols attached, would do any good ? We may i^rly 
ask that our author should be reasonable, or at all events 
that be should show some practical knowledge of the 
clinical aspects of the disease. We have no desire to 
characteiife his recommendations as utter nonsense, but 
we might do so in all 'good faith. Would it not be 
better that he should describe one or two carefully 
observed cases of enteric fever treated on the principles 
that he has enunciated, and that he should give some 
account of tbe pharmacological actions of tbe numerons 
drugs of the “ New Therapeutics” which he advocates? 

We have not tbe slightest doubt that he is sincere ia 
his convictions and that he has spent much time in the 
compilation of the work, hot we cannot refrain from 
asking the question: —“ What good is it, and what does 
it all lead to?” It is not pathology, ic is not thera¬ 
peutics, and it is not tbe practice of medicine, at all 
events in the sense in which we understand these termi. I 


(«) “ The Prescriber: A Dictionary of the New Theumpentiei." 
By John Henry Clarke, H.D. Sixth Edition. London: 13, Wii* 
wiok Lane, E.C. ieOi>. 

6*^ 


S*PT. 26, 1901. 


MEDICAL NEWS. 


Tux Mxdical Faxbs. 349 


AN INDIAN TREATISE ON MATERIA MEDICA. (a) 
This little work, which consiets of 108 pAgec, aod is 
preenmxbly intended for the nse of students in the 
author's class in the Calcutta Medical School, is a usefal 
compilation. It makes no pretence to originality, and 
the facts and tables have been gleaned from well-known 
eooroea. The writer has made the most of his opportuni¬ 
ties, and has arranged his material in a manner which can¬ 
not fail to be of service to men preparing for examination 
in this somewhat nnpopolar subject. There is but little 
to criticise, and the only errors we have detected are 
misprints, chiefly in the transcription of authors* 
names. Even in the preface there are signs of imper¬ 
fect proof-reading, but these will probably be corrected 
in future editions. Apart from this the work is well 
done and reflects credit on the author. 




Dublin Dea^-rate. 

In the Dublin registration area the deaths registered 
for the week ending Saturday, September 14th, 1901, 
were 164. They represent an annual death-rate of 22-8 in 
every 1,000. During the thiriy-seveu weeks ending 
Saturday, the 7th iust, the death-rate averted 26 8, a 
slight increare on the oorrespouding period of the past 
tea years. Sixty-four of the persons whose deaths were 
registered during the week were infants; of whom 
thirteen were under one month old, and forty-three 
under one year old, an infant mortality probably un¬ 
equalled in any other city. A disgrace to our civilisation. 

Death Under Chloroform. 

A DXATH under chloroform at University College Hos- 
jntal was the subject of au inquest last week. The 
victim was a man, ^e 47, who was undergoing an opera¬ 
tion on the month. The usual verdict was returned. 

Death from an Overdose of Morphine- 

An inquest was held on the 18th inst. on the body of 
Dr. Carmichael, of Southport, who bad succumbed to 
the effects of an overdose of morphine taken to induce 
slem. The deceased was seventy-eight years of age. A 
veroiot of death from misadventiure was returned. 

The Road to Bnln. 

Francis Scott Sandxbs, formerly a medical man, 
whose name was removed from tha Mtdical Regitter 
some years ago, conseqnent upon bis conviction for for¬ 
gery, was last week sentenced to a term of imprisonment 
for several more cheque frauds perpetrated at the ex¬ 
pense of Dr. Evans, of Pimlico, and others. 

Another Midwife Scandal. 

An inquest was held a few days since by the Coroner 
for Westminster on the body of an infant male child, 
who was stated to have died of oonvulsiona two hoars 
after birth. The midwife nevertheless took the body to 
the undertaker in a shawl and certified it as still-bom. 
The inquiry was adjourned, and it is to be hoped steps 
will be taken to impress upon the midwife the extremely 
serioos nature of the offence. 

Koch’s Theory in Court. 


Maculipennis, is the malarial parent, the other is the 
common grey gnat, Colex Pipiens. The latter insect 
has light bands round his b^y, and one proboscis, 
while the former has no bands, but three proboscides. 

A Municipal Convalescent Home. 

An interesting experiment is being carried out by 
the Health Department of Halifax Corporation. This 
is the opening, at Birka Ball, Pellon, of a convalescent 
home for scarlet fever patients Experience has shown 
that,when patients have been discharged direct from the 
Stoney Boyd Fever Hospital, there have been a number 
of what are known as "return cases,* through some 
other member of the family developing the disease. 
The patients are now to ^ isolate at Birks Hall 
entirely from acute infection for a fortnight before 
being finally discharged. It is intended, if the experi¬ 
ment answers anticipations, to provide and maintain a 
permanent convalescent home in the town. 

Tital StatlBUca 

Thk deaths registered in the w eek ending September 
14th in 86 large towns of Great Britiun and Ireland corre¬ 
sponded to an o-tifttia .1 rate of 21*8 per 1,000 of their 
aggregate population, which is estinmted at 11,463.028 
persons in the middle of this year :— 

Birkenhead 20, Birmingham 22, Blsuskbum 17, Bolton 
19, Bradford 15, Brighton 16, Bri^l 16, Burnley 24, Car¬ 
diff 14, Croydon 16, Derby 18, Dnblin 22, Edinburgh 16, 
Glasgow 17, Gateshead 28, Halifax 17, Huddersfield 14, 
Hull 20, Leeds 18, Leicester 17, Liverpool 19, London 16, 
Manchester 23, Newoastle-on-Tyne 27, Norwich 17, 
Nottingham 16, Oldham 22, Flymonth 11, Portsmouth 16, 
i Preston 24, Salford 26, Sheffield 20, Sunderland 24, 
Swansea 15, West Himi 17, Wolverbiunpton 21. The 
highest annnal death-rates per 1,000 living, as measured 
by last week’s mortality, were:—B^rom scarlet fever, 
1.2 in Bolton: from whooping-congh, 1’4 in Gateshead 
and 1*7 in Leicester} from “fever,” I'l in Swansea, 
in Nottingham, in Hadder8fiHd,and in Sheffield, and 1*9 
in Birkenhead; and from diarrhosal diseases, 6*0 in 
Birmingham, 5*6 in Hull, 6 7 in Sunderland, 6*9 in 
Manchester and in Sheffield, 6*0 in Preston, 6*4 in Sal- 
fold, 7*7 in Wolverhampton, and 8 0 in Gateshead. In 
none of the lazge towns did the death-rate from measles 
reach 1*0 per 1,000. The 80 deaths from diphtheria 
included 28 in London, 9 in Sheffield, 6 in West Ham, 4 
in Bristol, 4 in Mancbnter, 3 in Glasgow, 3 in Leicester, 
and 3 in Gateshead. Nine deaths from small-pox were 
registered in London, but not one in any other of the 
large towna 

: The Mortality in Foreign Cities. 

Thx following are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several of 
the populations:—Calcutta 28, Bombay 66, Madras 76, 
Paris 17, BruEsels 13, Amsterdam 14, Copenhagen 21, 
Stockholm 13, Christiama 18, St. Petersburg 21, Moscow 
29, Berlin 24, Hamburg 18, Breslau 28. Munich 32, 
Vienna 15, Bada*Peeth 14, Trieste 21, Rome 18, Ventoe 
23, Cairo 47, Alexandria 42, New York (indading 
BrooUyn) 22, Philadelphia 19. 


A BxooAR in Hamburg was recently in court on a 
charge of vi^boodage, and his defence wm that six 
tDontbs previously he had oontracted tabercalosis in 
slaughtering a cow, which had rendered bis right arm 
UMless, and this statement was home out by the hos¬ 
pital doctor. He was accordingly discharged. 

The Sanitary Instltnte. 

A DONATION of XlOO has been promised by the Leeds 
Fireclay Company to the fund for the new bnilding and 
endowment fund of the Parkes Muneum. 

Mosqnlto Models. 

A CASK of model mosquitoes has just been placed in 
^ peat hall of the Natural History Museum, ^nth 
Kensington. The models, which have been beautifully 
*aade by Mias E. D. Emett, are twenty-eight times 
natural size. Of the two models, one, the Anopheles 

(«) ** A Trwtlae on Mstsria Hedica snd Tbsnpenties, isdudisx 
rntmyj, _Diaj>engiTig, Pbarmacologr, and AdminiwtraUoa (3 
By Bakbaldas Ohoata, Lacturer on 

Calcutta Medical SctaooL Calcutta: Hilton and 




Society of Apothecaries of London. 

Thx following candidates have passed in their respec¬ 
tive enbjects during the September examinations:— 

Surgery: H. Richardson (^tions I. and II.), C. W. 
Rowntree (Sections I. and II.) 

Medicine: C. J. E. Edmonds (Sections I. and II.), 
R. L. Jones (Sections 1. and XL), G. J. W. Keigwin 
(Section II.), C. A. Lower (Section L}, C. W. Rowntree 
(Sections I. and II.). 

Forensic Medicine: C. J. E. Edmonds, R. L. Jones, 
O. Millauro, C. W. Rowntree, H. Smith. 

Midwifery : C. H. Allan, E. 0. Libbey, C. W. Rown- 
tree, W. P. Taylor, J. H. Williams. 

The L.8.A. diploma was granted to the following can¬ 
didates, entitling them to practise medicine, surgery, 
and midwifery : C. J. E. Edmonds, R. L. Jones, G. 
Keigwin, C. W. ^wntree, and H. Smith. 


J. W. 


ogl 




350 Thi Midioal Pbbos. NOriCBS TO CORRIi!SPO.NT)KNT8, 


Sift. 25. 1901. 


^loticee to 

®orre«^«mb«tts» §hort ^Ccttno, 


1^* COBUtronrari reqalring m reply in tbia oolnmn ue per- 
tienlnriy nqnaeted to make use of a dirHneHv$ lignatwr* or 
i itticla, and aroid the piaotioe of aiffalny themaetTea ** Bander,” 
■*Bnbaortber,” "Old Bnbocriber,’’ do. Ifooh oonfnalon will be 
Bpared by attention to thia mla. 

Bbpribts.— Bepiinta of articlea appearing in thia journal can be 
bad at a rednoed rate, providing anthora ffire notice to the pub- 
liaber or printer before the type hie been di»tribated. Thia should 
be done when returning corrected proofs. 

OaiQinaL A » Tin.«a or Lkttxbs intended for publication should 
be written on one aide of the paper only, and moat be antbenticated 
with the name and address of the writer, not necessarily for publica¬ 
tion, bnt as eridence of identitT. 

NEWSPAPEB PHYSIC. 

It is to be hoped that with the advent of real education there 
will be some (ieorease of the rant amount of quackery that la 
upon the public. In the pages of a well-known journal 
written for the domestic circle appeared a short while since what 
purported to be a reply to a fair correspondent who had asked how 
she conld cure an nncomfortable habit of flushing. The answer 
began with the remark that the symptom evidently arose from 
nervousnsBs, and that must be cured in the first place. Then 
followed about twenty or thirty lines of direotiona The blushing 
correspondent was directed to buy some preparation with a quaint 
naEe.inr ate in the morning bath. The stnlf oost half a crown, 
but on the other hand it was *' invigorating and beautifying." 
She was then to biave her spine rubbed up and down until the akin 
was in a glow with another half-crown preparation. She was 
directed to bethe her face frequently through the day with a 
♦ftTiwiw preparation sold at the ridiculously low price of one shilling 
and sixpence. After the lotion she was advised to nse camphor 
water, or "better still,” a lotion at half a crown. The latter is 
cheap at the money, for it is not only cooling and refreshing, but it 
imparts a velvety softness to the akin. The paragraph concludes 
with tbs advice " Not to think what other people think,’ but 
follow the foregoing directions and “ yon will aoon lose that ten¬ 
dency to flashing.’’ A oonrse of this kind would infillibly min 
the strongest skin on earth. How women can allow their money 
to be wheedled out of them by such nooaense is a thine ■' no 
fellow can nndersTand.” If he wanted to be beautiful for ever be 
would reaort to yellow soap and a jaok-toweL 

Da BCuaaBLL's papw on " The Yalne of Am and Sex as £tio- 
lo^cal Factors in the differential Diaguosis of Gastric Ulcer sad 
Ca^noma ” is marked for early insertion. 

THE STATISTICS OP THE IBISH HOSPITAL IN SOUTH 
APBICA. 

Ws hasten to correct an error which in some carious manner 
seems to have crept into Dr. Coleman's article on "Uedical Ex¬ 
periences in South Africa," which sppeared in our last issue. The 
mortality among the cases treated in the Irish hospital was 
wrongly given as 18-7 per cent. It should have been 11*7 per cent., 
aveiy material difference. 

Phtsicub. Cardioptcais,*' otherwise called Bnmmo’s Disease, 
is ascribe I to a wttknew of the snspeuory stmetnres of the heart 
in nenrasthenics, partionlsrly of the bundle of blood vcbmIb in 
which the elastic elements are not safBciently developed to snstain 
the heart in its normal position. A translation of a paper on the 
subject appears in the issue of the Ntw York Mtdicfd Jounu^ for 
August 21tb, 1901. 

THE MEDICINAL QUALITIBS OP PUBE BBANDT. 

A coaasBPOKDBHi writes ns that be has recently reed in one of 
the newspapers that very little pure brandy now eiiats containing 
those natuml medicinal qualities which won for it the favour of 
former years as the most valuable of all stimulants. He asks 
whether this wholesale thrust at one of the medical sheet anchors 
is true, or only the outcome of interested parties in the whisky 
trade. As to the Utter we cannot inform him. although his 
Burmim may have some indirect beariog; but with the former 
question we are in the position to assure him, as the result of 

caraful analyses of several samples of Cogni^ 

pure as itever was, and that be may continue to prescribe it where- 
ever indicated with the same confidence as formerly, provided be 
specifies the beat known brands. The recent ease in the liw courts 
in which it was found that a cheap composition was sold under the 
name of brandy which had not been produced in the brandy dis¬ 
trict of Cognac has undoubtedly had much to do with the rvport 
referred to. Pure Cognac cacnot bo purchased at the price of 
whisky, but the genuine article can be bad at its market value. 

Otis Prshch CoBBESPOitDEKT.—The Clinical Lecture by Pro¬ 
fessor Robin on "The Treatment of Gastric Ulcer has been 
received. 




GiLKBB, H. A. H., M.B., Cb.B.Edio., House Surgeon to the David 
Lewis Northern Hospital. Liverpool. ^ j -nr w 

LiviSGSTOSB, Thomas H.,M.B., Ch.B.Edm., District and Work- 

house Medical Officer of the Weardale Union. 

Macsehzis, F. D. S., M.B., Ch.B.Edin., AssisUnt Honse Surgron 
to the David Lewis Northern Hospital, Liverpool. 


Babt Leorard, M.D.Durh., M.B.C.S.Eng., Medical Officer of the 
Second District of the Devises Union. 

Brow, C. B . M.B., Ch.B.Edin., Honse Fbysictan to the David 
Lewis Northern Hospital, Liverpool. 

Stbover. Walter, M.B.C S.Eog., L.S.A., Medical Officer of 
Health of Chingford. 

Watts, Alsxarder, M.ILC.R.EDg. L.B.C.P., Medic 1 Officer'of 
Health of tbe Holbeacb Urban District. 


9a£aitcu0v 

Cork Street Hoepital and House of Recovery.—Assistant Lady 
Superintendent Rnd Matron. Salary £-10 p<r annum, with 
board and uniform. Applications to be sent to J. liUrsh^l 
Day, Be^trarand B.M.O. (Seeadvt..) 

County Anlum, Bnmtwood, near Lichfield.—Junior Assietant 
Medical Officer. Salary £lh0 per annum, increasing to £'200, 
with board, lodging, attendance, and washing. A| plications to 
tbe Medicstl Superintendent. 

East Biding ot Yorkshire.—County Medical Officer of Health. 
Salary £^ per annum, rising to £500 per annum, with certain 
allowances. Applications, on forms to be obtained tern (he 
Clerk, to be sentio the Clerk of tbe County Council, Conntr 
Hall, Beverley. (See advt.) 

Essex County Asylum, Brentwood. — Jnnior Assistant Msdioal 
Officer, undsr ’26 years of age. Salary £140. Appttostions to 
tbe Medical Si-penntendent. 

Hertfordshire County Asylum, Hill End, St. Albsns.—Jnnior 
Assistant Medical Officer, unmarried. Salary £160a y»t, with 
board, fdmishsd apartments, and washing. Applications to tbe 
Medictl Superintendent. 

Lancashire County Asylnm. Wlnwiok. Kewton-Ie-Willows.—Senior 
Assistant MMical Officer. Salary £225 per annum. Also 
Second Assistant Medical Officer. Salary £175 per annom. 
Also Assistant Medical Officer. Salary £150 per annnm. All 
with board, lodging, and waahing. 

Monaall Fever Hospital, Manchester.-Medical Snperintendent, 
unmarried. Salary £350 per annum, with residence, mainten¬ 
ance and attendance. 

North Wales Counties Lnnatlo Asylum, Denbigh — Second Aaswt- 
ant Medici Officer. Salary £120 per annum, rising to £160, 
with bosrd, residence, and washing. Applications to the Clerk 
of tbe Yisiting Committee. 

Owens Collie, Manchester. - Junior Demonstmtor in Physiology. 
Salary £100 Mr annnm, ri*ing to £150 per aiinum. Applici- 
tions to the Begistrar, from whom farther particulars may be 
obtained. 

Boy^ London Ophthalmic Hospital, City Boad.—Curator and 
liibrarian. SsiuTy £120. Applications to the S^erttorj. 

Somerset and Bath Lnnatie Asylum, Cotford, Tanuton.- Assistant 
Medical Officer. Salary £120 per annum, rising to £150, with 
fumisbsd apartments, bes’d, and washing, Applicaticw to 
the Medical Superintendent. 

Worcester County Asylum, Powick.—Third Assistant Medical 
Officer. Salary commencing at £120 rer annum, increasmr to 
£140, with boara, residencs, Ac. Applications to the Medical 
Supenntendent. 


girths. 

DcHK.—On September 19tb, at MildenbtU, Suffolk, tbe wife of 
William Dnim.M.B., of a daughter. 

HiCESOR.—On September 22nd at 64, Gloncester Place, London, 
W., tbe wife of kbjor G. B, Hickson (late B.A. Medical Ser¬ 
vice), ot a ^ughter. 


^Hanrtages. 


Avert—Noce.— On September 17tb, at tbe parish church, Alve- 
church, by tbe Bev John Avent, U.A. (father of tbe bride- 
grooml, Arthur Avent, L,R.C.P., to Kate Hurd, daughter of 
the late J. B. Nock. 

Cobber—Ockerdbh.— On September ]7tb, at St. George’s. Hu- 
over Square, London, Oharles Corben, M.B.C.S., to Annie 
Bulmer, widow of tbe late E. J. Ockenden, and daughter cf tbe 
late Major John Godson, Madrss Staff Corps. 

Beid-Mitcbell.— On S<>ptember 20tb, at Lbii»t Church, Bainp 
stead, James William, second son of Jamee Reid, F^-C-S., of 
Canterbury, to Edith Harriett, younger daughter of the We 
Francia Henry Mitchell, of Hampstead. 

Stevbrsor-Lamb,— On September i7tli, at St. Mary’s ChuM, 
Ealing, Walter Brodie Stevemon, M.B.C.S.Eng., LRC.P. 
Lend., to Anaie, daughter of William DovglaB Lamb. 

Worth—Shephard.- On September 17th, at St. John's Chorch. 
Eton, Francia Jamee Worth, M .D., B.S., L.B.C.P., M.B C3.. 
to Margaret Louisa, daughter of the Bev. J. Shepherd, vicar 


S&aths. 


ARDERSOM.-On September l»th, at Hallyards, Peeblesshire, Williui 
Anderson, M.D.. of Hallyards, and of Bicbmond, Surrey, 

BALFOTB.^n^ptember 11th, at 15, Marmaduke Street, Liv» 
pool, Alice, wife of David Balfonr, M.B. and C.M., aged 36 

DocGLA^-On September 18tb, at Bellingdon E^, Cheahaft 
James Ricbara Alexander Douglas, M.B.C.S., L.8.A, » 
Hounslow, in his 83rd year. 

MoRAR.—On September 2()th. in London, Lient.-Colonel JaiB« 
Moran. M.D.. of the IndiRn Medical Service. 


®lte ^xm atiA 

•‘8ALUS POPUIJ 8UPBEMA LEX." 

VoL. CXXIII. WEDNESDAY, OCTOBEB 2, 1901, No 14 


fans Clinital JCcchires. 

THE TREATMENT OF 

BRONCHITIS AND BRONCHO¬ 
PNEUMONIA IN CHILDREN. 

Bj Prof. MARFAN, M.D., 

Hopital d'Cnfacte, Frofewor of Clinical Medicine in the 
Uiiiveraitj' of Ptris. 

[BBPOaTBD BY OTIE PBKNCH CORBB8PONDBNT.1 

I TAKE for the subject of this lecture the treatment 
of bronchitis and of broncho*pneumonia in young 
children. Some years ago the therapeutics of these 
affections were much encumbered; the remedies 
employed were very numerous, and you know that 
the proverb "Apparent riches mask real poverty" 
bolds good here, a multiplicity of remedies recom¬ 
mended for a malady being a proof of their slight 
efficacy. I have no desire to recapitulate all the 
remedies tried for the last ten years. I will limit 
myself to indicating those which I have found the 
most useful. 

No matter what form of infection of the lun^ 
we have to deal with, whether simple hronohitis, 
capillary bronchitis, or broncho-pneumonia, there 
are eerfatn inea$ures which mu»l he taken tn every 
caee, even the most simple. 

Infants saffering even only from traoheo-bron- 
chitis must be kept indoors at least ten days, in a 
room well-aired and lighted, and at a temperature 
of 63'' F. It is well, also, that the atmosphere of 
the room should be saturated with water vapour; 
humidity, in fact, acts favourably in facilitating the 
expulsion of the bronchial secretion. The object can 
be easily obtained by placing a kettle of water over 
a spirit lamp. At tbe period of decline of the 
affection, a few leaves of eucalyptns can be thrown 
into the water, and thus the air which the child 
breathes will be loaded with balsamic vapour. 

It is common to meet with symptoms of infection 
of the mouth and throat in children suffering from 
bronchitis or broncho-pneumonia, and often it is by 
deecending infection that affections of the broncho¬ 
pulmonary apparatus aro provoked; their habitual 
point of origin is the region where the third tonsil,; 
the tonsil of Luschka, is situated. In case of 
bronchial infection it is rare that there does not 
exist suppuration of this region, even in the absence, 
of any adenoid vegetation. 

It is consequently necessary to effect the anti¬ 
sepsis of this cavity by the aid of an ointment. Tbe 
one we use in this hospital is composed as follows:— 
Boric acid, 3j • 

Menthol, gn iii; 

Vaseline, Jj. 

^ order to make this ointment penetrate, the 
child is placed horizontally, the head hanging down 
backwards; then with the point of a proM with 


cotton wool, or even the finger, a little of the oint¬ 
ment is placed in the veetibule of the nose, tbe child 
being kept in position for a minute or two, until the 
ointment melts and runs down the nostril. In a 
child of five or six the operation is even simpler; with 
the head as in the first case a few drops of a solution 
of menthol in oil (I—50) is poured into the nares 
twice a day. No attempt at washing through tbe 
nose should be made. 

Where infection exists in the mouth, stomatitis 
with or without ulceration, touch tbe gums, lips, or 
fauces with a solution of carbolic acid (1—if 
ulceration be absent, otherwise employ oxygenated 
water. 

Thus, in every form of bronchitis ensure asepsis 
of the month, nose, and pharynx; you will thereby 
prevent relapses. 

There is another precaution which you should 
never neglect; it is to recommend change of 
posture. In young children, as in old persons, the 
dorsal decubitus favours the accumulation of the 
secretions in tbe bronchi. You must consequently 
insist that care be taken not to leave the child 
always on its back, but to place it now and again on 
either side, and to take it frequently in tbe arms. 

I oome now to the treatment of the different 
forms of bronchitis. 

Traeheo bronckiiU (inflammation of the trachea 
and the large bronchi). 

In this case counter-irritation must be employed 
at the outset. Mustard poultices twice a day, in the 
morning on the back, in the evening on the cheet. 
The skin of young children is very ^icate, conse¬ 
quently the poultices should be left on only as long as 
is required to redden the skin. Ought this to comprise 
the whole of your treatment, or should you employ 
internal rememes P In my opinion you should take 
care not to inteifere with the phenomena of natural 
defence, particularly tbe cough, more useful to chil¬ 
dren than to any other patient, hindering, as it does, 
the propagation of tbe malady to the smaller bronchi. 
For that reason I advise you to order no internal 
treatment, unless the oongh be out of proportion to 
tbe degree of inflammation, and if it prevents sleep. 

In such a case you can prescribe tbe following 
mixture:— 

Syrup of orange flowers U „ • 

Syrup of codeme ) ^ ’ 

Tincture of aconite, H^vj ; 

Water, 5j. 

A teaspoonful a day for every three mouths of the 
child’s age. In this dose codeine is without danmr 
even in ^e youngest children, and gives good results. 

Throughout the duration of the affection, as in 
every form of bronchitis, you should follow mosely 
the evolution of the malady, thermometer in hand, 
and the ear on the chest; twice a day tbe tempera¬ 
ture must be taken and the patient examined to see 
if the collateral bronchi are not affected In their turn, ^ 



352 Ths Mxdicaii Pbxbs* OBiOINAL COMMUNICATIONS. Oct. 2, 1901, 


which would cosstitute a prelude of capillary broo* 
chitis, always to be feared in children. 

If the collateral bronchi are InTsded, instead of 
large buUts you will hear sharp sibilant r&les and 
mucous rales. If no fever be present it will not be 
necessary to employ more acuve treatment than 
that already mentioned, counter-irritation and cough 
mixture. If slight fever be indicated by the ther¬ 
mometer (100® F) you will apply mustard, but yon 
will take care not to give any sedative mixture. 
The secretion of the bronchi must be got rid of by 
the cough, consequently you must md the cough by 
expectorant. If the child is over a year old and 
otherwise strong you will give an emetic, such as 
ipecacuanha, and renew it every three or four days, 
but when you have to do witn a child under one 
ear yon had better abstain from it, as it only contri- 
utes to lower the strength and provokes oiarrhcsa. 
Yon might, however, administer the following mix¬ 
ture, wmch, although it will not provoke either 
nausea or vomiting, exercises a tonic action on 
Beissessen’s muscles, and on the vessels:— 

Hippo powder, ii grs; 

Boilmg water (filter, add), §ij ; 

Syrup of tolu, ^; 

Acetate of ammon. liq., IT\,xv. 

A teaspoonful in the day for each quarter of a 
year. 

The third form, diffuse bronchitis, with fever, must 
be treated energetically; incessant cough, accelerated 
respiration, mucous rSles distributed over the lungs; 
high fever 100®—103® F.; all si™ indicating 
approaching capillary bronchitis. Here the hot 
bath is absolutmy necessary. The temperature of 
the patient is taken every three hours, and when ever 
the fever reaches 103® F. a bath at 100® must be 
piven. The effect is very remarkable. Improvement 
m almost immediate; respiration becomes more 
active and deeper; the pulmonary ventilation is 
better; the temperature drops a little; diuresis is 
abxmdant, and after the bath the child sleeps 
quietly. After four or five baths the temperature 
falls definitively below 103®, that is to sa^, in twenty- 
four or forty-eight hours. When the friends refuse 
the bath, or if no means for it are at your disposal, 
the ^atment of Hensch, of Berlin, wiU form a good 
substitute. You take a towel folded in eight and 
dip it in ordinary cold water; you wring it out and 
appl^ it to the thorax of the patient, covering it with 
an oilskin; yon leave it in place for two hours and 
renew it, and so on every tw hours for twenty-four 
hours. The following day vou perform the same 
operation four times in the twenty-four hours, 
leaving the towel in situ an hour and a half each 
time. The results are similar to those of the hot 
Iwth. 

I now come to the treatment of capillary bron¬ 
chitis. Here, again, warm bathing is de riffueur, 
and twice a day mustard should be put in the bath. 
When the person who bolds the child in the mustard 
bath feels the skin of her arms commence to bum 
the child must be taken out. Warm and mus¬ 
tard baths consequently constitute the main ti'eat- 
ment of capillary bronchitis and broncho-pneumonia. 
But it will often be well to combat the infection by 
injections of semm; the following is the formula I 
prefer:— 

Chloride of sodium, gr. 4; 

Casein, OTO; 

Water, 18 ounces. 

For a child of six months, six drachms are injected 
in the morning and the same quantity in the evening. 
For a child a year old one ounce, and three years old 
an ounce and a-balf. If the patient is threatened 
with collapse, or asphyxia, it would be well to inject 
camphorated oil (1-10), five drops for a child under 


six months, ten drops under a year, and twenty drops 
for a patient in its second year. 

Care must be taken to keep up the strength of the 
patients bv food and stimulants. Under fifteen 
months milk alone should be given, over that age e^s 
m^ he beaten up with the muk. As stimulants, tM, 
coffee, and the following mixture:— 

Tincture of cinnamon, xv drops ; 

Cognac 1 - . 

Syrup of ether j ’ 

Acetate of ammonia liq., gtt. xv; 

Symp of acacia, 5ij> 

To be given by teaspoonfuls. 

Such is the treatment of capillary bronchitis and 
acute broncho-pneumonia. In the period of decline 
of any of the above forms, you should order the chest 
and back to be rubbed night and morning with equal 
parts of olive oil and essence of turpratine, and apply 
a layer of cotton wool; in children under six 
months balsams are not well borne, but in older 
children you can give the following mixture:— 
Terpine, vi grs; 

Benzoate of soda, xii grs; 

Syrup of acacia, 5ij> 


DIBT IN RELATION TO THE 

CAUSE AND CURE OF CONSTI¬ 
PATION. 

By JOSIAH OLUFIBLD, D.O.L., M A.Oxon.^ 
L.B>.C.F.Iiond., 

Senior Pbrticisa to tbe Hoapitel of Bt. Fnncif, and to Uie OrMit 
Hospital, lionghton. 

When I first began to undertake the difficult 
task of diagnosis, I used to ask patients “ Are your 
bowels re^dar P ” And I was satisfied with the 
answer “ les,” until I was one day startled by the 
disooveiy that a patient who had previously given 
me this answer had not had a motion for nearly 
week, and upon further inquiry I found that it vrs 
her usual experieuce to have a motion every Sunday 
morning after a late breakfast, and before going to 
church. This was the patient’s idM of a regular motion, 
and further observations and inquiries had led me to 
find—what everyone who has much to do with diseasM 
of digestion, fin^—that to many women their bowels 
are as regular as their menses, namely, once a month, 
if they do not take pills. 

The great prevalence of constipation in the hnman 
race is a matter of the gravest importance, and ore 
which confronts every physician all through his 
practice. Perhaps more fortunes are made directly 
and more lives lost indirectly through this trouble 
thau through aaijr other single compi^t. Fatret 
medicines, prescriptions, and infallible reme^to 
abound, but ^e evils still more abound, and with 
increasing civilisation it, too, increases. It is, there¬ 
fore, worth while oonsidwing with care any new light 
that Aftn be thrown upon its causation and 
cure. I remember one day having very gr^ 
sympathy with a dog; it had b^ agoniting 
for a long time over a particularly rmractory 
stool, and while it was still struggling and I 
still sympathising, a herd of cattle passed by, and as 
they passed idong one cow began to drop the usual 
fluid fjecal matter. It suddenly strucK me as a 
curious fact in nature that cats and dogs often had 
difficult motions, but that I had never known a cow 
to be thus troubled, and horses only sparingly so, and 
that when they had been kept for a long time from 
grass. I did not think more of the matter then than 
merely to let my mind recall the popular craze w 
green laxative without trying to solve the reason « 
this effect Years after I came across a wonderfol 
life-history of the liver fluke, and learned what was 

.Go^e 





Ocr. 2, 1901. 


OBIGINAL COMMUJinCATIONS. 


Tbi Msdioal Pbxss. 353 


nltimate end to •which a correct constipation 
patiently persisted in wotild lead. The liver fluke, 
bathed in nntritious juices containing but a minimum 
of waste matter, fiuds that his loser bowels are use¬ 
less, and when at length, by long disuse these have 
atrophied, be becomes the hap^j possessor of a 
stomach and diverticula without intestines or anus ; 
the happy possessor of a digestive system without 
the ne^ for an excretory one; the happy possessor 
of organs which need no pui^tives. When the 
problems of constipation became pressing ones in 

{ >ractice I recalled some of my old observations and 
earned the following lessons:— 

1. Concentrating nutriment leads to constipation. 

2. A certain amount of bulk and waste matter is 
necessary to secure frequent defacation. 

3. A vegetable diet tends to a laxative state and a 
flesh diet to a constipated state. 

At first I was inclined to include the third heading 
nnder the other two, and to assume that the vegetable 
diet was laxative because it was more bulky and con¬ 
tained more waste matter than a flesh diet. Later 
observations, however, led me to alter my views; I 
found, for example, that young summer spinach, 
which contains but a minimum of waste matter, was 
even more laxative than the toughest old cabba^ 
with a maximum of indigeetible cellulose matter. 1 
found, too, that a great number of my patients who 
li-ved upon generous meat dietary had large ab¬ 
domens, with their intestines full of ftecal 
matter, and that the presence, therefore, of 
much undigested matter in the intestines was not in 
itself enough to make the intestines empty them¬ 
selves. To refer again to a test dietary, spinach and 
butter, which contun practically a minimum of bulk 
in its waste matter, was g^tly laxative, while beef- 
tea, which also cont^ned little bulk in ite waste, and 
also contained a large proportion of water, was con- 
st>ipatang. and milk, though it contained a large pro¬ 
portion of fsecal waste, was also constipating. I was 
led by observations, extending over a large number 
of cases, to exclude from a large percentage the 
nsnally accepted theory that the ingestion of a con¬ 
siderable portion of waste matter was essential to, and 
was the chief cause of, a natural and regular motion 
of the bowels. Had this been true the cure of con¬ 
stipation would have been the simplest of simple 
things, instead of being, as it is, one of tbe most 
difficult of modern problems- While, therefore, I 
recognise that the ingestion of bulky foods contain¬ 
ing a fair percentage of indigestible •waste is one 
caose of defsscation, and while I recognise the im¬ 
portant function of the irritating elements of food, 
e.^., bones in tbe dietaiy of a dog, flints in the 
dietaiw of a fowl, bran spicules or fig seeds in the 
diet of a man; I do not consider that either or both 
of these solutions is sufficient to deal comprehen¬ 
sively with the great number of constipations in our 
midst. Still less do I look upon tbe ingestion of 
sncb irritants as magnesium sulphate, charcoal, or 
oolocynth, or any of the great variety of purgatives 
as in any way to be considered the ^st method by 
which a regular action of tbe bowels can be secured. 

For want of time, also, 1 omit all reference to tbe 
question of:— 

1. Regularity of going to the closet, and thus 
setting up a nervous rybtbm. 

2. Abdominal massage and intestinal kneading. 

3. Enemata and intestinal flushings. 

^ 4. Ifecbanical injury to intestinal blood circula¬ 
tion by initial feecal masses. 

And I proceed at once to say that when the 
presence or absence in bulk or irritation does not 
solve tbe problem of constipation it can generally ^ 
found to be connected with tbe presence or abeenca 
of foods rich in uric acid and xanibin. If I as¬ 
sume he fol'owing table as fairly accurate it will be 


seen that meat-eating and tea-drinking may be 
expected to cause constipation, and that such con¬ 
stipation can be cnred in one or two ways. 

1. Continue tbe dietary and give doses of certain 
alkaline salts (such, for example, as thialion), which 
act as uric acid solvents, and so undo the mischief 
which is being 83 mchronou 8 ly done, or, 

2. Discontmue the dieta^ which is causing the 
mischief and substitute for it one which is not only 
uric acid free, but one which contains a high propor¬ 
tion of potassium salts (such as green vegetables), or, 

3. Sufficiently reduciog tbe amount of uric acid 
contained in fo^s without entirely abstaining from 
them, and increase tbe amount of potassinm salt 
containing foods without living entirely upon them. 

By enjoining tbe third as the normal dietary and 
using the second as a curative dietary, I have been 
able to deal snccesafully—and by successfully I 
mean curatively for life—with a large number of 
cases that bad hitherto been obliged to resort to the 
habitual use of purgative pills or salines to secure 
any regularity of defecation. In cases, therefore, of 
chronic and obstinate constipation where I suspect 
the uric acid diathesis, and where, for example, the 
uric acid ratio to the urea rises in tbe urine 
above 1-30 for any long period of time, I cut off 
all flesh foods, restrict the eg$^ used to two 
per week; restrict the tea to twice a week (where I 
find it very inconvenient to out it off entirely); give 
a fair proportion of milk and cereals, and give s^ds 
or conservatively cooked greens twice a day, and a 
melange of fruit daily. 

Let me in illustration quote one striking case. It 
was that of a young lady, set. 20; she had always 
suffered more or less with constipation ever since her 
periods bad commenced. During the last two years 
she had got much worse, during the first of these two 
years she bad commenced to use enemata, and hud 
carried this on as a regular practice; during tbe 
second of the two years tbe enemata bad bfguu to 
lose their effect, and for a year and a half she had 
never in a single case had a natural motion. She 
then went nnder tbe Salisbury treatment, and was 
for some three months living upon chopped raw 
meat, hot water and dexterioised macaroni, and once 
each week she had a long tube passed and the lower 
bowel flushed out; the tube was said to be passed 
beyond the sigmoid flexure. When she came under 
my care she was very weak, suffering a great deal of 
headache, with nervous depression, and with, as I 
say, a constipation which had lasted the whole of 
this time. 

I put her upon the dietary I have mentioned above, 
and was rewarded on my visit at the end of six days 
by the mother greeting me with tbe words, “ Why a 
miracle has happened. My daughter has bad a 
natural motion tbis morning. ’ 

This is now two years ago, and the girl from being 
a semi-invalid is fairly well, and again enters into 
tbe joys of life, while now natural motions always 
take place. 

THE EESPONSIBILITr OF THE 

MEDICAL PROFESSION 

WITH SEOAUD TO 

PULMONARY TUBERCULOSIS, {a) 

By NOEL D. BARDSWELL, M.D., 
M.B.C.P.Edin., M.RC.P.Lond., 

Physician to the Desaide Sanatoriom, Banchory, N.B. 

Now that considerable attention is being paid to the 
claims of the sanatorium treatment to be considered a 
cure for pulmonary tuberculosis, and in view of the very 
optimistic opinion held bj a large section of the pro- 

(a) Paper read at the Britieh ConTress on Tuberenlosis, Anarut, 
1901. ^ 


D O 



354 Th* MtwcAL PBI88. ORIGINAL COMMUNICATIONS._ Oct. 2. 1901. 


fession and laity as to its possibilities as a onratiTe 
agent, it is not inopportane to review briefly some 
aspects of the sanatorinm qneetion in its relations to 
these two sections of the community, and I will en< 
deavoor in the following paper to show to how great an 
extent the success of this treatment depends upon them, 
especially upon the former, viz , the medical profession. 

On the strength mainly of statistics, published by 
Tarious continental sanatoria, it is very widely held 
thatsnch institutions should cure 80 per cent, of their 
patients, and probably this is not far from the mark— 
granting the "if’s” are met—and close analysis of 
statistics indicating 80 per cent, cures shows that there 
is inde^ a very big If " attached to them, viz., If 
they are early oases.” When this *' If ” is not forth* 
coming the figures are very different, as is well shown 
by the QOrbersdorf Sanatorium statistics, for such oases, 
vis., 57 per cent, of the 1898 admissions, 80 per cent, of 
the 1897 admissions, and 94 per cent, of the 1696 admis¬ 
sions were dead. Doubtless many of these patients 
were discharged in a very much better condition than 
when admitted, many, indeed, with disease arrested, 
thongh only, as subsequent events showed, temporarily. 
These could have bmn fairly enough classified for 
statistical purposes as disease arrested, and to many the ' 
term arrest is synonymous with care. Statistics as 
regards the sanatorium treatment will remain of com¬ 
paratively little value until the terms used, such as 
“ou>ed,” ” nearly cured,” and disease arrested” are 
very clearly defined. However, it is not my intention 
now to consider this question of statistics, but rather to 
show how the public and the profession can influenoe 
them for good or ill, inasmuch as it is they that supply 
sanatoria with the material from which their figures 
are ultimately compiled. 

With a view to demonstrating this, I have made an 
analysis of the first fifty-six amissions to the sana¬ 
torium with which I am connected, attention being 
specially paid to the following points, vis.:— 

1. Tbe duration of definite tuberculous symptoms. 

2. Tbe treatment received since the prcMble dia¬ 
gnosis of the disease up till date of admissiom. 

3. Tlie condition of the lungs on admission. 

4. The amount below the highest known weight on 
admisiion. 

6. The amount of fever present daring the first week 
after admission. 

This analysis has brought out several points of 
intereet as regards the attitude, both of the medical 
profession and the public, to consumption. 

The following are the tebles of the smalysis:— 

Tablb I. 

Duration of definite tubercnlous symptoms in all 
oases previous to admission. 

Dorstion of nineea. No. of Cases. Psroentsge. 

From 1 to 3 months ... ... 10 18 

„ 8 „ 6 „ . 16 80 

6 „ 9 .. 7 12 

„ 0 „ 12 „ 8 14 

Over 12 (o) . 16 27 

66 

Tablx II. 

Condition of the lungs on admission, classified 
according to the number of lobes diseased. 


Nomber of Lobes Diseased. 

No. of 

Cases. 

Perceatege 
of aU Cues. 

1 ••• ••• 

2 

4 

2 ••• ••• 

24 

41 

d •«« ••• 

10 

18 

4 . 

8 

14 

6 ••• 

10 

18 

With pleuritic signs only, but 

with bacilli m sputum 

2 

4 

Total number of all fifty-six 
cases, with definite signs of 

exoivation on admission 

27 

50 


(a) Tbis groop incln'fea six cases of recent relapte, following more 
0 r leas complete arrest for several rearm. 


Table III. 


Amouot below highest known weight 

No. of 

Percentage 
ot all 

Namber of lbs. below. 

Cams. 

Admissums. 

Up to weight 

... 9 

16 

From 1 to 7 lbs. below 

... 6 

10 

7 ,. 14 .. 

... 24 

43 

14 „ 21 

... 11 

20 

„ 21 28 

... 4 

7 

Over 80 lbs. 

... 2 

4 


Table IV. 

Amount of fever present during the first week after 
admission, calcnlatM in each case from the highest 
po'nts touched daily daring the first week, the average 
being taken. 

Degree of Fever, Ko. of Cues. PsTcentsge. 


Apyrexial, or very near it 

Slight fever (a^ve 98'6° at 

8 a.m., but not above 100^ 

daring the day) . 

Moderate degree of fever (above 

21 

38 

10 

18 

100® F. during the day) 
Considerable fever (above 101®F. 

13 

23 

daring day) . 

High fever (above 102® F. 
daring day, or with inverse 

6 

9 

temperature at high range)... 

7 

66 

12 


A glance at this analysis shows that in each table 
there is one subdivision bracketed with mnoh tbe 
highest percentage; these subdivisions, taking them 
serioftm, being (1) duration from three months to six 
months; (2) two lobes diseased; (3) seven to fooiteea 
pounds below highest known weight; (4) apyrexia', or 
very nearly so. 

M our fifty-six admissions, then, cases which could be 
classified un^ a definition founded on the titles of these 
fonr subdivisions have been more numerous than aay 
other type of case, and, along with the even more 
favourable cases of from only one to three months' dois- 
tion, up to weight or but ^gbtly below, and cases of 
quite recent relapse following long-stamding amst, 
account for some 60 per cent, of sdl patients admitted. 
It is from this 60 per oent. that we have to hope for 
80 per cent of cures. Of the remaining 40 per oent. of 
the admissions, it is seen that 21 per cent, hadfever 
range above 101^ F. during their first week after 
admission, this number including several about 102^ F., 
some 30 per oent. bad disease in either four or five lobes, 
and atrant tbe same percentage were anything from 
fourteen pounds to thirty pounds below their weight. 
With oases of this type it is idle to expect satisfsctofy 
figures, though, except when in an absolutely hopeless 
condition, even such may improve very oonsidenbly, 
gaining much weight and having the disease to a Ur^ 
extent arrested. Doubtless every year now will see s 
greater proportion of genuinely early cases sent to 
sanatoria, but in the meantime it is of interest to asesc^ 
te*» why it is that more of such oases— e arly in tbs 
pathological sense—are not seen in such institatioiis. 

To throw light upon this subject I have oloeely in¬ 
quired into the previons histories of all the fifty-six cssei 
already referred to, and find that the majority of them 
can be placed in one of tbe following divisions, the deUj 
in seeking efficient treatment being dne either to them* 
selves or to their medical attendants. 

The following table is an attempt to classify tbs 
oases in this respect:— 

Patixmtb Thxhszlves Chibplt Rbsponbibli. 

Group I. due to— 

1. Long delay in taking medical advice, in tbe hops 
of throwing off the cold, Ac. 

2. Sefusal to follow good advice, though quite sUs 
to do so, till frightened by onset of serious symptoms. 

8. Delay in following good advice, on t^e groonds 
of expense; the sacrifice eventually being nude wbsn 
' the cl^ces of cure are considerably poorer. 

Di-'tizedby 'OO^ C 




Oct. 2.1901. 


ORTGINAL GOMMUNICATIOIfS. Thi Uioical Pbms. 366 


Mimcu. Mkn Chixflt Bisponsiblc. 

Oroap II. doe to— 

1. Trae nature of disease not being diagnosed till it 
is far adranoed. Such oases bare nsnally been treated 
—often for a considerable time—for mnsonlar rheuma¬ 
tism, ansemia, debility, chills, or inflnensa, &o. 

2. Disease being diagnosed, but its nature concealed 
from the patient, irho is informed that he has not got 
oonsnmptlon, but a little catarrh of the lung, weak long, 
tendenoy to consumption, a lung toncdied, or some suoh 
indefinite condition. 

3. Disease being di^nosed, but apparently on the 
assumption that it is ineTitably fatal, nothing bat 
merely symptomatio treatment being adopted, until on 
the suggestion of friends or relatives the sanatorium 
treatment has been decided on as a last hope. 

4. Disease being di^nosed, and, in many oases, at the 
request of patient or their famUiee, sanatorium treat¬ 
ment at home having been tried without success. 

In preparing these tables I have nut considered the 
chronic oases of many years' duration, since their 
illness datei from pre-sanatorium days. 

So much m to the reason why many cases do not reach 
Sanatoria early enough. Now as to the remedies:— 

a. On the patient’s side. Better knowled^ on the 
subject of tuberculosis generally, and especially upon the 
value of early treatment of this disease. In this ques¬ 
tion of education the medical profession can do much. 

b. On the part of the mediou profession. In a paper 
of this length. I can only deal with the first two items on 
my second list of causes. 

First: as to that of failtire to diagnose the disease in 
the early stage, and sometimes, indeed, in a &irly or 
well-advanced .stage. Granting that physical signs of 
early phthisis are often very slight or very ind^nite, 
and that early symptoms are so iosidiotu th^ it is often 
difficult to say when a condition of poor general health 
ended, and tuberculosis began, there remains little or no 
excuse for a case being allowed to drift into a condition 
of well-marked disease, with such a certain and easy 
method at band for establishing a diMuosis, as the 
examination of the sputum. I have heard it urged that 
medical practitioners have something else to do than 
systematically look for bacilli in aU their suspicions 
cases; but with the facilities now offered for this pur¬ 
pose by public authorities and various associations, 
such a procedure is quite unnecessary. I feel con¬ 
vinced that systematic examination of chests and 
eputum, of cases who seem to be just run down, and out 
of health with no very obvious cause, would in many 
instances lead to an early diagnosis of hitherto unsus¬ 
pected tubercttloeis. It is more difficult to account for 
cases under medical supervision running into an ad¬ 
vanced stage of the disease, even a stone or more below 
weight, before the condition is recognised. 

Hurried and too superficial chest examination, the 
outcome of overwork, is no doubt responsible for some 
of it. The worst disclosure of all which may be re¬ 
vealed by a study of a consumptive’s previous history, 

I have fortunately not come across since giving up 
hospital appointments, viz.: that the chest bad never 
been examined except through clothes. 

Upon the question of wilfirily hiding the truth from 
patiente, and substituting such terms as weak lungs for 
the true name, there is doubtless much diversion of 
opinion. The word consumption certainly has as yet 
lost but little of its ill omen, and it is very striking how 
sta<hon8ly sanatorium patients avoid using it. More 
than one of such patients have told me that they had 
received quite a shook soon after admission, by hearing 
some older hand talking calmly about consumption, 
apropos of themselves. Still, however unpleasant the 
duty may be of telling a person that he mm consump¬ 
tion, I have personally no hesitation in saying that in the 
great majority of cases it is a duty. In very many in¬ 
stances, when the truth is concealed, the patient 
continues work, and takes but litt'e notice of medical 
advice, good enough in itself, but not enfficiently in¬ 
sisted upon nntil snbe^uent events show him that he 
has been living in a fool’s paradise. In my own expe- ' 
rtence I have met with many patients with advanced I 
disease, who have remarked: " If only I had been told ' 


the truth earlier, how differently would I have acted 
during the last six months.” Making all allowance for 
the factor of wisdom after the event, I feel sure that in 
nearly all cases, honesty, as 'regard this question, is 
the be>t policy—alike for patient and medical m%n. 


PHARMACY AND MEDICINE, (a) 

By ARTHUR P. LUFP,M.D.,B.Sc.,F.R.O.P.Lond., 

Physician and Leetorer on Forensic Medicine in 8t. Mary’s 
Hospital. 

It is twenty-eeven years since it was my good for¬ 
tune to be a etudent in this school, and I know of no 
greater honour and no greater pleasure that can be 
conferi'ed by one’s alma mater than for one of ita 
alumni to m entrusted with the duty of delivering 
this annual address. The occasion is moreover a 
pleasant and an auspicious one, since this jear marks 
the sixtieth anniversary—the diamond jubilee—of 
the Pharmaceutical Society. 

Pharmacv is a many-sided calling, and therein un¬ 
doubtedly lies one of its chief attractions. The 
scientific part of the work of an educated pharmacist 
does not consist solely in the dispensing of prescrip- 
tions, important as that branch of his catling 
undoubte^y is. We hold him to be the responsible 
person for the preparation of drugs in suitable forms, 
and for the standardisation of those preparations, 
while the pnhlic have to look to him not only as 
providing means for the restoration of their hs^th, 
but also nave to rely upon him for the safety of their 
lives. It is but a pessimistic and ignorant view to 
take that no great amount of skill or of scientific 
training is required to put together the ingredients 
: of a prescription. Such a view does not recog¬ 
nise, and perhaps the public do not adequately 
appreciate the great safeguard to them that the 
educated pharmacist is. It is no very uncommon 
matter for the medical man when hurriedly writing 
a prescription to make snch a mistake in the dose ot 
an important ingredient that disastrous results to 
the patient would follow the taking of the medicine 
if so dispensed; but now, happily, through the far¬ 
sighted wisdom primarily of this society, and subse¬ 
quently of the legislature the public safety is effici¬ 
ently provided for. The pharmacist detects the error 
in the prescription, and commxmicatos with the 
medical man. The public are nuaware of the means 
by which their health and possibly their lives have 
been protected, but how many of my professional 
brethren have to gratefully and thankfully acknow- 
led^ the tact, courtesy, aud delicacy with which 
their attention is drawn to their mistekes by their 
pharmaceutical confreres. Again, it is no very 
uncommon matter for a prescription to contain snch 
incompatible ingredients that perhaps the active, 
and, maybe, poisonous principle of the medicine is 
wholly precipitated, and so might possibly be entirely 
taken in the last dose, with results which would 
probably he disastrous to the patient; hut here again 
the skilled pharmacist acts as a guardian of the 
public safety by detecting and pointing out the error 
that has been committed. 

But, unfortunately, both medical men and the 
public are tending to heavily handicap the pharma¬ 
cist in that important function, and are in great part 
rendering him impotent to safeguard the public 
health, for there is a growing practice which is 
rapidly threatening to undermine to a great extent 
what 1 consider to be the skilled and rational em¬ 
ployment of therapeutic agents in the treatment of 
disease. I refer to the too general use of powerful 
drugs in compressed forms and of proprietory pre¬ 
parations. 1 do not for one moment wish to suggest 


(a) Abstract of address delivered at the Fbarmaceatical Society 
of Great Britain on October lat, 1901. 




t 



356 Ti» Midicai. Pubs. ORIGINAL COMHUNIGATONS. 


Qqr, 2, IflOL 


that tablets and other forma of compresBed drags 
have not their proper nsea—nndoubtemj tablets of 
certain actire principles in the hands of medical men 
are most convenient and nsefal for hjpodermic and 
occasionally for other forms of administration—but 
it is the ready facility with which powerful dra^ 
prepared in this form are obtained by the public 
which constitutes so grave a danger, a facility which 
is responsible to a great extent for the increasing 
practice of self •drugging—a state of affairs which 1 
am afraid has been brought about by the^e prepara¬ 
tions being so indiscriminately and so lar^ly pre¬ 
scribed by medical men. To take but one instance, 
it is to the ease with which tablets can be purchased 
by the public that, in my opinion, is due in great 
measure the preyalence of the comparatively m<Mera 
imd excessively pernicious evil—the cocaine habit. 
Equally bad is the use of some of the proprietary 
preparations which are so speciously puffed; with the 
samples and laudatory advertisements of which the 
members of my profession are so profusely deluged, 
tempting them, as they do, to the slovenly and 
enervating habit of thinking that the writing of an 
order for such a preparation is the writing of a pre¬ 
scription, and gradually rendering them absolutely 
impotent to exercise the true ait of prescribing. 
Many of these tablets and preparations are, 1 be¬ 
lieve, productive of infinitely more harm than the 
quack medicines which to some extent they are 
replacing, for the former are frequently TOwerful 
and, in unskilled hands, dangerous drags, whilst the 
latter, though generally worthless, are to a great 
extent innocuous. 

The fact is that the art of prescribing—that is, 
of ordering suitable remedies in suitable forms for 
the treatment of morbid conditions—is declining; it 
shows a fatal tendency to be usurped by the manu¬ 
facturer. I am bound to confess that the primary 
cause of this evil is due, not to any imperfections in 
the training of pharmacists to scientifically com¬ 
pound and dispense medicines, but to the altogether 
inadequate attention which is given to the 
teaching of prescribing at so many of our large 
hospitals and medical schools. I merely refer to 
this phase of the subject here, as I intend 
shortfy to deal with it in another place, and 
before those who are more closely interested in the 
preservation of this important bi'anch of a medical 
man’s duties. What a travesty on the art of pre¬ 
scribing it is for a patient to bring to a pharmacist a 
so-called prescription which merely orders, say, No. 4 
mixture (Smith and Jones)! Can anything be more 
degrading than to compel a scientifically-trained 
pharmacist to be the mere medium for the handing 
over of such a proprietary article ? Can anything be 
more degrading than the spectacle of a duly qualified 
medical wihti lowering himself to be the mere ex¬ 
ploiter of a puffed and probably over-vaunted prepa¬ 
ration? It appears to me that such so-called 
prescribing is nearly on a par with the dosing that is 
carried out on those ships which car^ a medicine 
chest, but have no surgeon on board. The bottles of 
medicine in the cheat are duly numbered, and with 
them is a book describing the symptoms which re¬ 
quire a dose of such and such a numbered mixture. 
Many of you may remember the tale of the ship’s 
steward who went to the captain stating that a 
sailor had some symptons which, according to the 
book, required a dose of No. 9 mixture, but that No. 9 
bottle was empty. “ That does not matter,’’ said the 
captain, who in the emergency almost rose to the 
level of a modem prescriber, ‘ give him equal parts 
of No. 4 and No. 5.^’ 

In connection with my special department of prac¬ 
tice as a physician I am brought in contact with 
only too many cases of self-dragging by the public, 
and only too frequently witness the evils rising 


therefrom. Especially does one see this in connection 
with the worship of that absurd fetish, the uric acid 
diathesis, and the consequent pandering to this 
modern craze by the unscrupulous vaunters of the 
many puffed remedies which are warranted to sweep 
away what is but a natural constituent of the human 
body. That absurd craze is fostered, if not fre¬ 
quently originated, by the specious advertisements 
of drugs wurranted to cure ills ignorantly, if not 
falsely, attributed to uric acid. The consequence is 
that it is now no uncommon sight ata dinner-party 
to see neurotic young men dropping their fithia 
tabloid into the glass of champagne to counteract 
what they imagine to be its acidity, lacking as they 
do both the gastric vigour to de^ with the wine, 
and the moral vigour to abstain from it. I venture 
to sound a note of warning, which I trust may reach 
beyond these walls to the ear of the public, as to the 
danger incurred in dosing tbemselves with these 
powerful drags in tabloid form—a danger which is 
in no sense an imaginary one, since we tM often see 
the pernicious effects resulting from their indis¬ 
criminate use, sometimes, alas, when it is too late to 
remedy the evil results. 

In conclusion, gentlemen, let me beg of you to 
remember that in joining this school it is your dnfy 
to endeavour to maintain its honourable traditions. 
Each one of you should strive to render yourself 
worthy of the high standard of education that has 
always been maintained here; each one of yon should 
endeavour to emulate the examples of industry, per- 
severence, aud success that have been set ^ou by so 
many of your predecessors. When you think of tbe 
honourable positions in pharmacy that have been 
reached by so many past students of this school, 
when you recall the names of such men as Bentley, 
Attfiefd, Carteighe, Hanbnry, Hills, Martindale, 
Allen, Umney, Greenish, and ^uire, surely with such 
examples of successful work and perseverance you 
should have the strongest stimulus to follow their 
examples; also, I trust, to achieve their deserved 
success. Tbe education that you will acquire ber^ 
although it will well enable you to pass your examina¬ 
tions, is not tc be regarded as serving that pnrpoee 
^one. Look on it as a talent entrusted to your 
keeping for your future use. Be careful that you do 
not, like the slothful servant, keep it laid up in a 
napkin, but see that you so utilise it as to increase 
it, if possible, tenfold. 

“ Strive, endeavour; it profits more 
To fight and fail than on Time’s dull shore 
To remain an idler ever. 

For to him who bares his arm to tbe strife. 

Firm at his post in tbe battle of life. 

The victory faileth never.” 

MEDICINE AS A* PROFESSION, (a) 

By Peofessoe RISIEN RUSSELL, M,D., 
F.K.C.P., 

Asalftant Fhyrician, UniTrrtitj' College Hoepital, Ao. 

Afteb welcoming the students and insisting on 
the importance of their becoming‘‘good, all-rotmd 
men,” the lecturer pointed out how essential a know¬ 
ledge of bacteriology bad become to tbe medical 
man, and how chemistry, always a most importot 
subject in the medical curriculum, had acquired 
additional importance since a knowledge of chemical 
methods had b^ome so necessary to the bacteriolo¬ 
gist. Chemistry had also become mere important 
because chemical analyses of tbe blood, the excreta 
and the contents of the stomach were now indispens¬ 
able in tbe diajmosls, prognosis, and rational treat¬ 
ment of many diseases. 

(a) Abutract of Introductory Addree* delivered et UniT«^r 
CoUige, October 1st, 1901. 

(le 


Oct. 2, 1901. 


G E B M A N T. 


Th> MsDICAL 357 


He next called their attention to the special 
adrantagee there were in entering the medical pro¬ 
fession at the present time. No other profession 
conld hold out tne prospect of so quick a return on 
the outlay that studenU were obliged to make. In 
support of this view he pointed to the fact that 
daring the last seven years there had been a falling 
off in the number of men entering the medical pro¬ 
fession, so that there were now 1,660 fewer men 
qualified to practice medicine than there would have 
been had the same number joined the profession 
each ;ear since as did so in 1893. In the meantime, 
as the figures of the last census showed, the popula¬ 
tion of the country had increased to the extent of 
over three and a half millions during the last decade. 
The colonies had always supplied many good 
openings for men who had received their medical 
education in this country, and they might be ex¬ 
pected to continue to do so; but to South Africa 
more especially he felt justified in looking for a 
large number of openings for young medii^ men 
when the development of the country was proceeded 
with after the termination of the war. Then again 
the vigorous and laudable action of the Genentl 
Medical Council in suppressing unqualified assistants 
and in stamping out the iniquitous system of 
covering,” h^ made many openings for qualified 
men. The expert oommittM appointed under Mr. 
Srodrick’s presidency had been an earnest of the 
Government's determination to reform the Army 
Medical Service. The scheme for the reorganisation 
of the service was now said to be ready, it had been 
passed by the Treasn^ and only awaited the signa¬ 
ture of the Bing. There was ample evidence to 
ehow that the Admiraltr would have to follow 
the example of the War Office and institute reforms 
in this branch of the service. 

Reforms in the medical services of the Army and 
Mavy would not only provide good openings for 
Toung medical men, but as more men were attracted 
by the Services those available for the civil popula¬ 
tion would be reduced, and the chances that a young 
yuan would have of making his way in private prac¬ 
tice would thereby be greatly improved. How small 
was the reserve of young medical men, even at the 
present time, had been demonstrated by the expe¬ 
riences connected with the South African war, for 
those reijuired for the Armv had not been supplied 
without mconvenience in other quarters. Provincial 
and other hospitals had had mfficulty in securing 
men to fill posts as house physicians and bouse sur¬ 
geons ; stmmship companies bad expeiienced a 
similar difficulty in getting medical officers; and 
many medical men in genend practice bad not found 
it easy to take a holiday this year, either because it 
bad not been possible to obtain locum tenentes or 
because the remuneration such substitutes now re¬ 
ceived was more than many practitioners could afford 
to give. These various considerations led him fo 
conclude that the medical man who was ready to 

g ractise bis profession in five or six years’ time would 
e in a most satisfactory position, so that students 
now commencing their medical studies could look 
forward to finding openings for the practice of their 
profession five years hence with a degree of certainty 
that did not obtain in any other profession. 

He complained of the unsatisfactory pubHc 
statxis of the medical profession, which he attributed, 
in part, to the way in which some of its members 
deported themselves, even where they occupied high 
professional positions. Aoiother reason why the 
profession did not rise to its proper level in public 
estimation was the difficulty the public appeared to 
bave in distinguishing between the medical man of the 
present day and the apothecary of the past, probably 
oecaose so many medical men still dis^nsed their 
own medicines. He recognised the difficulties that 


would bave to be contended with in many an out-of 
the-way part of the country were doctors not to dis 
pense their own medicines; but such cases were in 
the minority, and the majority of medical men in 
private practice could discontinue dispensing medi¬ 
cines with the greatest possible benefit to themselves 
and to the public. Tbe time now spent in doing 
druggists* work could be utilised to far greater 
advantage to themselves and to their patients if 
devoted to reading to keep themselves informed of 
the advancss that were constantly being made in 
every branch of medical science, abolition of the 
practice would help to educate the public to regard 
the medical man as something superior to a mere 
vendor of drugs, and would teach them to value him 
for his advice instead of for his medicine. 

Tbe lecturer then discussed the influence of Uni¬ 
versity College on medical teaching, observing that 
the influence which University College had had on 
medical teaching in London was very great, the 
scientific education received at tbe College l^ing 
unsurpassed by anything that could be obtainea 
elsewhere in this country, and the spirit of scientific 
research that was active had led to brilliant acliieve- 
ments by those who bad worked there, and by others 
who had gone forth to prosecute their researches 
elsewhere. 

He begged his hearers to cultivate the spirit of 
scientific inquiry, which, properly conducted, might 
be expected to disclose some new fact, and this was 
the only way in which true progress could be made. 
Medicine and surgery could only be expected to be 
advanced by a proper commingling of the scientific 
and tbe practical, so that scientific principles might 
find practical application in the elucidation and 
treatment of disease. If they required any stronger 
incentive to induce them to aim at being able some 
day to advance the science of medicine by their own 
investigations, let them read of tbe horrors of surgery 
in the days befoi'e antiseptics were introduced in the 
treatment of wounds, and compare that picture with 
what they saw when the time came for them to take 
up their duties as dressers in the wards of the hos¬ 
pital connected with the College. He would be sur¬ 
prised if tbe contrast between the two pictures did not 
stimulate them to emulate the example of men like 
Pasteur and Lister, even though they felt mere pig¬ 
mies compared to those giants. Well might l^rd 
Lister ignore the vituperations of a gang of agitators 
who, in tbe face of such an incalculable benefit as he 
had conferred on his fellow-beings, dared to treat 
him to some of the abuse that they visited on all 
those who by their researches sought to investigate 
the sum total of human suffering. 


^emtanp. 

[from oub own cobbxspondxnt.] 

Bbklik, September 29th, 190L 
Enubbsib in Childhood. 

Thb difficulty often met with in the treatment of this 
complaint renders the subject one of considerable 
interest. A paper on the snbject appeared in a recent 
number of the .fieri. Kl. Troehes«ch.',(31/1901) from the 
pen of Privatdocent Dr. Thiemich. The writer desig¬ 
nates the condition as a form of incontinence of nrine 
in whioh the nrine is passed without the knowledge or 
against the will of the patient. It may be due to a 
demonstrable affection of tbe urinary tract, or to a 
severe affection of tbe nervous system, or to genera 
illness in whioh oonsdousness is interfered with. What 
is generally understood by the term is a more inde¬ 
pendent lesion of whioh the functional disturbance is 


358 Thv Ubdical PBise. 


AUSTRIA. 


Ocr. 2, 1901. 


the only eympton. In infancy enoreais ie physiological, 
and the condition later on is a frequent symptom 
of imbecility.'one of the eymptome of the back¬ 
ward development of the ohilA Sometimes it 
is dne to careless ibringing up and training 
88 to cleanliness, so that it need not neces¬ 
sarily be considered as pathological if continued 
after the third year. The attention of the physician is 
demanded when it recurs in a child who has already kept 
ViTwafllf dry at night. 

Most of the children suffering from enuresis are the 
offspring ofi[nenropathio parents. Two causes partici¬ 
pate in bringing about the condition, first, the h»edi- 
tary tendency inherent in the offspring from marriage 
of neuropathic parents, and, secondly, imperfect train¬ 
ing. Not unfrequently'it may be ascertained that one 
of the parents suffered from such a condition. In many 
children who have suffered from enuresis or been cured 
of it symptoms [of ^hysteria develop. A. proof of the 
hysterical complication is the epidemic form of the 
affection that sometimes breaks out in schools, institn* 
tions, dec. The disturbance ceases as soon as the 
flUCfeoted children are isolated. Perfectly healthy chil¬ 
dren do not fall victims to this imitation of disease. 
Those who do so are all neuropatbic or hysterical. The 
remedies that have been found useful in hysteria are 
just the ones that prove serviceable in enuresis, and 
vice vtrsa. 

The Korr-Bl. f. Sclixo. Aetzt has an article on the 
Fatb or Hxbbditabilt Stfhilitio Childbxn, 
by Dr. J. Kaicher, Bale. Of thirty-one children treated 
between the years 1876 and 1866 and discharged as 
cured sixteen were traced. Six died as small children; 
four were found to he perfectly sound after reaching 
the Hni« of puberty. It was known that one other was 
a workman in a factory. Five children later on became 
infected with tubercle. The fate of syphilitic children 
is not so desperate as some would imagine. The 
article, taken in conjunction with the works of 
Hochsinger and Pott, shows many children lose all 
signs of the disease after puberty. It shows also that 
inunction treatment with yellow ointment is useful not 
only as regards evident symptoms, hut also as furthering 
good results in later life. 

PuBB Cabbolic Acid in Sbftic Wounds. 

Dr. B. Honsell, of Tubingen, has an article on this 
subject in the Bertrage z. Kl. Ch. 

The author says it is known that many surgeons have 
given up the use of pure carbolic add in the treatment 
of wounds on account of the great risks accompanying 
it. An American surgeon, Phelps, has recently tried to 
reintroduce it. After a wide opening into the abscess 
cavity or the joint the part is cleansed by curettement 
or other means, the cavity is then filled with pure 
carbolic add, which is allowed to remain for one or two 
minutes. It is then thoroughly washed out with 
alcohol. Into the wound so prepared a thick glass 
drain is inserted and tamponnaded. This is allowed to 
remain until granulations have formed. When this 
treatment was introduced morbus ooiffi was the disease 
for which it was first proposed. The fact that such a 
large cavity can be treated in such a way with pure 
csurboUc acid is one that calls for consideration. It is 
claimed that the treatment described is snperior to any 
other. 


In the TfibingenElinikthe plan has been followed 
under the direction of von Bruns. Eighty oases were 
treated in this way. More than tbree-fourtiis of tiie 
cases were acute or subacute affections. V. Bruns 
varied the procedure laid down to some extent. 

After preliminary purification of the wound, curette 
ment or excision of the diseased parte, the whole region 
around was thoroughly moistened with alcohol to pre¬ 
vent any caustio action on the epidermis. The carbolic 
acid (at most 6 gnus.) was applied by means of pledgets 
of lint. The wound, after the carbolic has been allowed 
to remain a couple of minutes, is thoroughly washed out 
with absoluto alcohol. Finally, the wound is packed 
with either sterile gause, or airol, or iodoform gaute 
strips, or more rarely moist dressings. The nxist 
suitable dressing has been shown to be a layer 
of antiseptic gause, and than packing with aseptic 
pads. No great pcun was observed at any part 
of the proceedings, on the contrary, was 

often relieved, possibly through an anesthetieing action 
of the carbolic add. One could not resist the impres¬ 
sion tnat the carbolic dressing did good. Only once 
was any disturbance set up, and that was in a case of 
very malignant traumatic suppuration of the knee-joint 
with absoeeses in tiie adjoining parts. Fresh snppora- 
tion came on, and the woimd had to be re-opened. All 
the other cases recovered quickly and simply. No 
retention of pus was observed under the tamponnade, 
even after several days. The tampons were allowed tv 
loosen themselves from the side of the abscesses. A 
second or third tamponnade was necessary in only a 
few cases. In toberuuloiu suppuration the procedure 
is recommended in cases in which the mixed infection 
is marked. The curette is a necessary adjunct to the 
treatment. An attempt was made to treat simple 
abscesses by aspiration and injection of carbolic add, 
but incisions had to be made later in all cases. This 
showed that the slough caused was not absorbed, but 
remained in the cavity as a compact mass. 


JlttBtriB. 

[bbom oub own oobbbspondbnt.] 

TnxsA. September 28th, 1901. 

Thb Action of Digitalis. 

Digitalis is one of those drugs which have given rise 
to endless controversies, not even excepting the latest 
Congress, with all our experimental science snd esact 
methods of measurement and testing as final proof one 
way or another. (Gottlieb commences hjs paper with the 
usual postulate, “all disturbances of the circnlatiM 
must be dne to some patholt^ical changes either at tbe 
heart or vasomotor centres, or it will scon return to its 
normal condition if not interfered with. 

If tbe innervation of the vasomotor fail the interul 
organs become filled, while the surface becomes pale sod 
bloodless; the pulse is small, the heart being imperfectly 
filled. If this failure of the innervation arise from nar¬ 
cotic agents or infections poisons cardiac drugs are of 
no use, as it lacks not in functional activity, hat ratiier 
in mafatr istl to Operate upon which has accnmnlated in the 
internal organs. It is very different when the vasomotor 
and splanchnic vessels are stimulated, 

I Hence life may often be eaved, not by giving digitalii, 
but by the use of strychnine, caffeine and camphor, at 

Di -'zedbv "O C 


Oct. 2, 1901. 


AUSTRIA._Thi Mbdicii. Pbbm. 


359 


well u {notion of the skin and cold applieaticnu as 
analeptics. Digitalis increased the Toloxne of poise and 
may r^e the force of the Tentricles and aoricles fonr* 
fold. Tbe dmg is indicated therefore when the poise 
is slow and feeble. This will empty the oardiao 
ohamben and pennit of an easy inward flow from the 
Teins daring diastole. The vasoolar empfying of the 
liTcr, longs, &c., is beet performed by vasomotor 
stimali, such as camphor. Caffeine acts on the heart, 
bnt is no snbetitote for digitalis. Alcohol is another 
agent which reeves tbe resistance of the heart by 
dilating the vessels. 

8abli oonsiders that diagnosis is an important factor 
in [prescribing digitalis. He is inclined to divide it 
into (1) congestion of the cardia, where the systole is 
insnfficient to empty the heart and thru prodooes a 
mechanical barrier to the inflow of blood daring 
diastole; (2) respiratory congestion, which maybe the 
resolt of the former or dne to some other 
canse; (8) vasomotor origin, owing to paralysis of the 
▼asomotor nerves. 

Digitalis, he affirms, is as asefal in the high pressure 
artery as in the low presenre. The former will oome 
down, the latter will rise after its administration. It may 
even prove a curative agent in the BO<called compensa¬ 
tion state, when the “ circnlns vitiosos is often checked 
for years. In “ essential congestion of the heart, or in 
those cases where the valves are so much damaged as 
to allow r^foigitation after the systolic contraction, 
little or no good can be obtained from digitalis; indeed, 
many serioas results are recorded that have not infre¬ 
quently brought opprobrium on the drug. 

He next drew attention to the importance of tbe dose; 
the large dose for the diastolic effect, and smaU doses 
for systolic action. 

As to the length of time it shonld be used, this, he 
askid, was very indefinite as many patients coold tolerate 
it for years. 

Caffeine and camphor were very different drugs. In 
vasomotor distarbanoee where dilatation was prominent 
these drugs were excellent stimalants. Sabli oonsiders 
them potent adjuncts to digitalis, in respect both of 
breathing and uiiue. 

Alcohol hitherto stands unsupported as a cardiac 
tonic, but may relieve the heart in high or normal 
presenre congestion, but on account of its fugitive 
action no reliance can be put on it. In acute fevers it 
may be viewed in the same light as of very little use on 
the circulation, unless in tbe rigor stage or after a cold 
bath, when it may be administered with considerable 
advantage. 

Schott contended that the firmer the contractions of 
the heart the better it was for the vasomotor action. 
Csnnphor, he thought, had but a feeble action on tbe heart. 

Jacobs Skgreedwith Ssbli that digitalis in aortic io- 
anfficienoy fails to give relief because tbe muscle of 
the heart is already strained to its utmost, and can 
not be farther stimulated to action as the digitalis acts 
through the vagus. 

Lang thought the variety of opinions in the profession 
was due to badly made preparations of the drug, aud 
thought there would be lees disappointment if the infn- 
aion was always administered. 

Tbe stimnlating action of digitalis can be increased 
bj the addition of camphor and alcohol. 


Heins was in favour of using fine powder rather 
braised leaves for making infusions. 

Ooldschneider recommended O'! to 0*2 gramme of 
digitalis for a month in compensation disturbance, to be 
repeated a week after. 

Hirscb gave his experience of the internal friction of 
the blood, or what he terms its active *' viscosity.’* 

The specific gravity of the blood and this viscosity 
do not run partial. Again, he this " viscosity *' 
is not confined to the corpuscular elements of the blood 
bnt is also found in the serum. 

Tbe hypertrophy of nephritis is not confined to the 
left ventricle, but invades both. The cause must there* 
fore be either a direct irritation of cardiac muscle or 
an increased viscosity of the blood. 

Ewald remarked that large doses of digitalis were 
often given in cases where the whole vascular system 
was loaded with fluid. The first duty is to relieve the 
vessels by puncturing the tissues, scarification, or by 
Dehio’s modification, which is by inserting a gum appa¬ 
ratus. All cardiac drugs affect the stomach, and for thia 
reason he recommended enemata or suppositories of 
digitalis or adonis vemalis. 

Pick thought that digitalis was suffiment to preduce 
the necessa r y contraction of the vessels to prevent 
cedema. For himself he had more fiutii in bydrastinin 
for bringing about contraction of the peripheral vessels. 

Unverricbt blamed tbe digitalis preparations for the 
difference of opinioo. If Golas’s dialysate were used this 
would be avoided, but it was much more satisfactory to 
use digitoxin. Digitalism and anorexia were as oommon 
when enemata were used as when the drug was given by 
the month. The canse of the disturbance was central 
and not looaL 

Bposenstein was in favour of strophantus as being 
superior to digitalis, in that it produces no anorexia as 
does digitalis. As for camphor, its action was too 
evanescent to be of much use in cardiac affections. 
When asked if he thought the production of an antemio 
murmur was dne to changes in the blood, he assented 
but added that viscosity” of the blood was not the 
cause of the hypertrophy. 

Nannyn had faith in digitalis, bnt in digitoxin he had 
none. The anorexia could be obviated by giving small 
doses, which can be given for a long time without fear 
of digitalism. 

Qrodel said it was impossible to preserve the life of tbe 
patient by the continuous use of digitalis, but his life 
might be prolonged. 

Boeenfeld said be bad returned to the use of an in¬ 
fusion of digitalis os tbe best way of giving the drug; 
digitoxin was of no uss. The active principle was in 
the stems as well as the leaves, which should be used 
entire. To get the best effects from adonis vemalis it 
shonld be made in the form of tea and one tablespoonful 
to a teacnpfnl shonld be taken twice a day. 

Schreiber thought the method of measuring “vis- 
oosity ” in blood might be useful in the pathogenesis of 
nnemia, &e., but was inapplicable in the event of hyper¬ 
trophy. 


Ths Council of tbe South Wales and Monmouth¬ 
shire University College are advertising for a suc¬ 
cessor to the late Principal Tiriamu Jones at a 
salary of £1,000per annum. 

DitiHized by VwjOOy It 



360 The Mxdicai. Pbbbb 


THE OPERATING THEATRES. 


Oct. 2, 1901. 


‘¥ht iDptratinQ ‘^heatree. 

GUT'S HOSPITAL. 

Opkajltion fob Oi.D'8Tandino Ii'bactubb of Fbxub. 
—Mr. AbbuthnotLakb operated on a boy, at. 16, who had 
Boatained a fracture of the femnr about five months 
previoasly, for which he had been treated at first by 
recumbency and eiteneion, and lately by a Thomas’s 
spTnt. It was only after a very long interval of time 
that be was able to get about at all, and then only very 
insecurely because of the very imperfect union of the 
fragments and of the considerable shortening of the 
limb. Osing to some sudden movement be lost what 
little power he had in the 1^, the fragments moving 
freely on one another. He then came under Mr. Lane's 
care, when a radiograph showed that the ends of the 
fragments, which overlappedconsiderably were rounded, 
and there was no sign of intermediate callus. A long 
incision was made along the outer aspect of the thigh, 
and the fragments freely exposed; the incision was made 
in this locality, Mr. Lane said, so as to reduce the 
damage to nerves and muacleB to a minimum, also be¬ 
cause a larger incision could be made in this situation 
than in any other, and the fragments were more readily 
approached, exposed, and dealt with from this aspect 
than from any other. The conditions found were as 
shown in the radiograph, a scanty amount of imperfectly 
calcified connective tissue being the only evidence of any 
union between the bones. The fragments were freed 
from the soft parts, and were protruded through the 
wound, every precaution being taken agaiost ^eir 
touching the surrounding skin. It was hsudly necessary, 
Mr. Lone thought, to point out that under no oircnm- 
stances in these operations are the fingers introduced 
into the wound, a'l the work being done by means 
of instruments. He is convinced that it is owing 
to the gross carelessness of surgeons in fouling 
such wounds by the introduction of their fingers into 
them that they are unable to employ a screw or other 
bulky medium as an efBoient means of establishing 
union between the fragments; that it is a common 
habit to use fingers in this dangerous way, he remarked, 
was shown in many illustrations of operations in recent 
publications, and as long as this is persevered in, and 
only a very modified asepsis obtained, the results wiU 
continue to be unsatisfactory. An examination of the 
fragments showed tiiat while the texture of the lower 
one was fairly normal and of a sufficient density to bold 
a screw that of the upper was exceedingly unsatisfac¬ 
tory, so much so that its sejtion with a saw in order to 
afford accurate apposition of oblique surfaces was ac¬ 
companied with a certain amount of comminution; in 
fact, it was so fragile that it seemed as if it would be 
impossible to connect it to the other fragment by any 
means short of a ferule, and such an implement was not 
obtainable at the momen*'. After a time, however, the 
operator succeeded in retaining the fragments in 
apposition by means of a wire which perforated 
both fragments, and of several wires which sur¬ 
rounded them. He remaiked that he had on several 
occasions observed this rapid degeneration of the upper 
fragment in a fracture of the femur in this situation 
n children in whom a considerable interval of time had 
elapsed between the receipt of the injury and the opera¬ 
tion, and in one case especially, the fragility of the 


upper fragment was so extreme that by no means was it 
possible to connect the fragments together. Why tiiere 
should be sucb a considerable difference in the behaviour 
of the two fragments of this bone does not, he thought, 
8«em quite clear. The wound was closed and the 
patient placed in a double Thomas's splint A fort< 
night after operation the progress made by the boy is 
most satisfactory. 

The next case was that of a mao, set 61, who had 
sustained two months before, a spiral fiucture of the 
femnr, and had been treated by recumbency and exten¬ 
sion ; no union whatever bad resulted. A radiograph 
showed that the fragments were not in apposition, and 
that they overlapped very considerably. They were 
freely exposed through a long incisioo, when the upper 
frs^ment was found to be displaced upwards, forwards, aod 
outwards, and the lower downwards, inwards, and back¬ 
wards, the direction of tbeplanesof the chUel-shapedends 
of the fragments accounting for the direction of the dis¬ 
placements. Although a considerable interval had 
elapsed since the receipt of the injury, the outline of 
the fractured surface was unchanged, it being covered 
only by a layer of soft fibrous tissue, which was easily 
separated from it W hen this had been done the length 
of the fracture was seen to exceed four inches, and it 
was possible to fit the sharp summit of each fragment 
into the corresponding angle of the other; the bones 
being retained in tbis position, [two stout virgin silver 
loops were introdnoed throngb the figments in such a 
direction as to afford a maximum of resistance to any 
tendency to their separation reenlting from a torsion of 
one npon the other. The reason, Mr. Lane said, a screw 
was not employed in this case was because of the extreme 
narrowness of the spikes of bone, and it was felt that in 
this partionlar fracture wire inserted at suitable angles 
would afiord a firmer apposition. The condition of (be 
limb during the fortnight that has ensued since the 
operation baa been most satisfactory. 

Fbactubi of Both Bokis of thk Fobxabh.— The 
same sorgeon operated on a boy. et. 10, for fractnre of 
botbbonesot the forearm about their centre. Theinjory 
had been sustained several months before, and thennim 
had taken place, so that the axes of the fragments 
formed a considerable angle with one another, tnd the 
range of pronation and supination was exceedingly 
limited. On aooonnt of tbis, as well as of the deformity 
of the arm, the parents were anxious that something 
should be done. The junctions of the fragments were 
exposed, and were divided by means of a saw, each in two 
oblique planes, so as to restore both bones to their 
normal form and relatimubips. The fractures were 
nnited together by loops of silver wire which perforsted 
them. Mr. Lane said that a similar case had been pub¬ 
lished in “ Operating Theatres ” in January last, and in 
this the result baa been perfect, the boy having at the 
present time fall and natural nse of bis limb. The 
present case three weeks after operation is progressing 
satisfactorily. 

A MEETING in support of Dr. J. G. Glover’s candi¬ 
dature for the General Medical Couacil will take 
place on Friday, October 4th, at the residence of Dr 
I White, No. 1, Highbury Place, N., in which Sir 
Thomas Barlow, Dr. Danford Thomas, and others 
wm ukepart. ,QQgj^. 



■Oct. g , 1901. 


LEADING ARTICLES. 


Thb Hbdical Pebss. 361 


Bkoistsbed roB FBABSimsioH Abboae. 

^ht JRtbital $refi0 ait^i Ctrcttlar. 

FaltUshad arerj Wedneaday morninf, Pnea M. Peat trte, 


A0TBBTI8EI1EHTB. 

fOB On iBtBBTiOBWltoU Pkca, AS Os. Od.; Ball PmWi 
AS lOi. Od. j QnaiiM Pac*. £1 Ss.; Ona-al^th. Ua. Od. 

Fob a BBBna or laaBBTioas t—WlwU Pafs, thirtaas inaertioiia 
Iwaaklf, fortnitbtlT, or monthly)^ at AS 10a. Od.} twaatj-aia 
Inaertioas (waAly or fortnightly) at AS So. Od.; fif^-two 
isaertiona (waekly) at £8 aaoh. Half PaBa^thirtaen Inaartkma 
at SSa,! twanty-aix at SSa.: flf^>two inoertiOBa at SOa. each: 
QnartarpaBa, 1 « inaarttons at 18s. twant^Hsiz inssrtiooa 
at ISa.: fifty-two inaartiona at ISa each. 

BbbU ansosscamanta of Praetieaa, ▲aaiatanolaa.Vaoaaclao, Booki, 
Aa.->4aTan Unas or nndar, 4s. par SaasrtlOB ; Od. par Unc 
beyond. 


%ht fttsB snb Cirrttlst. 


** 8ALU8 POPtJLI 80PK1MA LBX.*' 


WEDNESDAY, OCTOBER 2, 1901. 


HELP FOR THE TUBERCULOUS POOR. 

Omb of the great problems in connection with 
the eradication of consumption is unquestionably the 
provision of sanatoria for the tuberculous poor. This 
pressing and all-important question hfts been raised 
de novo in The Timee by two admirable letters from 
that veteran sanitarian, Sir John Simon, and by the 
equally illustrious physiologist. Sir John Burdon 
Sanderson. Sir John Simon’s contention is that the 
provision of sanatoria is an indispensable part of the 
measures necessary for the diminution of tubercu¬ 
losis,” in the terms of the resolution passed by the 
recent Congress. Addressing himself to the question 
how these sanatoria are to be provided, he urges that 
it is the duty of the local authorities to raise the 
necessary funds, if need be, by an addition to the poor 
rates. He pleads that any addition to the rates, and it 
would have to be considera^ile, would be more than 
counterbalanced by the gain to the public health and 
the avoidance of the incalculable loss of health and 
working energy resulting from present conditions, 
under which the working man wbo develops tubercu¬ 
losis is almost of necessity condemned to permanent 
invalidism and ultimate death No one with any 
knowledge of the subject would deny that accommo¬ 
dation for the tuberculous poor is ridiculously 
inadequate. What the working man requires is not 
merely medical relief but to be enabled to regain his 
lost working power, a result which cannot be 
achieved by the administration of any kind of drug 
or remedy but by rest, moderate exercise, good air 
and good food. The only way in which a chance of 
successfully struggling with his malady can be given 
him consists in enabling him to free himself for a 
sufficient time from the conditions of life and 
occupation which are dettimental to his well-being 
and favourable to the progress of the disease. We 
must look matters boldly in the face. We must 


recognise that there is practically no hospital 
accommodation for the tuberculous poor, for the very 
limited number of beds available in special institu¬ 
tions can relieve but an infinitesimal fraction of the 
sufferers, and such cases cannot, for obvious 
reasons, be admitted, or at any rate retained, in the 
general hospitals. Moreover, as has already been 
pointed out, it is not so much hospital treatment 
that is required, but transference to healthier condi¬ 
tions. As Sir J. Burdon Sanderson says, the object 
before us can only be attained by the establishment 
and maintenance of frugally organised sanatoria for 
bread winners of both sexes. Houses of recovery 
must be provided in healthy situations not too far 
removed from industrial centres, where working men 
and women threatened with phthisis may obtain 
such moderate accommodation as they require. Ad¬ 
mission must be free to those who are socially and 
medically eligible, and the number of beds must 
be sufficient to render possible the prompt admission 
of all who require it. The very magnitude of the task 
is calculated to make the public look askance at the 
proposal, yet many years ago the community ap¬ 
proved almost as great a departure in the endeavour 
to stem the ravages of small-pox, a disease which was, 
even then, far less deadly in its incidence than con¬ 
sumption. Subsequent experience has endorsed this 
huge expenditure of public funds, and the example 
may serve to encourage those who, while they deplore 
the present condition of things, lack the courage to 
initiate the steps by which alone real progress can be 
secui'ed. The matter is too vast and too urgent to 
be safely left to private benevolence, and it may well 
come to pass that the nation, as ratepayers, will con¬ 
sent to assume this additional burden in aid of the 
suffering and less fortunate members of the com¬ 
munity. 


THE SMALLPOX EPIDEMIC IN LONDON. 


That London is now faced with a serious epidemic 
of smaU'pox must be apparent to all wbo are 
familiar with the history of that malady. The 
gravity of the situation is shown by the fact that 
the cases hail from all quarters of the metropolis, 
and in that way point to a wide distribution of 
centres of infection. It is natural that under such 
circumstances the popular interest has been aroused 
with regard to the va'ue and desirability of vaccina¬ 
tion as a pi-eventive measure. On the whole the 
result has been satisfactory as regards the general 
adhesion of the populace to the beliefs of orthodox 
scientific medicine upon that particular point. During 
the pastfewweeksanenormoTisnumberof citizens of all 
ages, ranks, and conditions have submitted themselves 
to the not very formidable ordeal of vaccination or 
re-vaccination. This wholesale submission in the face 
of impending danger points to the fact that the 
main masses of our countrymen are favourable to 
vaccination. In spite of the general attitude, how¬ 
ever, there can be no doubt that the outlook is such 
as to demand our most careful and serious attention. 
There is, and always has been, fur instance, a great 


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362 Ihx Mzdig^ Fbsm 


LEADING ARTICLES. 


Oct. 2. 1901. 


margin of nnvaccinated persons in the metropolis; 
in other words, there exists in the midst of the huge 
congregation of Londoners a great mass of inflam* 
mable material, ready to light up at the first 
approach of small-pox, which is one of the 
most infectious of maladies. That fact, as we have 
persistently maintained, will sooner or later be 
blazoned forth by a disastrous invasion of one or 
other of the notoriously unprotected districts. In 
Mile End, for instance, the anti-vaccinationist atti¬ 
tude of the guardians, who have for many years re¬ 
fused to prosecute for failure to vaccinate, has given 
rise to a large unraccinated population. That dis¬ 
trict, as matteie stand, is a standing menace to the 
safety not only of its own inhabitants, but also of the 
metropolis generally. Unfortunately, the leaven of 
the anti-vaccinationist heresy is widely spread. 
The London School Board has given a feeble 
and half-hearted response to the appeal to help the 
public health authorities in their attempt to 
carry out vaccination to the utmost among the 
scholars. The attitude of the School Board is a 
faithful reflection of the retrograde Yaccination Act 
that has established the permissive principle in its 
administration. It is difficult to understand how a 
man of Mr. Balfour’s intellectual calibre could have 
believed that hie concessions, however ample and re¬ 
actionary, would permanently satisfy the noisy crew 
of anti-vaccinationists. In Eastbourne they have 
gone the length of issuing certificates of exemption 
signed by guardians instead of by magis¬ 
trates. The proceeding, if we mistake not, 
is a direct contravention of the Act, and 
will doubtless prove a subject of inquiiy before 
the higher courts of law. It requires no great 
experience of the methods of the anti-vaccinationist 
to recognise that he is of the temperament that 
demands an ell where be has been granted an inch. 
That aspect of his character, however, seems to have 
reaped the purview of Mr. Balfour’s Government, 
who gave him tbe inch with a vengeance when they 
brought into being that monstrosity, the “ conscien¬ 
tious objector." Before that worthless sop was 
thrown to the anti-vaccinationist elector the margin 
of children in London “ unaccounted for " in respect 
of vaccination amounted to no less than a quartei*, or 
one-third. That statement is made on the 
strength of returns issued by the Local Gk»vemment 
Board. In Bethnal Green there were 71'7 per cent, 
unaccounted for, 70 per cent, in Hackney, and 67‘4 
per cent, in Mile End Old Town. Those figures vrill 
naturally be swelled by the operation of Mr. Balfour’s 
Act, which we have all along predicted simply awaits 
theNemesisof avast epidemic. That event may ormay 
not be at hand, but in any case we regard it us abso¬ 
lutely certain sooner or later to overtake the unpro¬ 
tected population. It is like the voice of one crying 
in the wilderness to utter warnings to the 
antivaccinationists. At the same time we ven¬ 
ture solemnly to recall the following facte. 
During the period 1847-1868, when vaccination 
was optional, the mean annu^ death-rate per 


million at all ages amounted to 805. From 
1854-1871, when vaccination was obUgatory, but in¬ 
efficiently performed, the rate sank to 223. On the 
other band, during tbe years 1872-1891, when vaod- 
nation was better enforced, the mortality fell to 89. 
Could any stronger argument be brought forward P 
Tbe enormous saving of life has been among the 
children, for during the first period mentioned above 
the death-rate imder five years was 1,617 per million 
living; during the second 817, and the third 177. 
Those who love children, therefore, and wish to save 
them from a miserable death by small-pox, could 
not adopt a moie absolutely sure means of secur¬ 
ing their safety than by having them vaccinated. 
Meanwhile the enemy is within the Londoners’ gate. 


METHYLATED SPIRIT. 

Some few years ago tbe medical profession were 
alarmed by the report that essence of ginger pro¬ 
duced blindness, and as a consequence a valuable 
and tried carminative fell into disrepute. After a 
time equally bad reports came of other flavouring 
essences, in all cases tbe sight being affected. In 
some cases death followed, the lethal effects being 
found to follow the many compounds placed on the 
market to give the flavour of old whiskey to raw cheap 
spirits. Tbewbole catalogue of fictitious fruitessences 
and fictitious fruitwines that were employed to kill tbe 
“ fire" of raw grain whiskey, and give the desired 
bouquet to “ silent ’’ spirit, were found to bring 
blindness and death—tbe lesion being in one and all, 
nerve atrophy, commencing, as a rule, in the optic 
nerve. Tbe question suggested itself to what con¬ 
stituent of Jamaica ginger and made prune and 
other innocuous fruit products these poironous effects 
were due P Tbe study was undertaken by Hynson, 
who analysed quite a number of these flavouring 
essences, which were used for giving aroma and age- 
flavour to the liquor of tbe toper and producing the 
non-alcoholic beverage of tbe teetotaler alike, and in 
all he found methylated spirit—although they were 
described on the label as being prepared from ethylic 
spirit. It is but a few weeks ago since we drew 
attention to tbe poisonous properties of methylated 
alcohol in commenting on an inquest of a commer¬ 
cial traveller who died from sipping a preparation 
made on this spirit. Yamish drinkers suffer from 
optic atrophy, and not unfrequently from paralysis. 
From the literature of tbe subject it appears that the 
inhalation of the fumes of tbe alcoholic produce 
cause deleterious effects. Dr. Schweinetz (Memphis 
M. Mcmthly) reports a case of amaurosis occuring in a 
vamisher who used a polish made on methylated 
spirit. As it is, the law prohibits tbe use of methy¬ 
lated spirits in the preparation of foods, or any sub- 
stances, medicines, or otherwise intended for internal 
use. We believe that when attention is drawn to the 
subject that the evil will be suppressed, and as in the 
case of arsenic in beer the public health officers will 
give tbe beverages of the people the benefit of their 
attention. 

D!-! iT/'^OOglC 


Th« Mxdical Pbbss. 363 


Oct. 2 , 190L _NOTES ON CTJBBENT TOPiCS. 


^lUrUB 0n Cnrrntt 

Another Suicide at a Kent County A^lum. 

In our isene of August 28th it was our duty to 
comment somewhat severely upon the circumstances 
under which an inmate of Banning Heath Asylum 
committed suicide. At the ensuing inquest it was 
stated in evidence that there was only one attendant 
in charge of a ward of foTty>foar patients, several of 
them of a suicidal tendency. At the time we ex¬ 
pressed the opinion that the Lunacy Commissioners 
might safely be left to deal with the matter, assum¬ 
ing the state of affairs to have been that disclosed at 
the inquiry. It is hardly creditable to the manage¬ 
ment of the asylum that within a few weeks 
another case of suicide should be reported. The 
deceased was a young woman who suffered from 
" restless melancholia ; she was allowed to go from 
her ward to a dormitory for some needlework, and as 
she did not return a search was made and her body 
was found hanging from a cistern pipe by means of a 
strip of calico. It was stated that the deceased had 
been away from the ward for twenty minutes before 
a search was made, and that the attendant in charge 
had been discharged for neglect of duty. It is to be 
hoped that in fairness to the latter a full state¬ 
ment was made befoi'e the coroner as to the number 
of patients under individual control, and all other 
details of the attendant’s duty. The position of the 
authorities of the Harming Asylum is rendered un- 
enviable'from the recurrence of such disasters, and it 
is to be hoped that the Lunacy Commissioners will 
promptly Investigate the whole administration of this 
large institution. 

A Mysterious Enteric Fever Epidemic. 

An outbreak of enteric fever is reported from 
Coventry. In a supplementary report from the 
medical officer of health it is stated that during the 
past two weeks thirty fresh caseo of enteric fever 
have been noted, as against thirty-three in the pre¬ 
vious fortnight. The cause of the outbreak appears 
not to have been yet definitely ttaced, although sus¬ 
picion has been attached to a pump situated in a court 
opening on to a street in the neighbourhood of which 
there have been fifty five cases notified during 
August and the first fortnight of September. The 
water of that particular well enjoys a considerable 
reputation with regard to its coolness and superior 
taste, and it has been certified by Dr. Bostock Hill to be 
remarkably pure for a surface well water, and to show 
no trace of sewage pollution. The medical officer 
remarks that applying the test of mere numbers the 
milk might be more strongly suspected than the 
water, for while forty-four out of the fifty-five 
patients bad partaken of the water, no less than i 
forty-six had obtained their milk from a common 
source. Dr. Snell makes the extraordinary comment 
that the present outbreak was attracting undue atten- 
tion, inasmuch as cases were never absent from the 
town, and should always receive attention. That 


attitude is not a little curious, and the townsfolk are 
hardly likely to endorse that part of it which concerns 
the undue ” attention, especially while the origin 
of the epidemic remains undiscovered. Now and 
then the source of enteric fever baffies the most skilled 
investigation. Only last year one ingenious investi¬ 
gator advanced atheory of origin in fried fish shops, 
but the requisite proof has not yet been forthcoming. 
Speculation and enterprise, however, are more 
desirable qualities than fatalism in the equipment 
of the modem Medical Officer of Health. 

Pharmacy and Medicine. 

In the introductory address delivered by Dr. Luff 
before the Pharmaceutical Society, an abstract of 
which we publish elsewhere, the lecturer emphasises 
a fact to which we have often alluded, namely, the 
extraordinary stimulus to self-medication which the 
introduction of “compressed prescriptions’’ has 
given rise. To medical men active principles in this 
form prove extremely convenient, but the ready 
facility with which powerful drugs in this form are 
obtainable by the public constitutes a real danger. 
Then, too, the practice of prescribing exactly on the 
lines laid down by manufacturing chemists is 
derogatory to the science of therapeutics, and 
testifies to a regrettable want of original thought 
on the part of those who avail themselves 
thereof. Even more open to objection is the 
tendency to prescribe proprietary articles, the com¬ 
position whereof is given, if at all, only in the 
vaguest way. Dr. Luff was sure of a sympathetic 
audience in touching on these practices, for they are 
as prejudicial to scientific pharmacy as they are to 
therapeutics. His explanation is that the art of dis¬ 
pensing is declining in consequence, he believes, 
probably with reason, of the altogether inadequate 
attention which is given to this important branch of 
study in medical schools. It is a significant fact 
that we called attention to this lapsus in medical 
training in our last number, thus forstailing the 
lecturer, who is but voicing a feeling very generally 
expressed in medical and pharmaceutical circles. Let 
us beware lest, by our neglect of this, the practical 
aspect of therapeutics, we bring medicinal treatment 
into contempt and degrade the pharmacist into a 
mere vendor of ready-made prepai'ations. 

The CocBumption of Salt. 

Although in treatises on dietetics salt figures as 
a condiment, it is universally recognised to be some* 
thing more; indeed, it is an indispensable element 
of the food of man and animals. A well-known 
authority asserts that whenever the annual consump¬ 
tion of salt falls below twenty pounds per head of 
the population the public health is likely to suffer. 
In regions of the earth where salt is a scarce article 
it is regarded as a substance of great value, and 
salt starvation is, in its way, as distressing as thirst 
or hunger, although it is manifested in less obvious 
fashion. This fact long since suggested to impe¬ 
cunious governments an easy means of raising 

Dii..../ddbv 'OOg 


364 Th* Mxdical Pbxss. NOTES ON CURRENT TOPICS. Oct. 2, 1901. 

money, riz., by imposing a doty on this indispens- so many oenturies ago discontinued, and from the 


able article of food. In Italy, even at the present 
day, it is a pen^ offence to evaporate a bucket of 
sea water for tbe purpose of obtaining salt, but 
nowhere is this iniquitous tax applied on so 
large a scale as in India, where it forms the 
principal source of revenue. The deprivation of 
salt does not produce a definite disease, but reduces 
tbe vitality of the organism as a whole, so that the 
victim of administrative measures which restrict the 
consumption of salt more readily fall victims to pre¬ 
vailing epidemics, as well as to endemic maladies. 
How far this factor is at the root of the proneness of 
our Indian subjects to plague and kindred diseases is 
a point which might well engage tbe attention of 
physiologists and pathologists. A free breakfast 
table, which was long the device of a once popular 
school of politicians, is of vastly less importance in 
respect of tbe public health than free salt. Tbe 
matter is one which will sooner or later be forced 
upon the attention of the Indian Government. This 
nation stands voluntarily tn /oco parentis to' tbe 
natives of our Indian territories, and common 
humanity suggests a careful study of the question in 
its bearings on the health of those of whose well¬ 
being we have made ourselves the custodians. 

An Old Treatment for Scarlatina Revived. 

Bbadbbs of De Foe’s little known " Roxana 
may remember the description of tbe spare bedroom 
which was draped in red cloth and was kept for such 
cases of sickness as might arise. The old four- 
posters, with their heavy drapery of crimson cloth, 
were the sole survivors of the custom of the red- 
draped bedroom in modem days. Tbe origin of tbe 
practice had been forgotten, but tbe custom re¬ 
mained of surrounding the sick man with red 
drapeiy; it was banded down for centuries, and was 
recommended in the Jioea An/jflica (1305-1307) by 
John of Gaddesden, who probably borrowed it from 
Gilbert’s “ Laurea,’’ written when medicine was at 
its lowest ebb in England. Physicians then seemed 
to gain respect neither for their skill nor conduct. 
Piers Plowman writes: Murtherera are many 
leaches,” and again “ Lord, them amend.” As our 
readers are aware tbe practice has been in some 
degree revived, especially in cases of small-pox and 
scarlatina, and Don Julian Garcia Suetto (El Siglo 
Medico) reports a case demonstrating tbe successful 
use of red rays in the latter disease. Tbe patient, a 
child two years old, bad a severe attack, and on the 
fourth day of the illness the windows of tbe bedroom 
were covered with red cloth. At this time tbe 
temperature had reached 104'5^, the tongue, 
mouth, throat, and tonsils all indicated a fever of 
great severity. The only medication given was tbe 
sixth of a grain of tbe sulphate of quinine every two 
hours. Three days afterwards tbe child was con¬ 
valescent, tbe temperature normal, and the little 
patient almost in her ordinary health. No mention 
is made of the desquamation of tbe skin or of tbe 
condition of tbe alimentary canal on this date. Tbe 
ease is interesting both as a revival of a treatment 


wonderfully good results that treatment gave. We 
think it is worth trying; it iseasily and inexpensively 
carried out, and in no way precludes the ordinary 
treatment. 

Whooping-Cough. 

Every phase of medical thought seems to bring 
its impress on the puthology and setiology of whoop¬ 
ing-cough. Tbe story of changing views is seen in 
the multitude of remedies that as a cloud of witnesses 
tell bow unsuccessful our search for the source of 
tbe disease has been. Still tbe search continues, and 
MM. Jochmann and Krause (Zeitsek. fur Byg.) con¬ 
sider that from an examination of the expectoration 
of eighteen patients suffering from the disease they 
have foimd a specific bacillus. They describe the 
bacillus as very small, remarkably thick in propor¬ 
tion to its length, discoloured by Gram’s fluid. It 
was discovered some time ago by Eppendorf 
and physically its appearance resembles that 
described by Czaplewski; but it is more readily 
cultivated. Besides its morphological characters, it 
is known by its regaining colour after being de¬ 
colourised by tbe Gram fluid. If this latest of 
theories is accepted we may expect to find the disused 
vapourisers and inhalers once more called into 
activity, and tbe old time remedies of creosote, 
phenol, coal-tar, and so forth again actively employed. 
The bacterial theory is, however, quite as good as any 
other, and we make no objection, though we cannot 
see how it explains the onset of a paroxysm of 
coughing on tbe swallowing of some solid food—a 
phenomenon so familiar to the long-suffering hard- 
worked general practitioner. 

Waoted—a Test for Drunkenness. 

Thh conflict of evidence that goes on every day 
in tbe police courts of the United Kingdom as to 
the soberness or otherwise of a defendant empha¬ 
sises tbe need of a trustworthy test fur drunkenness. 
Tbe error of hasty inference irom such signs as tbe 
smell of drink, staggering, vomiting, heavy breath¬ 
ing. thick speech, and unconsciousness has been 
written in many a police cell tragedy. Indeed, the 
most striking of journalistic headings, Drunk or 
Dying,” is never absent from the newspapers for 
any great length of time. Nor is medical advice 
itself always infallible. Tbe fact of the matter is 
that it is often a most difficult task to decide whether 
a certain individual is or is not under the influence 
I of alcohol to such an extent as to render him in- 
I capable of being at large with safety to himself and 
j to other people. Tbe standard of the police inspector, 
of the intelligent constable, of the surgeon, and of 
tbe prisoner, are all personal and extremely variable 
factors. The pronouncing of certain difficult words 
or combinations of words of the ■’ truly rural ’’ type 
j constitutes a fair test, especially when supplemented 
by tbe bandwriting. An individual, however, may 
be unable either to read and write, or to speak in 
any but his own dialect, or he may be incapacitated 
by disease from exercising either accomplishment. 

D!'-' - - 


Oct. 2, 1901. 


NOTES ON CURRENT TOPICS. 


Tub Mbdioal Pubss. 36o 


Tbe Bo*oalled “ heel and fcoe” teet is clearly falla¬ 
cious, as many sober persons would find It a difficult 
or impossible physical feat to put one foot before tbe 
other in the requisite straight line. The fact Is that 
to diagnose alcoholic poisoning dexauds in not a 
few instances a most thorough and careful shilled 
examination of a number of circumstances, including 
history, nerrous system, and state of the bodily and 
intellectual functions. For a police inspector or 
surgeon to endearour to settle the question off-hand 
on tbe strength of a simple sign or symptom or 
arbitrary “ test ’’ is to court tragedy and disaster. 

Welshmen on the Hill Top. 

It is a well recognised fact that Welshmen a’e 
addicted to the tops of mountains for tbe celebration 
of yarious national rites and ceremonials. This trait 
has lately shown itself in aa unexpected quarter, 
namely, among the medical fraternity of the gallant 
little Principality. Last week a meeting of the 
North Wales Branch of the British Uedical Associa¬ 
tion was held on tbe top of Snowdon. Kembers Wt re 
not called upon to climb wearily to the summit of the 
mountain, as in days of yore, but were carried up 
thither comfortably and quickly in the five^mlle 
tramway that now stretches from base to 
peak. The presidential address was delivered 
by Dr. B. Parry, ex-Mayor of Oamarvon. 
Among; other speakers, Dr. Mills Roberts, from 
the Welsh Hospital in the Transvaal, related 
his military experiences. There is a pleasant sugges¬ 
tion of poetry and romance about this meeting place 
that one often looks for in vain in tbe halls of 
modem medicine. The completeness of the picture 
would be perhaps a little more nearly approached 
were the Executive Committee to appear in the 
crown of gold and other appropriate ancient garb, 
and the members to attend clad in whatever dress 
was affected by the Cymri of the past in their saci-ed 
excursions to the hill tops. Loftiness of aim is a 
thing to be cultivated by all earnest upholders of the 
dignity of the profession, even when it concerns a 
local branch of the British Medical Association. 
The organisers of the Snowdon meeting may be 
heartily congratulated on tbe freshness and origi¬ 
nality of their conception. 

Medioine as a Profesaion. 

These is no doubt that owing to various circum¬ 
stances, not the least whereof is the strengthening of 
tbe curriculum, the practice of medicine offers 
greater advantages than it did ten years ago. As 
Professor Eisien Russell points out in bis introduc¬ 
tory address, an abstract of which we publish else¬ 
where, the proportion of medical men admitted to 
registration has fallen, while the population has, of 
course, increased. The result is that newly-qualified 
men are able to pick and choose, as they have shown 
by their voluntary abstention from posts in the Ser¬ 
vices, in spite of sundry ameliorations which have 
been wrung from a reluctant Government. The 
lecturer ouebed upon one point which is likely to 


force itself upon our attention more and more as 
years go by, namely, that no material improvement 
in the status of the profession can take place so long 
as the bulk of men dispense their own medicines, 
and thus, in the eyes of the public, degrade them¬ 
selves into mere vendors of drugs. So long ^ this 
practice obtains the public will distinguish with 
difficulty between tbe duly qualified practitioner and 
the retail chemist who is so frequently addressed as 
" doctor " by his customers. 

The Art of Cooking. 

Those of our readers who are old enough to re¬ 
member tbe late Professor Hargreaves' lectures will 
recall the importance be attached to the value of 
good cooking in the treatment of disease. He in¬ 
sisted that cooking for the sick was a fine art. This 
idea seems to have taken root in Germany, for we 
find that a course of lectures on cooking for the 
sick has been commenced this year in the 
Medical School. The lecturer, Mademoiselle 
Hedwige Heyl, has a largely-attended class. Her 
pupils include not only Germans, but French, 
Russian, and Italian students. The lectures and 
demonstrations are of great interest to nurses, super¬ 
intendents, mothers, and particularly so to young 
mothers- Mademoiselle Hedwige Heyl does not con¬ 
fine her demonstrations to the preparation of foods 
alone, she shows how the majority of medicinal 
remedies may be administered, even when nn- 
^palatable, in a pleasant manner in made disbes, 
without the necessity of taking the unmasked drug 
in pill or potion. A regular formulary for such 
cooked medicaments is published by her, and has 
become so popular that it promises to supersede to 
some extent our familiar nostrums. 

The Scientific Investigation of “Consump¬ 
tion Cures.” 

Thebe is a general feeling among the public that 
methods of treatment for consumption which are not 
brought forward through the orthodox channels aie 
systematically boycotted by tbe medical profession. 
Tbe argument is one, moreover, which is put forward 
by irregular practitioners who lay claim to having 
discovered a “ cure ” for this too prevalent disease. 
It will be news to many of our 'readers ^that pro¬ 
vision at the Brompton Hospital for Consumption 
for the investigation of remedies for consumption 
was made nearly half a century ago, and Is still avail¬ 
able. According to a letter from Dr. J. E. Pollock, 
which was published in a recent number of The 
Times, the medical officers of that institution 
are authorised by tbe committee to avail themselves 
of any novel method of treatment which offers 
a reasonable prospect of usefulness. The only 
condition is that the nature and preparation of the 
proposed remedy shall be made known to them in 
writing. Tbe authorities even go tbe length of 
admitting tbe person proposing such remedy to the 
hospital to observe its effects. A very large number 
of remedies and methods of treatment have been 

Divyiized by Google 


366 Ths Midical Psiss. 


NOTES ON CURRENT TOPICS. 


Oct. 2, 1901. 


tested—and found wanting—in virtue of this per¬ 
mission ; but it is a significant fact that no secret or 
other remedy has ever been submitted by outsiders 
on these conditions, not even the at present notorious 
Lachnanthes. Of course everything would turn 
upon what the medical officers considereda rea¬ 
sonable prospect,” and this, it would seem, has not 
been put to the test for the simple reason that quacks 
and men of the Alabone type prefer to compile their 
own statistics, and carefully steer clear of any scien¬ 
tific control. 

Wanted, a Sumptuary Edict. 

Among the regulations bearing on the duties and 
conduct of a newly-appointed lady sanitary inspector 
in Southwark is one which stipulates that she “ shall 
provide herself with a uniform to be approved by the 
Public Health and Sanitary Committee.” We can¬ 
not contemplate without amused apprehension the 
prospect of a special meeting of the committee being 
summoned for the purpose of deciding upon the 
details of this lady official's toilette. If there are any 
lady members on the Board they ought forthwith to 
be constituted a “jury of matrons” to investigate 
and report, the task being so obviously beyond the 
scope of the average councillor. As an alternative, 
the committee might request the permission of the 
Board to throw the design of the uniform open to 
public competition, offering a small prize to the author 
of the accepted pattern. 

Methyl Blue and Methylene Blue. 

The unfortunate experience of a medical practi* 
tioner in prescribing methylene blue should once more 
warn the profession against trusting too implicitly 
to chemists taking the necessary care to avoid confus¬ 
ing methylene blue with methyl blue. In the case 
referred to the practitioner noticed that the charac¬ 
teristic blue colour did not make its appearance 
in the urine of a patient for whom he 
bad prescribed methylene blue. A visit was 
accordingly paid to the druggist, and an examina¬ 
tion was made of the supposed methylene blue, when 
it was discovered that methyl blue had l^een dis¬ 
pensed in error. The next time the practitioner 
prescribed methylene blue hesawthechemistwho was 
to make up the prescription, and upon being assured 
that he knew the difference between methylene and 
methyl blue he did not consider it necessary to in¬ 
sist upon inspecting the bottle in which the drug 
was kept, but in this instance again the same mis¬ 
take occurred and methyl blue was substituted. To 
avoid any further mistake of the kind, the 
physician arranged that the methylene blue 
for his patients should be dispensed from a stock of 
undoubted methylene blue put up in gelatine cap¬ 
sules ; but a fresh assistant disturbed this plan by 
placing methyl blue in the capsules. The error 
seems peculiarly liable to be made, and in one in¬ 
stance the substitution was almost on a wholesale 
scale, for a chemist who had ordered a supply of 
methylene blue received inatpad a large quantity of 
methyl blue, and it was not until a number of unfor¬ 


tunate pat'ents had suffered distressing attacks 
of vomiting that enquiry elicited an explana¬ 
tion of the affair. Every possible care should be 
j taken in prescribing the drug to avoid this untoward 
{ substitution, and it is well to remember that methy¬ 
lene blue can be distinguished from methyl blue by 
the fact that the meniscus on the surface of a solution 
of methylene blue has a green colour, while that of 
methyl blue is blue under all circumstances. More¬ 
over, if sodium hydroxide be added, methyl blue 
becomes purplish red, but methylene blue turns to 
a deep violet colour. Another practical test is that 
methylene blue solution does not change colour on 
the addition of ammonia, which decolourises a solu¬ 
tion of methyl blue.- 

Water in Batter. 

The presence of excees of water in milk has long 
been recognised by the public as a common offence 
That form of adulteration is so palpably suggested 
by the pump and the water-tap that the average 
honest milkman who withstands its blandishments 
must be ci'edited with unusual strength of mind. It 
is otherwise, however, with the more subtle form of 
adulteration which introduces an excess of moisture 
into the substance of butter. The milkman sells his 
added water at the price of milk and the buttennan 
at the price of butter. The latter tradesman, there¬ 
fore, gets a much bigger profit out of his fraudulent 
practice. For some time past a London firm, 
Messrs. Pearks, Gnnston, and Tee, have engaged in 
extensive operations in the butter trade, and it has 
been shown that their butter in several oases has eon* 
tained excess moisture. In Marylebone they have 
been convicted on eight summonses under the Sale 
of Foods and the Merchandise Acts and heavily fined. 
The excess of added water varied from four to nine 
per cent, beyond that usually allowed. The magis¬ 
trate remarked he had seen an advertisement stating 
that a quarter of a million of people were eating the 
defendants’ butter every morning at breakfast, and 
notwithstanding the water they liked it better tbaw 
ever. It is clear that trading operations conducted 
on a large scale under such conditions must yield 
profits sufficiently large to pay for many fines. 

Singers’ Nodules. 

Nodules the size of a pin's head have been noticed 
upon the vocal cords of singers, and are known by 
the name of “ singers’ nodules.” These are described 
by Dr. Chiari as consisting of hypertrophied epithe¬ 
lium and connective tissue, occasionally containing 
dilated blood-vessels but without any trace of glan¬ 
dular structure. Much confusion has arisen in 
regard to these nodules, chiefly from the want of 
a clear definition of what was meant by the term. 
Anything in the nature of a growth which has a 
pedicle should undoubtedly be excluded from ths 
group, and any tumour lai^r than the size of a pin’s 
head does not come under this head. Another dis¬ 
tinctive feature of these nodules is their situation 
upon the free edge of the cord, at the junction of the 
middle with the anterior third, and it is laid down 
that this is the only position in which they grow. 

D ■ 08 



Oct. 2, 1901. 


NOTES ON OURBENT T0PJC8. 


Tbb Medical Pbxsb 367 


Chinese Laundries. 

Not long emce an attempt was made to establUli 
a Chinese lacndrj in London, and it was yery perti¬ 
nently remarked at the time that probably but few 
people in the metropolis were familiar with the 
method of washing employed by the Celestials. A 
Chinaman of 8t. Lonis, who worked in one of the 
laondries, was recently discovered to be afBIcted 
with leprosy. In the opinion of an expert he has 
been in a leprous condition for nearly ten years* 
during the whole of which time his occupation 
has been that of a laundryman. When washing, 
the Chinese are said to sprinkle the articles of wear- 
ing apparel by forcibly ejecting water from the 
mouth. The inhabitants of St Louis were teiTibly 
scared on learning that the breath of a leper, especi¬ 
ally during the act of sneezing, has been found to 
abound in leprous bacilli. The nasal secretion of the 
leprous Chinaman was examined, and the presence 
of the specific bacillus demonstrated therein. The 
quarantine officials of St Louis have erected a 
special building for the patient, and the inci¬ 
dent has led to the demand that the Chinese 
should be subjected to a rigid inspection. With¬ 
out wishing in any way to minimise the dangers 
incidental to leprosy, a certain amount of comfort 
may be drawm from the consideration that the 
great majority of dermatologists hold that leprosy 
is but slightly contagious. There is an instance on 
record where a handsome young lady of good 
family xnarried a leper and lived with him eight 
years. Partly through jealousy on his part and 
partly through devotion on hers, they made every 
effort to have the disease in common, even going 
the length of making numerous attempts to inoculate 
the malady. The husband, however, ultimately suc¬ 
cumbed to the disease, and the widow survived in 
perfect health. There U, of course, a mass of testi¬ 
mony to prove that leprosy may be commnnicated 
under exceptional circumstances, and it is generally 
admitted that a proclivity to the disease is inherited 
by the offspring, in which case exposure to infection 
may be followed by development. 

Reform of the Army Medical Service. 

Thx: committee appointed to report on the steps 
to be taken to increase the efficiency and restore tbe 
popularity of the Army Medical Service have lost no 
time in formulating a series of recommendations 
which, it may be hoped, will go far to place that 
department of our army in a position to cope with 
the requirements of modem warfare and to secure a 
numerically sufficient staff. The recommendations 
may be grouped under four beads, viz., the creation 
of an Advisory Board, the position and duties of the 
Director-General, the appointment, pay, and promo¬ 
tion of the medical officers, and, lastly, the duties of 
certain officers. The Advisory Board will consist of 
the Director-General and his deputy, of two officers, 
one being an expert in sanitation, and tbe other in 
tropical diseases, of two civilian physidans and two 
civil surgeons. With these there wrill he a repre¬ 


sentative of the War Office, and one appointed 
by the Secretary of State for India, tbe nursing 
department being represented by tbe matron-in- 
chief of tbe Queen’s Imperial Military Nursing Ser¬ 
vice. This board will discharge many functions 
hitherto filled by the Director-General, and will 
report direct to tbe Secretary of State, who thus 
becomes virtually the head of the department, the 
Director-General being ex o_fficio the president of tbe 
board. The scheme of examinations is modified in 
that the entrance examination will henceforth bear 
only on clinical and practical medicine and surgery- 
After a period of training at Aldeiehot, followed by 
an examination in military law and technical sub¬ 
jects, the candidate will be attached to a regiment 
for duty, attached to which there is a station hospital. 
Three years later tbe officer may, if he choose, retire 
from tbe service, or he may elect to continue therein 
or engage for seven years in the Reserve of Officers. 
Should he elect to continue in tbe Service he will be 
sent for six months to a civil hospital, when 
be will be called upon to undergo a further 
examination tbe result whereof will greatly influ¬ 
ence bis future career. Tbe scheme comprises the 
establishment at an early date of a Medical Staff 
College in connection with a large military hospital 
in London, which will provide every facility for 
special branches of study. An increase of pay all 
round is contemplated. The neo-lieutenant will re¬ 
ceive £323 lOe., and tbe Director-General £2,000 per 
annum. The retired pay and gratuities are unal¬ 
tered, except for the £25 a year in the Reserve and 
for additional gratuities of £1,000 and £2,500 for 
retirement after nine and eigbtemi years respectively. 
We shall return to this subject next week, when we 
shall discuss more in detail tbe mechanism by which 
these results are to be obtained. 

Drunkenness Among Women. 

Thebe is reason to suspect that women are be¬ 
coming more prone to alcoholic drinking, and a 
lady temperance lecturer recently chaiged the 
medical profession ^ith “ aiding and abetting ’’ the 
present deplorable state of things by prescribing 
alcohol indiscriminately. Let us consider how far 
such a charge can be substantiated. During tbe 
past two or three decades, it may be unhesitatingly 
asserted, members of tbe medical profession have 
acknowledged tbeduty incumbent upon them toexer- 
cise the greatest prudence in prescribing alcohol. It 
is now almost the rule to order it In measured doses, 
and is withdrawn when its purpose has been fulfilled. 
We know that alcohol, in tbe form of whisky 
or brandy, is too often a domestic remedy, a sort ^of 
universal panacea, though a very untrustworthy one 
in irresponsible or reckless hands. We know an 
instance in which a mother had for years ^ven her 
daughter at her menstrual periods two or three 
glasses of whisky to relieve the suffering of the 
first day or two. Such a practice, repeated monthly 
over a considerable time, was surely calculated to 
create an appetite for strong drink. When other 

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368 Tbb Mbdical Pbsss. 


NOTES ON CUHRENT TOPICS. 


Oct. 2. 1901. 


remedies which are qaite safe can be given to relieve 
menstrual pain, and that often very speedily, surely 
a grave responsibility rests with those who thought¬ 
lessly but regularly dose their children with whisky at 
such times. The mention of this case should cause 
medical men to be on the alert for other cases of a 
similar kind, so as to put a stop at once to a most per¬ 
nicious practice. We know two large cities, at least, in 
which drinking among women has spread to an 
alarming extent. There can be no doubt whatever 
that many women avail themselves of the ready and 
dangerous facilities offered by the licensed grocer 
for obtaining their accustomed stimulant, at least in 
the initial stage of their drinking. We believe we 
express the wish of the medical profession generally 
that grocers’ licences should be withdrawn at the very 
earliest possible date. If temperance reformers will 
energetically exert themselves in that direction they 
will have, we are sure, the most hearty co-operation 
of the medical profession in removing from our 
midst what has long been recognised to be a serious 
menace to the sobriety and virtue of our female 
population. We think we have said enough to dis¬ 
pose of the allegation brought against the profession 
of carelessly prescribing strong drink. Therapeuti¬ 
cally, alcohol has its proper place, and we ate con¬ 
vinced that the medical men of to-day prescribe it 
with as strong a sense of responsibility as in respect 
of any other therapeutical agent. We are glad to 
6nd among the ranks of tempei'ance reformers many 
influential and leading members of the medical pro¬ 
fession who really do ''practise what they preach.” 

The Medical Aspects of President 
McKinley s Death. 

The evidence given at the trial of the murderer 
of the late President of the TJuited States finally 
disposes of the sensational statements emanating 
from certain too enterprising American journals as 
to the ” mysterious concatenation of circumstances ’’ 
which characterised the treatment, and the reported 
disagreement between the surgeons in attendance 
Yiewed in the light of the statements made under 
oath at the trial of the murderer, the course 
was just what experienced surgeons would have 
expected. Recovery would have been a brilliant 
triumph for surgery, but failure to prolong life 
involves no discredit upon either the operation 
or the surgeon who performed it. The optimistic 
tone of the bulletins was unavoidable under the cir¬ 
cumstances, indeed, they were only optimistic to 
those who were unable to read between the lines. 
In professional cii'cles it was felt from the first that 
in view of the late President’s age and sedentary 
habits a successful outcome was exceedingly unlikely. 


PERSONAL. 

Majob Cbook Cawlkt, B.A.M.C., Surgeon to the 
Coldstream Guards, has been ordered to take out the 
draft of 100 men of the Royal Army Medical Corps em¬ 
barking next week for South Africa. 


Wb are glad to be able to state that Dr. Peekett, the 
Medical Officer of Health for Leyton, has now almost 
entirely recovered from the effects of the serions trap 
aocident be met with on Sunday, August 18th. 


Mb. E. Ricb Mobqan, M.R.C.S., L S.A, of Morris- 
ton, Swansea, has been presented with an illuminated 
testimonial and a diamond ring by his patients 
friends on his returu from a voyage ronnd the world to 
recruit his health. 


Lobd Bbabbet has consented to preside at a public 
meeting to be held at the United Service Institution on 
Wednesday, October 16th, in connection with the open¬ 
ing of the third winter session of the London School of 
Tropical Medioino. 

Db. Mitchbll Bbucb will deliver the first Hunterian 
Leotnie of tbe session before the Hunterian Society, at 
the London Institution, Finibury, on fTedneeday n ext, 
October 9th, the subject chosen being " Cbeet Compli¬ 
cations in Abdominal Disease. 

Majob-Qbnbbal Sib Ian Hamilton, one of themost 
popular of our South Afruum soldiers, will distribute 
the prises to the successful students of St. Thomaa's 
Hoepital, London, this afternoon (Wednesday) at 3 pjn. 
A large gathering is expected. 


Sib Thos. N. Fitzobbald, FJS.C.S.I., Senior Soigemi 
to the Melbourne Hoepital, who served in South Africa 
during the early stages of the war, and whose eervioes 
were rewarded with a K.C.B., ie on his way to this 
country on six months’ leave of abeenoe. 


Thb following officers of the Royal Army Medical 
Corps have been placed under orders to leave Alder- 
shotLientenante Wells, Faulkner, and Mason, for 
South Africa; Lieutenant Bmnskill, for West Africa; 
LieutenantBostook, for Malta; and Surgeon-Lieutenant 
Boggs, for Belfast. 

A labgx gathering of past and present studmits of 
Weetminster Hospital is expected at the annnal dinnei 
on Friday evening, under the presidency of Mr. Chas. 
Stonham, F.R.C.S. About 100 names as stewards have 
been already given to the hon. secs.; these will be found 
on reference to our advertising columns. 


Db. Alfbbd Docolas Aiehan, of Hull, has been 
selected from over three hundred medical practitioners 
to proceed to the Gold Coast of West Africa at the io- 
stance of the Associated Boards of the Gold Mining 
Companies, for the purpose of making an independent 
investigation into the aetiology of malaria. 


Db. E. Sthxb Tboupson, Gresham Professor of 
Medicine, will deliver a coarse of lectures on "The 
Tuberculosis Congress,” in Gresham Qollege, Basinghall 
Street, London, on October 6th, 9th, 10th, and 11th, at 
six o'clock each evening. The lectures will be illus¬ 
trated by diagrams, and are free t> the public. 

Wb announced last week that Dr. Tellowlees was 
about to resign his position as medioal superintendent 

Dir lized by Google 


Ocr. 2. 1901. 


CORRESPONDENCE. 


Thv Mkdical Pb>88. 369 


of the Glai^w Asylom, at GartnaTel. He twforta* 
nately sustained an injury to one of his eyes by a 
carrii^ accident a few months ago, which necessitated 
him taking rest for some time. The directors wished 
him to take a holiday for six months, but he has pre¬ 
ferred to resign after twenty-seren years’ faithful ser- 
Tioe, which is rery fully appreciated by the board of 
directors. His tenure of office has been a peculiarly 
suooessful one, and his retirement is deeply deplored by 
directors, patients, and Asylum staff alike, by all of 
whom he is held in the highest esteem. The directors 
have just appointed him honorary consulting physician, 
thereby retaining his oonneotion with the Asylum. His 
successor will receive a salary of £1,000, with free 
house, Ac. 


SoTAL Abkt Mkdical Cosfb. 

To be Companions of the Order of the Bath.—Col. J. 
A. Cloiy, H.B., Lient.-Col. A. P. O’Connor, P.B.C.8.I., 
Major (now Lient-CoL) T. B. Lucas, M.B., Major (now 
Lieut-Col.) F. A. B. Dale, M.B., F.B.C.S.I. 

To be Companions of the Order of St. Michael and St. 
Geom.—Cols. W. H. McNamara, M.D., F.B.C.S.I., C.B., 
and Col. B. Exham, Lieut.-Col. J. C Dorman. M.B., Major 
(now Lient.>CoL) H. J. Peard, Majors S. F. Longheed, 
M.D., A. F. Bnssel, M.B., 8. Westcott, B. Kirkpatrick, 
M.D., B. J. S. Simpson, M.B., T. W. O'H. HamUton, 
M.B., 8. F. Freyer, M.D., N. C. Ferguson, M.B., H. C, 
Thurston, and O. B. A. Julian. 

To be ^mpanions of tht. Distinguished Service Order. 
—Majors B. J. Geddes, M B., and A. A. Sutton, Capts. 
F. Smith. H. J. Parry, M.B., F. J. W. Porter, H. J. M. 
Buist, M.B., and E. M. Pilcher, M.B., Lient (now Capt.) 
C. J. O’Gorman, Lient. (now Capt.) B 8. H. Fnhr, 
Lients. G. G. Delap, H. Ensor, M.B., and L. N. Uoyd. 

To be Majors.—Capts. 8. G. Moores and J. H. E. 
Austin. 

To hare the honorary rank of Major.—Qrmr. and Hon. 
Cwt. T. F. Kennedy (n«>w retired pay). 

To have the honorary rank of Captain.—Qrmr. and 
Hon. Lient. S. Dnffield (since deceased), Qrmr. and Hon. 
Lieut. F. Crookes. 

To have increased rate of pay under Article 232, 
Boyal Warrant for Pay, Ac.—Qmr. and Hon. Capt. E. 
Tbowless, Qmr. and Hon. Lient. (now Hon. Capt.) J. 
Hirst, Qmrs. and Hon. Lients. A. Bruce. J. C. B. White- 
horn, F. Bmce, T. Exton, T. J. Jaoomb, and A. H. H. 
Niblett. 

To have the Distinguished Conduct Medal.—Fst. Ch 
Staff-8ergt.-Major J. de S. Stewart, Serfft.-Majors B. 
Watson, A. B. 'litchener, D. Boberts, and F. B. Bowyer; 
Fst. Cl. Staff-Sergta F. H. Dolman, J. B. Gibbons, and 
C. W. Measures, Snd. Cl. Staff-Sergt. N. Cornell, T. 
Johnstone, H. Lattemore, F. 8. Marsland, J. Hamoton, 
mrd B. Borrows; 8taff-Se^(t. C. H. Cooper; 8ergts. T. H. 
y. Coad, J. Leonard, J. Bright, and E. I. C^ogan; 
Lanoe-Sergts. T. Davey, and F. G. Brigh^ Corpl. W. H. 
Servey: Ptes. A. Nnnns, J. Harvey, M. T. Sparkee, H. 
Borford, B. N. Macgregor, (Hoepit^ Orderly), D. Stuart, 
attached, and (Hospital Orderly), F. W. Woodier, 
attached. 


Cmtsponboice. 


[We do not hold oarsalvesrsiponsihle for the opinions of onr 
correspondents.] 

“LACHNANTHES TINCTOBIA.” 

To fks Editor of Thx Mbdxcal Fbkss amd Cibculab, 
Sib, —In my last letter I was rash enongh to make the 
statement "that no solid scientific data would be 
fwthooming to establish the claims pnt forth for the 
'laohnanthes treatment,’ and that the only evidence 
addndble wonld consist in ‘ testimonials from grateful 
atieuts' of exactly the same value as tiioee which 
ear witness to the power of Holloway’s pills and oint¬ 


ment to root ont the totally distinct causes of several 
score of totally diverse disomes.” In this it is evident 
1 was wrong. I ought to have added that the evidence 
of grateful patiente would certainly be supported by 
the testimony of some such well-known scientists and 
memters of the profession as Mr. H. J. Buck, L.B.C.P.Ed., 

Clapton Common, whose communication follows mine in 
your current number. No ono wonld be impertinent 
enough to ask Mr. Buck for an accurate clinical record 
including a verified diagnosis of a single one of the 
many cases " given up as absolntely hopeless,” of which 
he has had experience during the last ten years, and 
which, under “ Mr. Alsbone’s treatment have recovered 
and remained in good health;" everybody will be 
willing to accept the nnsupported \p»» dixit of 
so great an an^ority; and there is nothing more 
to be said here. But Mr. Buck's letter affords 
some further valuable information. It informs ui 
that laohnanthes “ is only one of the dn^ Mr. 

Alabone recommends,” and that the administration 
of these drugs is " combined with the open-air treat- 
ment.” We are not told whether Mr. Alabone was the 
inventor of the open-air treatment which has been 
recommended by Mr. Bock " during the past ten years ”; 
and whether a general boycott by the profession 
thronghont the civilised world, led in this country by 
the General Medical Council (as suggested in Tho T\mt» 
by Colonel Le Peer Trench), has prevented suffering 
humanity from being made aware of this as well as of 
the lachnanthes trmtment until quite recent times. 
At any rate, Mr. Buck's letter has pnt quite a different 
complexion on the whole matter. Everyone now can 
perceive the wisdom of Colonel Le Poer Trench’s last 
suggestion, namely, that an Alabone institution shall be 
at once opened whereat medical candidates can 
“qualify” in the special treatment before being 
admitted to examination. When this is done and Mr. 
Alabone is appointed president of a newly constituted 
General Medical Council, no doubt the boycott 
against his methods which has been practised not 
only at home but in Germany, France, and the 
United States will be removed; an ill-used, even mar¬ 
tyrised will be reinstated in the eminent position 
he deserves; and the cases of constructive muraer de¬ 
scribed by Colonel Le Poer Trench will no longer 
dis^^race the profession; for no longer will wretched 
patients, merely to gratify professional spite, or at the 
dictates of a sordid trades-union o^anisation, be allowed 
to perish miserably whilst in reach of the salvation 
offered in Mr. Alabone's neglected treatment. 

I am. Sir, yours truly, 

September 27th, 1901. Ubiqub. 


“ LACHNANTHES TINCTOBIA.” 

To the Editor of Thb Mbdical Pbbss and Cibculab, 

Sib —Dr. Buck states in his letter in your last issue 
that lachnanthes is only one of the drugs which Mr. 
Alabone recommends in his treatment. Does Dr. Buck, 
however, deny that Mr. Alabone pins his fnith entirely 
upon lachnanthes, asserting as he does, in bis book on 
“ Consumption,” in reference to the other dm^, “ if 
u^ed by thems^ves cases do no< recover, which is con¬ 
clusive evidence that they exercise no curative effect ” 
(page 170). With regard also to the question of in¬ 
halants, Mr. Alabone also states in the same book 
(pi^e 170), " but in ail cases an sthereal tincture of 
lat^nanthes should enter largely into the composition.” 
It is quite clear that the only differmioe between the 
treatment of consumption by Mr. Alabone and that of 
registered practitioners is the use of laohnanthes, a drug 
which was described by Mr. Morton, who “assisted” 
Mr. Alabone for more than sixteen years in his “ prac¬ 
tice,” according to the evidence sworn by him in court 
(Alabone o. Morton —Times Law Beport8,Juoel9di, 1693), 
as “ worthless as a medicine, in fact the whole compound 
was in his opinion a bogus.” I am not aware that any 
action for perjury has ever followed, and therefore this 
evidence must stand as reported. 

I hope that Colonel Trench will find some other way 
of depleting his balance at his bank more in accordance 
with the true spirit of charity, and more helpful to those 


370 Thb Mbdioal I'bbss. 


COERESPONDBNCB. 


Oct. 2. 1901. 


who may Bofler from the diieue which, in spite of mnny 
advertiBed ooref^ still baffles the world. 

I enclose my omrd, bat prefer to sign myself, 

Damoclbs. 


THB BIOLOGICAL TEST. 

To the Editor of Thb Hbdical Pbbss and Ciboulab. 

Sib,— If Mr. Berdoe eerioosly reconsiders his position 
he may disoorer that he is argoing opside down, and in 
this respect he reminds one of an amosing story of a 
certain barrister who upon one occasion wasmuangoing 
and gestioalating before a jury in the fashion so oharao- 
teristio of the doth, and wlmt he said was admirable, 
bat somehow he got mixed up with his other briefs, 
when all at once it oooarrea to him that he was 
arguing for the opposite side, bat with commendable 
promptitade and wit he tamed the tables by explaining 
to the jury that what he bad hitherto been talking 
about was precisely ahat the ^posing ooansel would 
eay. In the same tense Mr. ^rdoe is admirable in 
what he says, bnt in my opinion, judging from his first 
letter, to eay nothing of his las^ that he is in reality 
arguing in farour of the riTiseotionists, and if he only 
reads less and thinks more, or in other words uses bis 
own brains in lieu of other peoples, he, like the barrier, 
will probably find out bis mist^e. 

With regard to Mr. Berdoe's criticisms to my letter 
they appear to me altogether frivolous; for example, he 
says, “ The biological test in my relative’s case had a 
positive, not a negative result.” If Hr. BeMoe will 
kindly refer to my letter he will discover that I was 
speaking of inoculation in the lower animals when no 
disease is established, whereas, regarding Mr. Berdoe’s 
mice tuberculosis aas incurred, hence, as be truly says, 
*‘the evidence was positive.” As to his objection 
about the beef-tea on the score that experiments on 
animal and man are not identical, although, of course, 
in many cases this is so; nevertheless, on the other hand, 
I submit some are fairly conclusive; for example, I pre¬ 
sume a corrosive or irritant poison if tested on an animal 
would produce similar reetuts as in man, whereas a nar¬ 
cotic might have quite an opposite effect. The only pos¬ 
sible exoeption|tbat could be ^en in ^is beef-tea experi¬ 
ment, as I coDceive, consists in this, vis., that oerta<n 
nllowanoee might have to be made as to constitutional 
distinctions Iwtween the two animals, thus Hie one 
deprived of all food might be a much more vigorous or 
robust animal than the other, which in tome measure 
would contribute to the incident of its living longer. 
Farther, I never for one moment stated that beef-tea 
was valueless as food for invalids, because, as is so well 
recognised, it would play its part as a nitrogenous ele¬ 
ment in making up a complete dietary fora sick person. 

I am. Sir, yours truly, 

Clbxbnt H. Sbbb. 

Queen’s Eoad, Peckham, September 26th, 1901. 


THB ELECTION OF DIRECT REPRESENTA¬ 
TIVES. 

We are requested by Dr. Glover to publish the 
following:— 

Fellow Pbactitionbbv of Eholand akd Wales,— 
In offering myself again for re-election as one of your 
direct representatives in the Medical Council I have 
two duties to discba^e. First, to thank yon, a.* I do 
most heartily, for a long period of oonfldenoe and sup¬ 
port on your part, shown at three elections. Secondly, 
to explain the principles on which 1 have endeavonred 
to act as yonr representative in the General Connoil of 
Medical Ednoation and Registration, and to which I 
shall adhere in the event of yonr again electing me. 

The recent address which I delivered at Chel^ham 
and my action for years in the Cmncil make it nnneoes- 
sary for me to do more than very briefly indicate my 
views. 

First, I have endeavonred to the beet of my ability, 
in respect of medical edncation, to make it, above aJi 
tbinn, clinical and practical, basing it on as high a 
standard of preliminary education as the state of our 
general edncation vrill permit. 


Secondly, I have laboured to maintain the puriJ^ of 
the and, while not lightly ruing the di^plina^ 

power of the Council, have not besitat^ to apply it in 
the case of those who knowingly and pe wi st en tiy 
violate those traditions of the profession which are 
neoessary for its honour and for the protection of Hie 
public. 

Thirdly, in regard to Legislation to reralate the work 
of midwives 1 luve kept in view Hie foUowing objects: 
—(a) Storoing the practice of " Sarah Gamps ” as we 
stop the sme of poisoiu. (b) Limiting the praotioe cd 
midwivee to simple oases and placing them under strict 
compulsion to call for the assistance of regular medical 
practitioners on the ooonrrenoe of any irregnlarity or 
abnormality in mother or child, (o^ Providing, in re¬ 
spect of the training and oertiflcanon of the work 
midwives, a Board to do, with the sanction of law, what 
is now done without log^ authority by the Obstetrical 
Society of Loudon, and by ot^r more or less irregnlar 
bodies, {d) As midwivee are not medical praotitionerg, 
and can only safely work under the supervision of sash 
practitioners, I can only support legulatioa for re- 
oognising them on condiHou t^t it secures the above 
objects, by making the Midwives’ Board to oonaist 
chiefly of medical men and subjecting its regnlaHons to 
the approval of the General Medical Council. 

FonrUily, I have consistently sapported motions for 
an increase in the number of direct representaHves in the 
Council, and I should support any reasonable proposals 
for reducing the sise of the CounoU. 

Fifthly, Medical Council consists predomioanHy 
of the representatives of twenty or more qualifying 
bodies, these bodies having their own fimoHons and 
responaibiliHea It is very oreditable to the Connoil 
and the bodies that so litHe friction baa hitherto arisen 
between them and it. At present the best friends of 
medical education see, with oonceru and regret, a sharp 
difference between the Royal Colleges of England and 
the ConnoiL I shall only say here that while ready to 
support the just claims of the Connoil to the loyal sup¬ 
port of the individual bodies, 1 un iu favour of avoiding 
any course which neoessitates a reference to the Privy 
Council—which by law has the last word in any dispute 
between the Medical Connoil and the mdividual ex¬ 
amining bodies—believing it to be in the interest of the 
Council and of the profession to settle differences 
without such reference. 

Sixthly, I am strongly in favour of the formation of a 
Couoiliatiou Board to remove friction in the^ working of 
Friendly Societies; to improve the poeiHon of ^ 
m^ical officers; and gradually t) raise the oouoeptton 
of the value of medic^ service to the working o lsssm . 
As acting chairman of a committee on these subjects I 
have been much impressed with the disposition of the 
leaders of the Friendly Sooietiee to meet the just com¬ 
plaints of the medical profession ; and I may add th^ 
the same impression has been made on my oolleaguse in 
the Medical Counml and on the Committee of the 
Connoil of the British Medical Association. It will bea 
misfortune if the tendency in some quarters to dispa ra ge 
this movement should receive any saooHon at the ooming 
election of direct represeutatives. 

Seventhly, the fioanoes of the Council reqmre the con- 
sideraHons of its members—the expenditure^ of late 
years having largely exceeded the inoome. Serious pro¬ 
posals have been made for raising a huge inoome 
for the Council by a yearly r^istration fee. I am 
strongly opposed to such a saggeetion, and believe it to 
be unnecessary. The difficulty, in my judgment, is to be 
met rather by reduoiog the eipOTditure of the Connoil 
in obvious ways t^u by exacting what would be m 
a.wnnn .1 tax from the profession. Medical politics 
may seem unimportant to the majorify of praotitioiiers 
—the la^e abstention of voters in past elections of 
direct representatives, amouoting to two-thirds or more 
of the profession—give some ooTonr to that impression. 
Bnt medical politics deeply affect the welfare and repu¬ 
tation of the profession, and are entitled to the con¬ 
sideration of all who are in any way responsible for the 
composition of the Medical Coxmcil. 

Such are the views on which I have acted as the direct 
representative of Hie practitioners of England sod 


C 



Oat. i, 1901. 


lilTBRABT NOTES AND GOSSIP. Tg.i Midical Pbiss. 871 


Waks in the ConnoU. Though oonsdoas of 

many enor defeote, I appeal, with some oonfidenoe, 
to broad aad geneioos jadgment of the profeeeion, 
and remain, jonr obedient eerrant, 

Jaksb Gsxt G1.0TXB, M.D. 

25, Highbury Place, N. 

gipmal ^rtuU. 

TBICHLOBACBTIO ACID.—A NEGLECTED 
BEMEDT. 

By G»obo« Pot, F.E.C.S.I., 

Stu^eon to Whitworth HoapttaL 

Bablt in the oentnry, when Berzelins conaidered 
oxganio ohemistry to be the chemietry of the organio 
rMielee, Dumas rather startled the chemical world by 
tiig promulgatioa of his theory of metalepey. Based 
on his experiments on oil of turpentine in 183f, by which 
he found that he could substitute an atom of chlorine 
for each atom of hydrogen, he practically orerthrew the 
theories which had already bera adopted by Liebig and 
Berzelins, and generally accepted. 

The close similarity between the names metalepey 
and metalepis, the rhetorical figure led to the word 
snbetitntion ” ^ing adopted by Dumas. 

The substitution of atom for atom leaving a body that 
rooombloB ^e original body was the next theory of these 
products, and was due to Laurent, and not long after* 
wards Dumas discovered trichloracetic acid, an instance 
in which the substitution product exhibits a close 
analogy with the original substance. 

At first the acid was prepared by parsing gweons 
chlorine into a vessel containing a small quantity of 
acetic acid, whilst the mixture was exposed to sunlight; 
afterwards it was produced by acting on chloral hydnte 
with nitric acid in the presence of sunlight. 

It occurs in colourless deliquescent crystals, which 
are readily soluble in water and rectified spirits. 

For years the acid was looked upon as a chemical 
curiosity, the product that converted Dumas to the new 
theory. 

The well*known preservative pronertiee of acetic acid 
caused chemists to experiment with trichloracetic acid, 
which they found to be a powerful antiseptic. These 
properties, however, excited no interest until Filipovitch 
(Vratch) in 1883, when using the acid as a teat for 
ttihnmnn in nrine, observed tUkt urine treated in this 
way did not undergo any decomposition, evmi after 
standing for days. He now commenced a series of 
experiments to test its preservative action on beef 
tea, hay infusion, and other readily decomposable 
bodies, and discovered that a half per centum of the 
acid protects fluid from the development of fission- 
fungi, though it permits the growth of mould-fungi. 
Tnrrnnnnil to the strengto of two per centum, the solu¬ 
tion arrested every sign of organic life for some months. 
In his urine-testing, Filipovitch made the important dis¬ 
covery that the acid does not precipitate peptones, and 
qnite reoenUy Combmale and Deeoil (Areh. prov. de 
Med.), in nTwmtning the nrine of eclampsio patients, 
found that in many samples the fluid contained albumen 
soluble in acetic acid, and they look on .trichloracetio 
acid as the only trustworthy teat in such cases. 

After its antiseptic properties had come to be well- 
recognised, it came to be prescribed in dyspeptic troubles, 
especiiJly those accompanied by fermentation, or decom¬ 
position of focd in the stomach, or the growth of 
sarcina. 

In all these classes of iutomil diseases it came to be 
displaced by the salicylates and boric acid. A change 
brought about more by the lack of familiarly with 
chemical agents by prescribers generally than by the 
greater superiority of the more common drags. 

Its non-tozic properties recommended it to Bnrsian 
su^eons as a dressing for wounds, and in 1889 Von 
Stein, of Moscow, published (Med. Monat.f. Orh.) his 
paper recommending the acid as an ideal oauterant. 
Applied to putrefactive surfaces it stops the decom¬ 
position, destroys the smell, does away with febrile oon- 


sequenoes, and promotes rapid healing. In acute ooryza 
a weak solution brings prompt relief. 

The acid baa the drawback of being a painful oaustio, 
hence in sensitive patients the drag should be used in 
asBOtiation with an anasthetic, such as oocaine. Ehrman 
(Ueber Aud. und Wirk. det Ac. IVie*.} claims for it 
tbftfc it is superior to chromic add In that its action re¬ 
mains looaliM and is more persistent. A year later he 
writes ( Weiner Med. Blatter) giving directions for its 
nss. He applies the deliquesced crystals over the pirt 
which it is desired to cauterise. The tissues are whitened 
by the add, an esoohar forms, which usually drops off in 
eight or ten days, leaving a clean, healthy surface under¬ 
neath. In tills report he confirms all tl^ O. F. Brown 
(Am Bhin. Assn.) in 1888 had said in its favour. 
Sedsiak, in 1890 {Oae. Uk. TTars.) also recommends it as 
the beet of cauteries for diseases of the nose and pharynx, 
and J. W. Gleitsman (Med. Sev. N.T.) in 1891 published 
his experience with tnchloraoetio acid in two hundred 
oases of affections of the throit and nose, strongly^ re¬ 
commending it. Be applies the add with an aluminium 
rod, so fashioned that a cup-shaped depression exists at 
one end of it; this depression he fiUs with fine crystals, 
and applies directly to the affected part. To dull the pain 
he uses a solution of cocaine. 

It has been found equally useful in the treatment of 
syphilitic and ordinary venereal ulcers. 

As an aj^lication for verruca it is smd to be painless 
and certain, the wart withering and quickly falling off 

Cozzoline (7her. Gaz., '94) thinks it is superior to 
either chromic add or preparations of iron as a hse mo- 
static in epistaxia. He applies a pledget of lint or 
cotton wool wotted with a weak solution to the bleed¬ 
ing point and ^ims that it produces but slight reac¬ 
tion and gives prompt cicatrisation. 

North (Med. Rev., R.Y.), 1897, advocates its use in the 
treatment of ozseua. He recommends ics use after the 
crusts have all been removed, and there is no ten¬ 
dency for them to reform. He then applies a solution 
varying from one to five per centum. 

As an application to ulcers, partioularly indolent and 
phagedenic ulcers on the lips or cervix of the womb the 
add produces mnch better results than the ordinary 
retries. It promotes healthy granulation and leaves 
a small firm cicatrix. For sloughing ulcers about the 
vaginal orifice it is a sharp, rather painful, but prompt 
remedy. 


ptermre anb (Sasstp. 

“ Spiculibx must have reached an acute phase 
when it has been found necessary to issue an “ Inter¬ 
national Directory of Laryngologists and Otol<^ts’* 
(London: Eebman, Limited). On the same principle, 
we presume, that almost every hospital must have its 
own little sheet, each special department in medicine 
must now possess not only its own journal, but its 
separate directory as well. The little directory before 
usr^ted by Mr. Bichard Lake, F.B.C.8., is excellently 
turned out, and forms quite an object-lesson in 
geooraphy. ^ ^ 

Thb andent "tallyman* appears to be making a 
ooun^eons effort to re-assert his almost forgotten posi¬ 
tion. Complaints repeatedly reach us of the nuisance 
of book.hawkers, chiefly of American books, and 
American translations of German authors, who And 
their way into the waiting-rooms of busy practitioners 
and consume a lot of valuable time before they can be 
got rid of. Of course the profession have the matter 
entirely in their own hands. If at once discouraged the 
nuisance would of course cease, as it would not pay the 
publisher who sends them round unless orders for the 
books were secured. ^ ^ 

Althouoh little informa^on concerning uew books 
in medicine and surgery is forthcoming, new editions of 
standard works are more than usually numerous. Of 
these were announced in our Studswis* Numfesr an eighth 
edition of Carter’s " Elements of Practical Medicine,” 
the fifteenth edition of " Gray’s Anatomy,” the fourth 

D., 10 ^ e 


LlTERATUfiE. 


372 Tbb Mbdicil Pbbm. 


Oct. 2, l»>i. 


edition of Halliburton’s “ Physiology/’ the fourth edi¬ 
tion of Bose and Carless’s "Manual of 8ni^ry/’ the 
seventh edition at Altingham’s "Diseases of the Beo- 
turn/’ the fourth edition of Osier’s " Medicine/’ new 
editions of Musser's " Medi<^ Diagnosis,” Dr. J. Dixon 
Mann’s “ Forensic Medicine and Toxicology/’ Da 
Costa’s ” Medical Diagnosis,” Dr. J. F. Payne’s 

General Patholo^,” and a tUrd edition of Dr. Jellett’s 
" Short Practice of Midwifery,” of which a companion 
edition will shortly be isso^ entitled " A Short Practice 
ot Midwifery for the Use of Nursef.” 

••• 

Thi last volume of the Glasgow Hospital Repart$ 
before ns is, as usual, full of instructive material. It is 
imp<Msibl^ in the short space at our ^sposal, to give any 
fair idea of the wealth of information this report con¬ 
tains. A year’s work in one of the principal cities of the 
kingdom is told in ite pages, and &e editors have col- 
leotM round them a staff of contributors who oombiue 
practical experience of disease with sound theoretical 
knowledge and facility of composition. The subjects of 
the twenty odd oontribn'ions to the number are happily 
chosen from the exnerienoe of the writers, and deal wiui 
subjects about wbion practitioners ever seek for informa¬ 
tion. Messrs. Maclehose and Sons are the publishers. 
%• 

Mbssbs. P. S. Kino and Son, Westminster, have in 
the press a work by Dr. J. F. J. Sykes on "Public 
Health and Housing,” being ^e Milroy lisotnree de¬ 
livered before the ^yal College of Physicians in Feb¬ 
ruary and March last. The lectures have been carefully 
revised by the author, and many additions made which 
it has been considered would add to the oompletenees of 
the subject. 

Wx have received the last number of the Quarie^lj/ 
Journal of Inehrioiy. The journal is edited and published 
in Connecticut, n.S.A., under the auspices of an associa¬ 
tion of American medical men. The object is so praise¬ 
worthy that we wish the association every snooecs. In 
their efforts to promote sobriety enthnsiaate adopt 
varions methods, out there is none better, in our opinion, 
than an nnvami^ed statement of the moral ruin excess 
produces, and we have no objection to a plain moderate 
statement of the accepted theories of the action of 
alcohol on the human being, its physiological and patho¬ 
logical action. That alcohol is abused as a therapeutic 
agent is only too clear; there are extremists in the 
t^total wing of the mescal profession and there are 
those who find in alcohol a panacea for all ills. 'The 
unreason of both sections is unscientific, and positively 
prejudicial to the best interests of medicine. We heartily 
wish this temperance movement success, but we 
fear that the publication of snob hysterical writing as 
that before us is erne of the greatMt obstacles to the 
progress of the temperance movement. There is a tem¬ 
perance in writing and speaking as well as in drinking. 


NEW BOOKS AND NEW EDITIONS. 

Tbb following have been received since the publica¬ 
tion of our last list:— 

Biitu IBS, Tikdai-i., and Cox (Lendon). 

A Msnnsl of Sorsery for Pnotitioners sad Stndeats. By Wm. 
Bom, 3C.B.LoDd., P.B.C.6., sad Albert Cwless, M.S.Load., 
P.&C.8. 4th UniTOTsity Series. Fp. 1168, with 

xix. pistes sad 406 woodents. Price 21s. 

The Diagnosis sad Trestaient of Diseases of the Beetnm. By 
Herbert Wm. Allinghsa, F.B.C S., sad Herbert W. Allingham, 
P.B.C.8. 7tb ^iuoa. Pp, 568, with 69 illustrations. Price 
12s. 6d. 

The Pocket Gray or Anatomists' Vade Ueonm. 5th Edition. 
Bevised and Edited by C. H.FBgge,H.B.. B.8.Iiond.,F.B.C.8., 
Pp. 869. Price Ss. 6d. 

A Handbook of Diseases of the Nose sod Pharynx. By Jas. B. 

BalhH.D.l^d. 4thSditiOB. WitheiiUnstrations. Prioe7s.6d. 
Syphilis and Other Venereal Diseases. By H. de Meric, M.B.C.& 
Pp. 132. Price Se. 

Casskli, AMD Co,. Limited (London). 

Surgical Diseases of the Kidney and Ureter. By Henry Morris. 

H.A.. M.B.Lond., F.B.C.S. In two volnmee. Price 42s. 

J. AMD A. Chvichiix (London). 

A Text book of Medicine. By the tste Dr. C. Hilton Fagge. 
Edit^ be P. Henry Pye-Smith, M.D., F.B.8. 4th Editi^ 
YoL I. Pp. 1117. Price 21s. 


A Manna! of Minor Sn^gery and Bandaging. By Christopher 
Heath, F.B.C.S., LL.D. 18th Edition, revised by wton 
Pollard. F.B.C.S. Pp. 426. Price 6a. 6d. 

H. K. Lewis (LondonX 

The Sanlta^ Inspector's Handbook. By Albeot Taylor. 3rd 
ISdition. Fp. 406. Price 6a. 

Lokohams, Gbbes AMD C!o. (London). 

A Practical Guide to the Administration of Anssihetics. By B 
J. Probm-WUliams, M.D. 1^.211. Price 4a. 6d. 

Memoirs and Letters of Sir James Paget. Edited by bia son, 
Stephen Paget, F.B.C.S. With portiaits and other Ulnstra- 
tiona. Pp. 4{S. Pr^ 12 b. 6d. 

Anatomy, Deacriptire and Borgieal. By Henry Gray F.B.8. 
ISth ^itioD, edited by T. nckering Pick, F.B.C^, and 
BobertHowden.M.A.. M.B.,C.M. Pp. 1096. Price 32 b. 

Mackillax AMD Oo., LIMITED (Londos). 

A Mannal of Detorminative Bacteriology. By Frederick D. 
Chester. Pp. 401. Price 10s. 6d. 

JoHM Mdbeat (London). 

Handbook of Physiology. By W. D. Hallibnrton. M.D., P.B.S. 
4ih Edition. Pp. 888. Price 14a. 

Obaet Bicbabds (London). 

The Bevival of Phrenology, the Mental Functions of the Brus.'* 
By B. Hollander, M.D.fereiburg, M.B.C.S. P]^ 1,518. Price 81s. 

The SciEMTiric Pbebs, Limited (London). 

Tendencies to Consumption : How to Connteract Them. By J. 
D. £. Mortimer, M.B., F.B.C.B. I^. 138. 

Steamoewatb aed Soms (London). 

Clinical Pathology and Praclkal Morbid Histology. By T. 
Strangeways Mgg, M.A. Pp. 107. 

G. Stbimheil (Paris). 

Anatomie G4n4ra’e Appliqu^ a la Phjsiologie et a la Mededne. 
Far Lavier Bichat. Farts 1 and 2. 604, Price 4o. 

JOBM WBIOKT AMD CO. (BriStOl). 

Kitchen Physic, at Hand for the Doctor and Helpfal for Bomaly 
Cures. Bt W. T. Femie, M.D. Pp. S£^ I^ce Oa. 
Pulmonary Tuberculosis, its Prevention and Chile. By Prof. 
Carlo Busts, M.D. Pp. 148. PrioeSi. 




PHILLIPS' OUTLINES OP DISEASES OF 
WOMEN, (o) 

This work hms now reached iU third edition, and 
while several psragraphB on fibromyomata and ec^pio 
geetation have bera re-written and an excellent aum- 
mary of the bacteriology of the geoital tract has been 
added to the book we think that a more thorough revi¬ 
sion throughout would have greatly increased ite value. 
There are many excellent preeoriptiona thronuhont the 
text which will be of valuable aeaistance to the practi¬ 
tioner, and, what is very important in a work of tiiis 
c'ass, a capital index. 

There are many points, however, on which we differ 
from the author. The left lateral is the position favonied 
for examination, the hips being ooverM with a sheet; 
inspection presumably being necessary only if the 
patient complains of "being tender.” It is also recom¬ 
mended to pass the cathet^ “ without exposure of the 
patient,” and though one is instmeted to wash the in- 
stiument in 1-1,000 enblimato or 1-4U carbolic in order 
to avoid the risk of cystitis nothing is said as to the 
advisability of washing the urethral orifice or sepsuating 
the labia, which may to covered with a septic dueba^e. 
To counteract this modesty, however, under Uterine dis¬ 
placements the author says: " If neoeesary examine her 
in the erect poetnre,” hnt gives no indication for this 
nltra-soientiflo procedure. 

While quite agreeing that "the too frequent nse of 
the sound cannot to snfiSoiently deprecated,” we think 
that many of the evil resnlte caused by the sound are 
due to insufficient attention being given to asepeis, both 
of the patient and instrument, and here again we consider 
false modesty is to blame, the Sbdvice “when possible, 
especially it a pnmlent or offensive discharge is present 
adminis^ an aotieeptio douche ” is not sufficient 

There is a good chapter oo menstruation, the varions 
theories as to its natnre and caosation being clearly 
explained, bat we cannot follow the anthor when he 

(<0 " Oatlines of tfae Disesiaes of Women.” By John Phillips, 
M.A.. M.D.. F.R.C.P., Ac. Third Edition. Pp. 280. London: 
Cbaries (iriffin and Ltd. 

> 




Oct. 2, 1901. 


LITERATURE. 


Thi Medical P&ass. 373 


«zpliun8 the effect of hot douches in premenstmal 
djamenorrhoea as cansinff “ a constriction of the veesels 
at the bases of the broad ligaments, and so ” relieving 
oongeation. 

We quite agree with the condemnation of the 
faysterotome and expanding dilators, and we think that 
s^nge tents and the ^craseor which is recommended 
for the removal of a hypertrophic elongation of the 
cervix and mtra>nterine growths might well have been 
added to the list. 

The treatment of sab-involntion of the ntems is ex¬ 
plicit ; but after recommending douches, drugs, &o , 
*' and if the patient’s means allow of a visit to ” one of 
the foreign spas, the author says ;—" If, in spite of the 
above courses of treatment, the symptoms, especially 
hesmorrhage or the presence of offensive ^scharge go 
on, and the patient’s general health is suffering, a» era- 
minaiion of the interior of the uterus is necessary." {The 
italics are ours.) We think that this examination 
might, with great benefit to the patient’s health and 
po^et, be m^e at an earlier period. 


SEWILL’S DENTAL SUBGEEY. (a) 

Thx fourth edition of this book on dental surgery, 
which has just reached ns, fully maintain s the cha¬ 
racter of the work as a concise elementary hand-book. 
Its increase in size on the last edition is in keeping 
with the rapid progress which has been made in dental 
science during the last ten years, each chapter having 
been re-written and amplifiM. It has been carefully 
edited, the language is simple and clear, and no effort 
has been spared to make it a thoroughly practical 
manual. 

We note with pleasure the clear and exhaustive 
chapter on “ Caries and its Sequels in Infancy and 
Early Childhood." There is no part of dentistry which 
in the past has been more consistently overlooked, both 
by parents and dentists, than the care of children’s 
t^th. Without endorsing every point of treatment, 
putioularly the opinion expressed regarding the inad¬ 
visability of capping pulra in the milk teeth, we think 
the subject well handled as regards the preservation 
of the temporary teeth themselves and their infiuence on 
their permanqnt successors. 

Orsi sepsis as a cause of local and systemic disease, 
deserves more notice from the general practitioner thun 
it usually gets, and the author’s references to the obser¬ 
vations of Mr. Watson Cheyne, Dr. Hunter, and others, 
regarding the connection between carious teeth and 
tuberculous cervical glands are cogent enough to repay 
anyone who may read them. 

The author's summary of and oonolusions regarding 
the {etiology and pathology of caries are both compre¬ 
hensive and searching, and show a very thorough 
investigation of this important subject. His just con¬ 
demnation of many of the absurd theories which from 
time to time have been advanced to account for this 
dental lesion must meet with the approval of every 
thinking patholc^^t. Let us hope that his sarcastic 
footnote to pages 244 and 245 will at least tend to check 
the meandering of the " impressionist ’’ pathologist in 
regions where *' a liiile knowledge is’’ so evidently '’a 
dangerous thing.’’ 

Mr. twill's mcta regarding pyorrhoea alveolaris are 
unfortunately very wide of the mark, and cannot, in 
the light of recent investigations, be held to be even 
approximately correct. 

The chapter on pivot teeth (which is made to 
inclnde crown-bar and bridge work) U disappointing. 
It seems almost a pity that it should ^ve been 
written, because the subject is so large that no 
adequate idea of the function of crown work and 
alli^ prosthetic devices in dentistry can be given in 
the few pages which have been devoted to it. To the 
student of dentistry it is of little value, for while 
describing in a categorical manner a few of the crowns 
in use, and these are not representative, it makes no 

(s) “ w«T»ti«i of DentsI Snnrerr. includinx SDeci&I Anatomy and 
nthology.” By Hy. ^will. M.B.C.8., L.D.S. 4th Edition. 
Iditod by W. J. Eneland, L.D.S.Eny., and J. Sefton ^wljl, 
1LB.C.S., L.D.S. Fp. ^2. With 281 lUnatratlona. Frioel0a.6d.net. 
Linden; Bailliere, Tindall and Cox. 190L 


, attempt to classify thsm according to their spheres of 
applicability—snrely a matter of prime importance. 
No fall indication is given of when and when not to 
crown or bridge, and altogether the medical as well as 
the dental student is more mystified than otherwise by 
its perusal. It is to be hoped that in a future edition 
this chapter may be better illnstrated, amplified, an d 
. brought up to date, or else omitted entirely. 

The question of porcelain inlaying, and ^ther fillings 
is ably treated. The chapters on anatomy, histology, 
and development are particularly well written. 

Despite the few blemishes above noted. Hr. Sewill 
and his editors are distinctly to be congratulated on 
the result of their collaboration. 

HEWITT’S ANiESTHESIA. (o) 

This, the second edition of Dr. Hewitt's book, is prac¬ 
tically a new book. No person is more competent to write 
of the snbject, considering his great practmal experience 
in the administration of anmsthetiosand bis familiarity 
with the literature of the modem experimenters and 
practical anesthetists. 

The book consists of over 500 pages of royal octavo, 
clearly printed on good paper, profusely illustrated and 
well-indexed. His arranmment of the matter is excel¬ 
lent Be commences wim the history of anesthesia; 
then deals with considerationB before anesthetisation; 
the chapter on administration naturally follows ; then the 
treatment of the accidents and so forth incidental to 
administration are dealt with, and the ooocluding 
part deals with the condition of the patient after ad¬ 
ministration. In the production of the book be had the 
friendly oo-operation of Dr. L. Hill, who with Mr. H. 
Candy, scrutinised all his obemic^ statements; 
that of Hr. Bellamy Gardner," who spent much time in 
collecting and comparing all the available facts bearing 
upon the history of anesthesia.’’ 

Withal the l^k is disappointing. The scheme, the 
co-operation, the great practical experience of the author, 
raises hopes of an almost ideal book; yet, like tbe 
statue of the Babylonish king, its feet are of olay. Docu¬ 
ments dealing with tbe history of anmstbetics may have 
been collect^ and compared by Mr. Bellamy Gardner 
very oarefany,aDd we do not say they have not. But with 
the history as given by Mr. Hewitt we deal, and to ns 
it reads as if original papers on the subject were not 
consulted by the antbor. To point out bis errors would 
be to re-write the Skrticle. He tells ns of Dr. Long and 
bis assistant. Dr. Long in 1842 had no assistant. Ue 
further states that Long had taksn no steps, prior to 
Morton’s time, to make his discovery known—which is 
incorrect. He notioes that the use of nitrous cxide was 
discontinued, but gives no explanation of its disuse. He 
refers to Cotton’s visit to Paris, and says nothing of 
Well’s visit to Cotton. We reSrd that Morton got a 
patent for “ Lethon ’’ Morton sought a patent ter it, 
and in preventing him getting one Dr. Arthur Jacob 
bore no small part, as the editorial columns of Tax 
Medical Pbxss and Cibcdlar bear witness. 

Of tbe operation in the Massachusetts Hospital 
tbe account is neither accurate nor full. It is very 
unfortunate that a history so full of error should be 
placed in tbe hands of studente. In a third edition we 
hope the history will be either omitted or re-writteo. 

When we pass from this portion of the book we come 
to some go<^, useful writing, in which, however, tbe 
author’s bias in favour of ether appears. He writes 
with great clearness on the method of administration 
of ether, and provides an excellent text book ter those 
whose general anasathetic is ether. Nothing is for¬ 
gotten, from the examination of the patient to his 
complete recovery from tbe antesthetic. Of course 
ether is not to be looked on as a lethal agent, though 
careless administrators sometimes meet with deaths 
under ether and onsuitable patients die from its effects. 
He discnsses the different apparatns ter administering 
chloroform, and gives excellent advice as to the nse of 

(a) *'AofBstLettcs an<l their Administrstion. A Text-Booh for 
Medical and Deatal Pnctitionere and Studente. ' }*▼ Frederick 
W. Hewitt, M.A, M.D.Cantab., Ansstbetiat to Bis Majesty tbe 
Kin;. With Illustrations. London ; Macmillan andCo., Limited- 
1901 . 


> 



374 Thx Hbdical Pbbbb. 


MEDICAL NEWa 


Oct. 2; 1901. 


the dro{| bottle and Skinner's mask; bnt we think he 
OTer-estimatee the eonsmnption of chloroform by the 
mask as a drachm every four or five minutes; Riven on 
cotton web, we have never found it consume half the 
amount. 

When we oome to oonsider the physiological action 
of chloroform we come on debatable ground. Dr. Hewitt 
holds that chloroform is a direct cardiac dmreesant, and 
bases his argument to show its markedly lethal pr^»ertiee 
on the “oioss^urrenc" Cambridgeezperiment. We have 
no wish to enter on this ground. We think a eoientiflo 
question is quite capable of being discossed calmly; the 
odium theoloyieum should find no plaoe in science. We 
therefore rest content with giving a quotation from Dr. 
Oaskell’s letter to Dr. Lawrie, which letter Dr. Lawrie 
read at the Montreal meeting of the British Medical 
Association in September, 1897“The ligature on the 
subclavian of the right side proximal to the vertebre, 
which was the only ligature on that side, was in the right 
position, bnt was not tight, so that the injection was 
able to pass both into the vertebrse and into the area of 
that side. 


AULD’S PATHOLOGY, (o) 

An author's writings are always of most value and 
usually of greatest interest when considered in their 
relationships. Only too frequently much of an inveeti* 
^toris resets lie scattered through many publications; 
it is well, therefore, that all likely to be of service to 
other workers should be collected and arranged by the 
hand that wrought. We therefore think that Dr. Anld 
hae done wisely to bring together a number of import¬ 
ant papers which originally appeared in journals and 
transactions, and presenting them in convenient and, 
as literary material goes, permanent form. Although 
the freshness associated with new work is not here, 
there is much that is worth careful perusal. All has, 
however, been thoroughly revised, and, in 8<.ime, 
instances, new matter added. 

The eesays treat of emphysema, pneumonia, Bright's 
hffimatogenous jaundice, and Addison's disease. 
The most important and valuablo article in the whole 
book is that published in collaboration with the late Pro¬ 
fessor Coats, on atheroma and aneurysm. Within the com¬ 
pass of a short review it is impossible to d< al with all 
the subjects which are presented. In spite, however, of 
a somewhat involved style, and occasionally loose 
method of expression, there is much that is suggestive 
and likely to stimulate further reseerch. The investi¬ 
gations concerning the toxic effects of the chemical pro¬ 
ducts of the pneumococcus are particularly valuable 
and will prolubly prove of practical service. The 
chemical and experimental work in connection with 
Addison's disease is also on promising lines. 

In too many instances the author seems to have lacked 
the grasp which plucks from Nature's secrets the tangi¬ 
ble flower of a definite oonolueion, bnt with pathological 
problems this, in all fairness, can hardly be laid to him 
as a fault. The articles are well arrao^, the illustra¬ 
tions are clear, and the printing and general get-up of 
the work excellent. 

HERMAN ON DIFFICULT LABOUR. (6) 

This handy volume, with its 165 admirable illustra¬ 
tions has been completely revised, important altera* 
tions have been made in the chapters dealing with 
Cesarean Section and Symphysiotomy, and special 
attention has been given to bringing the technique as 
up-to-date as possible. The author’s style is un¬ 
doubtedly dogmatic, and he deals with his subject in a 
clear, concise manner, which cannot bnt be appreciated 
by both students and busy practitioners. 

His di^fmatism sometimes leads him a little too far. 
For example, in dealing with the treatment of face 
presentation, he rays, “ If it be possible to change the 
presentation into a vertex this should be done.” 

(a) “E^Iectei Be'euches ID Pstbolovy.” By Alex. Onnn Aold. 
M.D.,M.B.C.P. Pp.153. With 18 lUustrstioiu. London: J. and 
A.ChnrchilL 1901. . „ . 

(M “ Oifflenlt Labonr: a Guide to iti ICanuteinext for Student, 
and Praetltionere.” By 8. £mekt Heman, jf.R.Lood., F.B.C.P 
Hew and Bevised Edition. 1901. l<ondon: Ouaell and Co„ Ltd. 


We cannot accept this ae good treatment in oases where 
the face lies in the right oblique diameter with the chin 
miterior, to follow the author's advice you would con¬ 
vert a favourable face presentation into an nn&voar- 
able veitex. His direations for the treatment of 
accidental hsmorrh^e at term are based on theoretioal 
possibilities which are unfortunately seldom borne out 
in practice. His condemnation of plu^og the vagina 
as “ a clumsy and painful way of irriteting the cervix 
and etimula^g the uterus to contract” is net warranted 
in the light of the recent stdendid reeolte foUovring 
this method of treatment. We are glad to recognise 
that in the treatment of mpture of the uterxu his oon- 
olnsioDB are identical with those of Mere which appeared 
in the Areh. f. On., Bd. XIV,, inasmuch as he recom¬ 
mends drainage. Differences of opinion are inevitable 
in a work of this class. Nevertheless, we cannot bub 
oongrainlate Dr. Herman on the exoellenoe of the work 
here b-xiught together in “ Manual ” form, and the pob- 
lishers also on the way they have tamed it out. 


THE CARICA PAPAYA. («1 
It must be admitted that the Caric-a papaya has 
never taken a very prominent place as a tberapentioal 
agent, although its pharmacological action hiU been 
worked out with mnoh care by many competent 
observers. The whole subject of the digestive ferments 
is foil of interest, and, ooneidering the prevalence of 
funotionsl disorders of the stomach among all civilised 
people, and especially among those who are brain¬ 
workers and leM a sedentary life, it is surprising that 
artificial aids to digestion are so rarely prescribe It 
may be that their mode of preparation is imperfect, or 
that their action is unoert^; but undoubtMly many 
of them—the Papaw among others—have fallen into 
undeserved neglect. The author of this very instructive 
paper, which is reprinted from the American Journal of 
P)Urmaey, speaks as oDe having antbority, and there is 
evidence that he has devoted much time and attention 
to the subject. He goes into the history of the drag 
tboTonghly, and traces it from its source to the fluisbed 
produoL He does not write as an enthusiast, and teems 
to have no desire to unduly advocate the merits of the 
drag, but presents ns with a oontribntion which will 
be rMd with interest. 


^cbical <^cto0. 

Plagne at N^les. 

Bubobic plague is reported to have broken outamoug 
the dock labourers at Naples. Up to the present some 
twelve casee have been certified, of which several have 
ended fatally. The origin of the outbreak is attributed 
to a vessel from an Indian port. 

A Well-directed Prosecution. 

Tux wife of a tradesman in North London was fin^ 
last week for having made certain false statemente is 
registering the birth of a child, in order, as was admitted, 
to avoid the obligation of allowing the child to be vac¬ 
cinated. 

Fatal Circumcision. 

An inquest was held at the Loudon Hospital last 
week on an infant, eight weeks of ^e, who had suc- 
enmbed to hsemorrhage following circumcision per¬ 
formed at that institution. There is nothing in the 
evidence to sug^eet that the obUd was the Bnbject of 
hemophilia and it is difficult to exonerate those in 
oha^e from blame for allowing the loss of blood to 
become dangerous. A verdict of deatb from misadven¬ 
ture was returned. 

London Hospital Medical College Sckolarships. 

Thk following Entranoa Soholarshipe have bees 
awarded at the London Hospital M^cal College. 
Price Scholarship in Science, value A120, Mr. J. Owen; 
Price Scbolanhip in Anatomy and Physiology (open to 
students of Oxford and Cambridge only), value^£60, Hr. 
Theo Thompeon; Entranoe Scienoe Scmolarehip, value 

(•> “The Story of the Pepxw.” By P. B. Kilmer. Fhfledd- 
ph 1901. 

>ie 



Oot. 2, 1901. 


MEDICAL NEWS. 


Tbi Msdioal Pax88. 375 


MO, Mr. A. H. Pollard; Eatrsnoe Soienoe Scholarship, 
valne £35, Mr. E. H. A. Harries; Epsom Scholarship, 
raloe £126, Mr. 8. H. Scott. 

Bt. Thomas’s Hospital Medical School. 

Thi Entrance Scholarship in National Scienoe, of the 
Talne of £160, has been awarded to Harold B^lrwith 
WhitehoQse, and the Unirersity Scholarship, of the 
vaine of £50, to Geor^ Bammell Footner, B.A., of Pem¬ 
broke College, Cambridge. 

Open-atr Sanatoria. 

Opbn-aib sanatoria, now becoming so generally 
popolar in Europe, are said to owe their origin to Miss 
Florence Nigbtinf^e. This notable woman first cored M. 
Benet, of Mentone, by adrising him to pass the better 
part of his time oot of doors, to reject medicines, and to 
apply himself to a liberal diet. The first establishment 
deroted to the open-air core was founded at Ooerbers- 
doff in 1850 by Hermann Broehmer, thongh it was left 
to his disciple and pupil Bettweiler to perfect the 
theory in the course adopted in 1876 at the sanatorium 
of Falkenstein. There are now in the Valley of Davos 
about 3,000 patienti and sixteen physicians. 

Disease Transmitted by Ants. 

An English doctor residing in Cyprus has encountered | 
remarkable cases of disease being tnmsmitted in the 
sting of the solitary ant. In one instance a woman was 
stung in her sleep by one of these insects, and the wound 
showed active signs of anthrax infection. It was then 
found that in the field adjoining her oott^e there was 
a dead sheep, which had lain there for a week since it 
sooonmbed to that disease. Here, then, is yet another 
insect to be added to the growing list of those that, 
while not dangerous in themselves, are capable of great 
mischief owing to their transmission of malignant 
bacilli. 

War against Malaria- 

Thk Italians have determined to eliminate malaria 
from the Peninsula, if possible. Active prophylactic 
measnree were taken during the summer and autumn, 
and are to continned, against the disease. Stations 
for observation and experimentation have been insti¬ 
tuted in the provinces of Borne, Milan, Cremona, 
Mantua, and F<^gias. Propbylactio experiments are 
being conducted aloug the littoral of Emelia. In all 
the paludal regions the municipalities are taking part in 
the experiments to stay the propagation of the 
hsmataxoon. 

Vital Stotlstlcs. 

Thx deaths registered in the « eek ending September 
21st in 86 large towns of Great Britain and Ireland corre¬ 
sponded to an aniniAl rate of 21*3 per 1,000 of their 
sggregate population, which is estimated at 11,463,028 
psrvtms in the middle of this year :— 

Birkenhead 12, Birmingham 17, Blackburn 16, Bolton 
20, Bradford 17, Brighton 14, Bristol 11, Burnley 25, Car¬ 
diff 13, Croydon 17. Derby 11, Dublin 28, Edinburgh 15, 
Glasgow 16, Gateshead 22, Halifax 17, Huddersfield 19, 
Hull 15, Le^s 16, Leicester 16, Liverpool 19, London 15, 
Manchester 19, Newcastle-on-Tyne 20, Norwich 16, 
Nottingham 18, Oldham 20, Plymouth 15, Portsmouth 17, 
Preston 20, SiUford 20, Sheffield 19, Sunderland 25, 
Swansea 11, West Ham 18, Wolverhampton 18. The 
highest annual death-rates per 1,000 living, as measured 
by last week’s mortidity, were:—From scarlet fever, 
1*0 in Derby: from whooping-coush, 1*1 in Swansea; 
from **fever,” 1*6 in Salford,and22 in Huddersfield; 
and from diarrhoea! diseases, 3*7 in Hull, 4-0 iu Shef¬ 
field, 4*1 in Newcastle-on-Tyne, 4*8 in Sunderland, 5*4 
in Bomley, and 6*6 in Gateshead. In none of the large 
towns did the death-rate from measles reach 1*0 per 
1,000. 

Death from Alcoholic Poisoniog. 

A CHILD, age three, died at the Wolverhampton 
Hospital a few days since as the result of drinking a 
quantity of brandy which had been left within her 
reach. Bemedial measuree proved unavailing, the child 
being nnconsoious when divoovered. 

The Mortality in Foreign Oitieo. 

Thb following are the latest official returns, and r^ 
present the last weekly death-rate per l/XX) of several of 


the populationsCalcutta 25, Bombay 61, Madras 91, 
Paris 15, .Brussels 14, Amstodam 18, Copenhagen 21, 
Stockholm 14, Christiania 12, St. Petersburg 24, Moscow 
30, Berlin 22, Hamburg 18, Breslau 23, Munich 19, 
Vienna 16, Prague 18, BudapPestii 16. Trieste 21, Borne 
17, Venice 18, Cairo 68, Alexandria New York (in¬ 
cluding Brooklyn) 20, Philadelphia 16. 

The Gaol after the Workhonse. 

Eenbst Bichabd Evans, described as a medical prac¬ 
titioner. was sentenced to a month’s bard labour last 
week, at the North London Police Court, for absconding 
from the Hackney Union Workhonse with a suit of 
clothes, &o., the property of the guardians. 

Zymotic Disease In London. 

The hospitals of the Metropolitan Asylums Board on 
Saturday last contained 8,106 patients suffering from 
scarlet fever, 1,474 from diphtheria, and 170 from small¬ 
pox. The lut-nsmed disease continues to spread iu a 
quiet, unostentatious way, each day bringiog its quota 
of cases. 

Last Sunday being the sixth anniversary of the 
death of Dr. Pastenr, the disciples of the scientist, 
headed by Dr. Metchnikof, visited the crypt of the 
Pasteur Institute, where a memorial ceremony took 
place. At the same time M. Deorais, the Minister for 
the Colonies, presided at the unveiling of a statue in the 
principal square of Arbois, where Pasteur piu^ his 
childhood. Pastenr is represented as sitting in an arm¬ 
chair, in the attitude of ennnoiatiog to his andienoe 
some new departure in soientiflc reeearcb. 




University of Durham. 

Thx following candidates have satisfied the examiners 
in the first examinations for the degree of Bachelor in 
Medicine:— 

Old Begulations. 

Chemistry, with Chemicad Physics.—S.Mankar,L.S.A, 
Lond. Heap. 

New Begulations. 

Elementary Anatomy, Chemistry, and Physics.— 
Honours, Second Class: B. J. Douglas, SL Bart-’s. Pass 
List: J. H. Cooke, B. Litt, W. Cowden, A. B. Jones, 
W. E. C. Lnnn, and R. G. 8. Simpeoo, CoU. of Med., 
Newcastle. 

Chemistry and Physics.—B. Begg, M.B.C.S., St. 
Bart.’s.; J. B. Cooke, Coll, of Med., Newcastle; S. J. 
Fieldiog, St. Thomas's; A. Finlay, Lond. Hosp.; J. S. 
Gibb, ttt. Bart's; B. V. Khedkar, Grant Colley, 
Bombay: C. C. Lavington, E. L. Markham, and F.H. 
Hoxon, Coll, of Med., Newcastle; fi. W. Pearson, 
M.B.C.S., Owens College; A. J. Turner, Lond. Hoep.; 

E. Tate and Tys Visser, ColL of Med., Newcastle. 
Elementary Anatomy and Biology.—H. B. Cunning¬ 
ham, 8. L. MoBean, and Jno. C. Norman, Coll, of Med., 
Newcastle. 

Elementary Anatomy.—T. H. Bishop, Eldin. Univ. 

The followiog candidate} have satisfi^ the examiners 
in the second examination for the degree of Bachelor in 
Medicine:— 

Old and New Begnlations. 

Anatomy, Physiology, and Materia Medica.—Honours, 
First Class: J. G. O. H. Lane, M.B.C.S.. L.B.C.P., Guy's 
Hosp.; T. W. Maddison, Coll, of Med., Newcastla 
Houours, Second Class: G. E. Lloyd, Coll, of Med., 
Newcastle. 

Pass List: J. A. Bell, St Bart’s.; L. A. H. Bnlkley, 
A. Bndd, H. M. Braithwaite, and H. Christal, Coll, of 
Med., Newcastle; £. F. Edmunds, Univ. Col., Sheffield; 
H. B. Featherstone, A. H. Borg, and N. H. Hume, ColL 
of Med.. Newcastle; W. W. Jones, Bgham. Univ.; 
Sophia B. Jackson, Univ. ColL, Cardiff; F. W. Kemp, 
CoU. of Med., Newcastle; A. V. Maybnxy, Guy's; C. F, 

F. McDowall and C. Charlotte Bobertson, ColL of Med., 
Newcastle; L. M. Bosten, Rt. Barfs.; 8. Bobson, W. E. 
Stevenson, and W. Seymour, Coll, of Med., Newcastle; 
F. B. Sn^t, St. Thomas’s; A. L. Sheppard, W. T. 
SitweU, F. J. Straohao, and W. L. Tindle, ColL of Med., 
Newcastle; 8. G. Webl^ Bgham. Univ. 

Diu,. ) 




376 Th. M.DICXI. Peeob. NOnCES TO CORRKSPONDEPfTS. 


Oct. 2. 1901- 


(jjlotias to 

®orr«a?ronbcnt0, §hort ^tero, Ac. 

CoBUSrovDBKTB requiring » r®pl71® tlii* column arc par- 
ticnlarly rcqucatcd to make oae of a di*MnctitJ< riffnatur* or 
and avoid the praotiee of aisninB themselves " Beader.” 
Snbicrfber,” “Old Subecriber," do. Much oonfusion will be 
spared by attention to this rule. 

Stimulants should be freely »iven in cases of cwbolio 
4cid polsoniD^* and their aotiou may adTaotajeoaely be remwtjed 
bj the subcutaneous injection of caffeine or strychnine in the hop® 
or ooviating the depressing effect of the poison on the cardiac 

^*L? B?—We have no means of ascertainlnjr the merits of the dis¬ 
pute, of which we prefer to leave the settlement to the bodies 
immediately concerned. . 

Db. E, M. S.-We are unable to publish your paper, asit has 

already appeared, in great part, in a contemporary. _ 

Messrs. Bobik (Pabis).—I t is not for ns to offer an opimon m 
to the chances of success your pills mlqht hare in this oOMtry. If 
the active principle which you have succeeded in isolating really 
possesses the admirable properties which are claimed for it, we 
would advise you fo have it brought before the profession in the 
usual way, certainly not by meaoB of advertisements in tbe lay 

**^.’8ELiK.-The responsibility for the ststemmit rerts with the 
correspondent who made it. we are obviously unable to verify 
other people's references in every instance. It is, of course, open 
to you to challenge its accuracy or its application. 

THE STATISTICS OF THE IBISH HOSPITAL IN SOUTH 
AFRICA. 


latmtdtB. 

Burton-on Trent Infirmary.—House Surgeon Silary £120 for tbe 
first year and £140 for tbe second year, with board, fnnu^ed 
rooms, coal, and light. Applications to the Hon. Secretary. 

Clayton Hospital arid Wakefield Oeueral Dispensary.—Senior 
House Surgeon, anmanied. Salary £180 per annum, with 
board, lodging, and washing. Applications to the Hon. 
Secretary. 

County Asylnm, Mickleover, Derby.—Senior Afsistant Medical 
Officer. Salary £130, risina to £150 per annu^ with apart¬ 
ments, boa^, washing, and attendance. Applications to the 
Medical Superintendent. 

Hertfordshire County Asylnm, Bill End, St. Albans.—Junior 
Assistant Medical Officer, unmarried. Salary £160 a year, with 
board, famished apartments, and washing. AppUcatums to the 
Medic*] Superintendent. 

Manchester Children’s Hospital, PendlebuTy.-Medical Offioer. 
Salary £180 per annum. Applications to the Secratarr- 

Midlothian District Asylum.—Assistant Medieul Offioer, single. 
Salary £800, with furnished rooms, board, waahi^, and 
attendance. 

North Staffordshire Infirmary and Eye Hospital. Bartshill, Stoke- 
upon-Trant.—House Physician. Sala^ £100 per annum, in¬ 
creasing £10 pa annum, with furnished apartments, board, and 
washing. 

North Wales Counties Lunatic Asylum, Denbigh.—Second Assist¬ 
ant Medical Officer. Salary £120 per annum, risuig to £160, 
with board, residence, and washing. Applications to the Clerk 
of tbe Yisitlng Committee. 

St. Mary's Hospital Medical School, Paddington, W.—Curator of 
Mneenm and Assistant Pathologist. Salary £100 per annum. 
Full particulars oa application to tbe Dean. 

Stirling District Asylum. Larbert, N.B.—Junior Assistant Msdical 
Officer. Salary £100, witb board, £c. 


To the Editor 0 / The Medical Fbbsb akd Cibculab. 

Sib,—I n your issue of September 18th you were good enough to 
nubliih R paper of mlee on "Medical Eiperienoea in South 
Africa." In the original MS. and in the proof which I returned to 
yon the total enteric mortality was correctly given as 1 Iv pet cent. 
In your issue of ^ptembec 18th the total enteric mortality was 
printed as 187 per cent. , . , _ 

I wrote to pcint out the inaccuracy, and in your issue of Sep¬ 
tember 85th the foUowing appears:— 

•* We barton to correct an em>r which in some cnrious manner 
seems to have crept into Dr. Coleman’s article on " Medical 
Erperiinces in South Africa, ' which appeared in "urkrt isroe. 
The total mortality among the cates treated in the Irish Homital 
was wrongly given as 187 per cent. It should have been 117 per 
cent., a very material diSerenee." .... . j 

Tbe error, though "curious," is not mine, and it is supplementsfl 
by a farther blunder. '' The total mortality among the cases treated 
in tbe Irish Hospital" was 37 per cent. (102 deiths in 2,749 casea), 
while the total enteric mortality to which I referred m my i>aper 
was 11 7pAi cent. (79 deaths in 672 casea). 

I am, Sir, yours truly. _ 

J. B. COLEKAH, M.D, 

9, MArrion Square, 

Dublin, September 26tb, 1901. 


Ratings of the gccictus. 

Fridat, Oct. 4tk. 

West Lobdoh MbdicoChibdboical Sociitt (Weet London 
Hotpital, Hammeramith Bead, W.).—8.30 p.m. Mr. A. Cooper 
(President): In«ngiu^ Addreea. , w -n- * 

West Sent Hedico-Cbiburoxcal Society (Bo^u West Sent 
DispeoBaryp Oreenwicli Boad. S E ).--8.45 p.m. Clhii^ Eyepii«. 
Dr. Toogo^: Cases from Lewisham Infirmary.—Dr. Scbolefleld: 
Clinical Cases.—Dr. Dockrell; Dermatological Cases. 

Tdesdat, Oct. 8th. 

SociETT FOB THE Stcdt OF Imebbitt.— At 4 p.m. The Quarterly 
Meeting (rooms of the Medical Society of London), 11, Cbaados 
Street, Cavendieh Sqnare, when Pf^rs will be read by Mr. 
Charles Smith, of Maidstone; by Dr. Martyn Westcott, and by the 
President. 


,|4r))ointmntt$. 

Bbeslxt, Bobebt W., H.D., C.M., M.B.C.P.Edin., M.B.C.6.Eng. 
L.B.C.P.Lond., Honorary Medical Officer to the Bolton In 
firmary and Dispenssty. , 

Bbieb William H., M.B., C.M.Edin., Honorary Medical Officer to 
the Bolton Infirmary and Dispensary. 

Butt. Fbakcis J., M.B., C.M.Edin., Medical Officer of Health of 
Hoole Urban District. _ _ 

QOBPOK, Thomas E., M.D.Durh., M.E.C.S.Bng., Medical Officer of 
Health of Towyn Urban District. , „ t, o o, 

JOHHSO*. H.. L.E.C.P.Edin., L.E.C.S.Bdin., L.F.P.S.Olasg., 
Medical Officer of the Sontb District of the Lincoln Union. 
Jobhsos, William Cbobbt, M.B., Ch.B.Vlct., Junior House 
Surgeon to the Salford Boyal Hospi^. , „ 

Bobebtson, Qeobue, L.B.C.P., I,.fe.C.8.Edio., L.F.P.S.Olasg., 
Certifytog Surgeon tinder the Factory Acts for the Kirkpatrick 
Durham District of Kirkcudbrightshire. 

Scott, Bebhabd. M.B.C.S.Eng., Assistant Medical Offioer of tbe 
West Bromwich Workhouse. 

WiLsoir, Walter B., M.B., B.C.Cantsb., Honorary Surgeon to the 

Doncaster Infinnsry. _ 

Todno, Abchibalp, J.. L B.C.P., L.B-C.S.Edin.. L.F.P.S.Olasg., 
Medical Officer of Health of the Whitefleld Urban District. 


#irths. 

Martih.—O n September 24th, at59. High Street, Chelmsford, the 
wife of John L. Msrtin, M.B.. C.M., of s daughter. 

Willis.—O n September 24th, at57. Son^ys Well, Cork, the widow 
of Surgeon J. P. Willis. M.B., B.N., late of H.M.S. St. Vincent, 
Fortsmonth, of a daughter. 


Carriages. 

Olasier-Field,— On September 26th, at Benhilton Church 
Sutton, Sumy. Howard Olasier, M.A., M.B., Cantab, younger, 
son of W. B. M. Olasier, of Boyne Lodge, Tunbrir^e Wells, to 
Ethel May, youngest daughter of James Frederick Field, of 
Southwark, and Benhilton Mount, Sutton. 

Law—Williams, - September 25tb, at the Old Pariah Cbuich, 
Hove, Brighton, Herbert Henry, second son of Edmund l£w, 
of Northampton, to Ada Martin, second daughter of the late 
David Martin WIliiAms, M.B.C.S., formerly Indian Medical 
Service, and of Mrs. D. M. Williama Pembroke Creecent, Hove. 

Samwats ~SiM.— On September26th, at Kensington Chape). Allen 
Street, London, W.. Daniel Weat Samwaya, M.D., M B.C.P., 
D.Sc., of Mentone, to Sarah Sophia, widow of the late CaptAin 
A. D. Sim, Argyll and Sutherland Highlanders, and yoongest 
daughter of the late J. C. Bolton, of Carbrook, Aigyllwre. 


Sesth. 

Archer.— On September 80th. at Upper Woburn Place, Frauds 
Bonfield Arche', M.B., C.M., in h s 54th year. 


OPEBATION DAYS AT THE LONDON HOSPITALS. 
MONDAY.—London, 8 p.m.—St. Bartholomew’^ 1.30 p.m.—St. 
Thomas's, 3.30 p.m,—St. Oeerge’s, 2 p.m.—Ophthalmic, L15 

S .m.—St. Mary's, 2.30 p.m.—Middlesex, 1.30 p.m —St. Muk's, 
p.m.—Chelsea. 2 p.m.—Samaritan (Oyncecofogical, by Fhyd- 
ciane), 2 p.m.—Soho Square, 2 p.m.—Boytl Orthopi^ic, 2 p.m. 
- Citr Orthopedic, 4 p.m.—Great Northern Centr^ 2.30 p.m.— 
West London, 2.30 p.m.—Westminster. 2 p.m. 

TUESDAY.— London, 2 p m.—St. Bartholomew’s, 1.30 p.m.—Ouy’i 
1.30 p.m.—St. Thomas's 3.30 p.m.—Middlesex, 1 30 p m.— 
Westminster, 2 p.m.—West London, 2.30 p.m.—University 
College, 2 p.m.—St. George's,! p,m.-^t. Msry's. 1 p.m.—St. 
Marka, 2.30 p.m.—Cancer, 2 p.m. 

WEDNESDAY.—St. Bartbolomcw's, 1.30 p.m.—t'niversity College, 
2 p.m.—Royal Free, 2 p.m.—Middlesex, 1.30 p.m.—Cbartng 
Cross, 3 p.m. - St. Thon ss’s. 2 p.m.—London, 2 p.m. - Kii^i 
College, 2 p.m.—St. Mary’s, 2 p.m.—National Orthopemc. 
10 a.m.—St. Peter's. 2 p.m.—Samaritan,2.30 p.m.—Ot. Ormona 
St., 9.30 a.m.—Ot. Northern Central, 2.30 p.m.—Westminster, 
2 p.m.—Cancer, 2 p.m. 

TpiTMiiAY_Rt.. Bartholomew’s, 1.30 p.m.-St. Thomas's 3.30 

.m.—University College, 2 p.m.—Charing Crow, 3 p.m.— 
t. George's, 1 p.m,—London, 2 p.m.—King's College, 2 p.m.— 
Middlesex, l.S0p.m.—St. Maiy’e, 2.30 p.m.—Soho Square, 2 pm. 
North-West London. 2 p.m.—Chelsea, 8 p.m.—Qt. Northern 
Central (Gynmcol^cal), 2.80 p.m. 

FRIDAY.—London, 2 p.m. — St. Bartholomew's, 1.30 p.m,—St 
Thomas’s, 3.30 p.m.-Guy’s, 1.30 p.m.—Middlesex, l^p.m.— 
Charing Cross, S p.m.—St. George’s, 1 p.m.—King’s CoUcgt 
2 p.m.—St. Mary’s, 2 p.m.—Ophthalmic, 10 a.m.—Cancer, 2 p.m. 
—Chelsea, 2 p.m.—^t. Northern Central, 2.30 p.m.—Weet ton- 
dan, 2.80 p.m,—Cancer, 2 p.m, 

8ATUBDAY.—Royal Free, 9 a.m. nnd 2 p. m.—Middlesex, L30 p .m 

_St, Thomas’s, 2 p.m.—London, 2 p.m.—University College 

9.15 a.m.—Charing Cross, S|p.ia.—St. George’s, 1 p.m. 


1 








Mliedital Wms and ®iwnlar. 


••8ALUS POPUU SUPREMA LEX.’ 


VoL. CXXIII. WEDNESDAY, OCTOBER 9, 1901. No 15. 


jpiiris ClittiCiil Xwtuvcs. 

TINEA TONSURANS. 

Bj Peof. BALZBR, M.D., 

Professor of Dermatology. 

TJndeb tbo Dame of tinea tonsuracs many 
very diffeient affectlona of the scalp caused 
by various kinds of parasites are comprised. 
The tricopbyton tonsurans discovered in 1944 by 
Grnby and Malmestem is the most important of 
these by reason of its frequency. Of the others, the 
one most commonly met with is the microsporon 
Audouinii, which has been investigated of recent 
years by M. Sabouraud. This parasite may invade 
the scalp and the neighbouring tegument, and it 
produces a particular form of tinea tonsurans known 
under the name of tinea microsporic. This affection 
is characterised by extremely numerous spores, form¬ 
ing a sort of sheath around the root of the hair. Of 
a rounded form these spores are composed of a 
nucleus protoplasm and an epispore. They are 
arranged without order more or less in a mosaic. 

The tricophyton also presents several different 
varieties, but the essential elements are always the 
same. They are represented by spores roughly re¬ 
sembling those of microsporon Audouinii, viz., a 
nucleus surrounded by protoplasm and an envelope 
called epispore. These spores may be isolated or 
arrangdd in beadlike fashion. 

The tricophyton can be easily cultivated in a 
sweetened liquid, beer, must, See., and presents 
several varieties, of which the most important is that 
described by M. Fabouraud under the name of trico* 
phyton endotbrix, that is to say, characterised by 
its seat in the body of the hair. It presents two 
varieties according as the mycelium is affected or 
not by caustic potash (40-100), which is employed 
in examining it, viz., the T.E., with resisting 
mycelium and the T.E. with fragile mycelium. The 
former is peculiar to England, and is rarely seen in 
France, where the latter exists on the contrary in 
great abundance. This is the form we observe daily, 
and to which I wish to draw your attention as well 
as to the tricophyton ectothrix, a very rare parasite 
of animal origin, while the two former are invariably 
derived from human beings, and are propagate 
from one to another. 

Let us now discuss the clinical signs of these 
different varieties of tinta. We will deal first the 
tinea tonsurans with small spores, constituted by the 
microsporon Audouinii. 

This variety is very frequently met with in child¬ 
ren, especially in Paris, where it occurs in two out of 
every Aree cases of tinea tonsurans. It is usually 
present in a sufficiently characteristic form. It you 
examine the scalp you will see one or several spote 
of a rounded or oval shape, generally well-defin ed, 
varying in size, and in aoa)ift o^i^es so aum.irou.s as. to 


invade the whole scalp. On examining closely, with 
or without the aid of a magnifying glass, we can 
make out the characteristic sheath of the micro- 
aporon surrounding the root of the hair giving it a 
greyish colour. Ton will notice, moreover, numerous 
scales. M. Sabouraud considered that the affection 
was limited to the scalp, but M. Bcclere and other 
authors have shown that the parasite sometimes 
attacks the neighbouring tegument of the neck and 
temporal region. 

The microsporic tinea is ver^ common in Paris 
because it is extremely contagions. On the other 
hand this form, is perhaps,more easilvrecovered from 
than the tinea tricophyton properly so-called. It 
may even subside spontaneously towards the age of 
fifteen or sixteen. 

We will now pass on to the tinea tricopbvton, the 
form of alopecia determined by the tricopbyton en- 
dothrix with fragile mycelium. Here the apnearance 
of the spots is quite different from that of the pre¬ 
ceding form. The hairs have no sheath; they are 
sometimes thicker than in the normal state and 
slightly deformed; but the most characteristic phe¬ 
nomenon is that they break off close to the root. 
The patches are distributed irregularly, their outline 
is ill-defined, and they are frequently disseminated 
in small spots comprising but a few diseased hairs, 
so that there may m considerable difficulty in arriv¬ 
ing at a diagnosis in view of treatment. The malady 
may also he complicated by seborrhoeic eczema, 
masking more or less its nature; but the broken 
hairs are always present. They may be withdrawn 
by the aid of the forceps and examined under the 
micioscope. 

The duration of tinea tonsurans is indefinite. 
Spontaneous cure, though possible, is very rare after 
the patient has reached twenty years of age. 

A curious fact has been observed, viz., that the 
affection sometimes disappears in the course of a 
malady associated with nigh fever. I attended a 
child some time ago who was suffering from tvphoid 
fever, and who aJ^ presented the lesions of tinea. 
The latter affection got well spontaneously during 
the course of the fever. 

It would seem that high temperature, if sufficiently 
prolonged, has a destructive action on the parasite. 

I now come to the treatment. This comprises 
epilation and the employment of parasiticides. We 
must also consider the spontaneous cure of tinea 
tonsurans under the influence of expulsive follicu¬ 
litis, which frequently succeeds even in the most 
rebellious cases. 

Epilation.—In theory this method appears excel¬ 
lent but it is inadequate in practice, b^nse it is 
impossible to carry it out in a regular and methodical 
manner, the hairs breaking off for the most part in 
the teeth of the foroepe^ The operation, however, is 
not without its value io the tricophyton, but it^ is 
useless in. the tinea mi ^roeporic. , 

. ‘ ....7eci-bv 


ooglc 






Oct. 9, 1901. 


378 Th* Msdical Pbi88. OEIGINAL COMMUKICATONS. 


Parcuiticides. —All parasiticides, eren those which 
have anj marked action on coltnres in vitro, are 
al most powerless when applied to the scalp, becanse 
they cannot reach the spores situated in the interioie 
of the hair or follicles. 

ExpuUive Folliculitis —In tinea an acute suppura¬ 
tive folliculitis is produced which expels the hair. 
To cure tinea the same process must be produced 
artificially,that is to say, folliculitis must be provoked. 

Tinea Microsporic. —When a child comes suffering 
from tinea with small spores the first thing to be done 
is to order the hair to be cut off as closely as pos¬ 
sible to the scalp. We can then apply the epilatory 
paste of hydrosulphate of calcium. This substance 
IB applied in a thick layer and left in situ ten or 
fifteen minutes, then removed under a stream of warm 
water. The abrasion obtained is superior to that 
produced by a razor and presents no serious incon¬ 
venience. In persons with very sensitive skins there 
may be some inflammation, but in the majority of 
cases no inconvenience results. The application of 
parasiticide agents forms the third phase of the 
treatment. Of these there is a large smeotion. The 
most simple and the most convenient is certainly 
tincture of iodine painted on morning and evening, 
and covered with protective plaister. The epilatory 
paste should be renewed once or twice a week. The 
treatment is good, and is almost invariably successfui, 
but four or five months will be required to arrive at a 
complete cure. 

Instead of tincture of iodine a more energetic 
agent called chrysophan traumaticine (1-10) may 
be employed, especially if the tinea be limited to 
a small area. For the tinea tricophyton these various 
measures may be tried, but it is generally necessary 
to make use of the more active agents which I am 
about to describe. 

Tinea tricophyton. —Here epilation is indispen¬ 
sable, and should extend beyond the diseased area. 
After this operation the parasiticide substances are 
applied Recourse may m bad to tincture of iodine 
or to chrysophanic acid, or to carbolic ointment 
(5 percent.), or lo coiTosive sublimate (1 percent.) 
applied twice daily. Therapeutists have returned of 
late years to an irritant substance which was 
originally proposed by Ladreit de la Cbarricre, and 
employed oy Cadel de Garricourt and Sabourand, 
viz., croton oil. The formula of M. Sabouraud is— 
olive oil, two parts; croton oil, one part. The mix¬ 
ture should oe carefully applied exactly over the 
affected area, and repeated once or twice a week. A 
crop of pustules is generally the result, rendering 
extraction of the hairs easier. By reason of its 
irritant properties, however, this substance cannot 
be employed in every case, and certain authors refuse 
to employ it under any circumstances. Other sub¬ 
stances may be substituted, such as a 5 per cent, 
alcoholic solution of resorcine, naphtbol ointment 
(1-10), carbolic oil (1*20), monochlorophenol Sites, 
proof spirit, 3is8; essence of lavender, 3j. This is 
applied morning and evening, and covered imme¬ 
diately with oil skin. Such is the treatment of tinea, 
but, as I have already said, great patience is required 
by both patient and doctor; to arrive at a complete 
cure a period of from three to six months Ming 
necessary. 

In regard to prophylactic measures, they con¬ 
sist in isolating the patient either in the school 
or at home; the wearing of a cotton cap, easy to 
wash in boiling water; disinfection of combs and 
brushes with corrosive sublimate, and the observance 
of the usual hygienic precautions. 


Bb. Kobhan Moobb is to deliver the Harveian 
Or aiion at the Royal College of Physicians, on St. Luke’s 
Da y, October isth. 


A NOTE ON 

ANTI-TYPHOID INOCULATION 
IN THE ARMY, (a) 

By H. C. DRURY, MD, F.R.C.P.I., 

Viaiting PhyaicUn to Cork Street Fever Hospital; Aesistant 
Phyeician to Sir P. Dun’s Hospital, Dublin. 

Inoculation against enteric fever is still upon 
its trial. It is only in a great organisation like the 
army that such a measure can be properly tested; 
where a large number of individuals can he kept 
under observation for a sufficient time and methodical 
statistics kept from which to draw trustworthy de¬ 
ductions. 

The results of anti-typhoid inoculation in the army 
in South Africa will be looked for with keen interest. 
If it comes well out of the terrible ordeal of the early 
months of 1900 there will be this further regret to be 
added to those that are gone, that many more of our 
brave fellows had not received this weapon of defence 
asainet the mostinsidious foe of armies. That thus 
not ouly might the lonely veldt have bera robbed of 
hundreds of silent slumWers, but also to thousands 
might have been spared terrible weeks of suffering 
under the hard necessities of war. 

For the present we must content ourselves with the 
results obtained by the Arm^ Medical Department 
in the year 1S99, parlicularly m India. 

Enteric is the scourge of the army in India. In 
spite of all precautions it runs riot, and is a far more 
grave disease than it is at home. In 1898 it caused 
41'4 per cent, of the whole death-rate from all causes 
among the British Army in India. Of those attacked 
27*7 per cent, died, the average for ten years being 
26‘5 per cent. There were on an average 320 con¬ 
stantly sick from this disease alone. When it is re¬ 
membered that the average mortality for the twenty 
yeare ending 1891 in Cork Street Hospital, Dublin, 
was 8 6 per cent., it will be seen how vastly more 
serious enteric fever is in the climate of India. 

In 1896 Pi*of. Wright, of Netley, introduced his 
anti typhoid serum to the medical profession. It is 
well for us that it emanated from the Army Medical 
Department, and was fathered by the energetic Pro¬ 
fessor of Pathology. The troops, particularly those 
going abroad, have had the option of inoculation, 
and a large numl er of the men availed themselves 
of it—a sufficiently large number, at least, to make 
the statistics valuable. 

In India, in 1899, there was a diminution in the 
prevalence of enteric in the army as compared with 
1898. According to the report this is considered as 
ai l^t partly due to inoculation. Several of ths 
stations snow interesting statistics. “ As Lucknow 
holds the position of showing the highest average of 
enteric prevalence during the last ten years, it is of 
interest to note that even the single inoculations 
appear to have yielded satisfactory results ’’— e.g., 
selecting the two regiments having the largest num¬ 
ber inoculated :—The 3rd Hussars, with a strength 
of 488 had 325 inoculated, 163 not inoculated. 
Among the inoculated there were 10 cases with 3 
deaths, a percentage of 3'08 cases; among the not 
inoculated, 29 cases with 5 deaths, a percent^e of 
17'79 cases. 

At Bangalore, out of a total strength of 1,538 
there were 59 cases of enteric with 12 deaths; 454 
were inoculated, and of these only 3 contracted the 
disease, and all recovered. 

At IJmballa there were 57 cases and 16 deaths. 

" About 400 men of the Gordon Highlanders were 
inoculated with anti-typhoid vaccine by Professor 
Wright, of Netley. One of these men, who was st 

(n) A review of. the eubieot bwed on the Beport of the imj 
Medical DepRrtm'’itt for 1899. 

Ogle 


ORIGINAL COMMUNICATIONS. 


Thi Hbdioal Prub. 379 


Oct. 9, 1901. 

the time nnrBing enteric patients, was admitted three 
days iater for enteric fever, which snbseqaently 
proved fatal. He stated that before he was vacci¬ 
nated he had not been feeling well; evidently he had 
been sickening for the disease at the time of the 
inocnlation. excluding this case it appears that the 
ratio of attack for this regiment was 2'5 per 1,000 
among the inoculated, as compared with 40‘9 for men 
not inoculated. 

At Ahmednegar there were 55 cases and 9 deaths. 
Only 14 men were inoculated at this station, and 
none of these got the disease. 

At Mhow there were 49 cases, with 14 deaths. 
Here 85 individuals were inoculated, but none of these 
developed the disease. 

At Meerut there were 45 admissions, with 17 
deaths. Out of the total strength 728 men were in¬ 
oculated against enteric, of which number 4 con¬ 
tracted the disease, all within four months after 
inoculation, and 2 died. 

At Peshawar there were 41 cases, of whom 16 died. 
At this station there were only 78 men inoculated, 
but they all remained free of the disease. 

At Agra there were 83 cases with 10 deaths. Here 
inoculations arainst typhoid were made in 191 cases. 
One of these became ill with the disease. He was 
said to be sickening at the time of inoculation, and 
the case proved a mild one. No other case occurred 
among the inoculated men. 

At Jhansi there were 33 eases of enteric with 7 
deaths. All of these occurred among men who had 
not been inoculated. Among the 273 men who were 
inoculated no case of enteric appeared. 

At Eirkee there were 32 admissions and 4 deaths; 
only 36 were inoculated, and 3 of these developed the 
disease. 

At Banikhet there were 30 cases of enteric, with 
5 deaths. No inoculations were carried out at this . 
station, but a considerable number of men quartered 
there had gone through the operation elsewhere. 

“ Out of 337 men not inoculatM and with no pre¬ 
vious histo^ of enteric fever, 23 suffered from the 
disease, while out of a total of 57 inoculated there 
was not a single case of enteric or anything re¬ 
sembling it Had the latter body suffered in the 
same proportion, there should have been 4 or 5 cases 
among them. All these men were living under pre¬ 
cisely similar conditions. If the review is limited to 
young soldiers in their first year of Indian service, 
the figures are still more favourable to inoculation, 
as out of a total of 97 in the 3rd Hussars and Came- 
ronians (again excluding those who had had enteric) 
57 non-inoculated men yielded 4 cases of enteric 
fever, whilst among the remaining 46 who had been 
inoculated there was not a single case. 

At Quetta, 26 cases of enteric fever occurred in the 
year with 5 deaths; 228 inoculations were carried 
out, 33 of these having second inoculation. Among 
these inoculated 3 cases of enteric occurred. All 
three were very mild, and none of the three were in 
those who had been twice inoculated. 

At Ferozepore 23 enteric cases occurred, with 12 
deaths. Only one mild case appeared among the 97 
who had been inoculated against the disease. 

In the above reports from the stations, only those 
have been selected in which over 30 cases of enteric 
occurred, and in which inoculntions had been carried 
out, or already inoculated troops were stationed. 
The results must be considered to if not thoroughly 
satisfactory, at least extremely encouraging, and 
cannot be explained away or ignored by a sceptical 
observer. 

The following table is drawn from a similar elabo¬ 
rate one given by the A.M.D. Again India alone is 
referred to here, as in most of the other stations the 
numbers are rather small in some particular— either 
in the number of troops, the number of inoculations, 


or the number of enteric cases. For instance, the next 
mc^ important table for our purpose is that relating 
to Eg^t and Cyprus. There were 4,835 troops, 461 
were inoculated, none of these got enteric, but there 
were only thirty ^s of entenc altogether. From 
* if* ^ India we select only Aose corps in 

which 1(W or more men were inoculated, and at the 
end IB given the grand total for the whole strength 
of the army m India. 


1 

|ll 

S P 
-2 ® 5 

.3 

1 

Q 

.i-iU’ 

CO 

o 

£ 

m 

0 

S ^ 
".2 

^r‘r'*?^‘PN«x®9S® 

s 

N 

s 

Igl 

a 

S 

i 

a 

ssIS 1 1 I 1^ 1 


04 

ll 

< * 

« 1 .Ini, 1 • « • • 1 






- 


iai 

1 

a 

®^'-'FHeQNU50»^W®®OJ 



hi 

i B 

ll 

-•I • 

eoi-» 

r-. 

>o 

CO 

O 

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a 

1 

1^ 1 I I 1^^ 1^ 1 

® 

V 


id 

II 

■< ■ 



-pe}«[nooni »on 
asm JO xsqmnfi 

®nnc4ioo4®ia®®<oO’e 

-H -H CO <0 r-«o r-c-o 

•-I 

o 

OD 

asm JO isqmsg 

tieouso®owcOi-Hi-it..O'-= 

•e‘ 


568 

427 

498 

168 

818 

920 

060 

950 

846 

1,087 

947 

970 

947 

A 

lO 

CO 

g' 

Corps. 

3rd Hussars . 

11th Hussars . 

16th Hussars . 

“D” Battery E.H.A. 

2nd Boyal Scots. 

Ist Boyal West Surrey Begiment ... 
Ist Somerset Light Ittfanh^ 

2nd Yorkshire ^giment . 

let Scottish Rifles . 

Ist North Staffordshire Begiment ... 
2nd York and Lancaster Begiment... 

2nd Gordon Highlanders . 

8rd Rifle Brigade . 

Total for whole Army in India, 
inolndiog above . 


Having examined the rosults obtained in the 
several stations, and now seeing the principal results 
in the various corps, with the total for the whole of 
the troops in the command, it must be conceded 
that in the words of the P.M.O. in India, “ The re¬ 
sults obtained are very favourable, and would 
probably have been more so had second inoculations 
been always practised.’’ He adds “ The cases of en¬ 
teric fever which occurred among the inoculated 
men, were in the majority of instances of a mild 
character.” 

The report says finally : “ Other returns received 
show that, among troops proceeding abroad, mainly 
to South Africa, 30,014 individuals were inoculated 
on board ship, and the incidence of enteric fever in 
connection with these will no doubt be forthcoming 

D 












380 The Medical Pbms. ORIGINAL COMMUNICATIONS. 


Ocr. 9, 1901. 


in retams to be forniehed after the close of the cam¬ 
paign.” It is from these that we must next look for 
results which will encourage or discourage many in 
the futui’e. We feel that in Professor Wright’s hands 
the matter will neither be let fall, nor allowed to 
stand still, no matter what the South African reports 
may show. He will persevere and improve his 
methods if possible, and it will be, and is, the dutv 
of each and all to encourage him in this, instead of, 
by carping criticism, stirring up feelings in any 
quarter which may cause obstacles to be placed in 
hie way, thus retailing or stopping the methods and 
the means of investigation which undoubtedly have in 
them great possibilities. 

When these South African reports come to hand 
no fair-minded physician must lose sight of the ques¬ 
tion of diagnosis. Without wishing to cast the 
shadow of a reflection on the capabilities of the little 
army of doctors, who had such herculean tasks 
thrown suddenly upon them; but remembering 
rather the doubts and even errors which occur 
in well-regulated hospitals at home, where eveiy 
appliance, every convenience, every help is at hand; 
v^ere time does not pluck us, distracted, from one 
duty to another; where human endurance is not 
tried almost to the breaking TOint; it must be 
allowed that at the “ front ” amid the turmoil of war 
some errors have crept into the returns, and that 
therefore allowance must be made for these when we 
are and criticising the results of inocula- 

Uon. 

As a prophylactic measure inoculation cannot 
come into any very general use. It is applicable only 
on occasions where there is some gr^t local epi¬ 
demic, or where, as in the Army in India, experience 
shows that a large proportion of our youn^^r soldiers 
are attacked and many lives lost, m spite of the 
most elaborate efforts to combat the spread of the 
disease by gene^ and special sanitary measnreeand 
precautions. Or, again, where an army has to 
take the field in case of war, and where experienw 
has taught, that disease, especially typhoid fever, is 
more effective in reducing its fighting strength and 
impeding its progress, than the bullets of the enemy. 

As has already been pointed out, there is no mora 
splendid field for carrying out the necessary inv^ti- 

f rtions in that and many other subjects than the 
rmy. The civilian medical world would learn 
much on many different subjects, of the very highest 
importance, by a more careful and systematic study 
of the excellent Reports of the Army Medical 
Department than that which is usually bestowed 
upon it* 

A NOTE ON 

STERILISATION OF FLEXIBLE 
CATHETERS BY BOILING. 

By J. BEARD, F.R.C.S.E., 

Bssident Asaistast Medical OfBoer, Union Hospital, Bradford. 

In olden times metal catheters were the only kind 
available, and even now the silver catheter is the 
favourite instrument of some surgeons of eminence, 
and this no doubt from the fact that it can be readily 
sterilised by boiling. 

But there are a great mai^y sui^eons who use 
extensively some form of flexiole catheter, and in 
some cases a well-oiled flexible catheter or bougie is 
the only instrument which will pass through a stric¬ 
ture and into the bladder. 

There are surgeons who object to usings these 
fragile instruments on account of their liability to 
crack and break, and there is the objection that 
flexible catheters, or rather the point of the catheter, 
especially if it be a small one, cannot be felt as it 


is passing along the urethra in the deeper part of 
the perineum. . 

But the real crux is how to efficiently sterilise the 
catheter without destroying it. 

If one uses a strong antiseptic it very soon 
the catheter and renders it unfit for use, and the 
same may be stud of steam sterilisation. 

Many other methods of sterilisation have been put 
forth from time to time, some very good and some 
expensive, but most of them open to the objection 
that they are tedious, cumbersome, or too prolonged 
a process for the busy practitioner. 

I read in acontemporaryjournal,ashorttime aj^, 

of an article which appears in the Centralbl. f 
of Januaiy 19th, by M. H. Hermon, on the^ sterilisa¬ 
tion of silk catheters by means of boiling ^ 
saturated solution of ammonium sulphate, end by 
which means the cathetercould be efficiently sterilised 
without causing destruction of the catheter. 

He says that a very dirty catheter can be sterilised 
in from three to five minutes, but he has tailed them 
for as long as five hours and the^ have still retained 
their polish, the only change which takes place, he 
says, IS that the catheter is rendered softer and more 
elastic, and this he regards as an improvement. 

Now the life of a flexible catheter under the b«t 
of circumstances is but a short one if the catheter be 
in constant use, it soon becomes rough or cracked and 
rendered unfit for use, and one is constantly 
meeting with cases of filthy cystitis in which it is 
unwise to use the catheter a second time if the oi^ 
means of cleaning the catheter be doubtful in its 
result. Therefore the only alternative is to destroy 
the catheter at once, and this becomes a very expul¬ 
sive procedure. 

Now, in face of such facts, if a means of proper 
sterilisation can be found, and that cheaply, itBh(wd 
be tried ; therefore after reading of Hermon’s method 
of bmling in ammonium sulphate I gave it a good 
trial. 

I applied the test to silk-web, elastic gum, and 
the black olivary French catheter or catheter-a- 
boul4. and I found that they all stood the boilmg 
well, but are somewhat softer after long boiling than 
before. . 

I have boiled a lot of catheters of three wrts 
together every day for three weeks, giymg them wm 
two hours up to five hours at one boiling, and they 
seem little worse than when I put them in the first 
dav. 

I proceed as follows t— . , , . 

I wash them through and through with plain warm 
water till it flows through the catheter perfectly cleai. 
I then wrap them all up together in a pie^_ of plam 
gauze, and put them into an ordinary steriliser con¬ 
taining sufficient of a saturated solution of am¬ 
monium sulphate to well cover them, and allow them 
to boil. After boiling I allow the fluid to drmn out 
of them by tilting the dish which I put them on. It 
is as well when they are dry if they are not to be used 
for awhile, to draw them through a sterile piece of 
gauze, upon which are sprinkled a few drops of pore 
olive oil, or they can be taken straight from the 
steriliser and be used, as the ammonium sulphate has 
no' irritating effect upon the urethral mucous mem¬ 
brane. __ 

The Mortality In Forelsn Cities. 

Tax foUov.ing are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several of 
the populatioos:—Calcutta 24, Bombay 62, Madras 119, 
Paris 16, Bruesels 12, Amsterdam IS, Copenhagen 20, 
Stockholm 14, Christiania 11, St. Petersburg 23, Moscow 
30, Berlin 18, Hamburg 13, Breslau 22, Munich SO, 
Vienna 17, Prague 18, BudspPeeth 17, Trieste 21, Borne 
16, Venice 17, Cairo 46, Alexandria 40, New York (in¬ 
cluding Brooklyn) 19, Philadelphia 16. 

e 



Oct. Q . 1901. 


ORIGINAL COMMITNICATIONS. The Medical Peebs* 381 


A NOTE ON THE 

USE AND VALUE OP ANTIVENENE 

IN 

SNAKE POISONING, {a) 

By ALFRED E. PARSONS, M.D., F.R.C.P.I., 

FbjHiolAn to the Bojrel Git; of DabUu HoepiUl end to the Netioiial 
HoepiUl for ConstunptioD, Ireland. 

It is often alleged by those critics who have no 
•ympathy with scientific nr experimental methods in 
medicine, that while snoh investigations have nn> 
doubtedly thrown Hght on the causation of disease, 
they have done little or nothing to cure it Saoh 
people contend that modem scientific medicine has 
destroyed onr faith in the empirical therapentios of 
onr fathers, but it has failed to indicate a mom osefnl 
or rational line of treatment of its own. Its spirit, they 
hold, is mainly dMtmotive, mid shows little or no sign 
of any oonstmetive power. 

Ignoring for the preeent the fact that soienoe mnst 
be pnrsued for its own sake, and not in imy merely ntili- 
tar^ spirit, and also tho enormous braefitB which 
have aocmed to hnmanity in the prevention of dinoaco 
h«n a more accurate knowledge of its mtiology and 
mode of propmfation, we bold tlmt brilliant therapentio 
resnlta have dire^y arisen from scientific investiga¬ 
tion. In snpport ot this contention we may refer to 
the antirabic injections, introdooed by Pasteor, which 
have robbed hvdropbobia of its terrm, or to the oon- 
version of a heavy stnpid cretin, into sm intelligent, 
rational creature by thyroid feeding. Again, lees than 
ten years ago we had to oontend with a mortality of 
40 per cent, in diphtheria, now by the injection of antd- 
^phtheritio senun on the first day of the illnese the 
mortality has been zinced to about 5 per cent. Within 
the last few years serams have been prepared which 
have been need, apparently with marked benefit, in the 
treatment of puerperal fever and tetanus. 

Working on somewhat similar lines Professor Fraser, 
in Scotland, and Dr. Calmette, in Franoe, have en¬ 
deavoured to prepare a serum for use in oases of snake 
poisoning. We have before ns an aooount of a visit to 
the Pasteur Institutes at Lille and Paris, undertaken by 
Staff-Snrgeon Octarins W. Andrews, H.B., R.N. It oon- 
an interesting deecription of the preparation of 
antivenene, and from it we gather the following details. 
The first step in the process oonsists in obtaining a 
sapply of venom. For this purpose a large number of 
the most deadly snakes are kept at the Pasteur Institute 
in a glass house heated to about 27** C. Immediately 
before feeding, ^e animal is removed from its cage by 
Bf izing it just below the head with a oatoh forceps about 
two feet long. The head is now firmly grasped by the 
left hand of the operator, and the foroepe removed. The 
right hand is now free to clean the fangs and to faiili- 
tate the fiow of poison into a watch glass, which the 
aavuitant holds nodemeath them. When the venom 
hsB ceased to fiow a glass funnel is insert^ into 
the snake’s mouth, an egg broken into it and 
forced down the animal’s throat. The venom 
is collected in this way from three or fonr 
different apeciee and thoroughly mixed together. It is 
then drie^ and a 1 per cent solution in distilled water 
made from it. This solution is heated to 72^* C. for the 
purpose of co( 4 ;alatiDg the albumen, which falls down 
as a fiooonlent white precipitate and is removed by 
filtering through a Swedish filter paper. The filtrate 
is oulleotod in sterile flasks and is now ready for inocula¬ 
tion. For this purpose a horse which has failed to react 
to the malleio test tor glanders is selected, and is in* 
jected with a quantity of the solution oorresponding to 
1 mgrm. of venin. Ah abscess forms at toe seat of 
inoculation. It is snbeeqnently opened and dressed, 
and fifteen days after the first inooulation, if the abscess 
has healed, 2 mgrs, are injected. The dose is gradually 
increased from time to time, so that after one year the 
horse resist a doee of 0*5 grammes of venin, that is 

(a) A eritiqae oa an article b; BtaS-Soxseoa Andrews. tf.B., 
B.N., la the Mport of tbe Naval Medical Dei«rtment for the year 

M. 


I to say, an amount which wonld kill twenty-five fresh 
I horses. If the injections be still further pressed, at the 
I end of three years his resistance is doubled, for he can 
stand an amount of venin sufficient to kill ^ty horses. 
However, when a horse pan resist 0*6 grammes of venin 
injected subontaneously he is in a fit state to be bled. 
This is done by inserting a troohar and oannnla into the 

J 'ngular vein under stnct aseptic precautions. The 
ilood is oollectod in sterile glass vessels, and after 
coagulation is complete the serum is syphoned off into 
emul bottles. These, when filled, are sterilised by 
heating them for an hour on three successive dajs to a 
temperature of 60^ C. The antitoxic value of the 
I serum having been determined, the bottles are covered 
with mbb€v caps, ooa^ with paraffin wax, dated, and 
sealed, and are then ready for dispatch to any p^ of 
the world. 

It is easy to demonstrate on the lower if 

they are inoculated with a dose of venom, the curative 
and protective properties of antivenene, and M. Qn4rin, 
assirtant to M. Calmette, is himself a good illnstrsticm 
of its onrative value in the human subject. This gentle¬ 
man was bitten in the thumb of the left hand by a 
venomous snake. Five minutee later 10 o.o. of anti¬ 
venene were injected into the subcutaneous tissue of 
the forearm. For one hoar after the bite M. Guerin 
felt very ill, but subsequently had absolntely no dis- 
oomfort. 

The modus operamdi of antivenene is not very clear. 
That it is not a mfire chemical nentralisation is raoved 
by the feot that if venom and a small quantity of anti¬ 
venene be mixed in vitro the toxicity of the venom is not 
materially diminished, though the same quantity of 
antivenene, if administered tmore the venom, is protec¬ 
tive. M. Calmette, infinenoed, doubtless, by the 
teaching of the French school, explains the beneficial 
! action of antivenene by attribntiag to it the power of 
stimulating the white blood oorpnacles to carry on a 
process of cellular digestion; for M. Calmette holds 
that the destruction of the venom oocnrs only within 
the lenoooytes, and if these be sufficiently stimnlated by 
the uitivenene the miimal will recover. 

In all cases of nrgeniy the antivenene should 
bei injected intravenonriy, as by doing so it manifests 
ite antitoxic properties two or toree hoars sooner than 
if injected snixsntaneoasly. 

M. Calmette recommends washing tiie wound witii a 1 
per oent. solution of chloride of gold, or a one in sixty 
solution of hypochlorite of oaloinm, having first applied 
a ligature above the seat of the wound, but ne deprecates 
the use of the actual cautery or chemioal caustics. He 
objects also to the administnition of aloobol or ammonia, 
but reoommende tea or ooffee, and simple measures for 
promoting the action of the skin. 


INDIVIDUALISM IN MEDICINE, {a) 

By Sir THOMAS BARLOW, M.D., F.R.C.8., 
Ph;iiciAn to University CoUwre Hospital, London, Ac., Ao. 

Students, be remarked, should be impreeied with tiie 
necessity of being able to ooncentrato their whole heart 
and eou on the subject in band, and also with the 
great importance of seif-relianoe. In their professional 
life it wonld be their own personal power of observation, 
^eir own personal experiences, and the reasoned oonoln- 
sions which they had drawn from them, their own per¬ 
sonal skill, whether of handicraft or of that wider 
capacity of the adaptation of suitable means to definite 
ends, which would be called into hourly requisition. In 
a great many of their problems they would be able to 
rely on their lessons and on knowledge derived from 
books, but it was personality which oounted. It was tiie 
power of converting their own observations and dednc- 
tions npon toe acti^ case before them into a definite 
theory as to ite nature, and as to the proper method of 
itAaling with it, that constituted the solid foundation of 
their futore work. He granted that toe preparation 
for their examinations was the first and foremost dnty, 

(a) Ahstrsct of Introdnctory'Addreaa delivered at Uie Opening of 
the Sheffield Medical Sobool, October 1st. ^ 


c 


382 Thi Msdical Pbsss. 


ORJGINAL COMMUNICATIONS. 


Oct. 9, , 901. 


sad stroagly urged them never to miss a lecture or a 
demonstration, and to always remember that the defi¬ 
nitely preeoribed practical work was the most vital of all. 
“ Bat I hope to ^ow," observed the leonirer, *' that in 
everyone of these exercises individnalism can play its 
part. Now there is a type ot stadent who suggests the 
old ntueery admonition: “Shnt your eyes, open your 
moatb, and see what I will pot into it.” He is like a 
prize fowl reared by the modem methods of forced 
feeding, stuffed with food specially prepared for him, 
and in a given time fattened up for the examination 
market and almost bursting with cram-knowledge. He 
is a deadly dull creatnre, both to himself and other 
people, and if be doesn't alter his ways he makes a very 
poor doctor. But if you are to shun the ways of the 
very poor sinus’, who, as I once heard Professor Hnxley 
say, swallows his teacher’s brains and then simply spite 
them np again, bow can you bring in the role of indi- 
vidualism into your very deflate and prescribed 
curriculum ? ” 

Limiting bis remarks to the study of anatomy, physio- 
logy, and materia medica, the speaker gave much advice 
as to the methods for impressing knowledge upon the 
mind. In anatomy, let them make diagrams of their 
own dissections, and keep a journal of what they had 
dissected each day. In phrsiology, let them seise every 
opportunity of making such experiments as were prac¬ 
ticable, and of carefully noting the details, remembering 
that this was the subject which brought into play the 
reasoning faculty more than any other of their early i 
studies. He urged them not to be content with em- | 
piricsl facts, bat to try to get hold of the deductions 
which were to be drawn from the facte. The basis of 
physiology was applied chemistry and physics. Some 
of this was doubtful, hat a great deal of it was clear 
enough and ought to be mastered. The individualist 
differ^ from the smug in that be was determined to 
know what lay behind the facts, and what the facte led 
to, whilst the smug simply accepted them as empirical 
statements to be swallowed. In materia medica he 
advised them to practically acquaint themselves with 
the various drugs with which they bad to deal. There 
was nothing like vtra voce examinations for improving 
their readiness and accuracy of recollection for the cul¬ 
tivation of clear, forcible utterance, and for getting 
rid of that wretched self-consciousnesi which in all its 
protean forms was intolerable in a doctor. Considering 
the work of the young medical men in a hospital, the 
lecturer gave a number of hints as to systematically re. 
cording what they learned from particular cases, and as 
to acqoiring the power of rapid diagnosis in the out¬ 
patient department. Whatever else they did, they 
must never miss a post-mortem examination. When 
once they had said good-bye to the hospital they would 
probably have few chances of verifying or correcting 
their diagnosis in fatal cases. 

"It is net merely,” he added, " for the satisfaction of 
scientific cariosity that you should attend post-mortems, 
nor for the verification of physical signs, but yon nfed 
to attend as many as possible for the sake of acquiring 
a well-ordered store of facts as to the average diseases 
which are most likely to occur in everyday experience. 
The post-mortem room is like a sSeet anchor to the 
good ship clinical medicine, which moors her safely 
amidst the cross-currents of wild nnverifiabie hypothesis 
and transcendental speculation. To an earnest student 
one of the early results of the study of morbid anatomy 
is a state of scepticism as to any gcKxl that tberapeatios 
can do, and for a time he may b^ome a nihilist in treat¬ 
ment. But it is a wholesome scepticism, for it makes 
us realise whst are oar limitations, and how very narrow 
is the fringe within which it is possible for us to modify 
vital processes. And, paradoxical as it may sound, 
the post-mortem room often reveals to ns, even in the 
hoar of defeat, what a long and valiant fight the 
human oi^anism has made against its foes. To choose 
a familiar instance, the revelation of the existence of 
old tnbercnlons deposit in inch a large proportion of 
people dying from varions diseases, so far from making 
ns hopeless, suggests to us the great power of repair in 
the human subject from localised lesions of this kind. 

He expressed his satisfaction at the fact that the 


College was so excellently equipped with the Favell 
laboratory, and with a complete pathological and boio- 
teriologic^ department, ^t them be proud of their 
native town and county. Those shallow folks who vrere 
pleased to sneer at provincialism tittle realised how 
much keenness, concentration, solidarity, and tme 
citizenship existed in the great provincial centres, ee- 
peoially ^oee of the Noi^ of England. They were 
fortunate in the organic union of the three departments 
of that College, and in the hearty co-operation of the 
different hospitals with the medical department. In 
conclusion. Sir Thomas remarked t^t in no calling was 
there a greater likelihood of a fair competency as the 
resnlt of steady, oontinnous work than in the doctors*; 
moreover, the doctor’s life, though arduous, was full to 
the brim of every kind of soci^ and scientific interest. 


MEDICAL STUDENTS AND 
THEIR DUTIES, (a) 

By THOMAS H. KELLOCK, M.D., F.B.C.S., 

Aisistont Surgeon to Middlesex Hospital. 

In welcoming the new students, the opinion was ex-, 
pressed that rarely of recent years has the prospect in 
the medical profession been brighter than at the present 
time. Yarions causes, among them the addition of a 
year to the length ot the cnrriculum, the substitution 
of qualified for unqualified assistants, the war in South 
Africa, the widenii^g fields in the Colonies, and the 
prospect of better conditions in the Army had all their 
share in considerably increasing the value of the ser¬ 
vices of a well-qualified man. 

The advantages to the average man of an education 
at one of the smaller schools were mentioned, chief 
among them being the comparative ease of obtaining 
the resident appointments and the g^reat value and 
recommendation of these in later life. 

The main part of the address was devoted to a con¬ 
sideration of the relations between stndents and the 
hospitals during the time of their pnpUage and after¬ 
wards. Psssing over briefiy the time a student passed 
in the school before commencing practical work in the 
wards and out-patient rooms, and mentioning how im¬ 
portant it is for a stadent to make the beet use of 
that time and to learn well work that he is 
little likely to go back to, and of his getting 
into a good habit of work, it was mentioned 
that in the future it is possible that the time when a 
student begins his practical work may mean for all what 
it now mesms for those who come from the Universities, 
a first introduction to the hospital at all. It is easy to 
forget what past and present stndents owe to the hos- 
pitils, thsenormons snms of money oontribnted to them 
have enabled them, by years of nsefol work, to build np 
such a reputation that they have become the resort of 
the poor directly accident or disease come upon them, 
and they thus pjaoe at the disposal of the stadent a 
large mass of clinical material, and under the best con¬ 
ditions for studying it, one of these being the fact that 
in a hospital a patient consents to and expects a proper 
examination. The hospitals, too, provide the funds for 
acquiring the new and expensive apparaens that the 
progressive medicine and surgery of to-day render 
necessary, and the students get the advantages of this as 
well as the patients. 

What a stadent could do for the hospital in return 
wss considered. By carefully performing hie duties 
when acting as clerk or dresser be ooald not only help 
himself in acquiring knowledge, bnt also help in the 
work of the hospital; it is one important duty of 
stndents at all times to be oarefal of their behavioar 
and conversation to and in front of the patients, in the 
wards, ont-patient and casualty departments, hospital 
patients and their friends are not only observant, bat 
have a propensity for discussion among themselves, 
and the welfare of an institution gains or suffers very 
much by the behavioar not only of those who haxe 
actually to deal with the patients, but of all those wbo 

(a) Abstract of lotroductory Address dslirered at ths Middlesex 
Hospital Medici 8chr>oI on October 2nd, 1901. 


C 


Oci. 9, 1901. 


ORIGINAL COMMUNICATIONS. 


Th^ Midioaii ^mb. 383 


•re prsee&t, oTen if they be only onlookers. To learn 
how to deal with patients is a not nnimportant part of 
a medical edncation, and very often a man’s success, or 
the reverse, when he goes into practice, depends as much 
on this as on his professional knowledge. At the start 
men generally have to deal with patients of a class 
differing little, if at all, from those he has seen at the 
hospital; it is most important, too, that he should have 
at least some experience in the management of chil¬ 
dren and of the parents who bring them. All of these 
be can learn at the hospital, and in learning to do it 
properly he can be of use to the institution. 

The duty of students to their hospital when outside 
its walls is obvious. Clenerations of self-respecting and 
hard-working men have long since dispelled the idea that 
medical students are necessarily ill-behaved or rowdy, 
and those of to-day know very well that by their 
behaviour and conversation they can bring credit or the 
reverse on an institution to which they owe so much. 

When a man has become qualified and leaves the 
hospital to start on the real work of his life, there may 
still be a bond of union between them, closer than that 
which connects him to his school or university—he has 
probably done with the latter altogether, but at the 
hoepital there is always work going on that is of use and 
interest to a medical man, and if he wants to spend a 
few days or weeks brushing up his knowledge there is 
one place above all others to which he should go, and 
that is his old hospital. Students should always make 
welcome in all departments of the hoepital those who 
have preceded them, and who have an equal right with 
themselves to what is to be learned there. A fact that 
is not without its lesson is that qualified men are often 
more interested than the student in the treatment of 
patients, knowing by experience how important this is 
and the rapidity with which they can get their patients 
well is in practice. A correct di^nosis is the real 
scientific foundation, but will not in itself cure the 
patient, although it is everything in directing the 
medical man to what is the correct treatment. 

There must be something very wrong with a hospital, 
its staff, or the medical man himself, if be cannot find 
enough, and more than enough, there to satisfy him 
when he pays it a visit, and to prevent his having re¬ 
source to post-graduate courses and such like, at any 
rate for ordinary medicine and surgery. 

A very important feature in the relations between 
medical men and the hospitals is the practice of their 
patients resorting there for advice and treatment; 
statistics show wlmt a large portion of the population 
go to the hospitals at some time or another, and the 
question as to how many of them are depriving medical 
men of their fees by so doing is a difficult one to decide; 
the majority of the out-patients, for example, appear 
fairly well-^do, decently dressed, and sufficiently fed; 
the very poor and the partially starved are decidraly in 
the minority. Is this because the population, on the 
whole, is well-to-do, or is it also because the very poor 
cannot afford to live and be out-pstients, but have to go 
to the infirmaries if they cannot be admitted to the 
hospitals ? The opinion was expressed that the patients, 
as a rule, made no pretence to be worse off than they 
really are, and that instances of their dressing in shabby 
clothes to obtain admission are very rare. The causes 
that bring such people to the hoepital were considered, 
it can hardly be that they save money by coming, for 
often their travelling expenses, to say nothing of their 
time, mast be more than a visit to a doctor would cost 
them, one of these causes is the great confidence she 
public have in the hospitals and in the potency of the 
medicines given them there, they think their ailment 
is sure to be recognised and the right medicine given 
them. Many medical men have not acquired the art 
of gaining their patients’ full confidence, and they come 
to the hospitals only to see if there is anything more 
than they have been told the matter with them. Often, 
too, patients will submit at a hospital to a more 
thorough examination than they have allowed their 
medical man; in this respect at a hospital we have an 
advantage, and are sometimes able to (uscover the cause 
of an illness, the symptoms of which have for a con¬ 
siderable time resisted treatment. The ways in which 


medical men and the hospitals he of mutual assist¬ 
ance were considered, and if at times the relations 
between them are strained on account of the abuse of 
the latter by patients it must be rembered that there 
are three factors concerned, the hospital, the medical 
man and the patient, and ofton the tendency of each of 
them is to blame the others rather than to try and 
remedy the part of the fault which is its own. 

It is the duty of the authorities at the hospitals to 
keep a very watchful eye on their wards, out-patient 
and special de^tments, and prevent the admission to 
them of unsuitable patients; it is quite possible to 
decline to treat them in such a way as to leave undis¬ 
turbed the relations between them and their medical 
man, especially as they very often apply to the hospitals 
under quite a misapprehension as to the objects of these 
iuKtitutions. 

By working together the hospitals and general prac¬ 
titioners can, and probably do, educate their patients and 
the public generally in such a way as to keep this abuse 
of the hospitals within very fair limits. 


LIFE AND CHARACTER, {a) 

By PaoF. J. W. TATLOB, M.D., M.Sc., F R.C.S. 

Pbofsbsob Tatlor compared life to a journey—“ The 
road winds uphill all the way. Yes, to me very end ”— 
passing on to consider life as a fortone, one which may 
be squandered or spent wisely, and to life as a business, 
adopting Be Tocqueville’s definition, '*Life is not a 
pleasure or a sorrow, but a grave business which has 
been entrusted to our chaise, and which we have to 
carry through to an hononrable end. 

The Introductory, he observed, would mark to many of 
his hearers the acceptance of a special career or destiny, 
the entry on a life work. The manner of following that 
career would probably be of far greater importance than 
the mating of the choice. In dealing with this point 
he said; " It will hereafter be of comparatively little 
importance whether yon are a soldier or a sailor, a 
clergyman, or doctor, or lawyer, but it will matter very 
much whether yon acted as became a wm.n called to the 
duties and responsibilities of the life yon have chosen.” 
Prof. Taylor then spoke of the necessary requirements 
for successful service, a healthy and well-trained body, 
a well-educated mind, and a high mond purpose being 
regarded as essential. Looking back on his own 
ekperience of life, he passed these under review, consi¬ 
dered their relative value, and the instances he could 
recall of gain or loss resulting from their presence or 
their abwnce. Under the bead of bodily health he 
considered, first, lives in which this had contributed 
very largely to success, and, afterwards, lives which had 
been mined by the want of it, especUdly dwelling on 
those which by the incurrence of syphilis and alcoholism 
had come utterly to grief. 

Under the he^ of mental acquirements he considered 
both tie studies involved in medical training and the 
different types or orders of mind engaged as students in 
the pursuit of knowledge, reviewing toe careers of some 
who had done well, and of others who had disappointed 
expectations or failed of the highest in spite of high 
intellectual gifts. 

Under the bead of moral purpose or character he 
spoke of this as being of greatMt value—of the gradual 
perception of its importance as life went on, and of some 
of the more important of those good qualities which go 
to form the ideal physician and surgeon, putting in the 
first place love of ^th, then love of one’s kind, and 
then love of service. 

“ But what if we know that we are wanting P Then, 
Prof. Taylor said, it was necessary to insist'on the gospel 
of time edncation, and especially so, in these days, when 
so much nonsense was scattered broadcast on the sub¬ 
ject of heredity. ’’There is no weakness yon cannot 
grow out of if you set your heart upon it—no strength 
or goodness tliat yon may not aspire to, and in some 
measure attain.” 

Finally turning from the influence of character on 

(a) Abstract of Introdnctory Address delivered at Charing Cross 
Hospital Medical School on October 2nd, 1901. 


C 



384 Tbs Mkokul Pbuh. 


CLINICAL ftECORDS. 


Oct. 9, 1901. 


indiTidnal life. Prof. Tftjlor oonsidered the inflaeooe of 
character on national life. Briefly deecribing a recent 
visit to the Sooth of France, where evidences of Boman 
occopation, aiohiteottire, and life are still plentifol and 
striking, he considered the reasons for the decline and 
fall of Roman power, tracing it to thr decay of national 
character, and asked whether there might not be similar 
dangers in the national character of England to-day. 
He oonolnded as follows:— 

*' Gentlemen, we have been passing, and are still pass¬ 
ing throogh a time of “sifting,” as every time of war 
most be. Older and, as I think, purer Ideals, are again 
coming to the front. We begin to realise that the “ battle 
is to the strong,” and that the real wealth of a nation 
consists not so much in her material prosperity, as in 
the numbers of healthy upright ani manly lives who 
can give themselves to her service, and protect her in 
tne hour of nee^ Such have cot been wanting in our 
recent struggles, men who 

“Never turned their bsbcks but marched breast for¬ 
ward. 

Never doubted clouds would break. 

Never dreamed, though nghtwereworsted, wrong would 
triumph. 

Held we fall to rise, are baffled to flgbt better, 

Sleep to wtdce.” 

But we want more of these, and of this faith or spirit 
which ensures the victory. You who will be the 
doctors and advisers of the future generation, may do 
much by steadily honouring and upholding higher ideals 
of individual, family, and nationsJ life, to infuse a new 
and healthisr spirit into the coming age. For it is in 
the spirit of Browning’s epilogs tl^t the hardest tasks 
ate always accomplished, it is in this spirit that a 
nation may cometimeB be born again. 


Clinical ^ccmrbB. 

THE CASE OF THE LATE PRESIDENT 
McKinley, (o) 

Under the care of Dr. Mstthkw D. Mann. 

Thb President’s case is a striking example of how 
little pain may be inflicted by bullet wounds and how 
little conscious of their infliction the wounded person 
may be. The wounds were received from a distance of 
less than three feet The first penetrated the ab¬ 
domen, wounding only soft tissues, and the 
President seems not to have felt it at all and 
not to have realised what had happened. In 
fact, the shook and p^ of his wounds had thus far 
been so little that he htd to ask those around him if he 
were shot. Within ten minutes after the President 
was shot he was in one of the ambulances provided 
for emergen <7 oases, and was on his way to the 
Emergency Hospital on the Exposition grounds. 
The operating-room, about 12 by 20, though small, is 
reasonably well lighted and is thoroughly business-like 
in its air of absolute simplicity and cleanliness. 

As soon as the President arrived he was pu^ on the 
operating-table, but without removing the stretcher on 
i^icb he had originally been carried to the ambulance. 
This stretcher remained under him until after the opersk- 
tion was completed and served for his retransfer to the am¬ 
bulance when he was moved to the home of Mr. Milbum. 
Dr. Mann arrived at the hospital at five minutes after 
five. The President had bWn wounded at 4‘7 p.M., 
BO that practically an hour had elapsed. Examination 
showed that while the wound in the thoracic wall was 
only a superficial bruise, that in the abdomen bad pene¬ 
trated the abdominal cavity. The President’s condi¬ 
tion was good; there was as yet no rise of 
temperature, the pulse was running slightly over 
100, and the patient was evidently suffering slightly 
from shock. There had been two or more 
almost fainting spells, and one-thirtieth of a grain 
of strychnine was given as a stimulant. A sixth of a 
grain of morphine was administered to quiet some rest 
lessness due to the delay. The presence of a penetrating 
wound of the abdomen seemed to Dr. Mann sufficient 
indication for at least an exploratory laparotomy. 

(a) Complied from American acconnU Just received. 


Nineteen minutes after his arrival, that is, at 6.24 
p.m., Dr. Mann made his incision. The President had 
been given ether while the surgeons’ personal prepara¬ 
tions were making, and be took it very quietly and 
without excitement. The opening of the abdomen at 
once ! disclosed the fact that laparotomy was of vital 
necessity, indeed the stomach bad been penetrated and 
some of the stomach contents were already extravaaated 
into the abdominal cavity. 

An opening was found in the anterior wall of the 
stomach m the neighbourhood of the greater curvature. 
This opening was in the upper half segment of the 
stomach. Its position, small sise, and sharp inverted 
edges, and the contraction of that visons served to keep 
it rightly closed. That on the posterior wall was larger 
and more irregular, but its edges were also inverted and 
the amount of leakage of gastric contents was not large. 

It was about three hours before his wound was 
received that the President had taken his lunch, 
but though so long a time had elapsed the stomach was 
found alMut half fulL The edges of the wound were 
repaired with Lembert sutures. The posterior wall of 
the stomach was then exposed by turning the organ 
upward and backward, avoiding any contact with the 
intestinee, and a wound corresponding to that in the 
anterior wall was found. This was sutured as the other 
one. All extravasation was now at an end. No other 
visceral wounds could be found. There was pracUoally 
no btemorrfasge. The abdomen was thoroughly flushed 
out with sterile normal salt solution. As the bullet 
had not been found during the course of the rather 
lengthy manipulations (the patient was under 
ether about an hour and a half), further search 
for it was deemed inexpedient. Tne appsuent direc¬ 
tion of this bullet was, as has been said, array 
from the median line. There was no danger that 
it had injured the body of a vertebra, as in Gar¬ 
field’s case, and the fact that there was no noticeable 
hsemorrhage seemed to indicate that it bad lodged in 
the muscles of the back, where it might well remain 
without doing any harm. 

The question of using the Ron^en rays to locate the 
bullet was raised, but it was decided umt unless the 
ball gave rise to symptoms of irritation the use of the 
Rontgen rays shoidd be postponed until the President 
was convalescent. 

The President having complained on Tuesday of some 
tendemees in the neightourhood of the wound which had 
not only persisted but increased, it was thought better to 
investigate the cause for this discomfort. A small super¬ 
ficial collection of pus along the edge of the wound was 
foimd to be forming. Dr. Mann called the attention of the 
assistant surgeons to the fact that a small portion of 
clothing had been carried into the abdominal wound. It 
did not reach the abdominal cavity, but was found near 
the bottom of the fatty layer of the abdominal wall. The 
shreds of clothing were removed as carefully as possible, 
but it is a well-known experience that portions of snoh 
material are liable to be left in the wound. This Dr. 
Mann considers to have been the origin of the sopt^osl 
snppuration.tbat was found to exist. The collection of 
pus was evacuated without in any way disturbing ths 
coaptation of the wound edges, and the wound was 
dressed as before. As a result of the relief thus afforded 
the President passed a more comfortable night on Tim- 
day and was in excellent spirits on Wednesday, askisg 
for the paper and wanting to t^lk more than the attend¬ 
ing surgeons considered good for him. Feeding by the 
mouth was begun on IMesday morning and was well 
borne. After Wednee«toy all nonrifbment was 
given in this way, and the rectal alimentation of the 
first few days, which was fortunately always satisfac¬ 
torily retained and absorbed, was disooatinn^. 

Matters apparently progressed satisfactoiUy for the 
next forty-eight hours, when'uneasiness was excited by 
marked cardiac weakness, with hastened, shallow respira¬ 
tion. This rapidly increased in intensity, and on the 
14th at 2 a.m. the President succumbed to cardiac failure. 

At the autopsy both apertures were found perfectly 
dosed by the stit^es, but the rissnee around each 1^ 
he^ become gangrenous. The bullet, after p a s sing 
through the stomach, hit and tore the upper end of the 


C 


Oct, 2, 1901. _ TRAJ^SACTIONS 

kidaey, which wu also gacgrenous. There were no signs 
of peritonitis or visoenU disease. The heart walls were 
Te^ thin. There was no evidenoe of any attempt at 
repair anywhere. 

The revelations the aatopsy on the body of Presi* 
dent McKinley (says the 2f.T. Medical Secord) are deeply 
significant from many pathological and surgical points. 

Taken in connection with the clinical history of the 
case, and the extremely optimistic views of some of the 
constants, the discovery of certain of the lesions named 
M both a surprise and a disappointment. It is a pity 
indeed that such an evident faUure in diagnosis should 
have been to conspicuoualy demonstrated to the general 
public. 

^ The operation of suturing the stomach wounds was 
toely, proper, and, so far as it went, brilliant; but in 
the light of the autop^, we know that the operation, 
carefully conducted as it was, was necessarily an inoom* 
plete one. Time was precious, and prol<mged search for 
the ball was impossible, consequently the condition 
and course of the wound beyond the stomach could 
not be positively ascertained at the time. The 
sni^ns satisfied themselves, therefore, that it was safe 
to leave this terminal wound to itself and close up the 
abdomra. They used their best judgment under trying 
conditions; but, unfortunately, that judgment was in error 

Then came the bulletins, in which it was stated at fi^ 
that the stomach wounds were the only causee for anxiety, 
that the ball having lodged in the muscles of the back 
would become safely encysted, and that septic peritonitis 
from possible leakage of the stomach contents was the 
only thing to be feared. When the latter danger was 
over, there came the surprising intelligence that the 
patient would certainly recover. This in face of a con¬ 
tinued high temperature and rapid pulse! Then it was 
annovinoed that all the wounds had healed perfectly, and 
the only real danmr was centred in a weak heart. Hardly 
had this bulletin been issued when it was announced that 
the external wound was found to be infected, neoessi- 
tating the removal of some stitches. Still it was said 
that the distinguished patient was doing excellently 
well—in fact, even better than before. Next was the 
report of an attack of indigeetioo, claimed to be due to 
food given too soon, and last of all and without warning 
came the appalling accounts of his rapid collapse and 
surprisingly quick death. 

Ihe aotu^ facts of the autopsy seemed to prove that 
the conception of the case was wrong from the begin¬ 
ning to the end. 

Unfortunately, not one of the principal lesions gave 
any evidence of its existence during Ufe. The good 
condition of the wound behind the stomach, of whi<di all 
the surgeons were so pronouncedly confident, was an 
illusion and a snare. What was considered to ^amost 
insignificant factor became the most important of all. 
Instead of the terminal track of the bullet being healed 
and the hall encysted, it was found, at the autopsy, to be 
gangrenous throughout. 

Viewing the strictly surgical aspects of the case in 
the light of the autopsio^ demonstrations, certain 
points of treatment might naturally suggest them¬ 
selves. Everyone knows that such an injury as existed 
in the President's case isalmost uniformly fatal. The most 
favourable result that could have been expected was the 
healing of the wound and the possible establishment of 
a fistula. This would certainly be infinitely better even 
as a tentative measure than accidentally leaving a leak¬ 
ing kidney or pancreas in a closed cavity to work such 
mischief as wai manifested in the gangrenous condition 
of the snrronnding tissues of the case in qu'stion. 

Allowing that the bullet had actually lodged in the 
muscles of the back, also that the missile was within 
easy reach, it would be following a good surgical rule to 
establish drainage by the most direct route posteriorly. 
This course, however, could not be follow^, as the 
bullet, on account of the unfortunate conditions already 
noted, was not accurately located. Under the circum¬ 
stances, therefore, and taking everything into considera- 
tion, it is comforting to note that all was done for the 
distinguished patient that was possible. In fact, as was 
repeatedly stated by the operator, “ the case was a fatal 
one from the stsrt." ' 


OF SOCIETIES. Thx Mxdical Paxss. 385 

‘^raitBattions of goti^tics. 

OBSTETRICAL SOCIETY OF LONDON. 

MxaTlNQ HXLD WlDNXSDAT, OCTOBIB 2 nD, 1901. 
The President, Dr. Pxtbb Hobkocbb, in ihe Chair. 


Specimens. 

LABOE FIBBOMTOHA, APPABBNTLT ABISINO FEOM THE 
BBOAD LIGAMENT. 

Db. a. L. Galabim showed a large tumour, weighing 
over 20 lbs. Before operation, diagnosis was uncertain; 
menstruation had not been affected by the growth. At 
the o^iation the tumour appeared to lie in the meso- 
sigmoid, as both broad ligaments were quite free. The 
blood supply was derived from the mesenteric and 
hemorrhoidal arteries. Dr. Galabin was, however, in¬ 
clined to regard the growth as having orinnated in the 
outer part of the broad ligament, and ss naving spread 
behind instead of in front of the sigmoid. The tumour 
was shelled out and the edges of the cavity wen sutured 
to the abdominal wound. The patient recovered after a 
tedious convalescence. The tumour showed microscopi¬ 
cally a great preponderance of fibrous over muscular 
tissue. 

Mr. Alban Doban said that he bad recently met with 
a case of a small fibromyoma, originating in the meso- 
sigmoid. It was import^t, inasmuch as it demonsfarated 
that these fibromyomata might arise quite indepen¬ 
dently of the uterus. In the case of very large tumours 
like one that he showed at a previous meeting and like 
Dr. Galabin’s^ specimen the position was sot conclusive, 
because it might be alleged that they were originally 
connected with the uterus. 

Dr. William Duncan referred to his practice in deal¬ 
ing with broad ligament cysts and fibroids, which was 
to unite the walls of the sac and close the abdominal 
cavity alt(^ether. The convalescence was mote rapid 
when this plan was adopted. 

Dr. Galabin also «howed a uterine fibromyoma with 
sarcomatous degeneration. Abdominal hysterectomy 
was performed, under the idea that it was an ordinary 
fibroid, but microecopioal examination showed the 
presence of sarcomatous titsue. It was a question 
whether the sarcoma was a primary condition or a 
degeneration of a pre-existing fibroid tumour, ^e 
operation was done last March, and although (he cervix 
was left behind, the patient had so far remained in good 
health. ® 

The Pbxsident said that he saw no reason why a 
sarcoma should not develop in a fibromyoma just as 
readily as in the uterus priinarily; for uterus and flbro- 
myoma contained precisely same histological 
elements. 

FATAL CASE OF LABGE UNOPEBATED OVABIAN TUMOUB 
COMPLICATING PBBGNANCT. 

Dr. Hbbbxrt Spenceb showed this specimen. The 
patient had been known to have an ovarian tumour for 
two or three years, and when she became pregnant t 
had attained an enormous size. She would not consent 
to operation either before or after she became pregnant. 
She went through her labour without drawback, but 
three or four days afterwards the cyst ruptured and she 
became profoundly collapsed. She was at once trans¬ 
ferred to Univerbity College Hospital on an ambulance, 
but died on arriving there. Pos'-mortem examination 
showed that the tumour could have been removed with 
ease either before or during pregnancy. The case 
formed an argument iu favour of operation on all large 
ovarian tumours during prrgnancy. Such cases had a 
special tendency to rupture within a few days after 
delivery. 

BXCONDABT H^HOBRBAOE AFTEB INTBA-PEBITONEAL 
HTSTEBXCTOMT. 

Dr. William Duncan showed a uterine fibromyoma 
removed by hysterectomy. The feature of interest in 
the case lay in the complication. He always made a 
{special point of getting the stamp free from ooxing 
before suturing the flaps; in this case the operation was 

C 


386 Thx Msdical I'Bua. 


G E B M A N T. 


Oct. 9, 1901. 


done in the morning, and ererything appeared to be 
satisfactory; bnt in the afternoon he was sent for and 
fonnd that the patient was passing clots from the 
vagina. He packed carefully with ganse and the patient 
made a good recovery. He thought the case illustrated 
tbe importance of having a free passage through the 
oervicsd canal in the stump. 

Dr. F. J. McCann suggested that in a case of second¬ 
ary haemorrhage after an operation of this kind it would 
be ^ood treatment to remove the stump through the 
vagina. 

jh . William Duncan also showed a papillomatous 
broad ligament cyst. 

Dr. H. E. Andbiws showed (1) a flbro-sarcoma of the 
ovary; (2) a melanotic sarcoma of the ovary. 

Dr. T. 6. Stevens remarked that the microeoopioal 
appearance of the second case was suggestive of carci¬ 
noma rather than sarcoma. 

LEUEMMIA AND PRBONANCT. 

This ^per was read by Dr. O. Ebnbst Herman, who 
reported a case of pregnancy with lenkcemia. He had 
only been able to find twelve cases hitherto published 
as »nch. Critical examination showed that in five of 
these the evidence of leukiemia was deficient. They had 
therefore only eight cases from which to draw conclu¬ 
sions as to the mutual influences of pregoancy and 
leukeemia. These eight cases agreed in the following 
points : 1. The presence of an enlarged spleen and liver 
caused patients with leukemia to suffer more from the 
abdominal distension of pregnancy than healthy women. 
2. The symptoms of leukemia were aggravated during 
pregnancy. 3. In pregnancy with leukemia there was a 
great tendency to abortion or premature labour. 4. Death 
sometimes quickly followed the termination of preg¬ 
nancy with leukemia. 6. If the patient survived the 
termination of pregnancy great improvement took place. 
The author concluded from these facts that in pregnancy 
with leukemia tbe induction of premature labour or 
abortion was indicated as a therspeutic measure. 

Dr. Amand Eouth said that he had tried some time 
ago to find some information on the combination of 
leukemia with pregnancy, bnt with only a small measure 
of success. As Dr. Herman had remarked, tbe com¬ 
bination was one of a blooi-dysoraaia with a condition 
causing pressure, by the presence of a large spleen. It 
was, therefore, different from ordinary blo^-dyscrasias, 
such as bemophilia, and also from conditions causing 
simple pressure, such as tbe presence of an ovarian 
tumour. He would like to ask Dr. Herman what was 
the effect of leuksemia on the fcetns in utero. A good 
deal had been written on tbe transmission of diseases 
to tbe foetus ; and it appeared that a process of filtra¬ 
tion could be effected by healthy chorionic epithelium, 
whilst a diseased epithelium would allow of the trans¬ 
mission of disease. He'agreed with Dr. Herman’s oon- 
clnsion that labour should be induced when symptoms 
began to threaten, without waiting for serious de¬ 
velopments. 

Dr. Galabin said that he bad come across one case of 
leucocytes with enlargement of the spleen, associated 
with pregnancy. It was not, however, when he first saw 
her a typical leuksemia, because tbe number of white 
corpuscles was not greatly in excess of tho normal. He 
treated her with strychnine and arsenic. He saw her 
again when she was three months pregnant, and she 
then declared herself better; the spleen bad diminished 
in size. Tbe combination was new to him, and he 
expressed the opinion that pregnancy might be allowed 
to proceed. Soon afterwards she went abroad, and the 
view taken by those who saw her later was evidently 
that labour should be induced, bnt she died undelivered, 
apparently from btemorrhage. after the induction had 
been commenced. 

The President remarked that tbe condition was so 
rare that probably most of them had had no experience 
of it. He was struck by the verv slight amount of 
bsemorrhage in the cases recorded in the paper, for 
they were taught that leuktetnia was specially associated 
with hsemorrhage. Perhaps in some of the cases where 
death followed ^livery, in which the cauase of death was 
not stated, it may have been due to intern i orrhage. 


Similarly the tendency to abortion in these cases might 
be due to haemorrhage into the membranes. If this 
happened some time before the expulsion of the foetus 
there might be time for coagulation to take place, so 
that there was not much haemorrhage at the time of 
delivery. 

Dr. Herman, in reply to Dr. Hoirocks’ question, said 
that in one of the cases recorded the condition of the 
foetus was noted, amd it was fonnd to be perfectly 
healthy. With r^erence to the President's remarks, he 
did not think that baemorrh^^ was a common featore 
of these cases; for the patiento did not menstruate pro¬ 
fusely, and they did not suffer from poet-partum 
haemorrhage. 




[from our own CORREBPONDEHT.] 


' Bsuix, October Sth, 190L 

Tbe Cbl. f. Cynsek., 26/1901, has an article on 
The Treatment of Pruritus Volvac, 
by Dr. L. Sieborg. The anaesthesia produced by infil¬ 
tration auid tbe observation that after extensive injec¬ 
tion of physiological solution the skin over the site of 
the injection remains without sensation, or at least with 
its sensibility mujb reduced, led tbe author to try the 
method in the treatment of pruritus of the vulva, peri- 
naeum, and region of the anas. His point of view is that 
pruritus is a secondary disease kept up by constant 
scratching and rubbing. The urine is first examined 
to ascertain whether it coutaina sugar. In general he 
regulates the diet and forbids alcohol and spices. He 
recommends daily exercise and enough of it to induce a 
sense of fatigue and need for sleep. Patients should 
avoid too much rest and being alone, so that they may 
not be able to soratob at pleaanre, and ebott nails are 
recommended. Morniog and evening the patient 
should wash for about five minutes with soap 
and cold wat^, and through the day after every 
evacuation of the bladder. Carbolic washing is nsefol. 
An ointment is also recommended composed as follows: 
cocaine 2*0, ortboform 1*5, menthol 0'5, acid carbolic, 1*0, 
vaseline 20 0, and to be used whether there is abrasion 
of the muoons snrfaoe or skin or not. Patients should 
always have their ointment at hand, so that they may 
never be without the means of relief, and be therefore 
driven to relief by scratobing. Tbe fissures are best 
treated by painting with a 10 per cent, solution of stiver 
nitrate, after which they heal rapidly. In tbe evenieg 
a strip of gauze, spread with tbe above-named ointment, 
is placed over the affected parts, and over this a thick 
pad of wadding, and kept in position by a T-bandage 
firmly put on. Tbe pressure gives relief, and the patient 
canuot well get under the parts to scratch. If tbe 
disease has become chronic, and the skin is intact, he 
uses the following mixtnre: spir. rusoi 60 0, acid salicyl. 
0'6, resorcin I'O, painted on after the usual washings. 
As the mixture bums and smarts, it is well to 
paint on a little cocaine before applying it. It has a 
lasting, and therefore curative, effect. Along with the 
above tbe author has also used subentaneona injections, 
first of all with weak solutions of cocaine and carbolic 
acid; since then he bos learned that the effect is due 
not so mneh to any particular drug as to the quantity 
of fluid injected, and he now injects up to a third of 
I a litre of physiological solution. He uses for the pur- 
^ pose a hollow needle and irrigator, and injecti in 


Oct. 9. 1901. 


AUSTRIA. 


Ths Hidical Pkxsb. 387 


TarioQs spota antil there is a considerable elevation of 
the skin. 

The Htoienio Objection to Excess of Smoke. 

Prof. Babner has an article on the snbject in tbe 
rifTfeljahrich. f. tjerichll. m«d., 21/2. The professor says 
that the nndonbtedly injarioos effects of ezceesive 
^nantitiea of smoke in the atmosphere are doe to the 
various properties of the smoke. It is qnite a mistake 
to imagine that tbe bad effects are doe to the quantity 
of coal dust or soot in tbe smoke. From carefal inves¬ 
tigation it has been shown that tbe deposited 
mass consists only partly in carbon. A great many 
other snbstances are present, snch as carbo-hydrates, 
products of combustion snch as pyridine bases, phenol, 
but especially acids. In tbe deposits of soot 9 per cent, 
of snlpbnric acid and 7 per cent, of hydrochloric acid 
have been found. Tbe gases that escape from the 
chimney free from smoke contain the last-named adds. 
But the acids which would generally escape into the air 
condense on the particles of soot, and as these fall they are 
brought into the stratum of air that serves for respira¬ 
tion. Tbe action of the soot is not limited to the region 
through which thick masses of smoke are seen to be 
driving, bat particles, mostly invisible to tbe caked eye 
are pouring down from it. In addition to the above 
there are a number of tar products. With good stoking 
most of these products are completely consumed. The 
products of combustion and tbe tar products in con jonc- 
tioD with the acids are tbe substances that have the 
most injurions effect on the respiratory passages. These 
strongly smoky atmospheres may set np catarrhs and 
prevent or delay convalescence from snch complaints, 
Tbe smoke penetrates through closed windows and 
doors, and its bad effects are not confined to those out 
of doors. Imperfect combustion leads to tbe formation 
of carbonic oxide, and this was shown to be present in 
an atmosphere heavily charged with smoke. The de. 
velopment of smoke in towns is undoubtedly the cause 
of town fogs, which have different characteristics from 
country fogs. Tbe town fog is injurioas for all plants* 
tbe country fog is harmless and easily dispersed- 
Town fogs in the large cities are increasing in propor¬ 
tion to the increased oonanmption of coal. When a fog 
comes on there is a concentration of all tbe harmful 
substances. The town fog, whether lying high or low, 
does this harm, also that in the winter months especi¬ 
ally as it shuts ns off from the sunshine, which is an 
important health-giving element. 

Septic Endocarditis. 

Prof. Lenbartz, Hamburgh, believes in a chronic 
septic endocarditis which has nothing to do with rheu¬ 
matism, but is caused by the known excitors of septic 
disease. The diagnosis can be determined with some 
certainty when a murmur is heard. If fever is present 
along with a murmur, and it is known that no murmur 
was present before the illness, and if along with these 
there is enlargement of the spleen, there is a probability 
that valvular disease of a septic origin is present. The : 
prognosis is grave, and most cases end fatally. 

Treatment, according to the professor, affords no 
prospect. There is no specific for the various 
microbes. Marmook's serum in all cases in which tbe 
disease was proved to be due to streptococons, left him 
completely in the lurch, and even appeared to do harm. 
As long as no specific is known the case must be treated 


symptomatically, and everything must be done to keep 
up the strength and invigorate the heart. From internal 
remedies such as pbenacetine, salicyl, and antipyrine, 
quinine, no good result was obtsdnable. 

Jlustria. 

[from oub own oobresfondent.] 

ViBKBA, October 6th, 1001. 

Public Analtbis. 

Till a very recent date the town of Cracow was with¬ 
out a public analyst, which was looked upon as a danger 
j to its milk supply. Strange to say, last year’s report 
gives 84 (2*9 per cent.) cases of milk examinations out of 
a total of 2,841 with nothing to be found wrong. Of the 
total number examined, 1,016 oases (36 per cent.) had 
nothing to find fault with. The milk taken at the 
farms was not found to be any better than that in 
the milkshops; 36'4 per cent, of tbe whole was bntter, 
but nothing abnormal was discovered; margarine was 
forty-nine times examined, bat nothing found wrong. 

At tbe Cracow medical meeting Bnjivid gave the 
members a concise report of many experiments he had 
carried out in the laboratory with the object of con- 
vinoing himself whether tuberculosis was transmitted 
from tbe cow to man or whether it was not. His experi¬ 
ments, he said, were no new matter to them, as he had 
often on previons occasions repeated them, owing, no 
doubt, to the length of time experiments for a genuine 
test for milk had been goiug on. Our mycology demands 
proof in other animals. Now the frequency with which 
these animals have been operated on with abortive 
results lead first to a considerable amount of scepticism as 
to the microbe being tuberculous at all. He said that he 
had injected thirty animals with tuberculous milk, and 
had only succeeded twice in producing tuberculosis. 

Again, if it be conceded that 60 per cent, of tbe cows 
aro tubercnlons as diagnosed by taberoulin, the per¬ 
centage of animals affected after injection would be 
very small indeed without farther testimony. After six 
years’ experiments he was not confident that tnberon- 
losis was induced by milk, neither would he assure the 
meeting that it could not be 

Ttphdb Exanthehaticus. 

Typhus in Austria has been on the increase, but this 
most be taken relatively, as Galicia still claims a large 
number of victims. In 1899 there were 6,055 deaths re¬ 
corded for the Empire, of which 5,941 were for the 
province of Galicia alone. In the same year there were 
3,966 cases of small-pox in Galicia, while only 127 cases 
were reported from the remainder of the monarchy; 
thus the proportion would stand as 8,623 to 51; in 1895 
the proportion was as 6,291 to 67, showing that the 
other provinces are improving. 

Cancer is also very prevalent in this province, as the 
report of 1900 gives 1,487 deaths, or 2'4 per 1000. In 
previons years these nnmbers appear to be still greater, 
as 1891 gives 1,616 deaths; 1892, 1,479; in 1893, 1,625, 
or something about 2*4 per 1000. 

Pasteur Institution. 

Following a petition to the provincial committee the 
Government have ordered the erection of a Pasteur 
Institute for the reception and treatment, according to 
Pasteur^ method, of all rabies oases nnder the direction 
of Professor Bujivid, of Cracow. 

Di." ''zed by Google 


388 The Midical PBiat. THE OPERATING THEATRES. 


This is the oatoome of » discussion that arose during 
the sitting of the Polish Congress this year, when it 
was asked why patients suffering from rabies had to 
bo taken to Vienna, Berlin, or Paris ? Could the Govern, 
ment not provide for the treatment in the province P 
IjIOatubb op Splibn. 

Balaoesen has just recorded his experiments on the 
vessels leadiog to the spleen of animals. In all 
when the ligature was applied to the gastro-duodenal 
artery gangrene of the spleen was the result, with sub¬ 
sequent death in most of the oases. In those that did 
recover the toxic effects were very great, while the 
spleen rapidly atrophied in a few days. If only one 
artery or one vein were out off the organ made strenuous 
endeavours to establish a collateral supply by sending 
out connections to the abdominal walls in the form of 
adhesions, and thus minimising the atrophic process. 

PxBMiimTrvB Intbstinal Btbpbpsia. 

Strassburger at the last Congress drew attention to 
a form of dyspepsia very intractable to the ordinary 
treatment, which he has taken the liberty of designa¬ 
ting fsrmhntative dyspepsia. 

For many years past he has practised the analysis of 
the feces. With a light, easily assimilated diet there 
should be no trace of fermentation. When fermentation 
is present the nutritive value is greatly reduced. This 
is still more emphasised if the carbohydrates pass un¬ 
changed, as it indicates an insufficient change in the 
alimentary oansL This fermenting power of the feoee 
with pain about the umbilicus is a diagnostio sign of the 
malady. 

Ewald thought that very unsatisfactory results would 
be obtained from this test even on the patient. 
With the microscope the unchanged starch grannies 
could be found which would be more important than 
fermentation. In addition to this a large quantity of 
muscular fibres would be present to confirm the dia¬ 
gnosis. 

Bosenheim acknowledged the scientific worth of 
Schmidt and Strassbu^ris test, but feared their prac¬ 
tical value was remote. 

In the tables given for our guidance the difference 
was too minute to indicate patholc^oal changes. Again, 
the teat diet proposed is not sufficient, as many patients 
digest milk badly in health,’whioh would lead to error 
in disease. 


0ptrathtg ‘^kwtres. 

GUY’S HOSPITAL. 

Ofbbation fob Pbactubb and Dislocation of thb 
Hukbeus.— The patient operated on by Mr. Abbuth- 
NOT Lani had suBtained a fracture through the upper 
limit of the shaft of the humerus accompanied by a 
dislocation of the head of the bone forwards out of the 
glenoid cavity. The woman was seen by two medical 
men who dit^^osed the condition, and did the best 
possible under the circumstances. She came under Mr. 
Lane's care some months after with a very limited 
range of movement of the arm, and complaining greatly 
of the pressure exerted by the displaced head on the 
axillary vessels and nerves. A radiograph showed that 
the fracture was as diagnosed originally, and that the 
upper fragment had united at a somewhat abnormal 
angle. The greater part of the deltoid was turned 
down, and tho glenoid cavity was defined after 


Oct. 9, 1901. 

the fibrous tissue which occupied the space had been 
removed. The upper end of the humerus was freed 
from the parts which surrounded it and placed in 
the glenoid cavity in a satisfactory working relation 
ship to the shoulder girdle, where it was retained by 
sutures. 

Three weeks have now elapsed since the operation, 
and the patient has already got a fair amount of move¬ 
ment in the part. 

CHELSEA HOSPITAL FOE WOMEN. 

OVABIOTOMT FOB MCLTILOCULAE CtSTOUA. — Dr. 

ABTHDEGiLiBoperatedona woman,8Bt.48, who presented 
the following history:—She had been married twenty- 
one years and had not been pregnant; the menopause oo- 
ourred at the age of forty-five and a half. Eleven months 
before admission she noticed she was getting stout 5 
she began to suffer from epigastric discomfort and 
imagined herself pregnant, especially as she had morn¬ 
ing sicknees for some months. She supposed that the 
quickening occurred five months later, and made all the 
usual preparations for her confinement When the time 
for delivery came and labour did not ensue she sent for 
her doctor, who expressed a doubt as to the existen oe of 
pregnancy, suggesting that the distension was due to a 
tumour. On ex a mi nation the abdomen was found 
entirely distended by a i^stio swelling, which bulged 
out considerably at the flanks, and was dull on 
percussion all over. Vaginal examination showed that 
the uterus was small and pushed back by a swelling in 
front of it. The cervix was of normal consistence and 
small. The di^^osis was that of a multilocular ovarimi 
cyst. Operation was advised and carried out On 
opening the abdomen the cyst proved to be multi- 
loonlar. The contents of the loculi varied considerably, 
being dark and viscid in some, light and limpid in 
others; the total contents measured about twelve pints* 
There werenoadhesions and the pedicle was secured in the 
usual way, namely, by transfixion and ligature with silk. 
The abdominal wound was closed in three layers. Dr. Giles 
said that the history of the case was interesting because 
whilst a spurious pregnancy with phantom tumour 
was not very rare at or near tho menopause it was very 
unusual for an ovarian (^st to simulate pregnancy 
three years after the menopause. The supposition ^ 
pregnancy rested upon the patient's own analysis of her 
sensations, coupled with the abdominal enlargement and 
the ocourrenoe of morning sickness; a priori pregnmioy 
was unlikely, inasmuch as the patient had been sterile 
during twenty-one years of married life, and bad 
passed the climacteric by nearly three years. This 
spurious pregnancy, he pointed out, differed from 
that associated with phantom tumour in that there 
was no mimic labour such as might occur in the 
latter condition. On making an examination the 
physical signs rendered the diagnosis easy ; it 
was, however, instructive to remember that a 
doubt might arise as to whether a woman of 
forty-eight was pregnant or bad a tumour; but in 
the case of many unmarried women the ounditions were 
more easily mistsdien for one another, whilst a true 
diagnosis would necessarily be of paramount import¬ 
ance to the patient, as her reputation as well as her 
health would be concerned. A patient with a tumour 
would not try to deceive her medical attendant into the 
-belief that she was pregnant, though the converse 
D;- ‘ ^ed t- 





might happen. From these dicta Dr. Giles remarked 
that it was clear that the examination of physical signs 
was of the greatest importance, whilst the symptoms 
as related by a patient were of comparatiToly subeidiary 
Talue. 

Three weeks after operation the patient had left 
the hospital after making an excellent recorery. 

BsoDraasD roa raAHSiilssiotr Abboad. 

^h£ frtBg mb Ctrmlar. 

Published arerj Wedneedarmoniioa, PtieeSd. Pest tree. Bid. 
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PoB On lasBBTiOB Whole Psfe. P6 Oa. Od.; BmU PafSi 
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lasertioas (weekly or tortnichtlj) at 48 8s. 0^} flt^*two 
insertions (weekly) at 48 eaoh. Half Pace, thirteen insertlont 
at SSs.: twenty-eiz at SSa: fifty-two insortioiia at 80e. eaohi 
Qnarteri«C*> thirteen insertions at 18a twenty-eiz insertions 
at 18 b. I fifty-two insertiona at 15a each. 

SniaD anaonneenieBts of Fiaeticea, AsBlstnneiea,VaoaBeiea, Books, 
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beyond. 

- — 

JRtbual fxtBS attb Circular. 

*' BALDS POPDLI BUPBIMA LIX.” 


WEDNESDAY, OCTOBER 9, 1901. 


THE REFORM OF THE ARMY MEDICAL 
SERVICE. 

Thi ornate and comprehensiTe report of the Com¬ 
mittee has now been pabiisbed, and it affords evidence 
of a sincere desire on the part of those who were 
entrusted with the task to obviate the shortcomings 
which have virtually brought this branch of the 
Service into astate of bankruptcy and to reorganise the 
Service on a footing which, it may be hoped, will 
prove acceptable to medical men of a stamp likely to 
do honour to the army of which they form so essen¬ 
tial a part. In discussing the scheme, for it must be 
home in mind that it is only a scheme, that is to 
say, a series of mere recommendations, we are con¬ 
fronted with the drawback that we have no gua. 
rantee that it represents even approximately the 
schedule of conditions to be ultimately offered. 
The lay press has welcomed the report with 
a chorus of pi-aise, and affects to believe that the 
“ concessions ” are as handsome as could possibly be 
wished. So they may be, but a lay opinion is here 


of promotion by seniority stands self-condemned, 
bad anywhere, it is simply absurd when applied to 
men whose value depends exclusively on their tech¬ 
nical skill. The alternative is a somewhat alarming 
array of examinations—a form of competition which 
will revolutionise the Service and cannot fail 
to eliminate those whose heart is not in their 
work. These examinations will act as a powerful 
stimulus to continued study, and, if properly or¬ 
ganised, will effectually combat the intellectual 
lethargy which, in times gone by, fell upon members 
of the Service under the chiUiug influence of official 
routine. The introduction of the civil element into 
the proposed Advisory Board should go far to infuse 
a modern scientific spirit into the administration and 
to secure reasonable scope for energy and indi¬ 
viduality. However admirable this part of the 
scheme looks on paper its success in practice must 
necessarily depend upon the aptitude of the men 
who are appointed and upon their ability to enforce 
their recommendations. The weak point, indeed, 
seems to be that the Board has only “ advisory ” 
functions, and with a headstrong Secretary of State 
for War its well-intentioned suggestions may prove 
as sterile as others have done in the past, even when 
endorsed by Royal Commissions. It follows that 
unless the Government is animated by a spirit for 
which nothing in ^ihe past has prepared us, 
the substitution of an Advisory Board 
a Director-General may turn out; to be merely 
a shuffling of the cards. Looking at the report from 
a broad general standpoint, we are sanguine that if 
carried into practice in the spirit in which it has been 
conceived, it bids fair to secure adequate represen¬ 
tation of the most advanced medical and surgical 
thought and experience of the day, and the pro¬ 
visions aim at securing a periodical supply of fresh 
blood, As soon as the scheme is crystallised into a 
Royal Warrant the problem will have to be faced of 
placing the Army Medical Corps on a numerical 
basis in keeping with present and futni'e i*equire- 
ments. It is indeed expressly stipulated that the 
Board shall prepare and snhmit to the Secretary of 
State a scheme for the expansion of the Service to 
meet the needs of war or serious epidemics. We 
cannot doubt that the conditions of service, as modi¬ 
fied in the scheme before us, will, if adopted, attract a 
fair proportion of candidates, although the prospect 
of a long vista of examinations may prove distaste¬ 
ful to many who would otherwise be tempted to take 
up this branch of practice. It would, however, be 
unduly sanguine to expect that the traditions of un¬ 
popularity associated with the Army Medical 


without much weight. Experience alone will show 
whether the conditions of service have been framed 
on such lines as to commend themselves for accept¬ 
ance by those whom they are designed to satisfy. 
One of the great aims of the Committee has been 
to bring the Army Medical Service into closer and 
more sustained relations with the profession in civil 
life, and therein, unquestionably, lies an element of 
success of considerable importance. The princip'e 


Service will forthwith sink Into oblivion. The 


rehabilitation of the Service will take time, and any 
lack of sympathy on the patt of those in power will 
certainly jeopardise the ultimate success of the re¬ 
forms. We gladly recognise the conscientious 
manner in which this all-important subject has been 
dealt with by the Committee, and we sincerely hope 
that their labours may prove the turning point 


a long chapter of mismanagement. 

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390 'Ihs Medical Tbebs 


LEADING AETICLES. 


Oct. 9. 1901. 


EADIOGEAPHT AND THE MEDICAL PKO- 
FESSION. 

Ths rapid development of Eontgen ray diagnoaia 
haa placed that art npon an aaeared basia and raiaed 
many queationa that have a direct bearing upon 
medical and aurgical practice. Improvements in 
apparatus and in methods have brought every part 
of the body within range of the X-ray operator. 
Many obscure points, not only in medical but also in 
aurgical diagnoaia, may be cleared up with the aid of a 
Eontgen ray examination. Nor can it be doubted 
that in the course of time proreaaea will be eo 
perfected as to bring this weapon of accurate 
diagnosis within the rfach of every branch of 
medical practice. As things stand at present 
many of the ezuminations can be undertaken and 
the result properly interpreted only by an expert 
radiographer. It goes without saying that the ideal 
operator should possess a full knowledge of the facts 
of anatomy, both normal and pathological. Without 
such training it is impossible for him intelligently to 
manage a case so as to bring into due prominence the 
points to be investigated. The distortion due to 
alteration of relative position of the focus 
tube and the parts under examination, for 
instance, could hardly be appreciated at their 
proper value by any but an anatomist who 
had studied the subject from the standpoint of the 
practical radiographer. Clearly no one else would 
be able to speak with authority in the witness-box 
either for or against the presence of such fallacies, 
for the whole subject would be Greek to the non¬ 
medical operator. Then, again, in the case of result¬ 
ing injuries to the patient from X-ray dermatitis 
the responsibility of the medical man who employed 
an unqualified person to take the radiogram would 
be that of a principal. On the other hand, if he 
entrusted the application of the Eontgen methods 
to a medical confr^e the latter would bear 
the responsibility, and no British jury would 
convict him of malpraxis if he could show he 
had taken raasonable precautions. Indeed, from 
every point of view the employment of skilled medi¬ 
cal radiographers appears to be the right and reason¬ 
able course for the profession to pursue. So strong 
is the feeling upon the point in America that it has 
been currently reported that the Eontgen rays were 
not used to locate the assassin’s bullet in the case 
of the late President McKinley because the only 
available operator was a layman. Whether that 
rumour be founded upon fact or otherwise it 
serves to illustrate the existence of a growing 
sentiment in that direction among American sur¬ 
geons. If ever there were a new branch of medical 
diagnosis that ought to be kept in the hands of the 
medical profession it should surely be that of the 
Edntgrn ray investigation. That course is indicated 
by tbe highly technical nature of the work, by com¬ 
mon prudence in tbe after-protection of tbe practi¬ 
tioner, and in some cases even by mere concidera- 
tions of delicacy in the handlirg of many kinds of 
injury and disease. Yet experience shows that a 


vast deal of this kind of work is entrusted to instru¬ 
ment makers and photographers. Unfortunately, 
the history of medicine is full of such abandon¬ 
ments of legitimate claim. If we take the single 
instance of the electrolytic destruction of superfluous 
hairs. This useful little cosmetic operation has drifted 
almost entirely into the hands of advertising indivi¬ 
duals who possess tbe medical qualification. In this 
way many thousands of pounds are lost annually to 
the medical profession, who allow the exercise of a 
legitimate and purely surgical procedure to pass into 
extra-professional quarters. The remedy is clearly to 
obtain a reasonable amount of protection against 
unqualified practice alike in the interests of the 
public and of tbe medical profession. Now that 
the election of Direct Eepresentatives for the. 
General Medical Council is about to take place 
it would be a good opportunity of learning the 
views of candidates as to the best way of dealing 
with unqualified competition. With the present con¬ 
stitution of the Conncil, however, it seems ahuMt 
hopeless to look for any initiation of reform in that 
direction. Tbe increase of Direct Eepresentatives 
and reconstitution of the methods and powers of 
the Council lie at the root of this as of most other 
desirable changes in the medical world, and should 
claim the earnest attention of every voter in the 
forthcoming election. 

JCfltcs on (itumnt 

Sm ilin g as a Cure for Melancholia. 

A Transatlantic specialist in mental disease 
calls attention to the reflex effect of facial expres¬ 
sion in mental disturbances of a melancholic type. 
He asserts that just as the state of mind is reflected 
on tbe features, so, conversely, the contraction of the 
facial muscles reacts on the mental condition. If 
the risorins muscles are called into action, producing 
the simulacre of a smile, the trend of the thoughts 
is thereby changed and melancholy departs. So 
long as you laugh you cannot cry, such is his 
maxim, and he states that considerable experience 
has convinced him of the efficacy of this method of 
treatment All that the melancholic patient has to 
do, when he feels “ the blues ” coming on, is 
to curl up the comers of his month, and 
forthwith his drooping ipirita will revive and 
bis humour change. He invites incredulous 
readers to try the experiment on themselves and 
impartially to note the effect. Seeing, however, that 
mental depression is usually due to some organic or 
functional disturbance, dyspepsia or impaired cere¬ 
bral circulation, that is to say, cerebral amemia, we 
must confess to a certain scepticism. No doubt tbe 
reflex is prompt enough in the normal, healthy 
subject in whom the mental condition is merely the 
reflection of environment or circumstances, but we 
doubt the efficacy of the procedure to obviate the 
effects of some underlying circulatory or other dis¬ 
turbance. It may do for a Mark Tapley to turn up 

tbe comers of his mouth with an irrepressible deter- 

D: 


Ocr. 9, 1901. NOTES ON OUBBENT T0PJC8. Thi Mbdical Pbiss. 391 


mination to be jolly nnder adveree circamBtaiices, but 
it is precisely tbis determination to be jolly which is 
wanting in the individuals who suffer most from 
mental depression. 

Boracio Aoid as a Food Preservative. 

Sajtitast authorities very properly view with die* 
trust the addition of so-called preservatives to articles 
of food, but considerable difference of opinion 
obtains as to the actual effects attending their 
ingestion in food. The researches recently carried 
out by Dr. J. Eister, of Berlin, on the physiological 
effects of boracic acid are therefore of interest. He 
found that the ingestion of between forty and fifty 
grains of the acid daily, by strong, healthy subjects, 
gave rise in from four to ten days to albuminuria, 
which persisted concurrently with the administration 
of the drug. In other experiments even fifteen 
grains a day sufficed to determine vomiting and 
diarrbcea. The administration of fifteen*grain doses 
in a normal subject was followed within two hours 
by its appearance in the urine, complete elimination 
taking eight days. With half that dose excretion 
began at once, and cnly lasted five days. It follows 
that the daily ingestion of even small doses of 
boracic acid is apt to give rise to cumulative effects 
which may ultimately determine toxic symptoms, 
and his experience tended to show that young persons 
are much more susceptible to the influence of the 
drug than is the case later in life. We are there¬ 
fore justified in assuming that the addition of boracic 
acid to food is by no means as innocuous as we have 
been asked to believe, and the hands of sanitary 
authorities will be strengthened in prohibiting the 
use of a preservative fraught with danger to the 
public health. 

Individualism in Medicine. 

The subject of Sir Tho eas Barlow’s address at 
the Sheffield School of Medicine, an abstract of 
which we publish elsewhere, is an eloqnent appeal 
to students to ** be not like dumb driven cattle ” in 
Ihe assimilation of knowledge. Knowledge, he tells 
ns, is not merely to be acquired, but requires to be 
assimilated if it is to yield the results expected of it. 
The average student, it is to be feared, contents him¬ 
self with committing to memory such information 
as is placed before him, without bringing bis 
ri ason to bear thereon. Scientific facts are, 
after all, but intellectual tools, tne use and 
application whereof must be guided by the in¬ 
telligence, hence the importance of a reasoning 
apprehension of their scope and bearings. The man 
wbo trusts to bis memory in deciding diagnosis and 
treatment shows himself as devoid of originality as 
he who relies on his memory for bis jests. The stu¬ 
dent, and studentship is lifelong, should draw bis 
uwn diagrams, compose his own memorias technics. 
and thoroughly masticate his learning, not merely 
swallowing his teacher’s brains, to spit them up 
again at examinations. It is ihe individualists in 
medicine who are mainly instmmental in effecting 


progress, and not those who promptly lapse into rule 
of thumb as soon as they have acquired the right* to 
practise. A sceptical attitude is far more conducive 
to real knowledge than the omnivorous mind which 
accepts every fact placed within its reach withont 
taking tho trouble to master its associations and pre¬ 
cise significance. 

Pemioious Anaemia in Infancy. 

Pebnicioub an®mia is a condition very rarely 
met with in infancy. The diminution of red blood- 
corpuscles and hsmoglobin produces an ansmia 
extremely common in childhood. Children suffering 
from chronic diarrbcea, from extensive tuberculosis, 
or from scarlatinal nephritis, are invariably an®mio, 
as are also those who become atrophic in consequence 
of defective nutrition, and who are living in over¬ 
crowded rooms and damp cellars. But in all these 
cases the ansmia is of secondary importance. The 
form under consideration is known as pernicious 
ansmia, which develops in otherwise healthy chil¬ 
dren. It UBuaUy occurs between eight and ten 
years of age, and almost as frequently in boys 
as in girls. Under eight years of age it is practically 
unknown, though some oases of it in infancy are on 
record, one of the most interesting being that of 
Botch, brought before the American Pediatric So¬ 
ciety. The little patient was but nine months old, 
without any trace of syphilis or malaria. It was well 
nourished at four months of age; at nine months the 
symptoms developed, and a well-marked precordial 
Boufiie was found. The treatment consisted of 
arsenic internally and oxygen inhalations. The age 
of the child makes the case interesting and worth re¬ 
cording ; it being one of those unlikely diseases for 
such a young child to contract, the physician might 
easily be at fault in his diagnosis. 

Peychio Troubles in Heart Disease. 

Sleeplessness is the indication of a morbid con¬ 
dition, not necessarily involving the cerebrum. But 
when the condition is prolonged it may become the 
exciting cause of grave mental troubles. The most 
distressing forms of insomnia are those found in 
connection with heart disease. The influence of car¬ 
diac disease has long been recognised by psycholo¬ 
gists. It is possible that Nasse (1818) over-estimated 
the influence of cardiac lesions, but the fact remains 
that Tyerman in Colney Hatch found cardiac or 
valvular disease in one-seventh of the female 
patients in the asylum. Less severe adhesions 
than those prodnoing such untoward results 
constantly come under the notice of the prac¬ 
titioner, and give him grave anxiety. An 
attempt to classify the lesions into those that bring 
joyons, and tbosethatbringdepressingdreamshas been 
attempted by Dr. Zederbaum (NT. Med. Journal). 
He finds that in mitral insnfficiency there is mental 
depression, probably from venous stasis in the cere¬ 
brum. The patient is apathetic, melancholy, dis¬ 
satisfied with his surroundings. In the aortic lesions 
the psychic troubles partake more of the maniacal 

Div-I.zed by CjOO^Ic 




NOTES ON CURRENT TOPICS. 


Oct. 9, 1901. 


892 Thi Medical Pbsss. 


and delirious type, and in such cases the suicidal 
tendency is not unfrequently developed. The unfor¬ 
tunate part is that the condition of psychic unrest is 
amenable only to treatment through the cardiac thera¬ 
peutics, which in advanced cases are unsatisfactory. 

Functional Diaordera of tlie Heart. 

A GOOD example of the diversity of symptoms 
that dyspepsia associated with flatulence may pro¬ 
duce is recorded by Dr. Rumpe in a recent number 
of Detitsche Med. Wochenschrift. The patient, a 
man of thirty years of age, had long been in ill-health. 
He had rapidly lost flesh and complained of palpi¬ 
tation when he lay on his left side, when the apex 
beat could be felt in the axillary space. Like many 
dyspeptics the patient considered be had an incurable 
heart disease. He, however, submitted to treatment, 
and in three years put on flesh, forgot he had a 
heart, and was able to resume his ordinary calling. 
On examination the heart was found to have resumed 
ts normal position and rhythm. The explanation 
of the phenomena offered by the author is that a 
greatly distended stomach pressed up the diaphragm 
so much that the heart almost lay horizontally in 
the thorax. The wasting of the patient was solely 
due to the dyspepsia. It is interesting to note that 
not only did the man put on flesh but the stomach 
gradually contracted until it reached the normal 
size, and the heart gradually returned to its natural 
position. One is almost driven to suspect that there 
must have been abnormal mobility of the viscns for 
it to assume the horizontal position. 

The Birmingham Consultative Institution. 

It is stated that this institution, which has re¬ 
mained in a state of suspended animation since Dr* 
Irvine’s retirement, has now definitively‘‘given up the 
ghost,” the door-plates having recently been removed. 
It is to be hoped that we have heard the last of tills 
ill-starred attempt to provide consultants at store 
prices. The scheme was pre-doomed to failure from 
its inception, though it made a sturdy struggle for 
existence. The profession, as a whole, will experience 
a feeling of satisfaction at the success of the opposi¬ 
tion which carried the day by reason of the eneigy 
and united action of the practitioners of Bir¬ 
mingham. 

Medical Bulletine. 

It is to be hoped that the example set by American 
confrires in furnishing the press with detailed re¬ 
ports of the surgical and medical aspects of the late 
President's operation and progress will not be 
accepted as a precedent. Obviously the public have 
a right to know what an illustrious patient is 
suffering from, within certain limits, and to be made 
au courant with his condition from day to day. 
More than this is neither desirable nor seemly. To 
appreciate the difference one has but to compare the 
laconic and guarded utterances of the medical 
men in attendance on her late Majesty the 
Queen with the voluble statements which fed 
the daily Press in America with material for sensa¬ 


tional copy. The fierce light which beats upon a 
throne does not, or should not, penetrate the sick 
chamber, and the sufferer, however exalted his posi¬ 
tion, has not forfeited his right to a modicum of 
decorum and respect. The inopportunenees of pro¬ 
fessional garrulity was accentuated in the case of 
the late President by the unduly optimistic and 
misleading nature of the “confidences.’’ We make 
these remarks in no spirit of captious criticism, nor 
will we presume to condemn too harshly manners 
which are peculiar to countries other than our own, 
but we should he sorry to see the example generally 
followed. 

Oarbolio Aoid as a Dressing for Bums. 

On several occasions in the past the application of 
pure oarbolio acid has been recommended in the 
treatment of bums. In view of the active eeoharotic 
properties of this substance, the idea has never ap¬ 
peared to commend itself for adoption, but of late 
its use has again been advocated by pracHtioners in 
various parte of the world. Among recent advo¬ 
cates of the treatment Dr. Muench, of Washington, 
asserts that the application of the pure acid brings 
about healing much more rapidly than any other 
method of treatment. It also presents the advan¬ 
tage of suppressing the pain associated with this 
form of tranmstism, in virtue of its analgesic action. 
Dr. Muench states that the acid coagulates 
the serous exudation, forming an impermeable layer 
which effectnally protects the injured surface from 
contact with the thus fulfilling one of the most 
important indications in the treatment of bums. 
He bas employed this treatment in bnme of consider¬ 
able extent without ever having observed symptoms 
of absorption or the undue formation of cioatricial 
tissue. In the face of this evidence it must be con¬ 
ceded that the application of the pure acid is, at any 
rate, devoid of injurious consequences, and we com¬ 
mend it to the notice of our readers who have much 
experience of this class of injury. 

Sudden Death from Cardiac Disease. 

The frequency with which cases of sudden death 
occur among French troops hae, for acme time past, 
been engaging the attention of M. Eelsch, who, in a 
paper read at the Academy of Medicine, divides the 
oaidiao lesions producing this fatal result into 
three great groups. First, he includes cardiac 
hypertrophy, pure and simple, without any change 
of histological tissue, and free of fat accumu¬ 
lation. Secondly, valvular degenerations, and 
thirdly, aortic degenerations. These changes do 
not interfere with the eoldier carrying ont his 
ordinary routine duties; but when a sudden and 
severe muscular strain is called for the feeble aorta 
and heart are unequal to the task of carrying on the 
circulation in the presence of the greatly increased 
arterial tension. The heart becomes paralysed by 
over-distension, and the degenerated aortic waUs 
break under tbe strain. It would be interesting to 
know what part, if any, the dress of the soldier has 
'n the etiology of these diseases. The discontinuance 

D:. 



Oct. 9, 1901. 


yOTES ON CURRENT TOPjCP. 


Th< Msdical Pbksb. 393 


of tbe picturesque cross- belts in tbe British infantry 
has almost eliminated aortic aneurism from tbe list 
of the soldier’s diseases. 

Poisonous Stockings. 

In tbe manufacture of silk on the Continent 
sufficient euperrision is not exercised to prevent 
serious and dangerous contamination of tbe fabric. 
Tbe grave risks incurred by this want of inspection 
are especially noticeable in tbe lighter shades of silk, 
particularlj yellow silk, and care should be taken to 
avoid wearing such a material next to the skin, be- 
canse it is sometimes impregnated to a very 
considerable extent by tin chloride, in order to 
increase the weight and give the article a fictitious 
appearance of high-class quality; technically speak¬ 
ing, the proceeding imparts more “body" to tbe 
fabric. The medical interest in tbe matter arises 
from tbe difficulty of diagnosing the condition 
caused by the absorption of the tin chloride. Tbe 
Wiener Klin. Hundechau has done well in publishing 
tbe details of a case of the kind, and we consider that 
the subject should be pressed home to the notice of 
the responsible authorities. The symptoms in this 
instance, in a youn^ lady who bad been wearing 
yellow silk stockings, began with a sudden failure of 
motive power and of sensibility in her limbs. This 
disability was recoveted from, to a certain extent,but 
when the patient began to get about again and re¬ 
sumed tbe wearing of the yellow silk stock¬ 
ings alarming symptoms of an ataxic character 
set in, and an examination of the urine re¬ 
vealed albumoses, serum albumin, and globulin. 
Tbe urine was also observed to give the reaction for 
tin, and on examination the yellow silk stockings 
were found to be impregnated with tin chloride. It 
was further found that tbe patient exhibited con¬ 
siderable destmetion of the corpuscular elements. 
Recovery in this case was slow, and for months tbe 
urine continued to give the reaction to tin. A con¬ 
siderable amount of time and attention has been 
bestowed on the adulteration of certain goods with 
borax and boracic acid; it would be advisable if tbe 
more dangerous trade customs were also investigated 
and regulated. 

Ib the “ Conscientious Objector," a Fool ? 

The “ conscientious objector," that most curious 
offspring of a weak Cabinet, is a familiar object in 
the police-courts of tbe United Kingdom. Indeed, 
so frequent is his appearance that newspaper 
reporters have ceased to make any note of him, 
unless there be some special circumstance of interest 
connected with his visit. He is often soundly rated 
by the magistrate, but it is not easy to see why the 
conscientious man should be abused for taking 
advantage of a clause created for his behoof by the 
wisdom of tbeLeglslature. Surely what is good enough 
for tbe august members of Mr. Balfour’s Government 
should suffice to silence tbe rebellious sarcasm of 
police-court mp.gistrateB! Recently, at tbe Bideford 
County Sessions, the Chairman, Sir W. Dowell, is 
reported, when a gardener applied to him for a certifi¬ 


cate of exemption, to have said, “ 1 think you are a 
fool.” If tbe applicant be a fool, what in the name 
of common sense, is tbe position of tbe Government 
that have given him a legal standing for his foolish¬ 
ness P It is bard to understand the position of the 
magistrate who addresses in that fashion an appli¬ 
cant coming to the court on a perfectly legiUmate 
errand. The police magistrate is appointed to ad¬ 
minister the law, and in spite of every sympathy with 
his disinclination to act as tbe anti-vaccinationist 
catspaw, we must confess that it seems to us he has 
no right to do more than utter the mildest of remon¬ 
strances to the “ conscientious objector." 

A Departure in Workbouse Dietary. 

The wastefulness of the ordinary workhouse diet 
is notorious, not only in the direction of nutriment 
but also of cost, l^e issue per head of a certain 
quantity of each article leads to tbe inevitable return 
of a large excess, which is not replaced by 
any eqniv^mit. Apart from quantity the question 
of quality, so far as variety is amoemed, is open to 
greatly needed improvement. The administrators 
of the Poor-law, however, are slow to act, although 
of late years even their conservative minds have 
been to some extent permeated by tbe humaner 
methods of thought that characterise modem 
life. In some few districts attempts are now 
and then happily made to introduce practical 
reforms into the workhouse. Thus, tbe guar¬ 
dians of the Malton Union in Yorkshire 
have recently approved a revised dietary, whereby 
seed cake is substituted for plain cake for the in¬ 
mates of tbe house, with the option of having jam or 
marmalade for supper; while during tiie winter 
they are to have boiled beef instead of the ordinary 
cold joint. It is likely that with a little manage¬ 
ment similar changes could be made in other Poor- 
law institutions with little or no addition to the 
actual existing cost of maintenance. It has been 
proved over and over again that the system of ri^d 
allowances per head of inmates is in practice costly 
and extravagant. 

A Plea for the Domestio Servant. 

Of all classes of unskilled labour one that calls 
most clearly for reform is that of the domestic ser¬ 
vant. For many years past in the United States of 
America tbe old-fashioned, patient household drudge 
has disappeared for ever. Here at home, in the 
United Kingdom, she has for a long time been 
steadily decreasing in numbers, until she bids fair in 
time to become as rare as tbe white sparrow or other 
—rara avia tn terrie. The reason is not far to seek, 
that is to say, if the inquirer be a candid man, and 
not a prejudiced woman who can see nothing wrong 
in the way the average servant is treated in middle- 
class households with a not too liberal income. Re¬ 
cently tbe Medical Officer of Merionethshire, Dr. 
Jones, spoke out bis mind on the subject with no un¬ 
certain voice. He pointed out that many of tiie 
servant girls in tbe fashionable seaside resorts 
worked from morning to night—the first up and the 



394 Thb Msdical Pane. NOTES ON CURRENT TOPICS. Oct. 9, 1901. 

last to rest. They slept in the baseipent, at the top months, and consists essentially ir pachinj? 
of the house, in badly lit and badly rentilated rooms, the cleansed ear with dry gauze, and placing 


with no fireplace, or, worse still, in the dining-room, 
on a sofa, after the room was clear of its occupants. 
Ho had known cases where servant girls slept on 
such sofas when suffering from advanced phthisis, 
yet they went on working, a centre of infection for 
others inhabiting the same bouse. A good deal was 
heard about bettering the condition and environment 
of shop assistants, but he asked to be allowed to 
plead the cause of the servant maid. Other medical 
officers of health would do well to follow Dr. Jones’s 
example and devote some attention to a deserving 
and much neglected class of the community. 

The Parish Vaooinator in Sweden. 

At the present moment a special interest is at¬ 
tached to all that appertains to vaccination, so that 
there need be no apology for a note on some curious 
methods pursued in Sweden. The country in ques¬ 
tion is fairly free from small-pox, so that many 
medical men of the present generation have never 
seen a case of the disease. Thai immunity may be in 
great measure ascribed to the labours of the parish 
organist, who for many years has filled the post of 
Government vaccinator. The organist is a public 
official who has gained his position after a series 
of examinations, which cover not only his 
musical but also his general education. Among 
other things, be is required to prove his ac¬ 
quaintance with the principles and practice of 
vaccination. When appointed to a parish his 
duties include the registration of births and deaths, 
BO that he is able to check the vaccination returns, 
and act as prosecutor should occasion requiie. The 
organist has a small farm or estate granted him, and 
he is often a man of considerable education and of 
some importance in bis district. He is entitled to a 
small fee for vaccination, or it may be done in some 
cases gratuitously, but those who wish can go to 
qualified medical men to have the operation carried 
out. The origin of the custom lies clearly in the 
dearth of medical practitioners among the sparse 
population of the rural districts. Established 
churches, on the other hand, are distributed through¬ 
out Sweden, and the combination of the functions of 
organist registrar, and public vaccinator in one 
and the »ame person is no doubt a great convenience 
to dwellers in the country. 

Superheated Air ia Otitie Media. 

CoNSiDEBABLE success has attended the ti'eat- 
ment of chronic catarrhal otitis media by means of 
superheated air. At the outset we would especially 
draw attention to the fact that this therapeutical 
measure should not be resorted to in cases of arteiio- 
eclerosis, nor when there is serious effusion into the 
tympanum, nor in cases where the tympanum is 
perforated. One result appears to be an almost in¬ 
variable accompaniment of this procedni'e, and 
that is headache, which, however, can be re¬ 
medied by codeine. The method that is followed 
by the most marked success extends over several 


also a pad of gauze outside the ear. Then 
hot air is sent into the canal of the ear by means of 
a canvas-covered sleeve. The temperatute of the air 
should be at first quite moderate, and then gradually 
increased; 40(P F. having been usedinsome cases. If 
arrived at by degrees ; this intense beat is capable of 
being applied through the moisture being absorbed 
by the gauze packing. To secui'e the passage of the 
hot air into the ear special care should be taken to 
have at least one perforation in the canvas hot-air 
conductor close to where it touches the ear. Careful 
inflation of the Eustachian tube should then be 
carried out, and subsidiary measures generally 
seen to. The reason of the success of this treat¬ 
ment is apparently to be ascribed to the 
stimulation of the circulation by the intense 
heat which sets up an absorption of articular deposits 
and relieves the stiffness of the internal muscles of 
the ear. Certainly benefit accrues from the removal 
of adhesions between portions of the ossicular chain 
and the adjoining bony walls of the middle ear. 
We consider that with the limitations already 
detailed this therapeutical procedure should be more 
generally practised, and it Is encouraging to note 
that Hopkins, whose method it is, has only had four 
failures out of sixty-two cases daring the last four 
years. 

Watercress. 

The death of a man in Poplar after eating water¬ 
cress has led the local medical officer of health to 
issue a warning against the use of watercress grown 
in polluted waters. This is a danger to which we 
have often called attention, a danger which is pre¬ 
sented by watercress in common with most vege¬ 
tables which it is customary to eat uncooked. The 
ditches which furnish a large proportion of this 
vegetable in the market usually, if not invariably, 
contain more or less stagnant water contaminated 
with the washings of the neiglibouring land, and 
often the receptacle of all kinds of filth. The water¬ 
cress is more often than not washed in a most per¬ 
functory way, if at all, and enters the stomach laden 
with nameless forms of impurity. Careful cleansing 
is doubtless a certain safegard against the transmis¬ 
sion of disease, but it is from every point of view 
preferable, as far as possible, only to make use of 
watercress of known origin. 

The Si^iflcanoe of Intermittent Lim ping. 

It has been urged as a reproach against some 
English pi’actittoners that they are too ready to 
ascribe pain to the influence of gout, especially in 
patients over the age of tbirty.five, and the effect of 
this bias in the practice of medicine may lead to 
more or less serious conditions being overlooked. 
When a person has pain during the act of walking 
that is relieved by rest, but occurring again on the 
resumption of movement, one investigation that 
should at once be thought .of is to inspect the 
condition of the arteries of the feet with a view to 

'--dbv C 


Ocr. 9, 1901, 


SCOTLAND. 


Thx Medical Ji'bbss, 


determiniag the amoant of pulsation. In the 
middle - aged, and those older than that, the 
absence more or less of pulsation is sufficient 
to justify the opinion that the case is not one of gout, 
rheumatic gout, rheumatism, neuralgia, or sciatica, 
hut falls under the heading of the disease de* 
scribed bj Goldfiani {Neurol. Centralh., March 
Ist, 1901), as “intermittent limping.” In 28 per 
cent, of the cases gangrene supeirenes, and in a con* 
siderable number of others the mischief is of a pro¬ 
gressive nature, though experience shows that in a 
certain proportion the disease maj continue in a 
stationary condition for years. With careful treat 
ment, directed to securing necessary rest and the 
alleviation of the symptoms, combined with good diet, 
much can be done, but we should advise the practi 
tioner to give a guarded prognosis at first. 

The Epidemio of Small-Pox. 

Thb total number of patients suffering from 
small-pox actually under treatment in the hospitals 
of the Metropolitan Asylums Board is about 170. 
The disease shows no tendency to rapid extension, 
though each day brings its quota of victims In the 
meantime the desire on the part of the public to 
obtain the protection of vaccination shows no sign 
of diminution, and practitioners all over London 
are still busy in this direction. It has been decided 
to utilise the South Camp at Gore Farm, hitherto 
held in readiness for the reception of cases of plague, 
for the accommodation of convalescent small-pox 
patients, who will in future bo sent there. 

The winter course of clinical demonstrations by 
members of the medical staff of the Central London 
Throat and Ear Hospital commences next Wednes¬ 
day evening, the 16th inst., at eight o’clock with an 
introductory lecture by Mr. Lennox Browne on 
‘ The Helationship to General Medicine of the Special 
Diseases treated at the Hospital, also to other 
Diseases Constituting Separate Specialisms.” 


PERSONAL. 

Lieutenant F. W. Lambelle, M.6., B.S., of the 
Royal Army Medical Corps, has juat been appointed to 
the surgical command of Connaught Hospital, Aider- 
shot. 

Da. Lindsat Steven, Glasgow, has been appointed 
examiner in medicine and clinical medicine, and Dr. 
Charles Workman, Glasgow, examiner in pathology in 
Gla^ow University. 

SiB Wh. McCobhac will deliver an address on 
October 14tb, at 5 p.m., on the occasion of the opening 
of the new building of the Post-Graduate College at 
the West London Hospital. 

SiB Michael Fostbb has been elected to the office of 
Honorary Perpetual President of the Interoational 
Congress of Physiologists by the members of the Fifth 
Congress which recently met in Turin. 

IfOBD Bbabsbt will deliver an address at the Royal 


United Service Institution on October 16th, at 4 p.m., 
on the occasion of the opening of the third winter 
session of the London School of Tropical Medicine. 

Sib Francs Lovell, late Surgeon-General of Trini¬ 
dad, has been entrusted by the London School of Tro¬ 
pical Medicine with a mission to tropical and other 
oountriee, for the pnrpose of iuve.-tigating diseases pecu¬ 
liar to those regions. 

Db. T. B. Adam has been appointed Assistant Secre¬ 
tary of the British Medical Temperanoe Association, the 
large increase (over 1,000 members and student asso¬ 
ciates) involving more work tban the bon. secretary. 
Dr. Ridge, is able to devote to it. Dr. Adam will work 
specially among medical students. 

Sib Joseph Dimsdalx, the Loid Mayor-elect of the 
City of London, is a descendant of the famous Dr. 
Dimsdale who flourished in the middle of the eighteenth 
century, and xas the author of a much-quoted work ou 
“ General and Partial Inoculation ’ for the preven¬ 
tion of small pox. This Dr. Dimsdale it was who re¬ 
ceived a fee of £10.000 and an annuity of £500 for 
inoculating the Empress Cathericeand her son. 

Pbofbsbob Vibcuow will be presented with a costly 
congratulatory address on his eightieth birthday next 
Saturday in Berlin. Deputations from many parts of 
the world will be present, and the Italian deputation 
will bo headed by Minister Baccelli, who win hand to 
the great pathologist a portrait of himself in a very 
richly dscorated frame. Professor Virchow is, moreover, 
to be mad* an honorary Piofessor of the University of 
Rome, from which he will receive a gold medal. 


Scotlanb. 


[PBOM OUB OWN COBBESPONDENT,] 


THE CHANGE AT GARTNAVEL. 

Afteb the long period of twenty-seven years Dr. 
Yellowlees has resigned the appointment of Physician 
Superintendent of this classic institntion for the treat¬ 
ment of the insane in the West of Scotland. It is no 
exaggeration to say that no institution in Scotland is 
better known than Qartnavel for the work it >>m done, 
and for the importance of the position held by its phy¬ 
sician superintendent. It is gratifying to think, that, 
though an unfortunate accident is primarily the cause 
of his resignation, the accident will merely iucapacitate 
tor duty, and that Dr. Tellowlees has resigned only 
after a lapse of many years, and when his Ufe's work 
wsupraolically done. We shall look with Interest to the 
steps taken for the appointment of bis saocessor, for in 
Gaitnavel we have one of the leading institutions for 
the treatment of the insane in the country, an institu¬ 
tion to which we look for light and leading, and 
which requires to be guided by a man of first-class 
ability. Names are obviously unmentionable, but the 
management has a free band, and there is no scarcity of 
excellent candidates for the appointment in the papers. 
The salary is a handsome one, though considerably cut 
down from the previons one, to begin with ; but we have 
no doubt that the Board will deal handsomely with a 
good man as it has done in the past, and that the pres- 
rige of the position will not suffer from the change that 
is being made. One thing that is much reqnired, now 
that a change is being m^e, is that a superintendent 
will be appointed whose time will be taken up more with 
soientifio and administrative work and less with consul¬ 
tations; in this respect Gaitnavel hts been rather 
behind the times. 


Diyiiized by 


Google 



OOBRBSPONDEN’OB. 


Oct. 9, 1901. 


396 Thb Mbdicbl f bms. 


Qlasoow Mbdico*Chibuboical Socibtt. — The an- 
Dual general meeting of the above Society waa beli in 
the Faonlty Hall, St. Vincent Street, on Friday evening, 
October 4th. Dr. W. G. Don, President, delivered the 
preeidential address "On blood-letting in the treat¬ 
ment of diaeaae.” It was rather historical than oritical, 
and in it the history of blood-letting wa4 traced down 
through the centnries to the present day, when it waa 
very seldom resorted to. The address was a very 
instructive, and, at times, a somewhat amusing one, as 
when the case was mentioned of a patient who, in the 
coarse of an ordinary illness, had over 200 ounces of 
blood withdrawn, and one onnee and a half of tartar 
emetic administered, and yet recovered. Several oases 
were cited in which blood-letting undoubtedly oontri- 
bated towards a fatal result, and cases again were 
mentioned where it certainly did much good. Dr. Dun 
concluded by raying that he believed there were cases 
to-day in whi(^ blood-letting might very advan¬ 
tageously be used. Great discrimination, of course, 
would require to be exero'sed in the selection of suitable 
oases for it. On the motion of Mr. H. E. Clark, seconded by 
Dr. Lindsay Steven,a cordial vote of thanks was awarded 
Dr. Dun for his interesting and exhaustive address. 
Office-bearers for session 1901-1902: - President, Dr. W. 
G. Dun; vice-presidents. Dr. J. Lindsay Steven and Mr. 
A. £. Maylard. Council: Section of Medicine, Dr. J. 
W. Allan. Dr. Carslaw, Dr. Hinshelwood, and Dr. 
Robert M'Einlay; Section of Surgery, Dr. Rutherfurd, 
Dr. Edingtoo, Dr. J. H. Niooll, and Dr. Gibb; Section 
of Pathology, Dr. Teacher. Dr. Ferguron, Dr. R. M. 
Buchanan, and Dr. A. A. Gray; Section of Obstetrics, 
Dr. Gibson, Dr. Kerr, Dr. Balfour Marshall, and Dr. A. 
N. M*Lellan; treasurer, Dr. Barclay Nefs, 19, Woodside 
Place; editorial secretary. Dr. Hugh H'Laren, 44, Kel- 
vingrove Street; general secretary. Dr. W. K. Hunter, 
1, Newton Terrace. 

Bbbionatiom of Pbofbssob John Youko.— Professor 
Young, who has for thirty-five years been the occupant 
of the chair of natural history in Glasgow University, 
has just tendered his resignation on account of failing 
health. He has asked the University Court, as a 
special favour, to allow him to continue to bold the 
office of Keeper of the Hunterian Museum. 

The personnel of the Scottish National Bed Cross 
Hospital are to be presented with war medals at a 
par^eonthe York Hill drill ground, on the 26th inst, 
by Lient.-General Sir Archibald Hunter, commanding 
toe forces in Scotland. On this occasion an ambulance 
display on a considerable scale will take place. Snrgeon 
Lient.-Colottel Beatsoo, V.D., will be in command. 

Cabnboib Tbubt. —The funds of this trust are to be 
available for the coming winter session. Already 
between 4,000 and 6.000 applications have been received 
and are now being considered by the trustees. Appli¬ 
cations will still be accepted till the 16th inst. from 
Scotch students. 

Glasgow Southxbh Midical Socibts.— The first 
meeting of the session was held on Thnivday evening, 
October 3rd, when Dr. C. E. Robertson, the Swiety's re¬ 
presentative on the board of governors of the Victoria 
Infirmary, gave an aoconnt of his stewardship for the 
year. He t^erred in feeling terms to the loss sastAined 
by the hospital in the deaths of D/s. James Dunlop and 
Adam Kelly, both of whom were governors of the hos¬ 
pital. In Uio election of a gynseo^ogist to the hospital 
where there were two candidates—a lady and gentle- 
man—each with first-dass recommendations, he sup- 
fort ed the candidature of the gentleman, who was 
elected. The following office borers were elected: 
—Hon. President; Thomas M'Call Anderson, M.D., 
F.FP.6. ; President: John Stewart, M.D.; Vice- 
presidents : Duncan MACgilvray, M.B., C.M.. and 
Thomas Bicbmond, L.K.CP., L F.P.S.; Treasurer: 
Andrew 8. Tindal, M.D ; Secretary : John Fraier Orr, 
M.D ; Editorial Secretary: Andrew Wanohope, M.B., 
C.U.; Sealkeeper: Matthew Dunning, M.B., C.M.; 
Extra Members of ConneU: John Lindsay Steven, 
M.D, F.FP.S, Hugh Kelly, M.D., James Hamilton, 
M.B., C M., F.F.P.S.; Court Medical: Willian Watson, 
M.D., Ebenezer Dnuoan, M.D., F.F.P.8., Bobert Pollok, 
U .B., O.M., F.F.F.S., Thomas Kirkpatrick Monro, M.A., 


M.D., F.P.P.8., Alexander Napier, M.D., F.P.P.S.; 
Bepresentative to Victoria Infirmary: Charles E. 
Boberteon, M.D. 


OTDrrtBponiettce. 

LWedo not hold otmelTwreaponaihle for the opinions of oar 
rorrespondenta-J 

THE BIOLOGICAL TEST. 

To tht Editor of Thb Mbdical Pbxss and Circulab. 

Sib,— Dr. Sera invites me to reconsider my position. 
With your kind permission I will, in a very few words, 
restate my argument which be attempts to olmnre. 

1. My relative was suffering from a malady which 
seemed to be doubtful of diagnosis. 

2. To settle the question certain animals were inocn- 
lated with his sputum. They died, it was declared, of 
tnbercniosis, and my relative, it was then decided, was 
suffering from that disease. 

3. He was removed to the Sonth Coast, and a 
physioi-m. disputing the diagnosis, held that it was a 
case of ebron'o; neumonia, and treated him accordingly. 
My relative was perfectly cured in about six weeks. 

These are simple facts, and I merely ask how did the 
biological test help in this case ? 

With rega d to the action of corrosive or irritant 
poison on animals, of course ared-hot poker will burn an 
animal equally with a man, and ao will sulphuric acid 
and aqna fortis equally injure both ; but how about tbo 
action of opinm, belladonna, strychnine, and tiie 
poisonous allaloida ? 

I am. Sir, youra truly, 

Edwabd Bebix)b. 

London, October 4th, 1901. 


TBE CONGRESS ON TUBERCULOSIS. 

To the Edifor of The Medical Press and Cibcclar 

Sin,—My attention has been called to a letter in your 
issue of the 18th nit. from an anonymons oorrespondeot, 
which is written for the purpose of bringing contempt 
upon a proposal I have pnt forward in the interest of 
"sufferers from consumption," in the Timet news¬ 
paper. 

I have no intention of entering into a paper warfare 
with people who hare not the courage to sign their 
names, but I presume such a paper as yours would 
hardly admit snob a communication into its columns 
nnlesB it was from a person of some little standing, so, 
as yonr leaders might be misled by your correspondent, 
" Ubique,” I will ask you to give insertion to these few 
lines, more especially as he mentions me by name. 

"Ubique" somewha*: rashly, as it appears to me, 
undeitakes to speak for “every medicU man of the 
woild," and assures your readers that everyone such 
is willing to pledge himself that" no scientific data" 
wonll (or, I presume, could) be forthoomingto establish 
the claims put forward for the *'Laebnanthes treat- 
men*." 

He gives hia oolleaguee in the profession credit for a 
prejadlce and narrow-mindedness which they do nut 
deserve. What grounds he has for passing so sweeping 
a judgment upon them does not appear, nnlesi itbethat 
be judges of human nature by bis own standard. I do 
not believe that there are many in the noble profession, 
for which he presumes to speak, who would express a 
Nillingneas to give a "verdict" without a “triaL" 

" Ubiqne " pleads guilty to a very incomplete know¬ 
ledge of the " physiology of the lungs" and of the 
progressive morbid phenomena folloeiog tuberonloua 
infection!" I do not pretend to any knowledge on these 
subjects. I endeavour to bring a little common sens^to 
bear, and judge by results. " Ubiqne," it appears to me, 
instead of being prepared to study and work for the cure 
or alleviation of suffering, is satisfied to retire behind 
his ramparts of professional prejudios and sneer at any 
effort by a la>man to do good. He speaks of "false 
hopuB raised in the hearts of wretched Mtients!" If those 
hopes are not to be realised it will be through the 
"oDStinate blindness” to ^e. ex^iatenoe. of i^emediea 



Oor. 9. 1901. 


LITERATURE. 


Thi MmciL Pbbs8. 397 


which are known tobeefficaciooe in which he andoUiere 
indalgfe thcmcelvee—'* none bein^; so blind as those that 
won't see ”—bat of whcm, I trust, there are not many in 
tie splendid profession to which I aesome he be'ongs. 

He is kind enough to drop a sympathetic tear at the 
ocmtrmpiation of the panishment, which, he eaya, is 
to OTertake me when I realise the barm I have done! 
and he sngiteata that I would have done better to hare 
nlaced myself in the hands of “ advisers bavin g a know* 
led^ of science," nnder which description, I presume, 
he inclndea himself! If he does, let him state his name, 
show himself ready to pnt his hand in bis pocket and 
exert himself to farther develop his "knowledge of 
science," and apply it for the benefit of his saffering 
fellow creataree. 

I am. Sir, yours truly, 

W. LB PoiB Tbbbch, Colonel. 

fit, Huberts, Geirard’s Cross, Bocks, 

October 5tb, 1901. 

"A UNIQUE CASE OP GENERAL EMPHYSEMA 
FOLLOWING TRACHEOTOMY." 

To the Sdiior of Thb Mbdioal Pbbss and Cibculab. 

Sib, —In your issue of September 25th 1 notice, 
nnder the headins' of *' Clinical Records," a note by 
Mr. George Poy, F.R.C.8., of Dublin, on "A Unique 
Case of General Empliysema following Tracheotomy.'’ 
He mentions the case of Dr. EUett as being the only 
one be can find. I can add one more to the lim'ted list. 

The case occurred while I was junior house-surgeon 
at the Stanley H<^ital, Liverpool, in 1896. It was one 
of two cases of diphtheria admitted within a few days 
of each other, both of which required trsoheotomy, and 
in both of which the tiimhea became blocked below 
the tracheotomy wound, and in both of which we gently 
but thoroughly ourett^ the trachea for the removed 
of the obet^ting membrane. Both oases ended in com¬ 
plete recovery. 

In the second case the child developed general sur¬ 
gical emphysema within a short time of the operation. 
Every square inch of the child’s body*sarfaoe, from the 
crown ^ of his head to the tip of his toe, presented the 
condition, and, if I remember rightly, it was some few 
weeks before it entirely disi^peaMd. My colleague. Dr. 
J. I anson Dick, F.R.C.8., who was senior house sur¬ 
geon, reported both cases in the Lvka-t of 1896, but 
neither of us ttiought or knew that the general emphysema 
was such a rare condition, and the fact that it did 
occur was merely mentioned, our great object in report¬ 
ing the cases being to draw attention to a means of deal¬ 
ing with a gene^y fatal complication of diphtheria 
after tracheotomy. It is doubtless owing to this fact 
that Mr. Foy overlooked the case. I have not the copy 
of the Xancef by me, so cannot say what the child's age 
was, but I know it was quite young, being small enough 
for a child's cot. 

Dr. Diol^ who reported the case, id now practiaing in 
South Africa, or he would doubtl^ have sent you this 
little information himself. 

I am Sir, yours truly, 

F. Dbas. 

Uerfam Park, S.W., October 6tb, 1901. 


Iptaratttre. 

ROSE AND CARLESS' MANUAL OP SURGERY, (a) 

Such has been the success of this modern treatise on 
surgery tiiat in less than three years three editions have 
been disposed of, and the demand for a fourlh has been 
so rapid that the authors confess in their preface to it 
that "it has not appeared necessary to make many 
sl'erations in the text or in the iilostrations, and hence 
this edition is practically a reprint." 

We congratulate the modern medical student on 

(a) “ A Msnnal of Sorcery tor Stadents And Practitinners.'' Nr 
Wm. Bow, M.D., B.S.Lond., F.B.C.8., Profewor of Clinic^ Sur- 
S«r/in Etns's Colloxo, London, and Albert Carlew, B.8., F.B.C.8., 
Snrgeon to Kins'■ Oolleje Hoi pitil. Fourth Elition. Pi>. 1,182, 
UjBUratlous406. l|>nd>q : SuUiste,Tindall, sal<^i. PrioqgU. 


poesessin^ a text-book so clear, ter^ and fall; with 
snch an aid bis examinations should give him no tronble. 
For the practitioner the book is sufficiently full and so 
eminently.'nricticai as to be for him a trnstworthy guide 
in any ordinary operation he may be oalied upon to 
perform. Moreover, as a book of reference U will he 
found a trustworthy vade merum of modem praotioe, 
clothed withal in s'lch felicitous language that dry 
details become plea«ant reading and tbe memory aided 
with tbs facts set forth. As we reviewed fully the third 
edition but a few months since, and the one before ns is 
practically the same book with only neceeaary correc¬ 
tions, we content ourselves on the present ocoiaion by 
announcing the appearance of a fourth edition, advising 
all who have it no^ whether practitioners or students, 
to possess themselves of it. 


THE COMMONWEALTH OF CELLS, (a) 

This is, in a sense, a popular treatise on physiology, 
d he author has set himself tbe task of explaining, or 
rather of describing, the organs of the human body and 
their functions, in a genial narrative free from repellent 
technicalities. There is, however, a* wide difference 
between this oymmendable little work and what is some¬ 
times described as " popular physiology." Tbe author 
does not attempt to be bnmorons or even sprightly, 
but he starts with the cel), defines its cbaracterisiioa 
and propertiee, its composition and chemistry, and then 
proofs to show how the cell becomes specialised and 
assists in carrying on the complex mechanism which is 
the animal organism. His limpid text is illustrated by 
numerous original diagrams which will appeal to tbe 
vulgar, and may be trusted to convey ideas which words 
can but inadeqnstely portray. 

We cannot help asking ourselves for what class of 
reader* the author has written. We do not believe that 
his essays will snccessfully appeal even to the lower 
grade of science stadents, but to the educated person 
who yearns after a coherent and untechnicai account of 
his own organism they will doubtless prove ex¬ 
ceedingly welcome. Moreover, those who are engaged 
in lecturing on physiology, even to medical stadents, 
wUl ^d many happy and original suggestionB in these 
p^es which have been very carefolly thought out. 

ANDREWS ON PUBLIC HEALTH LABORATORY 
WORK, (b) 

This is a oolleotiou of lectures delivered by the author 
to surgeons under instruction at Haslar. The lecturae 
are divided into threeparts. Part I. deals with the in¬ 
spection of fish, flesh, and fowl intended for hnmvn 
food; Part II. with tbe examination of water, air, milk, 
varions other foodstuffs and wines; while Part III. is 
devoted to tbe subject of meteorology and the bearing 
of atmospheric conditions on health and disease. Al¬ 
though the three parts are bound in one volume each 
division has its separate index immediately following, 
an arrangement which obviously presents d!rawbacki iu 
looking up references. 

Tbe material is conveniently distributed and is set 
forth with oommen^ble brevity. There is an appendix 
to Part I. on the tuberoulin test for tuberculosis. Tbe 
au^or throughout abstains from stating " views," 
giving his facts didactically and withunt comment, 
^e text is illustrated by a goodly number of illustra- 
tions of the type with which we are familiar. 

The attention given to meteorologf in this volume is 
evidence of the increasing importance of this branch of 
stndy. The subject is a wide one, and tbe author has 
had to be very brief in his remarks. He describes the 
barometer and its use at some length as a preliminary 
to bis ot^rvations on climate—climate being defined as 
" meteorological conditions dependent upon tempera¬ 
ture and relative humidity." Directions are given for 
establishing ^e means of heat and humidity, together 

(а) “The Commonwealth of Cells." By H. O. F. Spurrell, B.A. 
Ozon. Lonilon; Bailliere, Tindall and Cox. 1901. Price 2s. 6d. 

(б) “ Hand-Boo k of Public Health, Laboratory Work, and Food 
lospeotlon." By 0. W. Aalrews, U.B., B.S., D.P.H C katb . A s. 
Ac., late Assletant Initmotor to Sargsons on Eatrr. Byit N uy 

' London: Bailliere, Tindall and Cox. 190L Prloe Ta Od. _ ■' . 


398 The Medical Pbess. 


iritli information bearin^^ on the significance of “ weather 
signs.” 

The work will be found very nseful, not only to naval 
surgeons, bnt also to students preparing for a diploma 
in public health. We must, however, enter a protest 
against the use of glazed paper which is very trying to 
to the eyes. 


TREVES’ SURGICAL APPLIED ANATOMY, (a) 

This welUknown manual is now presented in the form 
of a new and revited edition, compiled with the assist- 
ance of Mr. Arthur Keith, M.D., F.B.C.S., Lecturer on, 
and Senior Demonstrator of. Anatomy at the London Hos¬ 
pital. Applied anatomy may be taken to mean anatomy 
as it concerns the surgeon, and it deals with practical 
aspects of anatomy as distinct from tbe purely scientific 
description. Certein peculiarities of arrangement or 
structure, which possess no particular significance for 
the student of anatomy, possess considerable importance 
from a surgical point of view, and the object which the 
authors of such a manual as this have before them is to 
place these peculiarities in bold relief. 

We have nothin^ but praise for the way in which the 
authors have fulfilled their task. The descriptions are 
brief, lucid, and to tbe point, in fact those who know Sir 
Frederick Treves will recognise bis style in tbe text. 
Tbe work can be confidently recommended to students 
preparing for examination. 

HEALTHY HOMES, (b) 

This is a very handy little woik for intelligent per¬ 
sona who are desirous of learning what is healthy and 
the reverse in connection with house construction. Of 
course, as tbe author points out, no book, big or little, 
wilt make a man an expert, but this is a branch in which 
even a little knowledge is by no means a dangerous 
thing. Tbe author has gone very thoroughly into the 
subject, neglecting no detail, even to the manner in 
which tbe bonsemaid should he instructed to sweep 
carpets, for there appears to be a right and a wrong 
way of discharging even this simple function. We are, 
however, unable to find any reference to earth closets, a 
method of disposing of excreta which has much to com¬ 
mend it, especially in rural districts. No prerions know¬ 
ledge of the subjects referred to is assumed, the simplest 
language is used throughout, and no scientific or tech¬ 
nical term is employed without explanation, so that it 
is open to the general public to obtain a very fair know¬ 
ledge of what constitutes *' a healthy borne.” 

GIBSON’S TEXT-BOOK OP MEDICINE, (c) 

This work is ” the united efforts of several writers 
who repteaent different important schools in the United 
Kingdom,” under the editorship of Dr. G. A. Gibson. 
Tbe term Text-Book,” to some persons, snggests a 
work designed for the use of students; to others it may 
not bear this meaning. If the work under considera¬ 
tion was brought out primarily for the student of medi¬ 
cine, its multiple authorship is distinctly nnusual. At 
first sight it would appear that plural authorship should 
be a distinct advantage, but farther consideration leads 
ns to think that this is quite open to question. Tbe 
student reads bis book throughout; the busy practi¬ 
tioner turns np a special article for reference and to 
refresh bis mind on one subject. The style affects the 
former much more than the latter, and it does not do, 
when one has become accustomed to a certain style—a 
simple one, perhaps—to find, on turning a leaf, another 
style utterly different, nnd perhaps difficult. Many text¬ 
books for students have been written ; not many have 
” caught on,” their style did not suit, they contained 
the required information, but, as with some teachers. 


(a) ‘‘Surgical Applied Anatomy.” By Sir Frederick Treves. 
K.C.V.O , C.B., F.K.C.S.. Consulting Surgeon to the London Has- 
pita],Ac..&c. London: Cassell an-i Co., Limited. 190i. 

“A Healthy Home." By Fraucis Vacher, County Medicel 
Officer for Cheshire. Ac., Ac. Second Edition. London: The 
Sanitary Puhlishing Company. 

(i ) '■ Text-Book of Medicine," in Two Volumes. EditedbyG.A 
Gibson, M.D., F.EC.P.Ed., Physician to the Royal Infirmary, 
Edinburgh. Edinburgh and Loudon: Young J. Fentland. 1901. 
Two Vols. Price 258. net. 


Oct. 9, "1901- 

they did not readily impart it so as to salt the average 
learner, and thus were not a success. 

Some of the articles before os, as, for instance. Prof. 
Kanthack s section on the " General Pathology of 
Disease,” are too academic for tbe aven^^ general 
student of medicine, aad are addressed more to the 
post-gradnate student. For example, in acute inflam¬ 
mation :—"To select phagocytosis, or ohemiotaxis, or 
new formation and repair as essentials, and make them 
corner-stones of theories of inflammation, is nojnsti 
fiable. Phagoc) tosis, chemiotaxis, and proliferation 
are cocoomitant, or it may be constant, phenomena 
of acute inflammation, and each one of these may 
be traced back from the highest to tbe lowest 
form of aoimal; but surely it is not sound reasoning 
to evolve the whole process of inflammation from one or 
two of its phenomena, especially when such phenomena 
are very primitive protoplasmic properties. Evolution may 
teach how a property or a character has been acquired ; 
it may indicate something of the phylogenetic origin of 
an organ or process ; but it nowhere teaches that a com¬ 
plex process in a higher animal typa, which can be 
traced back to some property or function in a lower 
type, is identical with this property or function. In any 
appeal to evolution, tbe thread is often lost, and many 
gaps canoot be filled.” This is not addressed to the 
undergraduate student. On the other hand, some sec¬ 
tions have all tbe appearance of being writton for the 
undergraduate. Tbe articles on the Hsemopoietio 
system, for instance, give within a space of fifty pages 
all the main points of importance, but they pass over 
with disappointing brevity most of the recent work 
which has appeared with such abundance in thisdirection. 
We find it difficult, therefore, to decide from internal 
evidence for which class of students this text-book before 
us is intended. This also makes ns hesitate before we 
conclude tbat multiple authorship of a text-book of 
medicine is a distinct advantage to the nndergradnste 
student. 

In the preface we read that " certain symptoms, ooca- 
siooally dignified by the title of separate diseases, will 
be sought in vain under individual headings, bat will be 
found as parts of the subjeota to which they properly 
belong." We were surprised, therefore, to find tbat 
the very first subject treated under the section on 
diseases of the liver is " Jaundice.” Selecting typhoid 
fever for survey from among tbe fevers met with 
commonly in this country, we most confess to a 
feeling of disappointment. Taches bleuairet have 
nothing to do with the rash of typhoid any more 
than flea-bites have. To place them in a paragraph 
describing the eruption, without any notice of their 
occurrence in other fevers, or any explanation of their 
probable origin, is misleading. A work published in 
1001 might be expected to discass, if it did not advise, 
the snrgical crealment of perforation, which has aroosed 
interest in the snrgical world, in which oonsiderable 
woik has been done, and in which some, though unfor¬ 
tunately little, success has been obtain^. The whole 
matter is dismissed as follows —" If surgical interfer¬ 
ence is undertaken it shonld be within twelve hours of 
the perforation, if it is to have much chance of soc¬ 
cers.” The chief onus as to the success or otherwise 
lies therefore with the physician, but when we turn to 
the text for tbe diagnosis of this "the most dreaded of 
all symptoms” (complications, we should say) we find 
that there is not a single word about either the pn’se or 
temperature. There a small chart to illustrate a 
case of perforation, but no attention is drawn to its 
salunt points in the text. 

Nearly half a page is taken up with Ehrlich’s diazo* 

\ rfa^:^ion in the urine, as a diagnostic, which we consider 
absolutely useless, as it is present in so many other 
febrile states. Under *' Prophylaxis ” there is not a 
word about Wright’s anti-typhoid inoculation, fonr and- 
a-half lines being sutfioient to mention it earlier in the 
chapter under “ J mmunity.” 

In the discussion on modes of spreading the disease, 
and later, on disinfection, there is no mention at all of tbe 
urine, a subject which has excited much interest else¬ 
where. As regards general management, we read: ” It 


LtTEaATtJRB. 


O 



OcJT. 9, 1901, 


MEDICAL NEWS. Th* Msdical Prkss. 399 


(milk) shonld not be given too oftenj nor in too great 
quantity. About four ooncee, given every two-and-a-balf 
or three hours, will probably be found to agree well.” 
Four ounces every three hours works ont; 32 ozs. =: 1 pt. 
12oz. in twenty*four hours ; but a line and a-half lower 
down we read, *' The total quantity given in twenty-four 
hours should not, at a rule, exceed iwo-and- a-hal/ or three 
pinie" (the italics are ours). The unhappy post-graduate 
who applies here for help in his first case of enteric will 
not, we hope, consider that it is a matter of no concern 
whether he gives the patient one and-a half or three 
pints of milk in the twenty-four hours. 

The question of stimulants is well discussed, but in 
the sentence" It is seldom that more than 6 or 8 ozs. in 
the twenty-four hours are demanded” we would leave 
ont the words " more than.” “ Diarrhcea, if slight, may 
require no special treatment ” is too vague. If the bed- 
pan is used constantly, four, five, or six motions will be 
fonnd a usual number, and not call for any treatment; 
it the bed-chair is na^, one, two, or three will be the 
usual number, and over four will require to be strictly 
watched and probably treated. 

On the subject of epidemic cerebro-spinal meningitis 
there is no mention of " lumbar puncture ” as a 
means of diagnosis either ante- or post-mortem. 
The dis'ases more commonly met with in foreign 
countries are admirably treated by Dr. Patrick Munson. 
The articles are a model of clear, concise writiog; 
short but full of information, without a line that could 
be omitt^, making most attractive reading even to one 
not directly interested in the subjects The chapter on 
Malaria gives, it is needless to say, everything worth 
knowing, and contains numerous illustrations. Dr. 
Munson is also responsible for the section on 
Diseases caused by Animal Parasites, and here again we 
are treated to a splendidly condensed and well illus¬ 
trated article, complete and up to date. It seems 
strange that in the article on Cancer of the Stomach 
there is no mention of the presence or absence 
of H Cl in its contents, as an aid to diagnosis. The only 
reference to it is: —" Secretion may not at once be 
effected, but as the diseaie progresses the hydrochloric 
acid diminishes.” This under the sub-head " Morbid 
Anatomy.” 

In "Diseases of the Blood,” vol. ii., p. 14, "cadaveric 
bodies, formed in the intestinal canal,” we prefer the 
term cadaveric snbitances, "bodies” sounds strange. 
Again, " The bone marrow is altered, especially in the 
ends of the long bones the yellow marrow being con¬ 
verted into deep red tissue.” Surely the shafts of the 
long bones should be referred to here, not the ends. 
Tenderness of the bones is not mentioned at all und^ r 
Pernicious Ansemia. Leucocytbaemia must be diagnosed 
from several things, but pemicions assmia does not 
appear to be one of them (p. 33). On p. 42, "the skin 
begins to secrete sweat and perspiration.’' 

Addison's Diesase is headed " Diseases of the Supra¬ 
renal Bodies.” and we think the word “ body ” miijht 
have been used all through instead of “ gland,” as they 
are not glands in the ordinary acceptation of the term. 
The disonsslon of their glandnlar function would have been 
scffioient without dabbing them glands on every occa¬ 
sion. "The symptoms of Addison’s disease . . . 
undoubtedly depend on abolition of the gland function ” 
is very precise, bnt the next line reads “We are quite 
ignorant bow this brings about the pigmentation, and 
we can only offer surmises regarding some of the other 
symptoms,” Diseases of the kidney are thoroughly well 
bandied. Here, however, the appearance of whole pages 
nnbroken by a paragraph do not tend to lighten a heavy 
subject. We have nothing bnt praise for the section on 
the nervous system. 

The book is excellently turned ont and it is practi¬ 
cally free from clerical errors, which wo consider a feature 
of Scotoh work. One, obvionsly an author’s oversight, 
is in Vol. I., p. 25, where “ castor oil ” is cited instead of 
" croton,” as an example cf an irritant which may cause 
sterile suppuration. It is a cause of wonder that such pro¬ 
gressive publisher s still adhere to senseless page headings. 
For instance forty-two pages contain fourteen different 
subjects, bnt each page is headed on one side " Respira¬ 


tory System,” on the other "Diseases of the Lnogs.” 
The same applies in sixty-eight pages with fifteen sub¬ 
jects headed right and left Diseases of the Kidney” 
and " Structural Diseases,” bnt one must hnnt through 
the whole sixty-eight pages for Acnle Bright’s Disease. 
This is worse than useless, it is a nuisance, and a waste 
of labonr and prioter’s ink ; better leave the page heads 
blank. It is less irritating, but a mnch more senseless 
custom than sending ont a book with nncut leaves. 

Also we regret the tendency to send ont big, heavy 
books, and especially with glazed paper. Because of 
the weight they cannot be comfortably read except at a 
table, and on account of the reflection from the glazed 
paper they cannot be comfortably read nnlees the light 
comes directly from behind the reader, hence the diffi- 
cnlty of ever reading them with comfort. We think 
that our pnblisbers, in this, are following a bad Ameri¬ 
can lead. 


Jflcbkul 

THE ELECTION OP DIEECT EEPRESENTATIVES 
TO THE GENEEAL MEDICAL COUNCIL. 

A WELL-ATTENDED meeting in support of the candi¬ 
dature of Dr. Glover was held on Friday evening, 
October 4tb, at the residence of Dr. White, 1, High¬ 
bury Place, N., with Dr. Danford Thomas in the 
chair. Dr. Glover gave a brief statement of bis 
position and views, after which Sir Thomas Barlow 
proposed the following resolution : " That this meetin>*, 
having heard from Dr. Glover a statement of the work ol 
the Medical Council and of his views thereon, and 
having regard to his action in the three periods during 
which he baa been one of the direct representatives of 
the profession in the Council, hereby expresses its un¬ 
abated confidence in him. and its determination to do 
all in its power to ensure his successfcl re-election.” 

This resolution was seconded by Dr. Ford Anderson 
and carried unanimously, after Dr. A. G. Bateman bad 
spoken in support. 

Dr. Buckell then moved: "That this meeting, 
believing that Dr. Glover's re-election will be in the 
interest of the profession generally, as well as in that of 
the principle of direct representation, desires to com¬ 
mend bis candidature to the heartiest support of all 
registered medical practitionei;8 in England and Wales ; 
who, it is hoped will, in their own interest as well as in 
that of the public, record a much larger vote at the 
coming election than on any previous occasion. ’ 

This resolution was seconded by Mr. Jago, and sup¬ 
ported by Dr. Malcolmson, and was also carried unani¬ 
mously. After the meeting bad formed itself into a 
committee for the fnrtherance of Dr Glover’s election, 
and after a vote of thanks to the chairman had been 
proposed by Dr. Glover and seconded by Mr. Keele, the 
proceedings terminated. 


007*8 Hospital Hedioal School. 

The following entrance scholarships and certificates 
have been awarded — 

Senior Science Scholarship for University Students: 
^0, Mr. A. F. Heitz; and certificates to Mr. W. M. 
Moliison, King’s Coll., Cambridge, and Mr. E. C. 
Hughes, Clare Coll., Cambridge. Junior Scholarships 
in Science: Mr. P. B. Mills, Dulwich Coll., and Mr. W. 
Trethowan, Plymouth Technical School and Guy’s 
Hospital, £105 each; and a certificate to Mr. C. M. 
Wenyon, University Coll., London. Entrance Scholar- 
uhips in Arts: ^100, Mr. C. Mayer; £50, Mr. M. J. 
Rattray, King’s School, Brnton, Somerset; and certifi¬ 
cates to Mr. T. E. A. Carr, Lancing Coll., Sussex, and 
Mr. K. J. Saunders, Clifton Coll. 

St. Thomas's Hospital Medical School. 

The following is n list of prizes distributed at the 
opening of the winter session at this school on Wednes¬ 
day last: — Prizes for Winter Session, 1900-1: 
Entrance Science Scholarship: G. Y. Yoirall, first 
scholarship, £150. University Scholarship: W. L. 
Harnett, scholarship, £50. First Year’s Students 



400 Thx Mcdical Pbssb, 


MBDTCIL NEWS* 


Oct. 9 , 1901. 


E. C. Norbury, the Wm. Tite scholarship, £27 10a.; O. 
K. Contts, Collof^e prize, £20 s It- J- U. Cox, College 
priza, £10; A. W. Hooker. S^ond Year's Students: 
H. A. Kisch, the Mnsgrave soholarship, £38 lOi.; E. 
W. Parry, Col'ege prize, £20; T. P. Puddicombe, Col* 
lege prize, £10; K. Takaki. Third Year’s Studenta: 
H. 8. Bennett and F. W. W. Smith, second tenure of 
Peacock soholarahip. Fifth Year’s Students: C. N. 
Sears, College prize, £10 (medicine); C. Burrows, Col¬ 
lege prize, £10 (surgery); H. E. Ro^rts, College prize, 
£10 (midwifery); W. M. G, Glanville, Hadden prize, 
£10 (patholo^); C. N. Sears, College prize, £10 (phar- 
maoology); H. W. Sinclair, College prize, £10 (forensic 
medicine and inssmity); H. W. Sinclair, College prize, 
£10 (public health. Frizes for Summer Session, 1901: 
First Year's Students : L. E. C. Norbury, College prize, 
£15. Medals: W. M. G. GlanvUle, the Wainwri^ht 
prize in practical medicine; J. E. H. Sawyer, the Bris- 
towe medal for pathology and morbid anatomy; C. N. 
Seats, the Treasurer’s gold medal for general proficiency 
and good conduct. 

University CoU^e. 

Mbdical Entranoe Scholarships.—Bnoknill Scholar¬ 
ship, £30 a year for four years, J. A. Watt; 60 guineas 
loholarship, H. R. Erans; 60 guiueas scholarship, L. F. 
Hirst. Medical Exhibitions, each 80 guineas, J. A. 
Ferri^re and E. E. Maples. 

Westminster Hospital Medical School. 

Tub Annual Dinner of the Past and Present Students 
took place at the Hotel Cecil on Friday evening last, 
Mr. Charles Stonharo, F.R C.S., in the chair. There 
was a very large gathering of students and their friends. 

After the usual loyal tmts the Chairman proposed 
the toast of the evening, “ Students Past and Present,” 
and he remarked that although Westminster rank^ 
among the smaller schools its students contributed more 
largely, in proportion to its size, to the services than 
any other school in Great Britain. Mr. Stonham ap¬ 
posed to put students to stand by the institution and 
to aid so far as they could in its progress. He then 
referred at tome length to the events in South Africa 
and to the part in the campaign played by himself 
and the students, Ac, who 1^ accompanied him 
as dressers, Ac. In order not to be accused of 
favouritism he carefully abstained from promoting any 
of the medical students under his command from their 
position of privates, an austerity which was doubtless 
appreciated by those who had to bear the burden. He 
spoke most highly of the way in which his men had dis¬ 
charged their duties under what were often very trying 
circumstances. The toast was responded to by Mr. J. 
W. Batterham and Mr. G. L. [Bunting. The toast of 
“ The Medical School ” was proposed by Dr. AUohin, 
who discussed the probable influence of the reconsti¬ 
tuted University of London on medical education in 
the metropolis, and was responded to by Mr. A. H. 
Tubby. A very pleasant evening was spent, musical 
interludee being rendered by Mr. Pearson, Mr. G. W. 
Hodgson, Mr. Fred Wright, Mr. Trebelli, and others. 
The Entrance Scholarships competed for before the 
beginning of the winter session have been awarded as 
follows:—Epsom Scholarship, of the value of 110 
guineas, to Mr. J. M. Platt; Scholarship in Arts, of the 
value of £60, to Mr. R. 8. Statham, from Dover College; 
Natural Science Scholarship, of the value of £60. t? Mr. 
A. C. Bryson; University Soholarship, of the value of 
£40, to Mr. J. H. Hebb, from St. John’s College, Oxford; 
Scholarship in Arts, of the value of £40, to Mr. H. 
Galloway, from 8l. Paul's School; and a Soholarship in 
Arts, of the value of £30, to Mr. C. C. Hickey. 

On Saturday last a new electrical laboratory and 
Bontgen-ray room was opened at Westminster HoepiUd, 
havinglwen built andequLpi^by private donations at a 
cost of about £1,000. 

Doctors on Strike. 

Accobdino to the Pall Mall Oazeitt , the junior medi¬ 
cal staff of the Civil Hospital at Venice, twenty-seven in 
number, have just sent an “ultimatum ” to the governors 
demanding a complete reorganisation of the sanitary 
conditions of the ho^ital, an increase of their own 


salary, and an augmentation of their numbers. Failing 
a satitfactory reply, they threaten to ftrike in a body. 
The governors, support^ by the municipal and Govern¬ 
ment authorities, l^idee refusing any concession, have 
determined to replace all the signatories, who are at the 
same time held criminally responsible for leaving their 
post} before their successors are appointed, 

A Bogus Doctor. 

Sons curious facts came to light at an adjourned 
inquest held last week on the body of a seaman at W«t 
Ham. He had been medically treated by a person 
called Head, who posed as an nnquali^d medical assist¬ 
ant of forty-one years’ experience. On his plate he 
described himself as *' Surgeon Dentist and Aooon- 
chenr,” although he did not pretend to be a registered 
dentist. His therapeutical armamentarium consisted in 
some burnt snsar, Epsom salts, and bioarb.>nate of 
soda, none of which was likely to afford much relief in 
pleurisy of old standing which had degenerated into 
empyema, from which, as the autopsy showed, the man 
had died. The jury found that death had been accele¬ 
rated by the gross ignorance of Head, for whose presence 
as witness a warrant had had to be issned, and there¬ 
upon the coroner committed him for trial on a charge 
of manslaughter. 

A Medical Man Chafed with Fraud! 

At Todmorden, last week. Dr. J. Cnbbtn, of Char- 
nock Pritchard, near Chorley, was cha^^ with obt^- 
ing money by false pretences. Prisoner called utoo the 
Vicar of Hytholmroyd, and representing that he had 
seenred a clerkship in Bradford, and, being pennilees, 
had tramped from Blackburn, the Vicar (Mr. Walton) 
gave him a few shillings to pay his railway fare ana 
get something to eat. ^veral charges are pending, and 
he was remanded for inquiries. 

Fall from a Train. 

Thb body of a man was discovered on Hie Great 
Western Rulway, not far from Chippenham, last week, 
he having apparently fallen from an express train. On 
him was found a card bearing the name of Dr. Reid 
Crow, who, it was stated, had recently arrived from 
^uth Africa. 

A Ssrions Accusation. 

Db. WiLLiAX Ttndal Watsok, medical officer of 
health to the Tottenham District Council, is under 
remand on a charge brought under the Criminal Iaw 
A mendment Act. On hearing that a warrant had been 
issued for his arrest Dr. Watson, who was absent 
on his holiday, at once returned and presented himself 
at the police station. 

Typhoid Fever in Oermany. 

A SBBions epidemic of typhoid fever is raging at 
Gelsenkirchen, the number of cases up to the present 
being estimate at upwards of 1,300. The outbreak is 
attrirated to |the unsanitary condition of the district 
and an impure water supply. 

A Snrceon charged with Fraud. 

A KAH called Robert Wilson, aged 44, described as a 
surgeon, and shabbily dressed, has been remanded on a 
charge of attempting to obtain money by false pretences 
from Dr. Theodore Dyke Aoland and others by pre¬ 
tending that he was Dr. William Dyer Fraser, who is at 
present in South Africa. 

An Unoonscientions Objector. 

A MAN applied to the Bromsgrove magistrates last 
week for a certificate of exemption for his child, on the 
ground that he believed it would be injurious to his 
child by causing unnecessary pain. He was informed 
that this did not constitute a conscientious objection, 
but in answer to a qnestion he said he could not Con- 
Bcientionsly declare that he believed that vaccination 
would be injurious to the health of his chil^ The 
certificate was accordingly refused, but we agree with 
the magistrates that the applicant *' was about the first 
for whose opinions they hM any respect." 

Death under Chloroform. 

A LAD, sixteen years of died from the effects of 
chloroform last week at Wimslow, neM Manohestw, 
when about to undmrgo an operation on the mouth. 



Oct. 9, 1901. 


MEDIOAIi NEWS. 


Tex Hbdioal Pbbsb. 401 


Awwiia .1 Hsdtcal Servic* at 8t Faal'a 
Thb annoal medical eervice at St. Panl’s Cathedral 
will take place on Thursday, October 17th, at 7.30 p m. 
As in past years, many memhera of the medical pro¬ 
fession hare 8ignifi«d their intention of attendinK in 
academical robM. The arrangements of the service this 
year have been considerably modified with a view to 
make it simpler and brighter. The sermon will be 
preached by the Bev. Canon Oore, and the music ren¬ 
dered by the London Choir Association, the choir being 
conducted by the Ser. Dr. U. Walford Daria, organist 
of the Temple Church. Admission to the spaces under 
the dome will be by ticket only. 

A Tribute to a Victim of Science. 

Tbb tablet to the memory of the late Dr. Walter 
Myers, of Birmingham, given by the Liverpool School 
of Topical Medicine, is now fixed within the walls of 
the Birmingham University. It sill be remembered 
that Dr. Walter Myers died of yellow fever, in bis 29th 
year, last January, at Para, Brazil, whilst ioTestigating 
the pathology and etiology of that disease for the Liver¬ 
pool school. Dr. Myers was educated at the High 
School, New Street, Birmingham, and went from there 
for a time to the then Mason College, which he left after 
gaining an open scholarship in natural science, at Cains 
College, Cambridge. 

Vital Statistics. 

Thi deaths registered in the a eek ending September 
28th in 86 large towns of Great Britain and Irelandicorr^ 
Bponded to an anw oftl rate of 16*7 per 1,000 of their 
aggregate popnlation, which is estimated at 11,463.028 
persons in the middle of this year :— 

Birkenhead 16, Birmingham 21, Blackburn 17, Bolton 
16, Bradfo^ 12, Brighton 16, Bristol 13, Burnley 17, Car¬ 
diff 12, Croydon 10, Derby 12, Dublin 17, Edinburgh 16, 
Glasgow 15, Gateshead 22, Halifax 17, Huddersfield 15, 
Hull 20, Le^s 19, Leicester 9, Liverpool 18, London 15, 
Manchester 21, Newoastle-on-Tyne 25, Norwich 19, 
Nottingham 13, Oldham 16, Plymouth 13, Portsmouth 16, 
Preston 18, &dford 17, Sheffield 20, Sunderland 27, 
Swansea 19, West Ham 17, Wolverhampton 17, The 
highest annnal death-rates per 1,000 living, as measured 
by last week’s mortality, were:—EVom fever, 1*1 in 
Huddersfield, 1*3 in Hull, and 1*4 in Sunderland; and 
from diarrboeal diseases, 3*3 in Blackburn and in Shef¬ 
field, 3'5 in Bull, 4*2 in Oldham, 4 6 in Sunderland, 5*0 
in Wolverhampton, and 5*7 in Gateshead. In none of 
the large towns did the death-rate from scarlet fever 
reach 1*0 per 1,000. The 83 deaths from diphtheria 
included 84 in London, 10 in West Ham, 6 in Bristol, 
6 in Liverpool, 5 in Manchester, 4 in Bolton, 8 in Car¬ 
diff, and 3 in Salford. Five deaths from smaU-poz were 
registered in London, but not one in any other of the 
large towns. 

A Crematorlam for Variolous ]>ead. 

Thb Works Committee of the Metropolitan Asylums 
Board have under consideration a propos al to erect a 
O^matorium at the Joyce Green Hospital for the dispcsH 
of the bodies of those who die of small-poz. 

On tile Altar of Bdenee. 

Db. J. B. O’Bribn, of Lowestoft, wishes to emulate 
the devotion of Dr. Geranlt, the French physician who 
some time sioce offered himself as a subject for experi¬ 
ment in regard to the tranemissibility cf tnberoulosis 
from animals to man. Professor Koch naturally enough 
declined the responsibility of inoculating the applicant, 
but advised him as an alternative to drink the milk of a 
tnberonlous cow nnder a restricted diet for twelve 
months. According to the reports before ns this tedious 
experiment does not satisfy the aspirations of thU 
wonld-he victim to to'ence, who sighs for intravenous 
injections of highly virulent bacilli or other dramatic 
method of arriving at a conclusion. Such experiments 
are to be discouraged in view of the fact that there is so 
much scope for fallacy that, be the result what it may, 
no trustworthy deduction would be possible. We fear 
that a thirst for notoriety has as mncb to do with these 
offers of self-immolation as devotion to science. 

Dublin Death-rate. 

In the Dublin Begistration Area for the week ending 


September 28tb, 1901, the deaths registered represent an 
annnal rate of mortality of 16.5 in every 1,000. During 
the thirty-nine weeks ending with Saturday, September 
2l9t, the death-rate averaged 266. Twenty.eight 
infants under one year of age, of whom six were_ nnder 
cue month old, died daring the week. Fourteen infants 
died between the ages of one year and five. Disease) of 
the respiratory sy«tem caused twenty deaths, of which 
twelve were cansed by bronchitis and seven by 
pneumonia. la three instances of infants under one 
year of age the deaths were nooertified, there having 
been no medical attendant daring the last illness. 

Unlvarsi^ of Durham Faculty of If edldne. 

Third Examination. 

Thb following candidates for the degree of Bachelor 
in Medicine have satisfied the examiner):— 

Hononrs.—Second Class: Chella Mary Hankin, 
Arthur Gibson Dunn, Charles Harold Crass. 

Pats List.—Thomas Engelhart Amyot, Bobert Story 
Browp, Annie Tombleson Bmnyate, Ambrose HaroM 
Bateman, William Morton Emmerson, Frwcls Jollie 
Gowans, Bryden Glendining, James William Gibson, 
Daniel Bichard Gnns, William George Thomas Hepple- 
white, Lizzie Evelyn Kendal, Flora Murray, Thomasin* 
Georgina Prosser, Briton Smallman Bobson, Joseph 
CoUingwood Stewart, Marmaduke Cordeux Wetherell, 
Auburn Lawrence Wilkinson, John Eobert Wylie. 

Doctor in Medicine.—Henry Edward Davison, M.B., 

B. S., B.Hy., Dnrh.; Herbert George Harris, M.B., B.S., 
Dnrh.; Henry Douglas Johns, M.B., B.8. Durh.; Albert 
Ezra Neale, M.B., B.S., Dnrh.} Vaughan Pendred, 
M.B.Darh.. F.B.O.S.; Arthur Biley, M.B., B.S., Dnrh. 
(is afy»entia) ; Frederick William Eowland, M.B., B.S., 
Durh.: Alfred Edward Steven*, M.B, Dnrh.} 

Harry Vincent, MB., B.S., Dnrh., M.B.C.P.; Leslie 
Herbert Walsh, M.B., B.S., Durh. 

Doctor in Medicine for Practitioners of Fifteen 
Years’ Standing.—William Eobert Etches, M.E.C.S., 

L. E.C.P., D.P.H.; Charles Joahua Joseph Harris, L.9.A., 

M. E.C.S., L.E.C.P.; John Henry Harris, M.B.C.S., 

L. S.A., D.P.H.; Edwin Guy Hunt, M.B.C S., L.B.C P.; 
James Thomas Neech, L.B.C.P., L.M., L.P.P.8.G., 
D.P.H.; William Henry Wright, M.E.C.S., L.K.Q.C.P., 

Master in Surgery.—Bertram Croesfield Stevens, 

M. D, B S., P.E.C.8., B., ME.C.8., L.E.C.P., L.S.A.; 
George Grey Turner, M.B., B.8., Durh., M.B.C.S., 

L. E.C.P. 

Bachelor in Medicine (M.B ).—Curtis Crispin Adeniyi- 
Jones; Arthur John SpiUer Brandon, M.B.C.S ,L.B.C.P.; 
Clifford Harold Brookes. L.S.A.; Thomas ^ymoM 
Coa’es; George Ernest Froggatt j Philip Oell Garrett, 

M. B.C.8., L.E.C P. 5 Charles Henry Gibson; John Spencer 

Hall, M.B.C.S., L.B.C.P.; Eobert Simpson Hindmarch; 
Albert Ernest Hodge; Ernest George Klumpp, M.E.C.S., 
L.E.C.P.; Ernest Edward Norman; Alfred Parkm; 
George Woodyatt Procter, H.E.C.S., L.B.C.P.; Frede* 
rick Biddle Scott? John Ernest Sidgwick; Biohard 
Thome-Thorne, M.E.C.S., L.B.C.P. . . , . . 

Bachelor in Sui^ry (B.S ).—Curtis Crispin Adeniyi- 
Jones; Arthur John Spiller Brandon, M.B.C.S., L.B.C.P.; 
Thomas Seymour Coatea; George Ernest Froggatt; 
PhiUp GeU Garrett, M.E.C.S., L.B.C.P. s Charles Henry 
Gibson: John Spencer Hall, M.E.C.S., L.E.C.P.; Eobert 
Simpson Hindmarch; Ernest George Klumpp. M.E.C.S., 

L. EC.P.; Ernest Edward Norman; Alfred Parkin; 
Frederick Biddle Scott; John Ernest Sidgwick; Alfred 
Edward Stevens, M.B.; Biohard Thorne-Thome, 

M. E.C S., L.B.C.P. , . 

Bachelor in Hygiene (B.Hy.).—Thomas Momsou 

Clayton, M.B., B.8., Durh.; Thomas Yeates, M.B., 

C. M., Ed. 

And the following gentlemen received the Diploma in 
Public Health, (D.P.H.), viz., Thomas Morrison Clayton, 
M.B., B.S., B.Hy., Durh.; Henry Edward Davison, 
M.B., B.8., B.Hy., Durh.; Duncan Macfadyen Millar, 
M.B., C.M., Glas., B.Hy., Durh.; Edgar MitcheU, M.D., 
B.8., B.Hy., Durh.; Thomas Yeates, M.B., C-M-, Ed.» 
B.Hy., Durh. 

It 


402 Thx Medical Pazca. NO TICES TO CORRESPONDENTS._ - Oor. 9, 1901. 


Streef, Ed^ware Boad. W.).-8.30 p.m. Hr. Campbell Williami 
will read a paper on Hsmaturia in Childhood." 


4^otice0 to 

dorreapoitimts, ^hcrt jCctters, &£. 

CoauBroHCKHTa reqnirinr a reply in thia colnmn are par. 
tlcnlarly reqneeted to make nee of a dMtnctto* nunolurt or 
1 \itiMU, and avoid the practice of eifnina themBelvee “ Beader," 
"Snbeoriber,” "Old Snbecrlber," Ac. Hnch confnalon will he 
spared by attention to this mie. 

Okioisal AnriCLES or Letters intended for publication should 
be written on one side of the paper only, and must be authenticated 
with the nameand address of the writer, not necessarily for publicn- 
tion, but as evidence of identitr. 

One would think, remarks the N.Y. MflUtil Rfronl, that when a 
novelist had once been convicted of gross ignorance on me iical 
matter concerning which he wrote with glibness, he would not make 
a second incursion in that dangerous field unless he was fairly sureof 
bis ground. Not so Mr. Hall Caine {though perhaps we err in 
dignifying him with the title of novelist). In his latest effort, 
"The Eternal City," he describes how a medical man esamiaed. 
the breast of a patient and the glands under ber arme, and, finding 
cancer, announced that a nurse must, be summoned imm^iately. 
This practitioner, who is supposed to be the most fashionable doctor 
in Borne, tells the friends a few p^es farther along in the dnary 
talethatif the cancer had been diagnosed earlier "nephrectomy " 
might have been possib'e, but that the case as he found it was 
beyond the reach of surgery. 

Mibarilib.— Our correspondent would not be justified in taking 
sneh a step. 

A STUDY IN EMBEYOLOGY. 

Bt F. B. Sawter, M.D., Harioh, O. 

In an ovary one night was an ovnm just right for the process of 
Ovulation. 

As she passed from her lair she was caught on the hair of the 
fimbriated prolongation. 

.In the tube to the right was a full armoured knight, desiring to 
produce fecundation. 

She complies then and there and begins to prepare by her polar 
globule formation. 

For before they could meet In this vitalline street by on arch of cell 
germination. 

She must accomplish a feat. In its way very neat, to prevent 
portbenoge nation. 

Then the knight wiggles in to the temple of sin where the Idol of 
his adoration. 

Full of vigour and vim, is awaiting for him tc fertilise her pro- 
nucleation. 

As he entered this p'lo, he exclsimod with a wail, in accents of 
at desperation, 

am minus my ‘tail,’and I'm sure I shall fail to fully induce 
impregr.ation." 

But she meets him halfway, saying "Do not dUmay," affording 
him muchgra'ifleation; 

So together they stay, and the devil's to pay, for there’s formed a 
new nucleation. 

Then changes take place at a very fast pace, a process called 
segmentation, 

And in most every case, to the end of the race, there follows the 
time of gestation. 

— Cincinnati /.nncef-Cfinic. 

Dr. S.(Croydon\—We do not 8«eo»ir way to adopting yoursug. 
gestiOD, as to do so would place us in a false position towards the 
vendor of the drug in question. There sppears to be no reason why 
J. B M. (Senthport).—The vaporisation of a solution of stroeg 
ammonia in a room which bos been disinfected with formalin is 
stated to obviate the irritating effects of the latter on the respira¬ 
tory tract. This i an bo injected thronth the keyhole, or ammonic 
gas may be passed in through a tube. In this way urotropin, a com¬ 
paratively inert product, is formed. 


Meetings of the §ocutics. 

Wbpkisdat, Oct. 9th. 

Hcntebiah Societt (london Institution, Finsbury Circus, 
E.C.).—8.30 p.m. Dr. Mitchell Bruce: Chest Complications in 
Abdominal Diseasa (Hunterian Lecture.) 

DEBMATOLonu'AL SwiETT OF LONDON (11, Chondos Street, 
Cavendish Square, W.).—5.15 p.m. Demonstration of Cases of 
Interest. 

Tbuesdat, Orr. 10th. 

British Gtn*colooical Societt (20, Hsn'^ver Square, W.).— 
8 p.m. Speciuifns will be shown by'Dr, H. Macnaughton Jones 
Dr. Travers: Inte-tin»l Obstruction caused by Unsuspect^ 
Uterine Fibromyoma simulating Appendicitis. 

Fbipat, Oct. 11th. 

Clinical Societt or Lonpon (20, Hanover Square, W.).— 
8.30 p.m. Papers Mr. J. J. Clarke : Note on a Painful Condition 
of the Twelfth Pair of Bibs.- Mr. T Bryant; A Case of Displaced 
Strangnlaterl Femoral Hen ia. Mr. C. Wallace: Wounds of Joints 
and their Treatment.-Mr. C. Han'ell MouUin : Omental Fixation 
for Ascites. 

[Thurspat, Oct. 17Tn. 

Hahveuk Societt or London (Stafford Booms, Titchborne 


Bailbt, j. C. H.. U.B.Lond., H.B.C.S., L.B.C.P.LoBd., HoRse 
Physician and Hoiue Surgeon to the West London Hospital. 

Fxtherston, B. H. J.. M.B.Edin.. L.B.0.8.Irel., Acting Omcar of 
Health for the City of Prahran, Yictoriia 

Findlat, John, M.B., M.Ch.Aberd., Second Assistant Medical 
Officer. Dorset County Asylum. 

Noall, Wm, Patntir, M.B.Lond., U.B.C.S., L.B.C.P., Stirgson to 
the East London Hospital for Children, Shad well. 

Bicbmokd Marshall Leoh, L.S.A.Lond.. Msdi<^ Officer and 
Public Vaccinator to the Mary TAvy District of the Tavlstook 
Union. 

Thornton, B. Q. C., M.B.. B.A.O., B.U.L. District Medical 
Officer uf Wellington (Salop). 

Warner. Allan, M.D.Dorh., M.B.C S.. L.B.C.F.Lond., Besident 
Medical OfflMr of the Leicester Isolation Hospital. 


%acandr 0 . 

Belfast, Boyal Victoria HospitaL—Medical Superintendent. Salary 
commencing at £300 per annum, with board and restdenoe. 
Applications to the Hon. Sec. (See Advt.) 

Bristol General Hospital —Assistant House Snigeon. Sslary £70 
per auDum, with board, residsnoe, Ac. Applications to the 
Secretary. 

Bnrton-OD Trent Infirmary.—House burgeon. Salary at the rate 
of £120 for the first year and £140 for the second year, with 
board, furnished rooms, Ac. Applications to the Hon. Secre¬ 
tary, the lofirmary, Burton-on-Trect. 

Clayton Hoapital and Wakefield General Dispensary.—Senior 
House Surgeon, unmarried. Salary £190 per annum, with 
board, lodfring, and washing. Applications to the Hon. 
Secretary. 

Clifden Union,-Medical Officer. Salan £140 per annum as 
Medical Officer, and £10 a year as MMioal Officer of Health, 
with the usual Begistration and Vsociaation Fees. Applica¬ 
tions, accompanied by diplomas and testimonials to F. Eing, 
Clerk of Union. (SeeAavt.) 

Cornwall County Asylum. Bodmin.—Junior Assistant Msdlcal 
Officer, unmarried. Salary £180. rising to £150, with boa^ 
apartments, laundrr, Ac. 

County Asylum, Mickleover, Derby.—Senior A<sistaQt Medical 
Officer. Salary £130, rising to £150 per annum, with apart¬ 
ments, board, washing, and attendance. Also Junior Assistant 
Medical Officer. Salai7£110, rising to £130 per annum, with 
apartments, board, washing, and attendance. Applications to 
the Medical Superintendent 

Denbighshire Infirmary, Denbigh.—House Sorgmn. Preference 

S ven to one having a knowledge of the Welsh language. 

dary £100 to commence, with board, residencs, and waahi^. 
Applicatkirs to the Secretary. 

Essex County Asylum, Brentwood — Junior Assistant Medical 
Officer. Selaiy £140 per auDum, Apply to the Medical 
Saperintendeat. 

Glasgow Boyal Asylum for Lunatics. - Pbyrlcian Superintenent. 
Salary £1,000 per annum, with a honse at the Instit ition and 
free coal, gas, and water-supply. Appli'^tiona to the Secre¬ 
tary, Glasgow Boyal Asylnm for Lunatics, 190, West George 
Street, Glasgow. 

Ingham Infirnury.-Senior House Surgeon wanted. Salary £100 
pM'annum, with residence, board, and washing. Applications 
to the Secretary, 74, King Streep South Shields. 

Manchester Children's Hospital, Pendlebory.—Medical Officer. 

Salary £180 per ammm. Applications to the Secretary. 
Midlothian District Asylum.-Assistant Medical Officer, single. 
Salary £200, with furnished rooms, board, washing, and 
attendance. 

North Staffordshire Infirm'ry and Eye Hospital, Hsrtabili, Stoke- 
upon-Treiit.—Hooie PbysiciuL Salary £100 per annum, in¬ 
creasing £i0 per annum, with apartments, board, and washing. 
Applications to the Secretary. 

North Wales Counties Lunatic Asylum, Denbigh — Second Assist- 
snt Medical Officer. Salary £180 per annum, rising to £160, 
with board, residence, snd washing. Applications to the Clerk 
of the Visiting Committee. 

St Msjy's Hospital Medical School, Paddington, W.—Ckmnalty 
Physician. Salary £75 per annnm. 


^Harriagee. 

Goodfellow-B oBEarsoH.—On Sept 85th, at St. Wilfrid’s 
Church, NorthenOen, Chesbire, Thomas Ashton Goodfellow, 
M.D.Lond,, of Didsbury, to Eleanor Winifred, only daughter 
of W. J. Robertson, of Northendeo. 

UoBOAN— Prosser. ■ On Oct 2Dd, at Llanarthney Parish Church, 
Wales, Edwin Morgan, L.D.S.Eog., youngest son of the lats 

1 W. Evans Morgan, M.B.C.S., L.B.C.P.Lond, to Margaret 
Agnes, youFgest daughter of W. W. Prosser, of CapcI Dewi 
Hall, (^msithen. 


^eathe. 

Kino.— Ou Oct 2Dd, at 13, Eton Bead, South Hampstead, Anns 
Farsous King, widow of the late Abraham King, M.D., of 
Bridgwater, Somerset, in her 76tb year. 

Boobs.— On Oct. 1st, Edith, wife of Bobsun Boose, M.D.Brux., 
F.R.C.P.£d., of Hill Street, Berkeley Square, London] 
aged 50. 

Diplll/HM !)>' 



ibe and Cimlar. 

“SALU8 POPULI 8UPBBMA LEX.'* 


VoL. CXXIII. WEDNESDAY, OCTOBEB 16, 1901. 
(Slittital ^ecturce. 


RAYNAUD'S PHENOMENA : 

Being the Abstract of a Lecture deijtered 

AT THE London Hospital, on June 19th, 1901. 
by JONATHAN HUTCHINSON, P.B.S.,(fco.,&o. 

Gentlemen, —It is always pleasant to an old man 
to renew the avocations and pleasures of bis youth, 
and so I come before you witn a subject which ra* 
minds me of my work in the wards of the London 
Hospital, where I believe some of the earliest cases 
of “Baynnud's disease'* in England were observed 
aod studied, and where the first observation was 
made as to the connection between paroxysmal hsema- 
tinuria and Baynaud’s diseaae. 

First, 1 think we shall gain a clearer idea of our 
subject if we discard its name, for the expression 
" Baynaud's disease " would imply that there is some 
one malady complete in itself, and having all the 
symptoms the same in all cases which is suita^ deno¬ 
minated by tbatname. That is not the case. Weknow 
what we mean by syphilis, variola, and pulmonary 
phthisis. Understand that I wish to do all honour 
to such a man as Raynaud—a man of singular ori¬ 
ginality of mind and of great pertinacity in observa¬ 
tion, who devoted himself to tne pursuit of clinical 
truth. But by being precise in the signification of 
the names we employ we shall be honouring his 
name, and therefore 1 would speak rather of Ray¬ 
naud’s phenomena than of Baynaud’s disease, for 
the former are things which we understand and are 
the same in all cases. In this substituted expression 
we must include a large group of maladies which 
differ widely in their etiology. What do we mean 
by Baynaud’s phenomena? You are aware that 
local syncope, local asphyxia, symmetrical gangrene 
of the extremities are synonymous terms. More 
recently the prefix aero- has been applied as in 
(aoro-sphacelus) i.e., gangrene ocenrring at the 
very extremities. 1 think it is a very useful term to 
employ in that connection. Under the.-e different 
words we imply the knowledge that the circulation 
in the extremities is liable to be interfered with, and 
this interference may lead to malnutrition of the 
parts and to local symmetrical gangrene. To sim¬ 
plify our problem, we must remember we are all the 
subjects of Baynaud’s phenomena in a greater or less 
degree. We are all liable not only to coldness of the 
hands through exposure, but also through the influ¬ 
ence of the nervous system. Our next assertion will 
be that no two of us are alike. We are all different 
as regal ds the susceptibilities of our tissues and our 
circulation to be disturbed by separate influences. 
Thus we at once recognise the reality of personal 
peculiarity, and the importance of its recognition. 
The term “ local syncope ” is given to the phenomenon 
which is sometimes known as " dead finger.” Some 


No 16. 


persons, after undue exposure to cold of their hands, 
will be liable to have tne circulation in those parts 
quite suspended. This condition depends on a spasm 
of the arteries supplying the finger, whereby its blood 
supply is cut off. it is attended by the condition of 
local asphyxia, in which the parte become not pale 
but very dusky and of a livid hue, though not 
8hrivell<^ as in local syncope, where the finger would 
be like that of a corpse. Lo^ asphyxia, in contra¬ 
distinction to local syncope, is due to fulness of the 
small veins of the part; in both, the arteries are 
more or less affected by being thrown into spasm, 
but in the former the closure of the lumen is less 
complete. 

Is it true that these conditions always or usually 
go together P We must not insist too strongly upon 
these phenomena having any relation in point of 
time to each other. Perhaps usually one condition 
does precede the other, the “pale” stage being 
followed by the “ livid ” condition. But in some per¬ 
sons the fingers become dusky straight off; in others 
they become pale first and remain so. In a great 
many cases there is a certain amount of dusky 
mottling and pallor mixed up together, as in a 
corpse. 

In order to constitute a typical resemblance to 
Raynaud’s phenomena the patient ought to be liable 
to have the phenomena in a paroxysmal manner. 
But there are cases which are not paroxysmal, which 
occur only onoe in the patient’s life and then pass 
away and do not come again, and these cases must be 
considered with the others, although not exactly 
parallel. The periods of liability may sometimes 
extend over several weeks, during the great part of 
which thu limbs remain in a state of extreme duski¬ 
ness or pallor. The phenomena may recur after a 
long time. 

Should symmetrical gangrene of the extremities 
rank as precisely synonymous with Baynaud’s 
phenomena ? In this connection I will relate two 
cases. Both patients were healthy men. Their ill¬ 
ness involved them in the loss of all the ends of the 
fingers, the tip of the nose and ears, and the ends of 
the toes. The drawing of the cases would lead one 
to suppose that there were black kid gloves thrown 
over the fingers. After the sloughing the men got 
quite well. In neither case has there been any dis¬ 
ease subsequently. No renal disease or heart 
disease could be found to account for this local 
gangrene. No cause could be found. The historv 
was that suddenly the extremities became painful, 
the limbs began to ache, next the aching was ex¬ 
treme. The patients were then put to bed. Severe 
illness followed, attended by symmetrical gauCTene 
of the extremities. There was no evidence, I tnink, 
in these cases of susceptibilitv of the nervous 
system. A patient may be liame to asphyxiated 
extremities because that part of the nervous system 
which regulates the size of the arteries is very sus- 
Diiiiiized r oogc 


ORIGINAL COMMUNIOATIONP. 


Oct. 16, 1901- 


404 Thz Msdical Pbkbs. 


■ceptible. When a cold impulse is transmitted through 
'the band to the nervous centres and the arteries are 
thrown into a condition of spasm, we may infer from 
the degree of irritation produced what tendency 
there is to local asphyxia and local syncope. If it 
j?oer to an extent w^ioh is morbid, then the slightest 
exposure to cold will induce either a roflex dilatation 
of the veins or a reflex contraction of the smaller 
arteries, and then the term under discussion becomes 
applicable. 

What was the nature of their illness ? You must 
keep in mind three or four different elements which 
may go into partnership in a case, one of which may 
gradually preponderate over the others. 

First, we think of the vital endowments of the 
tissues, which differ in each individual. Next we 
pay regard to the arteries, which may be diseased 
or sound, small or large, or liable in a greater or less 
degree to be thrown into muscular spasm. Next we 
take into consideration the state of the nervous 
system and ask ourselves whether the reflex irrita* 
bility of the muscular part of the arteries is morbidly 
irritable, and whether tbe nervous centres regulating 
the amount of tbe blood supply are in a state oi 
irritability P Lastly, we have to consider the central 
oigan of the circulation itself. The heart may be 
weak, very weak. If it were possible to depress the 
heart’s action to that point at which it could only gust 
carry on the circulation and keep the patient alive, 
we might explain the condition in which the blood 
could not get to the very ends of the fingers and toes; 
the extremities are manifestly at a disadvantage in 
being situated so far from the heart. So that is the 
hypothesis I would suggest in these two cases, 
namely, some serious unrecognised temporary con* 
dition of tbe heart, some inflammation of the heart 
substance. Tbe fingers in both cases healed well. 1 
make this suggestion with some diffidence, for 1 have 
no proof of its truth. The only other explanation 1 
can offer is that the patients were liable to blood- 
poisoning also acting on tbe heart. 

I always recommend students of medicine to study 
the diseases of tbe lower animals and plants, for in 
that study they will find some light thrown upon the 
problems of pathology in reference to tbe human 
subject. You see we can study the phenomena of 
acro-asphyxia, even see the point of death in plants 
under conditions in which we get rid of the nervous 
system and also of the centi-e organ of the cir¬ 
culation to some extent, though not wholly. The 
roots are the plant’s substitute for the heart m refer¬ 
ence to the circulation. Tbe power in the extreme 
ends of the roots that helps to drive the sap upwards 
to the topmost buds, must be considered as some¬ 
what simuar to that by which tbe heart drives blood 
to tbe fingers. Every living thing must have a cir¬ 
culation. To prove that the rootlets do drive tbe 
fluid up, I may mention that you may cut across a 
birch tree three feet from the ground and leave not 
a single bud or leaf attached to it. Leave it stand¬ 
ing during tbe winter, and in the spring you will 
see the once dry top of tbe tree beginning to pour 
out fluid, which will nm down tbe sides in large 
quantity. So 1 assert that there is a vt$ a tergo 
which is generated by the roots below. As to what 
lessons the diseases of plants and trees may 
give us in reference to our interpretation 
of Baynand’s phenomena, you will see many 
examples of auro-spbacelus, i e.. the tips of tbe leaves 
are dead, the rest of the leaf being alive. Or in a 
lofty tree, perhaps, the very tops of the twigs are 
dead. Here, then, we have examples in which the 
extremities of a living thing will fall off owing to 
want of nutrition, caused by their distance from the 
vi$ a tergo to which I bare gust referred. Tbe tissues 
and cells may have been attacked by cold, which 


! may have been sufficient to kill the ends of the 
branches, though not the whole of tbe tree. The 
tree, like the animal, is liable to be influenced by 
anything which enfeebles its roots. Thus, if a tree 
is dead at the ends of all its branches, while it is 
still producing a few leaves near tbe trunk, you may 
be almost certain that such a tree has something 
amiss with its roots. So I suggest as regards planto 
that they afford instances in proof that tbe peri¬ 
pheral parts of tbe tissues are more liable to be 
influenced by external cold, and they also show that 
the want of vigour in propulsion of the roots (equiva¬ 
lent to the heart in animals) may be tbe cause of 
their gangrene. Further, they illustrate disease of 
arteries; if the tracheides become blocked you will 
see that death ensues of the part of tbe bud. So in 
calcareous arteries; their calibre is diminished, and 
consequently tbe risk of acro-sphucelus of the part 
below is very much increased. 

Now, a few words about tbe more common forms 
of the malady, in which we recognise Raynaud's 
phenomena. Not infrequently children of five years 
and onwards—not in youn^ infants, for the nervous 
system is in them not sufficiently developed—we have 
a juvenile form. I might have mentioned chilblains 
on tbe extremities as one of the acro-spbacelous condi¬ 
tions, for they have an intere--«ting relation to 
Raynaud’s phenomena, although quite different. la 
chilblains there is local inflammation, which is ab¬ 
sent in Raynaud’s phenomena. 

Children are more liable to chilblains than adults. 
Again, infants very rarely suffer from cbilblai's, 
b^ause these have a good deal to do with the 
nervous system. Tbe typical cases in children are 
of extreme asphyxia—blue bands, blue cheeks, the 
latteralmostlividfrom the exposure. Typical cases of 
Raynaud’s phenomena, sometimes running to gan¬ 
grene, not merely of tbe extremities, but of the 
limbs themselves, may be induced, not by blood dis 
order, but through the influence of tbe nervous 
system. The juvenile form is liable to recur re¬ 
peatedly in those who first become liable to it 
through the enfeebling inSuence of some illness. 

There is another form which occurs in old people 
or those, at any rate, who have passed middle life. 
Here, not to tbe nervous system so much, but to the 
heart and tbe pulse you must pay attention. 
Ordinary senile gangrene must be toought of dis¬ 
tinctly from Baynaud's phenomena, because it is 
scarcely ever symmetrical. From this we infer 
that local causes have to do with senile gangrene. 
Tbe latter frequently results from some sli^t injury 
to an extremity in a person with diseased ajrieries. 

Senile gangrene is, however, related to some forms 
of Baynaud's phenomena. If ever yon see a case in 
which both extremities are infects, and in which 
the two hands in an old person are affected as well 
as tbe feet, yon must investigate it on the lines on 
which you would investigate any other case of 
Raynaud’s phenomena. As an illustration of such 
a case, 1 will mention that of an old man, st. 80, 
whom I saw in the German Hospital of Great 
Yarmouth. The ends of cdl hie fingers were in a 
state of gangrene. His arteries were so calcareous 
that 1 could scarcely feel tbe pulse. He had been in 
hospital several years before for what was considered 
ordinary senile gangrene in the big toe of one foot 
only. Otherwise be was in good health. There was 
no nervous element. What it was that produced 
the symmetrical attack in both hands and left tbe 
feet quite free was the problem. The attack 
occurred quite suddenly, not after any undue ex¬ 
posure. 'There was no obvious disease of the heart, 
but still I am inclined to think that tbe explanation 
lies in the progressive calcification of tbe arteries 
acting as a predisposing cause at first and then 


Oct. 16, 1901._ORIGINAL COMMUNICATIONS. Thb Medical Press. 405 


l)ecomtng the determining factor, some slight un¬ 
noticed depressing influence of the heart being 
the final cause of the outbreak of the gangrene. 
Lastly, I have to mention another curious form with 
which 1 daresay some of you may he familiar. If 
not, ask in the skin department to be shown a 
good eEsmple of diffuse scleix>si8 of the skin or 
diffuse morphcBa. In this disease, the skin of the 
hands becomes stiff and hard; the fingers ai'e 
stiffened and their ends look empty of blood; and 
the hands, when held up, look like badly-coloured 
pieces of tallow more than anything else, with 
patches of blood here and there. In this condition 
the hands are useless owing to the stiffness. This 
indurated condition of the skin will extend up the 
arm, according to the severity of the case, passing 
off very gradually. “Diffuse morphma” was for¬ 
merly used to discriminate between this condition— 
not distributed by the nerves—and another form of 
morpbcea, in which the skin passes into the indurated 
state, as in herpes zoster or shingles, and is un¬ 
doubtedly distiibuted by the influence of the nervous 
system. The digits of the lower extremities are 
less affected than those of the upper, and the face 
is affected. It nearly always occurs in women. It 
is impossible to pull up the skin of the face or of the 
hands, and this IS a characteristic of the condition. 
The lips are hard and rigid, and the skin glossy 
and pitted over with little punctate vessels. You will 
thus gather that this diffuse scleroderma of the skin 
is a very definite condition, and easily recognised 
once you have seen it. The patient is liable to more 
or less paroxysmal change. Buttbehandsarenever 
well. After a time the bulbs of the fingers are all 
contracted and hardened, and little bits of gangrene 
occur close under the nails. Sometimes the whole 
end of a digit will become gangrenous. After ten 
or fifteen years a little improvement may take place 
as the result of treatment, but these cases never get 
abeolntely well. Raynaud himself described some 
of these scleroderma cases in bis first thesis, but 
they must not be confused with the others as they 
constitute a group quite apart. We must not, how¬ 
ever, simplify too much and make classifications in 
the same way that we would classify plants and 
animals according to species. For pathologfical 
phenomena run into each other, and so we find rela¬ 
tionships which (ve must recognise and not differen¬ 
tiate t<w arbitrarily. 

I might say a word or two more about the senile 
form of fiaynaud’s malady. Weezpecttofind struc¬ 
tural organic diseases. I have one case of a man in 
good position who baa never had a good circulation. 
He is 62, lives well, and has enjoyed good health 
When he holds his hands up, they look painfully 
like those of a corpse, dead twenty-four hours. The 
bulbs of the fingers were dried and shrivelled, and 
there were little blue marks round the ends of the 
nails. His fingers were on the verge of going into 
gangrene. His pulse was rather feeble, and the 
question of calcareous arteries was doubtful. I 
refer to this case to mention a new symptom which 
I have recently observed in reference to these phe¬ 
nomena. The case also illustrates the importance of 
listening to what a patient has to tell you. He told 
me he had got a red mark in his nails. It was a 
little line exactly where the nail leaves its bed. Ic 
was very conspicuous and present in all his nails. 
The redness could not be removed by pres¬ 
sure. He had a condition of thrombosis of the 
capillaries at the very ends of the nails. I then 
looked at other portraits of cases with Raynaud's 
phenomena, and found (what I had overlooked) this 
red fringe accurately depicted. I ordered this 
patient to bed at once, and he has now been under 
treatment several months, and I hope he will escape : 
Actual gangrene. 


1 Gentral Treatment .—The first preliminary to all 
ti'eatment and the advancement of therapeutics is 
to thoroughly understand all the causes of disease. 
It is no use for the most part acting in an empirical 
manner. If the nervous system is very susceptible 
' in a reflex manner to the influence of cold, we must 
protect the patient from this cold. In the juvenile 
, form we must insist on warm clothing, and if possible 
a warm climate. We w’ant information as to inter¬ 
national medicine and tbe influence of climate. Are 
these phenomena less prevalenbin the Tropics ? We 
I know symmetrical gangrene occasionally occurs 
among the Hindoos. Would a young patient be 
I benefited by living in the Tropics ? I think so, and 
in private practice 1 recommend wintering in Egypt 
—a warm but not tropical country. If the case is 
one of sclerosis or morpheea, the cause is less easy to 
assign, but the paroxysmal nature of the illness im¬ 
plies susceptibility to external cold to some degree. 
If he be an adult and cannot winter abroad, tbe best 
drug is opium—constant small doses (three or four 
drops of the tincture three or four times a day). If 
purgatives be given, then small quantities of opium 
do not agree. This should be given in combination 
with tonics, and caieful attention should be paid to 
tbe liver. There should be also, 1 think, a moderate 
use of stimulants, but they should be given with very 
great care. Raynaud himself insisted in the later 
part of his life a great deal upon electricity. I have 
tried galvanism according to bis methods, but I place 
my faith in the use of tonics, the maintenance of the 
external temperature, and the exhibition of small 
doses of opium over a long time—even years. 

Jari© Clinical Kecturc©. 

THE H^MODTAGNOSIS OF 
APPENDICITIS. 

By Dr. TUFFIER, 

BnrKSon to the Ptfle HoepiUli. 

The woman occupying No. 19 bed of the Jargavay 
Ward came under our care on account of an affec¬ 
tion of which the clinical aspect is one of exceeding 
interest. It will be of advantage, I think, to discuss 
and classify her symptoms in the study whereof will 
convince you, a point upon which I have so often 
insisted, that clinical surgery ought, at the present 
day, to avail itself of laboratory research in the en¬ 
deavour to make a certain diagnosis and thereby to 
arrive at> the appropriate treatment. 

The case is that of a dressmaker, 47 years of age, 
who, on April 4th last, came complaining of pain in 
the right iliac fossa and in the loin of the same side, 
also on accountof a certain difficulty in walking. 

Married at the age of eighteen this woman bad a 
miscarriage a year later; she afterwards had two 
normal labours, one fifteen years ago. and the second 
three years after. In 1891, having gone up a ladder 
to reach a heavy parcel, she felt herself being forced 
backwards by the weight which she bad lifted. To 
save herself from falling she bent herself sharply 
forwards, and immediately felt a sharp pain in the 
iliac fossa and right lumbar region, accompanied by 
the sensation of something having “given way.” 
She was carried home, and almost at once a painful 
tumour appeared in the ride side, visible on a 
cursory examination of the belly, and this was 
accompanied by some difficulty in passing water. 
Many surgeons, had they been consulted, would 
have diagnosed a “fibrous tumour,” and suggested 
operation. This view having been disposed of, tbe 
patient was left at rest in bed with tbe head low. 
The swelling gradually diminisbsd in size, the pain 

D )0^ DC 



406 Tks Medical Pbbbe. ORIGINAL COMMUNIGATONS. Oct. 16, 1001. 

Bnbsided, and in about four months no trace rpmained I faTonr of the idea of a osteosarcoma, the next in- 


of the lesion, the nature of which was obscure, but 
which we will endeavour to elucidate later on. 

During the following ten years the patienten joyed 
perfect health, and in the interval she bore a child. 

The menopause occurred a year ago without 
giving tise to any trouble. At about this period, 
in July, she believed herself to have been poisoned 
by eating fish. She had lunched at ll.SO a.m., and 
at 2 p.m. she was suddenly seized with a feeling of 
discomfort and with flushes of heat and nausea, fol¬ 
lowed by copious vomiting and slight colic. She 
continued in this state till six o’clock in the evening. 
There was no distension of the abdomen, and no 
part of the bell^ was the seat of any particular pain. 
Five days’ rest m bed and two purgations relieved 
these symptoms; the abdominal pain and digestive 
troubles disappearing for good. 

In January the patient experienced vague discom¬ 
fort, aching all over and pain in the legs, which was 
attributed to an attack of influenza. Lastly, on 
March 14th. feeling out of sorts, she took an aperient, 
and later in the day she experienced sharp pains in 
the right iliac fossa, running down the front of the 
thigh and along the crest of the ilium, of a shooting 
character and unaccompanied by either nausea or 
tympanites. The pains continuing, she was obliged 
to take to her bed; a physician having been called 
in, he treated her for “ inflammation of the intes¬ 
tines,” by milk diet and ice to the belly. From that 
day onwards the tendency to flexion of the thigh on 
the abdomen became more and more marked. 

On April 4th the patient came into the hospital. 
Examination of the abdomen revealed neither tym¬ 
panites nor any particular tumefaction in the iliac 
regions. There was no pain so long as she kept 
still. She only complained of pain, and even then | 
not very acute, when the region of the iliac fossa, 
where all muscular resistance was absent, was; 
deeply palpated. The examination furthermore | 
showed us that the whole iliac fossa was filled 
by a mass of wooden hardness, rounded, projecting, 
with fairly well-marked outline, which appeared to 
extend from the ilio-umbilical line to the crural | 
arch. This mass had a smooth surface, and was inti- | 
mately connected with the bony framework of the 
region. 

We also noticed, on the same side, a flexion of j 
about 30® of the thigh on the pelvis. We were able 
to increase this flexion without causing pain in the 
hip-joint, which was evidently not invmved. Exten¬ 
sion of the limb was, however, impossible, and all 
endeavours to do so caused pain. I may add that 
examination of the uterus and its adnexa showed 
them to be normal We did not discover any lesion 
of the vertebral column or of the pelvic bones. 
Questioning did not reveal any tuberculous or 
syphilitic taint in the antecedents of the patient. 

Her general condition was good and her appetite 
was go^. Nevertheles, the patient had lost flesh. 
The thermometer registered 37® 5 C. at night; twice 
only, during the week she was under observation, did 
it rise to 38®2. Moreover, the temperature fell in the 
morning to about 87°. Within a few days, indeed, 
this woman became almost completely apyretic. 

In the presence of these facts—tumour in the 
right iliac fossa, progressively increasing in size for 
the past eight months—a tumour which was hard 
and indolent and was closely connected with the iliac 
bone—what diagnosis were we to form P It was 
either a solid tumour of the pelvis, very probably a 
primary osteo-sarcoma, or a cold abscess occurring 
m the sheath of the psoas. If the latter diagnosis 
were the correct one it would still remain for us to 
decide what was the primary origin of the iliac 
abscess. 

Ton may have remarked my hesitation one day in 


I dining to Ihe hypothesis of an abscess. The pro¬ 
blem was far from simple. The bony hardness of tbo 
tumour, its rounded shape, its situation in the iliac- 
fossa, of which it seemed to form part, its fixity, it» 
indolence, and the age of the patient, all seemed to 
me to favour the idea of an osteosarcoma, especially 
as I did not see clearly what could be the possible 
origin of an abscess. Moreover there was not, in the 
immediate antecedents of the patient, any trauma¬ 
tism, either direct or indirect, which could account 
for the existence of an inflammation of the psoas. 
Neither could any general infection, typhoid fever^ 

I septic mischief, &c., be made to account for it. Nor, 
again, did there exist any neighbouring form of in¬ 
fection, osteomyelitis of the iliac Done or of 
the lumbar vertebrte, peri-appendicular abscess, 
suppurative peritonitis, perinephritis, &c., which, 
by extension, might explain auppurarion within 
the sheath of the psoas. Now yon are all aware 
that the three great factors of the production 
of psoas abscess are ; tramatism, infectious pyogenic- 
affections, and inflammation propagated by con¬ 
tinuity or contiguity of surface. We were therefor© 
justified in admitting the hypothesis of oateosarconm 
of the pelvis, in spite of the occurrence of two 
febrile attacks; moreover, Yemeuil has alluded to 
the frequency of fever during the evolution of 
the grov^h in question. This diagnosis was unani*- 
mously accepted by all my colleagues and by the 
candidates at the clinical examinations who 
examined the patient. 

In spite of this I was haunted by the recollection 
of two veiy similar cases in which ordinary suppu¬ 
ration of the iliac fossa was mistaken for osteo¬ 
sarcoma. The first case especially was interesting. 
It was that of a woman, set 50, who had been 
seen by a number of surgeons, the diagnosis 
formed being unanimous, a neoplasm of the 
iliac fossa.” I was requested to attempt the 
extirpation of this tumour, and when I bad 
incised the pelvic aponeurosis 1 came upon a collec¬ 
tion of stinking pus. My second patient whom I 
saw in conjunction with Dr. Selle, in 1897, was a 
man, set. 60, suffering for several months past 
from pain, &c., in the right iliac fossa. The loss 
of flesh, the yellowish tint of the skin, the digestive 
troubles, characterised by alternations of diarrhoea 
and constipation, and also the presence of a tumour, 

?uite wooden in consistence, indolent and nodular, 
orming part of the iliac bone, and the whole without 
any febrile reaction, inclined me to look for an 
adherent neoplasm of the csecum. A few weeks later 
the constipation increased and symptoms of intes¬ 
tinal obstruction became evident, and an operation 
—having for object to establish an artificial anus— 
was performed. The seat of the neoplasm rendered 
it necessary for me to make an incision in the right 
iliac region. I found the aponeurosis slightly in¬ 
filtrated by clear serum. I proceeded to investigate 
the nature of the tumour adhering at this point, for 
it appeared to me to be abnormal; I made an in¬ 
cision into it, and then I pushed in a grooved 
director, and suddenly I came upon a collection of 
stinking pus, whence issued a fsc^ calculus. I had, 
in fact, opened up a peri-appendicular abscess. 1 
drained the cavity, my patient recovered, and is stili 
living. 

The remembrance of these cases to the one under 
consideration reduced me to a singular state of per¬ 
plexity. I feared to meet with a similar condition in 
this case. 

It was in this frame of mind that I requested ih© 
Head of the Laboratory, Dr. Milian, to make an ex¬ 
amination of the blo^ of this woman. I then 
' awaited that light which might be thrown on th© 
case by bsemotology before deciding on an operation. 




Oct. 16,1901. 


ORIGINAL COMMUNICATIONS. Tm Midical Pbms. 407 


The following; is the note which was addressed to 
me by Dr. Milian on the very morning of the opera¬ 
tion :—“ Red globules 5,637,000 per cubic mm.; 
white globules 49,600, of which 75 per cent, were 
polynuclear, 25 per cent, mononuclear, and no eosino- 
philes. Too many white globules for a sarcoma, too 
many[red globules for epithelioma; therefore it must 
be an abscess.” 

This diagnosis was amply confirmed by the opera¬ 
tion, on April 10th, under analgesia produced by the 
intraspinal injection of *0 gr. 0*5 centigr. of cocaine. 
I made an incision about 10 centimetres in length 
rery near to the right anterior superior iliac spine, 
in order to attack ^e tumour from its external sur¬ 
face. I was first of all struck by an cedematous 
infiltration of the subcutaneous cellulartissue and of 
the muscular wall, which was not less than 2 5 centi¬ 
metres thick. Haring arrived at the sub-peritoneal 
layer 1 found ahard, white, rounded, smotb mass, which 
I opened up gradually by the aid of a grooved director 
from the external surface to the inside without 
opening the peritoneum. This immediately gave 
exit to a considerable quantity of a thick, creamy, 
greenish pus of an extremely fcetid character. The 
finger, being inserted through the opening, pene¬ 
trated into a cavity the size of an orange hollowed 
out in the surface and in the very thickness of the 
psoas muscle, the fibres of which could be felt. I 
inserted a drainage tube and a strand of sterilised 
gauze in the abscess cavity, and the dressing was 
complete. The operation had taken eleven minutes. 
The treatment after this was extremely simple, 
Every day the deep dressings were changed, and the 
walls of the abscess cavity flushed with oxygenated 
water. Two days after the operation the thi^ could 
be completely extended, and the temperature fell to 
normal. The cavity is at the present time nearly 
dry, and the patient will leave the hospital com¬ 
pletely cured. 

The bacteriological examination showed, as is 
often the case with old-standing suppurations, the 
pus was poor in microbes. Only a few attenuated 
bacteria, whose exact nature has^ot been determined, 
were seen. They were apparently anaerobes, since 
the majority of foctidabscesses contain this species of 
microbe. 

What name ought we to apply to the lesions 
found? To what origin can we trace the psoas 
abscess ? 

An explanation might be found in the accident 
that occurred to the patient ten years ago. The 
tumour which appeared in the right iliac fossa, re¬ 
sulting from a sudden twisting of the body, might 
possibly be a brnmatoma consequent on rupture of the 
psoas, which became infected and suppurated when 
she was attacked by influenza in January. But the 
tumour had disappeared ten years previously, and 
all functional troubles had ceased, and it is not easy 
to admit the suppuration of a sanguineous collection 
which had remained latent and quiet for so long a 
time. It is mure likely that the trouble which 
occurred last July, and which this woman put down 
to poisoning, was in reality an attack of appendicitis 
wim the ^rmation of a peri-appendicular abscess, 
which subsequently opened into the sheath of the 
psoas. The bacteriological examination of the pus 
only revealed the existence of a common species of 
microbe; but you must bear in mind its fcetidity, 
which reminded us of suppurations of intestinm 
origin. 

In any case it is not these retrospective considera¬ 
tions which constitute the interest of this case, and 
I should not have discussed the diagnosis at such 
length if it had not afforded me an opportunity of 
demonstrating the utility of laboratory methods and 
the spirit in which they ought to be pursued. 

Yon recollect the hEematological note which I 


read to you, the rather laconic ending of which wa8‘ 

too many white globules for a sarcoma, too many' 
red globules for epithelioma, therefore it must be a 
collection of pus.” You are naturally convinced of 
the correctness of this deduction since you assisted 
at the evacuation of the abscess, but you have not^ 
perhaps, exactly grasped the salient features. 

It was Professor Hayem who first insisted on the* 
necessity of examining the blood of patients suffer¬ 
ing from disease and who showed what help this gives' 
to diagnosis. His work on the blood, which already 
dates from 1889, foretold the numerous discoveries' 
which have since arisen therefrom. "The future 
belongs to hsematologyhe wrote, " this it is which 
will solve those great nosological problems.” It is 
astonishing that an attempt was not made in this 
direction sooner since doctors were urged in this 
direction by popular belief; to the ordinary person 
even at the present day it is the changes in the olood, 
" corrupted blood, turned blood,” the "nerves stronger 
than the blood, &c.,” which are at the root of every 
morbid condition. It is, thanks to this belief, that 
you never experience any reluctance on the part of 
the patient to have his finger punctured to draw 
blood, for be is profoundly convinced that therein 
lies the key to all the pathological mysteries. 

What are the changes which occur in the blood 
during an illness P They may be chemical, physical, 
or histological We will put aside the first two since 
they are but little known. Not so is it with the his¬ 
tological changes since, thanks to the energy taken 
during the last few years in the study of the figura¬ 
tive elements of blood, they commence to be well 
understood. The red globules, the white globules 
(polynuclear, mononuclear, eosinophiles) undergo in 
the course of disease variations in their formula and 
in their equilibrium which may guide us to the 
affection which causes them. 

In a general way the " injections ” give rise to an 
increase in the proportion of white globules, leuco- 
cytosis. which increases the number of leucocytes to- 
20,000, 30,000, and even 50,000 cubic millimetre,, 
the ordinary proportion being from 6,000 to 8,0(X). 
Leucocytosis, above all, affects the polynuclear 
elements. This formula is especially true in connec¬ 
tion with the acute suppurations which interest 
surgeons. 

The tumours, epithelioma at least, are also- 
accompanied by polynuclear leucocytosis. This is a‘ 
fact wnich M. Hayem proved a long while ago, and 
certain latent varieties of cancer of the stomach 
may thus be revealed. But that which makes us 
think rather of cancer than of suppuration, is the 
ansemia which accompanies this leucocytosis 
(Hayem). This ansemia, in addition to the clinical 
phenomena with which you are familiar, manifests 
itself hsematologically either by a diminution in the 
number of red corpuscles or by a diminution of the 
blood in htemoglobin, globular richness as it is called, 
or by both at the same time. We have thus means 
of discovering the anemia and therefore the cancer.. 

Till lately no attempt has been made to differen¬ 
tiate between epitheliomatous and sarcomatous 
tumours. Now, it would seem, from tbe researches- 
of M. Milian, which were laid before the AnatomicaT 
Society two months ago, that it is not impossible to 
do so. Sarcoma, at least globo-cellular sarcoma, 
does not generally g^ve rise to leucocytais, and, above 
all, not to anemia. On the contrary, as regards the 
red corpuscles the few elements found point to 
hyperglobulia, the proportion of red corpuscles may 
even attain to from six to seven millions per cnbio 
millimetre instead of the normal proportion of five 
millions. Besides, you must have noticed that- 
patients suffering from sarcoma, and who have not 
reached the peri^ of cachexia are not pale, nor are 
the mucous membranes discoloured. 



OKIGINAL COMMUNICATIONS. 


408 Thx Mkdioxl Fbb88. 

From this explanation, a little diagrammatic it is 
true, but conforming nearly enough to the reality, 
you will understand the following: “ Too many 
white globules for sarcoma, too many red corpuscles 
for epithelioma, therefore it must be a collection of 

The beematological researches are few in connec¬ 
tion with appendicitis. It was recently claimed that 
eosinophilia was a symptom of appendicitis. My 
own experience was not in favour of this view; we 
bad the polynucleosis (75 per cent, of polynuclear 
cells instead of 60 per cent.), but we did not count a 
single eosinopbile cell in our percentage, while a 
healthy subject possesses one or tvo leucocytes per 
100 of this vanety. In infections the eosinopbile 
cell is much more affected by the resistance of the 
organism and the disappearance of the infectious 
process than by the nature of the illness, this being 
the outcome of a communication made last May by 
HM. L<eper and Milian before the Anatomical 
Society. Eosinophilia occurs at the termination of in¬ 
fections states, in subsident appendicitis on each occa¬ 
sion, in other words, in which the organism comes out 
of ito struggle victorious.” The blister test, of which 
MM. Roger and Josue have recently shown the 
utility in view of the prognosis, is in favour of this 
explanation, since in healthy subjects or in those 
who vigorously resist injection, the eosinopbile cells 
constitute 25 per cent, of cells of the blister fluid. 
Eosinophilia is produced in affections due to animal 
parasit^ (Milian); you may rem«*mber in connection 
with this subject the man with hydatid cyst of the 
lung on whom I operated under spinal anesthesia, 
and of whom I show you photographs taken during 
the operation. The examination of the blood made 
beforehand revealed 5 per cent, of eosinopbile cells 

Ton will see therefore that the increase in the 
number of eosinopbile cells cannot be of any use to 
us in forming a diagnosis of appendicitis, quite the 
contrary, since there still remain temporisers, par¬ 
tisans of the ice-opium treatment without purgatives 
who might perhaps seek in this reaction oi the blood 
indications of cases in which on operation should not 
be performed. 

With regard to appendicitis accompanied by an 
abscess similar to the one we have just been deuing 
with, hsemodiagnosis furnishes us with a means of 
detecting it not by the existence of eosinophalia bnt 
by the ” inflammatory reaction ” of the blood, of 
which the polpmncleosis is the most important ele¬ 
ment, and which is found in cases of infection or 
suppurative collections. 

I hope you will profit by this lesson, and that you 
are convinced of the utility of these researches, so 
often neglected in surMry. Tou see them pursued 
daily in my wards, and you are aware of the help 
they afford us. Never, therefore, neglect hamo- 
diagnosis or cystodiagnosis when you think they are 
likely to afford you a clue to the a^ection; these are 
methods which ought at the present day to replace 
exploratory laparotomy, or at least to considerably 
reduce the necessity for it. 

SOME 

PRACTICAL MODERN ASPECTS 
OF GOUT AND GOUTINESS. 

By DAVID WALSH, MD.Ed., 

Hon. PhysicUn Weatorn SUn HosplUI, London, W. 

The close connection between gout Md certain 
skin affections is a well-recognised fact in practical 
medicine. The important bearing of such know, 
ledge upon prognosis and treatment quickly becomes 
evident to any physician paying special attention to 


_ Oct. 16, 1901, 

diseases of the skin. It is only by slow degrees, 
however, that be learns to fathom the mystenes of 
irrezular gout in relation to various cutaneous 
troubles. 

As everyone knows, the malady of gout has 
attracted the attention of physicians since the 
earliest dawn of medicine. It has furnished a group 
of sigus and symptoms so well marked and so strik¬ 
ing as to have stimulated the curiosity of all ages of 
scientific mankind. Nothing could be more graphic 
than some of the classical descriptions of a “ fit of 
the gout,” which presented the same features to 
Galen, or to Boerbaave and Sydenham, as it does to 
the practitioner of to-day. For all that, much of 
the inner history of gout remains to he written. 

The great modem theory ascribing gout to the 
presence of uric acid in the blood was advanced by 
Forbes and others towards the end of tbs eighteenth 
century, (a) That theory has since held the field 
through many vicissitudes. Its greatest confirmation 
was the demonstration by Garrod of ntic acid in the 
blood of gouty patients. A definite basis was thus 
furnished to the proposition that gout was due to a 
chemical poison circulating in the blood. From that 
point, however, the thread of investigation appears 
to have been lost, and we find ourselves faced with a 
host of conflicting theories as to the origin and the 
exact part played by nric acid in the gouty state. 

The origin of the uric acid, for instance, is in 
dispute, whether it is the product of tissue changes 
or of the decomposition of, so to speak, uout-pro- 
ducing food introduced into the body. Although 
uric acid is formed in the blood of gouty patients its 
presence has not yet been satisfaictonly demon¬ 
strated in the blood of healthy individuals. That it 
must be manufactured somewhere in the Ixidy is 
clear, inasmuch as in small amounts it is a normal 
constituent of human urine. The most rational 
inference appears to be that the uric acid is formed 
in the kidney, at any rate while it remains within 
physiological limits. The ratio of nric acid to urea 
IB inconstant, but that fact does not prevent some 
physicians from attaching great importance to the 
ratio as revealed by analysis. 

The theory of the renal origin of gont is attractive, 
and may be stated shortly as follows. When fur 
some reason or other the kidneys fail to excrete uric 
acid it is thrown back into the circulation, where it 
exists, at first as a soluble quadrinrate of sodium, 
hut later saturation of the blood leads to the forma¬ 
tion of an insoluble biurate, which is deposited in the 
tissues and sets up characteristic acute and chronic 
local changes. This view was first advanced by 
Bence-Jones and Roberts on the strength of chemiciu 
experimentation. It has lately been disputed by Drs. 
Tunnicliffe and Rosenheim, (A) who say there is no 
evidence as to the existence of qnadriurates either in 
the amorphous urinary deposits or in the fluids of 
the body. Short of chemical proof of the interme¬ 
diate combinations, the presence of uric acid in the 
blood and of the specific uratic deposits in the 
tissues may be regarded as established gouty 
phenomena. 

The theory of the renal origin of gout is sup¬ 
ported by the frequent association of kidney disease 
and gont with lead poisoning. Here the order of 
circumstance might readily be, first, a kidney 
damaged by lead; secondly, a damming np of uric 
acid in the blood, with consequent gout; thirdly, 
the granular kidney so constantly associated with 
chronic gout, due partly to the lead and partly to 
irritant gouty material. 

Substitute for lead any other blood-bome irritant 
that would check the excretory function of the 

(a) “ Treatise upon OnTel and Qont,” Forbea. 1793, 

(b) Lanul, June ISth, 1900. 



Thb Msdig^ Pbiss. 409 


Oc^l^lWL_OBIGINAL COMMUNICATIONS. 


kidneys, and we at once find a great yariety of 
chemical and bacterial irritants that might be con¬ 
cerned in the prodnction of gout. In the year 1890 (a) 
the present writer pointed out how the general irrita¬ 
tion of excretory organs occurred during the elimina¬ 
tion of the TOUty and other irritanta from the body. 
This generjil law of excretory irritation (6) explains 
the action of irritants such as metallic poisons, drugs, 
and sp^ific micro-orranisms and their products 
circulating in the blood. In the case of gout it gives 
a key to the eczema, dyspepsia, diarrhoea, bronchitis, 
and kidney troubles associated with that disease 
both in its regular and irregular forms. 

The attempt to settle the pathology of gout in the 
chemists’ laboratory, then, has not hitherto been 
conspicuously successful. The physician must there¬ 
fore fall back upon snch facts as he can gather from 
his own observation. He may conveniently divide 
the symptoms of gout into two groups: first, that 
due to uratic deposits in the tissues of joints and 
other internal structures ; and, secondly, that in 
which skin, mucous membrane, kidneys, and other 
excretory organs are irritated by the elimination, or 
attempted elimination, of some toxic substance con¬ 
nected with gout. The second group includes the 
two arbitrary forms, visceral and cutaneous, into 
which not a few writers still divide the manifesta¬ 
tions of irregular gout. 

Diagnosis 

Gout in its typical form is sharply marked off 
from other diseases. There is no need to detail its 
hereditary nature and proneness to attack males 
between thirty and forty years of age; its painful; 
nocturnal onset of acute articular and periarticular 
inflammation with uratic deposits, at first monarti¬ 
cular and usually in the great toe; is tendency to 
recur again and again, and in time to deform and 
cripple progressively; its choice of the well-to-do 
and full-blooded ; and its association with bronchitis, 
asthma, eczema, dyspepsia, neuritis, gravel, kidney 
disease, bmmorrboids, varicose veins, and other 
symptomatic and degenerative troubles. 

Irregular gout is less readily distinguished, but 
can u-ually be diagnosed by a careful consideration 
of the facts of the case. 

Bbeumatism, on the other hand, is prone to attack 
young persons; it attacks the larger joints, and, if 
acute, is attended with high temperature and acid 
sweats. In all forms the heart is extremely liable to 
be affected, and the arthritis is of a shifting nature, 
rarely involving the entire destruction of a joint. 
There is no depoeit of nrates in the joints or else¬ 
where. The modem view is distinctly in favour of a 
specific micro-organism in rheumatism. 

Rheumatoid or osteo-arthritis (or “rheumatic 
gout”), may also be possibly connected with a 
specific microbe. It may be confused at times with 
ccronic gout, although in most cases a close examina¬ 
tion will serve to distinguish the two conditions. In 
polyarticnlar rheumatoid arthritis many joints are 
successively involved, and the disease piogresses 
steadily onward until the joint is disorganised; 
there are not the acute recurrent attacks and the 
remissions of gout, neither is there any deposit of 
nrates. It is true that the rheumatoid condition 
may gradually supervene in joints affected with 
chronic gout, or that gouty deposits may take place 
in joints that have long been the seat of rheumatoid 
changes. A clear survey of all the circumstances of 
the case, however, including the family and personal 
history of the patient and of bis complaint will 
generally furnish ground for a diagnosis. It should 
be borne in mind that rheumatoid arthritis is the 
resnltof poor living and depressing mflnences. 


(a) Ukdical Pbkss ikd Cibcelab, October 22nd, 1890. 
“Excretory Irritation." London: Bailliere. 1S97. 


_ In all chronic arthritic complaints a mere inspec¬ 
tion of a joint may fail to reveal the nature of the 
disease, which can often be ascertained only by the 
most careful and skilled investigation. 

Teeathint. 

The treatment of gout may be conveniently dis¬ 
cussed uuder the three headings:_ 

1. Drugs. 

2. Genera] hygiene; exercise, diet, water, &o. 

3. Baths, massage, superheated air, and other 
external theraMutics. 

1. Drujs.—The most valuable drug daring an 
acute attack of gout is undoubtedly colchicum, 
which has so far been r^laced by no product of the 
chemists’ laboratory, lx is usually combined with 
sulphate of magnesia, and its efficacy appears to be 
increased by the addition of guaiacum. Free purging 
with blue pill and saline aperients, such as Hunyadi 
Janos, or other laxatives, is an essential measure. 
The acute pain in the joints may be relieved by warm 
alkaline fomentations or by the “AB.C.” liniment 
(aconite, belladonna, and chloroform) sprinkled on 
lint and applied to the joint under oil silk. 

Between the attacks of acnte gout, and in the 
chronic and irre^lar states, the best drugs are 
sodium salicylate, iodide of potassium, and guaiacum. 
Of those remedies the two first-mentioned appear to 
increase the excretion of uric acid by stimulating 
the activity of the kidneys. Their good effect cer¬ 
tainly does not result from their solvent action upon 
biurate of sodium deposits ; nor, in spite of theo¬ 
retical chemistry, is that solvent action exercised in 
the body, at any rate to any considerable extent, by 
lithium, piperazin, lysidin, and other much lauded 
uric acid solvents. At the same time those drugs no 
doubt have a valuable place in treatment. 

2. General Hygiene. —This forms one of the most 
imjiortant points in the treatment of the gouty. The 
patient should take daily exercise, as far as possible 
in the open air. Golfing, cycling, tennis, bowls, 
riding, and shooting are all excellent, while indoors 
billiards offer a good excuse for sustained moderate 
activity. There is no need to remark that a man 
who lives an active life can eat and drink with safety 
a good deal more than one who is lazy and inactive. 
From the nature of bis surroundings the average- 
town dweller combines a minimum of exertion with a 
full allowance of food and drink. It naturally 
follows that he is not able to use the fuel wherewltn 
fashion and habit have led bim to feed his bodily 
engine. Fortunately, it is still open to him to some 
extent to rebtore the balance of input and output by 
regulating the supply of fuel, both as to quantity 
and quality. The more one knows of modern Eocia] 
habits the stronger grows the conviction that the 
chief error lies in quantity rather than in quality. 
It is not the one glass of champagne or of port that 
does the harm, but the three or four glasses or the 
bottle. Neither is it tbe occasional excess that works 
the mischief, but rather the constancy and the fre¬ 
quency of tbe indulgence. Many a man who has 
damaged his liver and kidneys by drinking at and be¬ 
tween meals would indignantly resent the suggestion 
that be was anything but a temperate man. As with 
drinking so with eating. It is not the quality 
of the food so much as the quantity that does the 
harm. Three heavy meals a day is tbe rule rather 
than the exception with the well-to-do nowadays. 
Meat is taken on each occasion, to say nothing of 
other dishes, and of a formidable array of wines, 
liqueurs, and other alcoholic stimulants. So far aa 
tbe gouty are concerned, the present writer is inclined 
to the view that the sufferer if enfeebled is all the 
better for a glass of sound wine at meal times. The 
quality must w good, and the quantity be kept rigidly 
within tbe limit of a single glass. The permissible wine 


Co.gb 



410 Thx Medical Pbesa. 


ORIGINAL COMMUNICATIONS. 


Oct. 16, 1901. 


would be, e&y, sound dry sherry or claret at Ion* 
oheon, and champagne or light port well-matured in 
the wood at dinner; with perhaps a “ night-cap ” of 
mellow Scotch whisky .well-diluted with Nronenquelle, 
seltzer, or other pure plain or aerated water. Malt 
liquors should not be allowed under any circum¬ 
stances. 

It should be clearly understood that although 
alcohol, under the foregoing precautions, may be 
allowed to gouty patients, yet on the whole it is likely 
that unless they are suffering from marked debility 
they would be better without alcoholic beverages. 
'The main difficulty is often a social one, for it wants 
some courage for the average man to ask for plain 
or aerated water when a guest, say, at a friend^s 
house or at a public dinner, or even when dining at his 
own expense at an hotel or restaurant. Tet water 
is beyond a doubt the best thing for a gouty man to 
drink under ordinary circumstances. Perhaps one 
of the surest advances hitherto made in the treat¬ 
ment of gout was the discovery of the solvent action 
of water upon uric acid. There can be little doubt 
that as a rule we do not drink enough water. More¬ 
over, what we citizens drink is as a rule hard water, 
the influence of which upon the human constitution 
has never been scientifically gauged. The Londoner 
drinks water that is heavily charged with earthy 
matter, inasmuch as it contains no less than fifteen 
.grains to the gallon of lime and magnesia salts or 
heir equivalents, (a) 

The influence of water with a high degree of per¬ 
manent hardness upon the health of the consumer is 
definitely show in some cases by dyspepsia and 
diarrhcBa. Another malady that appears to be re¬ 
lated to the quality of drinking water is eoitre, but 
the subject requires further research. The opinion 
was at one time commonly held that hard water was 
ooncemed in the production of urinary calculi and 
gravel, but lately it has fallen more or less out of 
eight in the absence of definite proof. On the whole 
it may be said that while there is no positive evidence 
to connect hard drinking water with gout and gravel, 
yet, on the other hand, there is nothing to ex¬ 
culpate it from the charge. The daily intake of 
a large amount of lime and magnesia salts 
into the system must throw an unnecessary stress 
upon the kidney by way of subsequent elimination. 
In that way, if in no other, hard water may possibly 
contribute iudirectly to the causation of gout. 
Atheroma of blood vessels, again, is common in 
advanced gout, and it is worthy of consideration 
whether that form of calcareous degeneration may 
not possibly be connected with the constant drink¬ 
ing of water heavily charged with lime Bills. At 
any rate, gouty people cannot afford to take unneces¬ 
sary risks, and the oest drink for them is di-tilled 
water, plain or aerated, but it should be borne in 
mind that many of the aerated waters are made from 
ordinary bard drinking water. In many cases a mild 
alkaline natural spring water is the safest and best 
water for habitual use by the sufferer from regular 
or irregular gout 

The quantity of water consumed needs regulation 
as well as the quality. To drink a tumblerful of 
water fasting in the morning is good for almost any¬ 
one, gouty or not gouty. A copious draught of 
water under these circumstances flushes the kidneys 
and assists the action of the bowels and skin. To 
drink tumblerful after tumblerful of water, however, 
at intervals throughout the day is to spoil a good 
thing by carrying it to excess, especially when the 
debauch of water is combined with low diet. A full- 
blooded patient plaoed under this system would no 
doubt benefit up to a point, but after that he 
would be more likely to down hill than to recover. 


Chronic gout, it cannot be too strongly insisted 
upon, is a disease marked in its advanced stages by 
debility. Such a patient requires nutritious die^ 
together with, in some few cases, a moderate 
amount of alcoholic stimulation, while all lowering 
measures should be adopted with caution. 

The choice of a good water, then, may not improb¬ 
ably exert a considerably influence in the treatment 
of gout. It has long been accepted as a maxim that 
no combination of drugs can produce the medicinal 
effects of anatural mineral water, and some continental 
physicians claim excellent results from the use of 
Kronenquelle by the gouty. That particular water 
is mildly alkaline, and contains sodium, magnesium, 
calcium, lithium, and other bicarbonates, sodium 
sulphate, a small quantity of sodium chloride, with 
traces of iron and other salts. It has been shown 
by Fiirst that bicarbonate of sodium, when well 
diluted, is a solvent of uric acid, and that the bicar¬ 
bonate of calcium, which in 1 per cent, solution does 
not dissolve uric acid, when reduced to a strengfth of 
5 per mills or *5 per cent., becomes almost as 
powerful a solvent of uric acid as the carbonate of 
lithium, lliis striking observation suggests s pos¬ 
sible explanation of the good results reported from 
the use of Kronenquelle water in the uric acid 
diathesis. 

3. Bath*, superheated air, and other external 
therapeutics. 

The value of tbe Turkish bath has long been recog¬ 
nised in tbe treatment of tbe gouty condition. So 
also has the value of a course of systematic ^thing 
and massage at some suitable spa, where the life is 
simple and plain. But with Turkish baths and 
with spas the experience has generally been that 
though they often alleviate they do not cure the 
malady. What physician is not familiar with tbe 
story of tbe gouty patient who has gone in vain from 
spa to spa and has tried in vain drugs, massage, 
electricity, baths of every kind, water cures, and ull 
other recognised or unrecognised methods in the pur¬ 
suit of health P 

Tbe therapeutics of gout, however, have made a 
solid advance in the shape of the Tallerman super¬ 
heated air treatment, invented in England some 
ten years ago. As most people know, one part of 
the ^dy, say, an arm or a leg, is subjected to a tem¬ 
perature of between 200® and 300®. Copious sweat¬ 
ing follows and analysis shows that tbe quantity of 
uric acid excieted by the kidneys is greatly increased 
under ordinary circumstances. The extraordinary 
results that often attend tbe application of tbe 
Tallerman treatment in cases of acute or chronic 
gout must be seen to be believed. In one instance 
under the notice of tbe present writer a stockbroker 
was treated for an incipient attack of gout, from 
which be often suffered. The toe was red, shiny, and 
painful when put in the apparatus, but on tbe fol¬ 
lowing day he was able to join a shooting party. 
That result will speak volumes to all who are 
acq^uainted with tbe ways of acute gout. In chronic 
and in inveterate cases the benefit is striking: move¬ 
ments of joints are restored and uratic deposits and 
bursal swellings often disappear rapidly. 

There can be no doubt that beat applied accord¬ 
ing to the Tallerman method has curative results in 
gout that cannot be equalled or even approached by 
other plans of treatment. 

That a patient undergoing the superheated air 
treatment will derive benefit from a combined course 
of medical treatment need hardly be added. Tbe 
use of Kronenquelle water, for instance, will always 
be of service, c^ometimes drugs will be needed, and 
in all cases careful attention most be paid to details 
of general environment of tbe patient. Tbe physi¬ 
cian, indeed, will find it necessary to investigate 
every detail of the case before him, and to study th 


(a) Firkea osd Kenwood "H7pene,"p. 13. 


ORIGINAL COMMUNICATIONS. Thb Mbdical Pabbb. 411 


Oct. 16, 1901. 


peculiarities of his patient to a greater extent in 
gout than in most oi the maladies that be is called 
vpon to deal with in his coD8ulting>room. The most 
careful and conscientious attention of the physician, 
however, will avail little without the utmost obedience 
and self-control on the part of his patient 


LOWER BIRTH-RATES 

CONSIDERED AS THE 

REAL CArSE OF LOWER 
DEATH-RATES, (a) 

By CHARLES B. DRTSDALE, MD., M.R.C.P., 
P.R.O.S., 

CosBoItiDg Physician to the Uetropolitan HoepiUl, London. 

Thirty years ago, and for many years previous to 
1877, the main effort of sanitarians was directed 
towards the improvement of water supplies, drainage, 
And cleansing of cities and village. Sir Edwin 
Chadwick and Sir Benjamin Ward Richardson were 
most ardent sanitarians, and I had often the oppor¬ 
tunity of hearing their views as to the possibility of 
reducing the death-rate of our cities by the rigid 
■carrying out of such methods of cleansing and re¬ 
moval of all filth. Being rather sceptical on this 
point, I ventured to remark that as long as people 
are very poor, death-rates will remain high, 
cleanse as you wilL Well, the following figures 
taken from the Registrar-General’s Report for 
the year 1877 seem fully to bear out my contention. 
On page Ixzxvi. of that Report, 1 find that the mean 
rate of mortality in London for the 38 years between 
1840 and 1877 was 24 per 1,000 inhabitants annu¬ 
ally. Now this was just the epoch in which distin¬ 
guished sanitarians like Sir Edwin Chadwick had 
accomplished so much in improving the drainage of 
London, and the cleansing of its houses and streets. 
But, up to 1877, the effects of all these excellent 
endeavours had been nugatory, as regards the main 
aim of hygienists, viz., the lowering of the death-rate. 
Since 1877, however, the birth-rate in Loudon and 
in almost all our cities baa fallen considerably. The 
birth-rate in 1877 in England and Wales was 36'2, 
and it baa fallen in 1900 to 28'5 per 1,000 inhabitants. 
This fall in the birth-rate has been seen to occur 
in all civilised countries since 1877. and is univer¬ 
sally attributed by enlightened statisticians, such 
as Dr. Billings, of rhe United States Registry Office, 
to the voluntary lessening of the number of 
children to a family. This lower birth-rate is due 
to the discussions on the population question which 
took place in 1877 when Mr. Charles Bradlaugh, 
M.P., and Mrs. Annie fiesant were prosecuted for 
the publication of Dr. Enowlton’s pamph'et on this 
eubject. Immediately on the birth-rate falling there 
occurred a similar fall in the death-rate, and last 
jear the death-rate in England and Wales bad 
fallen from 20‘4 per 1,000, its figures iu 1877 to 18 
per 1,000. The meaning of this is that the human 
race could, if amply supplied with food, double its 
population in much less than twenty years, so that 
the more thoughtless and indigent classes are con- 
ctantly being cut off by the want of sufficient whole¬ 
some lood, and by over-crowding, which favours the 
cpread of fevers and tuberculous diseases. I have 
mentioned that the birth-rate has fallen in almost 
.all civilised states since the year 1877. The most 
notable examp'e of this statement is to be found in 
the case of our beautiful and flourisbing colony of 
New Zealand. 

The birth-rate iu 1880 in New Zealand was 4078 
per 1,000 inhabitants, and has fallen, owing to the 
Aame cause which has lowered it here, i.e, parental 

(a) f^per takeo at read at the Cheltenham Keeting of the British 
AsaMiatloui o 1901. 


prudence, to 25 per 1,000 in 1900. The death-rate, 
however, in modem New Zealand is given at 9'1 per 
1,000 in 1896, so that the colony may be said to have 
reached the zenith of hygienic existence. The death- 
rate, we see, is only one-half that of the death-rate of 
England and Wales. The actual number of deaths 
registei'ed in 1887 was 6,137, with a mean population 
of 596,374 that year, and in 1896 the population was 
706,846, or 110,472 persons more than m 1887, and 
yet there were only 295 more births in 1896 than in 
1887. The marriages, however, show a remarkable 
increase in New Zealand. In 1887 there were 5‘97 
marriages per 1,000 inhabitants, and in 1896 there 
were 6'^ per 1,0(X). Hence the lowering of the birth¬ 
rate in New Zealand has caused an extremely low 
death-rate, and a much higher marriage-rate. Ob¬ 
viously we in Europe have much to learn from the 
modern inhabitants of that colony. 

In a paper read before tbe Medical Society of 
London in 1879, on the “ Mortality of tbe Rich and 
Poor,” I cited, first of all to show that poverty was 
tbe main cause of premature death, the paper of Dr. 
Tillerme, of Paris, in 1834, which snowed that 
between the ages of 40 and 45 the death-rate of per¬ 
sons in easy circumstances in Paris was 8'3 per 
1.000, whilst among the poor the figure was 187, i.e., 
21 times as high among the poor as among the rich. 
Sir Edwin Chadwick, in a pamphlet which he gave 
tome at Paris in 1877, “On the Dwellings of tbe 
Wage Classes,’’ mentioned that it was misleading to 
cite the death-rate of a whole city, since there were 
sub districts in London where the death-rate does 
not exceed 11 per 1,000, whilst there are adjacent 
dwellings where the death-rate rises in some years to 
38 per 1,000 inhabitants. That able statistician in 
1843 made an inquiry in Bethnal Green, when the 
general death-i'ate of London was 24 per 1,000. From 
this it resulted that in Bethnal Green the gentry, 
professionals, and their families showed a propor¬ 
tion of 6'5 per cent, of deaths from zymotics to total 
deaths: whilst tbe figure for the labourers and their 
families was 22*2 per cent, of all deaths occurring 
among that class; there was 1 death in 10 among tbe 
children of the former class in the first year of life, 
and 1 in 4 among the latter; 247 deaths percent, oc¬ 
curred among children of tbe richer class under 10 
yeara of age, against 54‘5 among tbe poorer. The 
mean age at death of all dying among the well-to-do 
was 44, and only 22 among tbe poor. Lastly, the 
mean age at death of all after the age of 21 was 61 
among the wed-to do and 49 among the labouring 
population. 

These statistics of Sir E. Chadwick are quite suffi¬ 
cient to prove that the mortality of the wage classes 
is far higher than that of the well-to-do classes. 
And we know that the birth-rate of the poorer 
c'aases is often double that of tbe rich, which ex¬ 
plains my contention that to lower death-rates we 
must lower birth-rates, or give up the attempt to 
improve the public health iu despair, since, do what 
we will, low vrages and large families are always in 
Europe followed by high death-rates. 

Perhaps the most telling of all statistical in¬ 
quiries on this point is the one made by Mr. Charles 
Ansell, jun., Actuary of the National Assurance 
Company, published in 1874, entitled, ” Statistics of 
Families of the Upper and Professional Classes 
(England and Wales).” 

The Report referred to 48,044 children of these 
classes and Ansell found that among these childi'en 
the death-rate in tbe first year of life was 80‘45 per 
1,000; vrhilst we know that in some cities, such as 
Preston, the infantile death-rate sometimes exceeds 
400 per 1,000. Again, among the children of the 
richer clMses Ansell found the death-rate between 
the ages of 1 and 5 was 47, against 113 among the 
general population. He found the mean age at 


Oct. 16, 1901. 


41^ T„ p...., TRAKSACTIPyS OF SOCIETIES. 


death among the well-to-do claaeee to be 66 jeara, 
and that 80,000 out of 100,000 born aurrived to the 
age of 21, againat 66,700 among the general pop\^a- 
tion. One etatement made by Mr. Anaell m ma 
Report waa very atriking. It aeema that m 
the year 1873, 368,179 peraona died m Eng¬ 
land and ‘Walea under the age of 60 and he 
calculated that had the general mortaHty been only 
aalow as that of the well-to-«do claasea, only 2-6,0^ 
would have died. So that, in one year, that of 18(3. 
poverty destroyed 142,130 lives in England and 
Wales alone. Our great philosopher, Profeasor 
Alexander Bain, has summed up the question m 
follows:—“ That prime requisite of bappineaa, health, 
is very imperfectly secured in the lowest grades even 
of respectable citizenship. The public registers have 
demonstrated that mortality and disease dimmish 
with every rise in the scale of wealth.” The obvious 
inference from this is that hygienists must study the 
science of wealth, i.e., political economy. 

A great deal of interesting information has been 
acquired concerning the influence of various trades 
and occupations on health; but it has b^n truly 
remarked by Dr. D'Espinf, in the Annales d'llygiene, 
that the so-called mortality of several trades is only 
another name for poverty (since well-to-do people 
will not expose themselves to such dangerous occu¬ 
pations). Dr. Tbouvenin, too, in an article on the 
“ Influence of Trades on Health,” arrives at the con¬ 
clusion that, with the exception of cotton-beating, 
dividing and carding of silk cocoons, white lead 
grinding, and one or two others, industrial pursuits 
do not exercise any directly injurious effects on the 
health of the workers. He traces the deterioration 
of the health of the wuge classes in towns, and their 
higher death-rate to defects in their dwellings, to here¬ 
ditary and skin diseases, to venereal and tuberculous 
diseases, to the excess of their premature labours, 
and the scanty nature and bad quality of their diet, 
the irregulai’ity of their lives whilst still immature, 
and lastly, to drunkenness The summary of these 
causes is but another way of naming poverty, and 
D'Espine showed that which my own experience as 
physician to the North London Consumption Hospital 
nasshown me, that whilst tuberculous disease forms 68 
per 1,000 of all deaths among the well-to-do classes, 
no less than 230 per 1,000 of the poor die of tuber¬ 
culosis per 1,000 of aU their deaths. Rickets, too, are 
lamentably frequent among the poor children of 
London, Manchester, Glasgow, and even in our 
villages from the poor nutrition of such children. 
The late Dr. Edward Smith found that the parents 
of the patients coming before him as consumptives 
had given birth on an average to 7’6 children to each 
fami^, whilst Dr. Lutaud, of Paris, in a letter to 
Hr. Hausmeister, mentions that the wives of 100 
medical practitioners in Paris give birth to only 150 
children, i.e., to 1'5 children per family. It is easy 
to see that the children of pei-sons with low wages 
and large families are doomed to be ill-fed, and thus 
ready to contract that terrible scourge tuberculosis. 

In the year 1898 the Board of Physicians of Ham¬ 
burg published the following statistics as to the 
connection between income and infantile mortality. 
In 1898 21,399 living children were born in Hamburg, 
of whom 4,033 died in their first year of life. Of 
these, 1,784 died of mal-nutrition. A comparison 
between the several districts of the city showed j—- 


Qaarter of the tows. 

Ajerage income per 
bead in marks. 

1 mark 1 shilling. 

Mortality 
of infants 
per 1,000 
Inhabitants. 

Harvesthude ... 

. 2,829 = A141 

... 202 

Rotherbaum 

. 2,160 — 

... 2-47 

iJstadt Sad 

. 668 — 

... 3-63 

Newstadt Sad ... 

353 — 

... 9-39 

Horn . 

. 295 == £15 

... 10-85 

Bel warder Auseohlag. 

.. 266 — 

... 9-00 


Thus, in the poor quarter of Hamburg (Horn) th» 
infantile mortality is five times that of the ricb 
quarter (Harvesthude). So that wealth is the main 
lactor in producing longevity for the masses. 

The statistics of London (as appearing in the- 
Briiiah Medici Journal) for the year 1899 show the 
same facts. Thus, the birth-rate of a well-to-do- 
district, Hampstead, was 19'8, and its death-rate waa 
11'6, whilst the poor district of St. Luke's had a birth¬ 
rate of 44 4 nnd death-rate of 28 4 per 1,000 inhabi¬ 
tants in 1899. Some years ago the late Mr. Ernest 
Hart, at my suggestion, had a column headed 
“ Deaths from Phthisis added to the Statistical 
Table of London ”; and this showed that the death- 
rate from phthisis in well-to-do Hampstead was only 
0-8 per 1,000, whilst in St. Luke’s the figure was 3 per 
1,000 inhabitants, or more than thrice as high as in 
Hampstead. 

It seems to me that these few statistics, which I 
could multiply to any extent, prove clearly that the 
death-rate of the poorer classes is very much higher 
than that of the richer, and also that their birth¬ 
rate is usually twice, or even thrice, as high, Henco 
I think I am entitled to say that I have shown that 
the main cause of high death-rates in this country ia 
high birth-rates; and that if we wish really to im¬ 
prove the health of the classes at the bottom of 
society, we must endeavour to persuade them to have- 
families of not more than four children as a maxi¬ 
mum ; and better still, to content themselves with 
even fewer than this, until the moriali^ of the worst- 
paid classes shall fall to 12 or 13 per LOGO, which ia 
now the rate among the inhabitants of Hampstead 
and some of our richer towns. 


‘llransadicnB cf §0£iel:cs. 

CLINICAL SOCIETY OP LONDON. 
Msitiko h*ld Feidat, October 11th, 1901. 


Ma. Ahtbue Barker, P.E.C.S., Vice-President in tho 
Chair. 

The Pbxsidbkt presented the new volume of tho 
Transoftioiis, remarking that surplus copies could be 
obtained by members at a reduced price. 

Mr. J. Jackson Clarke read notes of a case of 

PAINFUL CONDITION OF THE TWELFTH PAIR OF BIBS. 

The patient was a nursemaid. She first came for treat¬ 
ment on account of a forward bend of the spine 
(kyphosis) accompanied by a painful backward projec 
tion of the tills of both twelfth ribs. The former wae 
corrected by the use of an antero-po»terior support, but 
the condition of the twelfth ribs remained unchanged,, 
any forward preesure upon them causing great distress. 
The pain was deeply seated, and Mr. Clarke referred the 
abnormal condition to rheumatoid inflammation of th» 
costo-vertebral joints. So long as the spinal support 
was worn it sufficiently protected the ribs from pres¬ 
sure; when, however, the time came for leaving- 
off the support the patient found that she could 
not bear the pressure of her dress upon the ribs. 
An attempt was made to palliate the condition 
by making apertures in the patient’s stays, but this 
did not succeed. The patient was therefore advised to- 
undergo an operation for the removal of as much of 
em- H twelfth rib as could be taken away without incis¬ 
ing the erector spines. The uperation consisted of 
catting down on each bone in turn and removing one- 
inch, including the cap of cartilw, with the periosteum. 
The deep psrta were carefully drawn together by fine- 
silk sutaies before the skin-wounds were closed. Rapid 
healing ensued. There was no subsequent bolging at- 
the site of the operations, and the pain was at once 
relieved and has not since returned. Mr. Clarke men¬ 
tioned another case in which one cf the twelfth ribs waa 
the seat of occasional swelliog, accompanied by grwt- 
pain. The patient was a lady, set. 40, and the &welliii£ 


OS It 







TBAN8A0TI0NS OP SOCIETIES. Th* Mmicai Pbmb. 413 


Oct. 16, ISOl. 

waa dae to inflammation aboot the janotion of the 
cartilage and bone. In this case relief was obtained by 
an abdominal belt made with a recess to receive the tip 
of the rib. 

Dr. Ewaat referred In connection with this case to a 
condition known as aoru ohoadralgia, a strictly 
localised condition dne to a variety of causes. It was 
aggravated by the pressore of corsets unless one of the 
ribs thereof was broken tbrongb. He expressed sur* 
prise at bearing that osteo-artbritis of the joint was 
relieved by the removal of a distal fragment of bone, 
and be asked what length of rib was excised. He also 
asked wbat evidence there was of the existence of oeteo- 
aitbritis 

Mr. rLAREB, in reply, did not think that tight-lacing 
bad anything to do with the production of the condition 
in his case. He thought that it was probably doe to 
the action of the muscles on a weakened articulation. 
He took away about half an inch. The cases referred 
to by Dr. Ewart were interesting, but were not parallel. 
He referred to the case of a lady, set. 40, who bad acnte 
pain in the tenth rib, which, when first seen, in the 
interval of the attache, presented nothing abnormal, but 
later, dunsg sn attack, be found a swelling at the end 
of (he rib the size of a filbert. The pain was relieved 
by a suitable support. 

CASE OF DISPLACED STBANQCLATSD FBMOBAL HBBHIA. 

Mr. Tbokas Bbtant read notes of a case brought on 
April 8rd, 1901, by Dr. Robinson, of Wandsworth Com¬ 
mon, into Bolingbroke Hospital. Sbe was a married 
woTuan, esK 32. who had been troub'ed with a femoral 
rupture for aboot five years and had not worn a truss. 
The rupture had come down every now and then, and 
she said she had never expei ienced difficulty in its re¬ 
duction, abbough on questioning her husband later on 
be was sure that she had often used much force in re- 
dncing the rupture, and particularly on March 29fch, 
two days before her present illness and the attendance 
of Dr. Robinson. Her illness was supposed to date from 
March SIst, and it commenced as a " bilious attack,” to 
which sbe was rather prone by sickness and headache, 
and it was not till three days passed, and the vomited 
matter had become stercoraoeoua, that the possibility of 
the case being due to her reduced hernia bad been 
rsalisfd and my advice was sought. 'Whenhesawberon 
April 3rd sbe • as in an extreme state of collapse, end it. 
was clear that life could not be saved. Her abdomen 
was distended, but not tense, and there was no swelling 
in the right femoral region, which was given as the seat 
of ber hernia, althongb pressure with the pulp of the 
index finger over the right femoral canal elicited pain. 
No enlargement of the thigh was noticed in the 
region into which the hernia was subsequently traced. 
An exploratory operation in the femoral region was, 
however, determined upon, based upon the good old 
practice of first examining, in every case of intestinal 
obstruction associated with a hernia, the regi. n in which 
the hernia existed. The operation was carried out in the 
usual way by a vertical incision of the soft parts over the 
crural canal, and the explore of the crural sheath, 
which did not seem to be expanded, althongb on palpa¬ 
tion over the femoral canal it was thought to be slightly 
distended. The sheath was then opened with great care, 
when a small piece of tissue which looked like omentum 
was seen, but no bowel; the femoral ring was quite clear 
and npon passing a director it was slightly enlarged up¬ 
wards and inwards ; as a resnlt of this action a piece of 
pale intestine which before had been collapsed and bad 
not been seen, suddenly on ite distension arched for* 
wards in the femoral canat, and was lost downwards 
through a narrow opening at the apex of the femoral 
sheath, an inch or an inch and a half below the femoral 
ring. At this point the bowel was strongly held and 
strangnlated; upon a grooved probe director this ring or 
canal was divided, when he was enabled to draw out of a 
space situated below and to the inner side of the opening 
in the femoral sheath at least four or five inches of 
highly congested hot not otherwise injured intestine, and 
redured it easily into the abdominal cavity. The 
operation was thus completed, bnt the patient 
sank as expected, and died a few hours later 


A partial post-mortem examination could alone b» 
obtained, bnt from the speoimen which was secured by 
Mr. Lyster, the house surgeon of the hospital, and which, 
as dissected and mountM by Mr. Shattook, is now in 
the museum of the Royal College of Surgeons of Eng¬ 
land, preparation 2977 a ; it seems clear that the sac of 
thr femoral hernia had been forced through a rupture 
of the femoral sheath at its lowest part or apex into the- 
connective tissue of the thigh on the inner aide of 
Scarpa's triangle, and that the seat of strangulation 
was at the neck of the sac, which was not as is usually 
the case, at the femoral ring, bnt at the orifice of the 
femoral sheath through wbi(^ the hernial sac bad been 
forced. Semark $.—The case which has just been read 
is clearly a very unusual one, and as such is worthy of 
publication, indeed he had never seen or read of a 
femoral hernia being displaced as this must have been 
into the fatty connective tissne of the inner side of the 
thigh, with the seat of strangnlation being at least an 
inch and a half below the femoral ring, its usual seat,, 
and situated at the month of the opening in the femoral 
canal through which it was probably forced. Had there 
not been a distinct history of an old femoral hernia in thia- 
case there would not have been any local indication 
to lead the surgeon to suspect that the intestinal 
obstruction which the symptoms snggested was due to 
such a caose, for there was a total absence of all swelling, 
and the sign of pain on pressure over the femoral canal 
stood alone. Under these circumstances an abdominal 
operation might have been undertaken, and if so it 
won'd have been useless, for the toat of strangulation 
was outside the abdominal cavity, and could not by such 
a measure have been relieved for it must be emphasised 
that during the operation, when the femoral sheath was 
first opened, the bowel which was in it was not seen, for 
it restei in a bloodless and collapsed condition upon its 
posterior wall; and it was not till the crural ring was 
enlarged that it made itself manifest by bulging for¬ 
wards and arching downwards from the femoral ring to 
the seat of its stricture and the apex of the femoral 
canal. This portion of exposed intestine was quite 
healtby-looking and pale, and contrasted strongly with 
the deeply-congested bowel which was subs^nently 
withdrawn from the displaced hernial sac. The cause 
of the displacement of the femoral hernia in the case re¬ 
corded must doubtless have been mechanical, and was 
probably due to the forcible attempt by the patient at 
reduction of the hernial tumour after its descent. The 
force employed having bronght about primarily a rnp- 
ture of the femoral sheath at its lower end, and second¬ 
arily the gradual herniation of the femoral sac with 
its contents into the space in the connejtive tissne 
as demonstrated by the dissected specimen. It is pro¬ 
bable also that what the patient described as berbiliona 
attacks were due to a partially obstructed hernia. There 
was, therefore, in this case an example of athird variety 
of displaced femoral hernia: the jirtt being the well- 
recognised form in which the small strangulated femoral 
hernia with its sac may be pressed out of sight and re¬ 
duced, still strangulated behind the abdominal parietes, 
The one of “reduction en matte.' The ttccTul being 
where a large femoral hernia by some rupture of its 
sac, may show itself as a tumour in the subcutaneous 
connective tissne above or below Poupart’s ligament; 
and the third as a displaced hernia following the coarse 
of the case first described. In the many varieties of 
“ displaced inguinal ” hernia which have been described, 
and patticularly by Mr. J. Birkett and the reporter of 
this case in his “Practice of Surgery,” the injurions 
effects of misapplied force have b^n fully recognised; 
indeed, it seems probable that in all the varieties of dis¬ 
placed inguinal hernia it should be regarded as their 
probable cause. In the case now under consideration of 
femoral hernia, as in its other varieties, the same con¬ 
clusion has to be drawn, and the truth of the following 
aphorism enforced:—“ That as in the treatment of every 
variety of obstructed or strangnlated hernia, forcible 
taxis is the direct cause of all cases of displaoements of 
the inguinal or femoral varieties, as well as of rupture 
of the sac or sac’s oootents, so forcible taxis ought 
strictly to be avoided. 

The Pbbsxdent said he bad never met with exactly 


TRA.NSAOTIONS OF SOCIETIES. 


414 Thx Msdicil Fbssb 


-this variety of hernia. He raised the question whether 
taxis ought ever to be applied to a strangulated hernia, 

A practice which he had abandoned, he believed, with 
advantage. He thought that if this view were endorsed 
by a surgeon of the author's experience it might produce 
a good effect in practice, both private and in hospital, 
where he had often seen violent taxis applied in such 
^ases to the detriment of the patient. 

Mr. Golding Bird remarked that though the 
author had called it a femoral hernia he gtthered from 
the paper that the crural canal was found empty. If 
so, was it rightly fo described P A parallel case was 
reported by Creely in which the hernia came down under 
Poupart’s ligament and did not go into the crural canal 
at all. Having come down, by whatever path, taxis 
seemed to have ruptured the sac and product the con¬ 
dition which he had described. He thoroughly endorsed 
what the President had said as to the unt^visability of 
-employing taxis in strangulated hernia, a practice which 
he thought was productive of more haim than good. 

Mr. Brtant, in reply, said it was clearly a femoral 
hernia, though when be first opened the sac the crural 
canal appeared to be empty, Uie intestine being collapsed 
■and flat. When he divided the ring to get more room 
some flatus came down, and then the intestine became 
visible. He was disposed to ^ree with the President in 
his remarks on taxis, at any rate in regard to femoral 
hernia, but an inguinal hernia was rather different. He 
would not, however, employ taxis even in the latter 
unless the patient was under an anesthetic, and then 
only very gently. Anything like violence would be 
iniquitous. In a scrotal hernia the neck was usually 
very large, and it was much mixed up with omentum, 
so that the bowel was not so readily injured as in a 
femoral hernia. 

Mr. CuTHBCRT 8. Wallack on the 

TBXATVZNT OF WOUNDXD JOINTS. 

Wounds of joints fall into three groups. (1) Those in 
which the joint injury is complicate by compound frao. 
tnre, and in which the wounded joint is the lesser injury. 
'The treatment of such a case depends more upon the 
-complicating wonnds than on the wound of the joint. 
(2) Wonnds, or probable wounds of joints. (3) Doubt¬ 
ful wonnds of joints, such as perforating or punctured 
wounds. The notes of three cases of the second group | 
were read, one of which ended fatally, one recovered with I 
a stiff knee, and the other with a movable joint. The 
treatment of such injuries was then discussed, and it 
was maintained that the cleansing of the wound must 
be mechanical, and, therefore, that alldirty tissue should 
be cut away with knife or scissors, and a douche if used 
was only beneficial because it removed fragments of dirt 
or soiled tissue, it was, therefore, sufficient to employ 
sterilised saline fluid, and that antiseptic solutions were 
^unnecessary. A search for a wound into the joint was 
not recommended, as if found, it was unlikely that much 
.good could be done, and if an opening was accidentally 
made into the capsule a serious harm might result. If 
the opening into the joint was obvious, it was recom¬ 
mended to close the capsule without irrigation of the 
.joint and awa<t developments. The notes of five cases 
of punctured wonnds of joints with resulting infection 
were then read. In four instances practically full 
movement was obtained, and in the fifth, movement was 
limit°d to about one-quarter that normally present. It 
was thought that the best treatment of such cases was 
artbrotomy with sterilised saline solution and suture of 
the joint cavity. This process could be repeated once 
or twice if the condition required it After this, if the 
temperature remained high, the incision into the joint 
could be left open, and lavage practised daily. The 
writer thought that it must be recognise that if the 
infection reached the peri-aiticular tissue, surgery 
-could do but little, save opening any abscess that might 
form, or in ablation of the limb. Drainage by means 
-of tubes through the joint or continuous irrigation were 
l^ely to do more harm than good. 

The Pbssidint agreed that in these oases antiseptics 
were not only useless but were often positively injurious. 
Por many years he had employed only irrigations of 
'normal i^ine solution, whereby his results had im> 


Oot. 16, 1901. 

proved. When a joint had suppurated it was not 
enough to irrigate it from one side to the other; the jet 
must be carriM into the recesses to expel the matter. 
With this treatment he had obtained very good mpve - 
ment even in very severe cases—gonorrhceal arthritis 
forinstance. He wished to lay down the principle 
that once a joint was infected it conld not be 
disinfected. 

Mr. Wallis observed that it would be an advantage 
to have some definite plan of treatment laid down for 
these cases. The author's cases resembled those he had 
brought before the Society in 1898. He had himself 
attempted what the author appeared to have attempted 
in his own cases ; in one case the joint was ankylosed, 
in another there was fair movement, and in a third the 
movements were free. These perforating wounds of 
joints, if they became at all infiamed, might be treated 
by a fairly free opening and drainage, a plan which had 
given him excellent results. In one case the knee-joint 
was exposed for six weeks, yet movement, though 
limited, was good. The introduction of drainage tntoi 
into the interior of the joint and the use of antiseptics 
was likely to bring about absolute ankylosis with pro* 
traoted recovery. 

Mr. Abbot pointed out that it was long the practice 
in suppurative peritonitis to make a small opening and 
to irrigate the cavity, and that treatment was generally 
agreed to be of the moat hopeless kind. It was only 
; recently that they had made large incisions and turned 
I out the intestines so as to enable them to cleanse the 
entire cavity, and they had thereby got improved 
results. As to the treatment of adhesions in joints, he 
asked whether forcible movements were likely to be of 
more benefit than could be obtained by simple massage. 

Mr. Wallace, in reply, thought that where there 
was a large outw wound and a small wound into the 
joint it was worth while giving the joint a chance. He 
insisted on the fact that cleansing the joint was a purely 
mechanical procedure, and it was no goc^ trusting to 
antiseptics. He did not think that forcible movements 
conld do any good. 

Mr. Mansell Moullin read the notes of 

FIVE CASES or ASCITES DEPENDENT UPON CIBRB 0 S 18 OF 
THE LIVER, 

in which he had sutured the omentum to the anterior 
abdominal wall, with the view of establishing a col¬ 
lateral circulation after the Drummond-Morison method. 
Two oases died, one four weeks after the operation from 
pleurisy; the other, one week after from exhaustion. In 
both of teese the operation had been performed too late. 
The disease was too far advanced, and there was no time 
for the development of a collateral circulation. In one 
of them, who weighed over 15 stone, the liver was only 
three pounds and a quarter. The three other casee 
were discharged from hospital relieved. One conld 
not be traced. The two others were alive and at 
work at the present time, two years after the 
operation. Mr. Mansell Monllin pointed out that so far 
as ascites was of mechanical origin there conld be no 
question that the operation was capable of giving relief. 
There is the clinical evidence that a certain proportion 
of patients suffering from cirrhosis of the liver, who are 
treated by repeated tapping!, get well at last even after 
they have been tapped twenty or thirty times; and there 
is the pathological evidence of the enlargement of the 
ordinary anastomotic channel between the radicles of 
the portal and systemic circulations ; and of the very 
great development of accessory channels in the freshly 
formed adhessions, as, for instance was shown 
most plainly by one of Morison's casee which 
died from an operation for ventral hernia two years 
after the omentum had been sutured. If on the other 
hand the ascites is held to be not meohanioal, or not 
wholly meohanioal in origin, but to be due to the im¬ 
pairment in activity of the liver cells consequent upon 
the defective blood supply, it is equally the fact that the 
only hope of restoring the activity of these cells, and 
giving them a better blood supply, consists in establish¬ 
ing a number of vascular adhesions between the con¬ 
tiguous surfaces of the liver and the abdominal wall, at 
' a period when compensatory growth is still possible 




GERMANY. 


Oct. 16, 1901. 

Hr. Muisell MooUin pointed out that the operation, if 
the cases are promrlj selected, is not one that is attended 
by any serioas degree of risk. It U true that the 
mortality, as judged by statistics, has been very 
high np to the present; but this is always the 
case with new operations, and is due to the 
fact that many of the cases are unsuitable, often 
because of disease in other o^ans of the body, and that 
there is a tendency to look upon the operation as a last 
resonroe, one only to be performed when everything else 
has been exhausted. With better selection and earlier 
operation, there is no resson why the mortality should 
be appreciably higher than that of exploratory laparo¬ 
tomy. So far as technique is concerned, a median incision 
above the umbilicus is the most convenient, and gives 
least trouble afterwards. Through it the whole of the 
upper surface of the liver can be reached, and the 
omentum can be fixed to the abdominal wall by sutures 
passed from its peritoneal surface. Drainage is un¬ 
necessary, and may be dangerous, as offering addi¬ 
tional risk of sepsis. The fluid always coUects 
again, but it collects in the lowest part of the 
abdomen, and does not interfere with the formation 
of the adhesions. If it becomes excessive at any time 
it can be drawn off again; and this, as shown by the 
history of the cases which recovered, may have to be 
done many times in the oonrse of the first few months, 
until the anastomotic channels have enlarged sofficiently. 
Asm^es is a late and a very serious symptom in cirrhosis, 
aggravating all the rest, and hastening the progress of 
toe disease. If, therefore, it is not complicated by 
diseases of other organa, and if the accumulated fluid 
doee not quickly disappear under the inflnence of iodide of 
potassium, it seems more rational to try and eetsblish an 
efficient collateral circulation, without farther delay, by 
an operation which is not, under such conditions, 
attended by a serious degree of danger, than to allow 
the patient to drift on in a state of perpetnally increas¬ 
ing misery, relieved now and then by tapping, until, in 
the vast majority of cases, his strength sinks so low that 
it is too late to do anything more &an watch the pro¬ 
gress of the disease. 

Dr. Caxpbkll Thohson referred to a paper on this 
subject which he had read last session Iwfore another 
society in which he bad drawn a distinction between the 
cases in which the ascites was directly due to the cir¬ 
rhosis of the liver and those in which it was caused by 
peritonitis resulting from the cirrhosis. The latterwere 
the cases in which operation was likely to prove bene¬ 
ficial, as proved by post mortem investigations. The 
former class usually proved rapidly fatal. The cure, 
when it took place, was presumsbly dne to obliteration 
of the peritoneal cavity by the formation of adhesions, 
just as pleurisy was cured by the adhesion of the layers 
of the pleura. 

Dr. Sanbok did not think that clinically it was possi- i 
ble to differentiate between the cases of pure cirrboeis, 
and those associated with peritonitis. Cirrhosis was not 
a simple condition, on the contrary it was a very com¬ 
plex thing, and he was not disposM to accept the pre¬ 
vious speaker’s conclusions in r^ard to the cases which 
recovered, and those which did not. Therapeutically it 
was necessary to modify the balance of circulation, and 
he thought surgical measures constituted a better way 
of effecting this than the old-fashioned plan of tapping 
with copious diaphoresis. 

Dr. Nobman Dalton agreed with the author that a 
great deal depended upon the condition of the other 
organs. Certainly if there was marked oedema of the 
feet the results were not likely to be as good as when 
there was only ascites. He thought that the higher 
the incision was made the better, in order to guard 
against the occurrence of ventral hernia which so often 
proved fatal later on. 

Mr. Manbbll Moullin, in reply, f^reed with the 
last speaker in respect of the beet site for the incision. 
He had operated after one or two tappings, i.s., some¬ 
what early in the history of the aeoitM. 


Thb Mb dical Pbbsb. 415 

ftermattg. 

[fbou oub own cobbbspondint.] 

Beklix, October 12tb, ISOL 
Contusion ob Eoptube or Intbbtxnb. 

ThkPmIA. Med. Chir. Preset contains the following 
interesting case, recorded by Dr. J. Toth. 

The patient, about an hour and a half after supper, 
was kicked on the abdomen by a horse, upon which 
there was inclination to vomit, but none actually took 
place. The pain, however, was so great that the patient 
had to sit down on the ground in a doubled up position; 
he was then taken to bed. The condition on the follow¬ 
ing day was the following: The face bad a pained 
expression ; the patient lay in bed turned towards the 
right, with the right thigh drawn np. The breathing 
was costal and superficial; there was no abdominal 
respiration. The abdomen was distended, painful to 
pressure over the whole surface, but more so about 
the umbilicus to the right, where there was a 
feeling of hardness. There was no trace of injury 
externally. On percussion there was dolness in 
the lower part, which varied with change of 
position. Collapse was extreme. Temperature 38 C., 
pulse 120, small and easily compressed. There was 
no vomitiog and no action of the bowels. One hour after 
admission the patient passed 300 to 400 o.o.m. of bright 
red urine, but there was no further attempt. In deter¬ 
mining a diagnosis the question arose as to whether the 
peritonitis clearly present was due to contusion or to rup¬ 
ture of the bowel. The answer to this question was not 
easy to obtain, ai the symptoms present might be dne to 
either injury and the hematuria still farther complicated 
the matter. The hematuria was evidently dne to trau¬ 
matism of the kidney and not to any injury to the 
bladder, as after exclusion of rupture of the bladder, the 
ohief symptoms of rupture of bowel, such as vomiting, 
action of the bowels, and disappearance of liver dulness 
were absent, the diagnosis must be determined by the 
farther course of the case. As a matter of fact, both 
vomiting and action of the bowels took place about mid¬ 
night of the following night, the vomit being slimy and 
of a green tint. The abdomen became more distended. 
A diagnosis of rupture of bowel could now be made 
with confidence. Death took place the following day. 

The autopsy showed meteorism, no trace of external 
injury either of the skin, the subcutaneous connective 
tissue, or of the muscular strocturef. On opening the 
abdomen a foul odour was perceptible. The abdomen 
contained about two litres of thin dark blood. The 
peritoneum was covered over most of its extent with a 
removable pseudo-membrane and beneath this was deeply 
injected. The pseudo-membrane glued together the 
coils of intestine. On the duodenum there was loss of 
substance over about one-fourth of the periphery. The 
loss of substance extended to the lumen of the bowel, 
the edges were rather sharp, and the rent lay trans 
versely to the axis of the bowel. There was a large 
quantity of blood-clot lying among the adjoiniog in¬ 
testines and adherent to them. The bladder was intact. 
The case shows the unreliability of the sopposed 
symptoms of rupture of intestine. 

Constipation or THiBTT-riva Datb’ Duration. 

The Munch, Med, Woch. has the following :— 

The patient a girl, set. 14, in spite of strong pnxgativeB, 

CoogI< 



416 Thi Midical fbsbs. 


AUSTRIA._Oct. 16, 1901. 


had bad no action of the bovrels for a week, nor had she 
passed any flatus. The constitutional condition was 
good. In the left iliac region, reaching on the right 
to the middle line, and upirards to above the umbilicus, 
was a tumour, tender on pressure. From the rectum, 
which was empty, it could be felt as irregular in outline 
and slightly doughy. The diagnosis was obstruction by 
a fffioal tumour in the sigmoid flexure. The treatment 
was light, digestible diet, and enemataof water six times 
a day. Occasionally they were mixed with oil, salt, or 
vinegar and water, but a litre was not retained much 
more than a minute. As the appetite, which had been 
good, now changed to complete anorexia, and vomiting 
came on, an attempt was made with ext. colocynth 
and croton oil, but both drugs and atropine also were 
without any effect. After sixteen injections the bowel 
was washed out twice daily for two hours at a time. At 
the first washing out, the water broke up some of the 
mass and retnrned mixed with a good deal of fsecal 
matter. The obstruction was overcome, the vomiting 
ceased, and the appetite returned. The irrigations 
were repeated twenty-two times, the tumour bad th en 
disappeared, but the patient at the time of reporting 
had not been cured of her habitual constipation. 

The Col.f. Qynslcol. 30, 1901, contains an account of a 
new way of treating 

Chronic Pklvic Exodation, 
by Dr. 0. Folano, BoyU University, Frauen Elinik 
Qreifswald. The method consists in the application of 
warmth by means of an apparatus devised by himself 
and Dr. Elapp. Without entering into minute details 
difficult to understand, the instrument may be said to 
distribute heat derived from the barning of gas by a 
Bunsen burner equably over the lower part of the abdo¬ 
men, the back, sacrum, and hips. A thermometer is 
placed on the lower part of the apparatus that registers 
to 150*^ C. On the first day a temperature of 120^ C. is 
applied for twenty minutes. On the following days 
the heat is greater anl the sitting is gradually ex¬ 
tended, so that after a week a heat of 136 to 150 C. is 
applied for three-quarters of an hour at a time. It is 
a safeguard to know that the heat reaching the body 
is always below that registered by the thermometer. 
The action on the skin is very marked, and the patients, 
especially the obese ones, sweat profusely, and through a 
speculum the cervix uteri is seen to secrete freely. The 
only sensation perceived when the apparatus is rightly 
applied is a slight prickling. To relieve this a damp 
cloth may be placed on the forehead. When the heat 
haa been applied long enough cooling may be brought 
about within five minutes by turning off the gas. When 
this is done the patient is thoroughly dried, a towel 
over wadding or lint is then wound round the abdomen 
and the patient is put to bed for an hour. 

Jlnatria. 

[xBOX OTJB OWN OOBBIBPONDXHT.] 

ViKHNA, October 12bh, 
Htslitib Acuta. 

Bidlich, in his lecture, gave a riaumi of the patho¬ 
logical anatomy of myelitis, which he was pleased to 
divide into two divisions according to Leyden’s nosology. 
The symptoms, he said, had long been known to the 
profession, which were then attributed to myelomalacia 


as the initial cause of the disease. It is now ascertained 
that there are now two causes; (1) the true inflamma¬ 
tory form; (2) the hsemorrhagic or hffimatomyelil^ 
differing little, if any, clinically, from the inflamma>- 
tory. This is not to be wondered at, as inflam¬ 
mation and h{emorrh^;e have much in common. 
Myslitia may be either transverse, disseminated 
poliomyelitis or compression myelitis. Notwithstanding 
the modifications in the classification, it osmnot be 
denied that there is always a certain amount of iafec- 
tiona poison at the root of the disease. This has been 
amply proved in poliomyelitiB by bacterial, examina¬ 
tions. The same pathogenic agent may be the origin of 
other obscure cases. Weichselbaum and others have 
recently gone so far as to affirm that the original cause 
lies in a streptococcus in the cerebro-spinal meninges. 

Be this as it may, we have many proofs of myelitis 
following on attacks of influenza, typhus, and alight 
affections of the throat, as well as after confinement. 
Post-infections myelitis is not yet unknown after an 
accident or shock to the system, although these cases 
may even be hsemorrhagic in nature, as many of them 
are found to be of the disseminated type which lends 
much colour to the assumption. Tubercle, syphilis and 
gonorrhoea are too well known in chronic myelitis to 
require notice; while the acute are nanally produced by 
alcohol, lead, arsenic, and carbon monoxide. 

The site will vary from the bnlbar to the cervico-dorsal 
region. Its progress is often more than acute, and may 
be designated “ acutissima.’’ Commencing low in the 
cervical region it may rise rapidly, and produce bnlbar 
paralysis, endangering tbe life of the pstient, and as 
rapidly recede, bnt never perfectly recovering func¬ 
tional activity. As a rale it produces cystitis-trophic 
distnrbances. and ultimately gangrene of the extremities 
The transverse, disseminated exudation and hsmor- 
hagic varieties are all capable of retrogression and partial 
recovery ; or may merge into the chronic state. 

The microscopical pathology is as variable as the 
symptoms. According to some observers it has been 
affirmed that the inflammatory process may first assume 
a transverse coarse, and in its diffusion induce the dia* 
seminated form, and finally ending in poliomyelitis. This 
order has been disproved and it is shown that the 
reverse order may be followed. 

Acnte poliomyelites in the freeh state has all the ap- 
pearanoe of an inflammatory process with a preceding 
vascular lesion, not in the anterior horns alone hat in 
the artoriaspinalis anterior and arteria centralis as well.. 
It is possible that in individoal cases, as described by 
Charcot, acute degenerative phenomena in the ganglionic 
cells may occur, but this is not constant. The acute 
form of poliomyelitis has a preference to form centres in 
the grey matter resembling multiple disseminated 
myelitis with vascular infiltration as seen in young 
individuals. 

In other oases of acute myelitis the histological ap¬ 
pearance assumes two other different forms—first, degen¬ 
erative changes in the nerve element—nerve fibres and 
axis cylinder which sometimes have vacnolss and at other 
places swellings. The vascular part haa fatty degene¬ 
ration with infiltration of the neighbouring structure. 
In some of the cases necrosis of all the tisanes is seen, 
most prononnoed iu the vascular region. 

In all the cases there is decided changes in the 


Diyiiized by ^OOQIQ 


Oct. 16, 1901. 


THE OPERATING THEATRES. 


Th« Medical Fbkba 417 


meniogea. Id conclusion, he thought Mayer's theory of 
vascular changes insuGBuient for all the changes of acute 
myelitis; while Brun’s hypothesis of intoxication did 
n^t always appear to explain the real origin; neither 
did Virchow’s thrombosis or embolism theory throw 
1 ght on this much obscure inflammation. 

In the greatest number of cases cold, intoxication, 
injury, &c., would be found as the origin of the disease, 
while bacteria, embolism, &o, would appear as subse- 
■qnent complications.. 

©pcrating ^heatrce. 

WESTMINSTER HOSPITAL. 

SUPPUBATIOM OF MIDDLE EaB EXTEEDIKO TO 
Lateral Simus. —Mr. Williau Turner operated on 
■a child, set. 5, who had been sent up to hospital by Dr. 
Joyce, of Battersea, with a diagnosis of thrombosis of 
the lateral sinus, and who had been admitted the day 
before with the following history:—The child bad been 
taken ill with severe pain in the right ear ten days 
before admission. Two days afterwards there was high 
fever with delirium, which continued for three days: 
The temperature then came down, and the little patient 
became conscious, but still complained of pain in the 
right ear, and the head was kept turned to the opposite 
eide. Three days before admission the child had a rigor, 
and vomiting occurred once or twice without any sppa> 
rent cause. The temperature when brought to the 
hospital was 100, tmd it went up to 102 the night before 
operation. There was no dischai^ from the ear on 
admission, and there had been none during or previous 
to the illness. The patient seemed very ill, and 
was in constant pain over the ear, but had no 
signs of meningitis or trouble over the mastoid process 
itself. A little swelling was noticed occupying the upper 
third of the stemo-mastoid muscle on the right side 
apparently due to inflamed lymphatic glands. The 
edges of the right optic disc were more blurred than on 
the left side, and the retinal veins were engorged. On 
the morning of the operation some purulent fluid was 
found in the external auditory meatus, which on micro* 
acopical examination proved to be pus; the child was 
deaf on that side; no perforation could be discovered in 
the membrane, which, however, was swollen and red, but 
there was no pulsation viaibls on it. It was deemed, 
therefore, necessary to explore the mastoid. Chloroform 
was administered, and the usnal semi*cironlar incision 
behind the ear made down to the mastoid process, the 
periosteum excised, and a gouge put on over the position 
of the antrum. The outer wall having been removed pus 
was immediately found, and was traced forwards and 
backwards into the middle ear in front and to the lateral 
sinus behind, the bony canal of the lateral sinus being 
found full of pus. It being deemed inadvisable to 
deal with this until the internal jng^ular vein had been 
tied in the neck, this wound was covered up smd an in¬ 
cision m^e at the anterior border of the sterno^mas- 
toid at the lower part of the neck, and the internal 
jugular vein separated from the carotid artery and liga¬ 
tured in two places with catgut but not divided. This 
last wound was now stitched up, covered with collodion 
dressing, and the operation on the sinus continued. 
All the pns was traced downwards and found to go to 
the jugular foramen; this pns was removed by means 
of BTruill swabs on a probe; next the vein itself was 


opened and found to bleed readily, showing that throm¬ 
bosis had not occurred at that spot. The bsemor- 
rhage was easily stopped by means of a small plug 
of gauze. An incision was then made in the 
neck corresponding to the swelling just below the 
mastoid process ; a lot of inflamed glands were found 
which were not suppurating. The internal jugular 
vein was exposed just below the jngular foramen, but 
there was no pus around the vessel. A drainage tube 
was left in this opening. The tympanum was then freely 
opened up with a gouge and made to connect with the 
original opening in the antrum. The facial nerve was 
touched during this process, as was evinced by spasm of 
the muscles on that side, bat was not divided. The 
subdural space was also opened, but no pus fonnd in tiiis 
sitnatioo. Tbe posterior part of the cartilaginous 
lining of the external auditory meatus was incised to 
make tbe meatus itself larger ; the ear put back into its 
original position; the edges of the first incision were 
stitched up; iu this manner the packing came ont 
through the external auditory meatus instead of through 
the incision over the mastoid. Ordinary dressings were 
applied. The operation lasted two hours and fifty 
minutes, and the child took the ansesthetic very well. 
Mr. Torner said that the diagnosis made before 
admission was absolutely confirmed by the operation. 
The symptoms, he considered, were certainly obsonre 
on account of the child never having bmt any previous 
tronble in the ear, also on aooonnt of the fact that there 
hod been no discharge from the ear until the morning of 
the operation, and then so slight that it had to be 
microsooped to prove it to be pns, and also because 
there was no redness, swelliDg. or acute tenderness over 
the mastoid process itself. The case having been 
dealt with, and the patient only having had one rigor 
three days before led him to hope that pysemia would 
not intervene, as even if a portion of clot in the vein 
had been separated, it did not follow that it was neoes- 
sarily infective. With regard to the operation, he re- 
' marked that the " complete ” operation had been per¬ 
formed and all the possible situations for pus explored; 
the opening into the subdural space, he pointed 
ont, was originally unintentional, and although 
it proved that there was no tronble there at 
the time of operation, it undoubtedly left a risk 
of meningitis intervening from the wound, though 
from other oases where the same had been done the 
ganza packing has nsnally prevented this complication. 
No real difficulty, he said, was experienced in finding 
tbe jugular vein deep in the neck, altbongh it had to be 
done in such a small space owing to tbe age of the 
patient; but with tbe muscles well retracted with blopt 
hooks an incision of only about an inch long was neces¬ 
sary. Tke object of tying tbe vein low down, he ex¬ 
plained, was to prevent septic clots passing down from 
the lateral sinas to the lungs and heart and setting np 
general pyssmia. The latter part of tbe operation, when 
the antrum, tympannm, and posterior wall of the meatus 
were converted into one cavity and the cartilaginons 
portion of the ear incised so as to increase tbe external 
anditory meatus to allow the picking to come ont there, 
was done for several special purposes—first, to follow np 
the primary origin of the suppuration in the sinus; 
secondly, to avoid continued suppuration and necrcsis 
occurTing from trouble in the bone left uncovered; 
and thirdly, to allsw the ear to go back into its original 


418 Thi Mkcicil _ LEADING 

poaitioii, and not produce an nnsi^btly opening behind, 
accompanied by the bulging forward of the anriole. 
This latter part of the operation, he said, waa more 
nsnally done in chronic caaea of continued maatoid anp* 
pnration, bnt it aeemed to him the moat thorough 
method of finiahing the preaent operation, and if the 
child got over the acute symptoma, the after-treatment 
would thua be rendered very much eaaier. 

Unfortunately, the child auccumbed in thirty-aix houra, 
with aymptoma of acute meningitis coming on aix houra 
before death, bnt at the post*mortem examination no phy. 
aical aigna of this condition or of any condition to lead to 
death could be found, and the operation wounds were all 
perfectly satisfactory, no pna being found in any of 
them. The only abnormality disoovered was someearly 
endocarditis of the mitral Talre. The only presumption, 
therefore, as to the cause of death, Mr. Turner thinha, 
waa that it waa due to acute aeptic absorption from the 
original trouble. 


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SALD8 POPULI 8UPRBUA LIX." 


WEDNESDAY, OCTOBER 16, 1901. 


REFOBM OF THE ARMY MEDICAL 
SERVICE. 

If henceforth the United Kingdom ie to maintain 
a great Army it will be clear to every level-minded 
citizen that the organisation and equipment of that 
force must be of the best in every particular. Tbe 
present war at tbe Cape has disclosed many faults in 
ouF military system, and nowhere more emphatically 
than in that important branch included under the 
title of the Army Medical Service. For many years 
past that Department has been hampered by official 
neglect and discouraged by many obstacles, both 
social and professional, that have been] placed in its 
path. The inevitable result has been a growing 
unpopularity of the Army Medical Service, and an 
absolute lack of any businesslike oi^ianisation for 
supplying the medical wants of a large army in tbe 
field. Nemesis followed close on the outbreak of the 
Boer War, the scandals of which have sunk deep into 
the hearts of the nation. The conditions of the 


ARTICLES. _ Oct. 16. 1301, 

military hospitals have undoubtedly been s '.c!* as to 
add materially to the avoidable mortality among our 
sick and wounded troops. In plain words, tbs Army 
Msdical Dspartment broke down utterly under the 
strain of an arduous campaign. The true position 
of affairs at the Cape would probably never have 
been known had it not been for the courageous atti. 
tudeof Mr. Burdett-Coutt8,who, almost single-handed, 
has fought the hydra-headed officialism of the War 
Office, backed by a self-satiefied and nonchalanh 
Government. Mr. Burdett-Coutte’s exposures in the 
House of Commons wrung from Mr. Balfour the Com¬ 
mission of Inquiry, which resulted in a complete 
whitewashing of all (joncemed in the failure of the 
military hospitals. Mr. Burdett-Coutts exposed the 
defective conetitution of tbe Commission, tbe disin- 
genuousnesB of its methods of inquiry, and the fatuity 
of many of its findings in a series of criticisms that 
have never been fairly answered. Indeed, apart from 
plentiful abuse, the main recognition of the truth of 
his charges has lain in the subsequent action of tbe 
Government. Thus, following the Army hospital 
inqniry a Board was appointed to report on the best 
means of reot^fanising the Army Medical Service. 
The report of that body has been issued, and baa 
given rise to a chorus of more or lees hearty jour¬ 
nalistic approval In all parts of the United Kingdom. 
Undoubtedly it contains, as we pointed out in our 
last issue, the germs of many useful reforms. At 
the same time it may be questioned whether it 
reaches the root of tbe matter. Broadly speaking, 
tbe trend of the whole recommendations lies 
in the attempt to make the Service more attractive 
to the medical profession. Would it not be 
more vital to consider first tbe inherent faults that 
have led to tbe present breakdown? What has Mr. 
Burdett-Coutts to say upon tbe matter ? In a letter 
to The Times of October 8th he has published a well- 
informed and scathing criticism of the (government 
proposals. In an article like tbe present it is impos 
Bible to deal with his remarks seriatim, but readers- 
who are interested in Army medical reform will do 
well to read, mark, learn, and inwardly digest every 
line of that able communication. His list of things 
left unreformed is formidable enough, iu all con¬ 
science, when it is remembered that tbe Committee 
was appointed by the Government to draw up 
a scheme for the fntnre organisation of the Army 
Medical Service. What can be tbe value of a report 
that leaves untouched tbe present and future position 
of the Militia Medical Staff Corps, the Militia 
Medical Reserve, and tbe Volunteer Medical Staff 
Corps, or the questions of an Army Medical Reserve 
of the employment of civilian doctors in war time, 
of tbe employment of civilian nurses and orderlies, 
of voluntary civilian hospitals, of the Red Cross 
Society, of the control of hospital orderlies, and 
of a number of other important matters bearing 
upon hospital administration that have been, 
brought prominently into notice during the present 
campaign P As to what has been actually suggested 
we pointed out last week:—** One of the great tuma 

Dim. lOOg C 



Oct. 16, 1901. 


LEADING ARTICLES. 


Thi Mbdicix Pbcbs. 419 


of the Committee has been to bring the Armj j 
Medical Serrice into closer and mora snstained re¬ 
lations with the profession in civil life, and therein, 
unqaestionablj, lies an element of anccess of con¬ 
siderable importance.” Tbei-e can be no doubt that 
the newlj-qualified man vrante a practical training in 
professional work that he cannot get in ordinary 
military life. Such training he can get by holding 
residential posts in medical institutions and by post¬ 
graduate work of variouskinds. Weprotest, however,in 
the strongest way against the assumption that the best 
and most suitable men for the service will ever be 
obtained by examination tests. The high standard 
examination is at best a feeble guarantee of the 
possession of the qualities necessary to make a sound 
and conscientious medical practitioner. Yet that 
appears to be, broadly speaking, the upshot of the 
whole I'eport. As Hr. Burdett-Coutts remarks 
The scheme starts on a wrong basis, or at least on 
an extremely narrow one. It seems to assume that 
the Army medical breakdown proceeded from the 
inferior scientific status of the Army doctor.” For¬ 
tunately the suggestions of the report are not final, 
and in the present stage will fulfil the useful pur¬ 
pose of raising free and adequate public discussion. 


THE .iJTIOLOGY AND CONSEQUENCES OF 
MOVABLE KIDNEY. 

A CERTAIN number of practitioners, it is to be 
apprehended, still regard movable kidney as an ex¬ 
tremely rare, and even doubtful, lesion, although an 
attentive study of the fairly copious literature of the 
subject during the last few years should convince the 
most refractory that the condition is not only toler¬ 
ably common but is often fraught with exceedingly 
distressing consequeoces to the unhappy possessor 
of the displaced or nomad organ. The fact that 
movable kidney is met with in a very large 
proportion of patients suffering from neuras¬ 
thenia, according to one authority as many 
as 80 per cent., has led to the symptoms being 
regarded merely as neurasthenic manifestations, and 
not dependent upon the mobility of the viscus. It 
may indeed be conceded that movable kidney is fre¬ 
quent in neurasthenics, that in most instances it is 
not productive of serious injury, and that the sym¬ 
ptoms referred to the kidney by the patient are 
frequently not due to its abnormal mobility but are 
really neurasthenic in character. On the other 
hand, as is pointed out by Dr. F. S. Watson, 
of Boston (a), while it is true that renal sym¬ 
ptoms are often neurasthenic, it is also often true 
that the neurasthenic condition is directly depen¬ 
dent upon, and secondary to, the mobility of 
the kidney. This is clearly shown In the 
numerous reported cases in which movable kidney 
associated with painful crises has, in persons of pre¬ 
viously good health and with no previous evidence of 
a neurasthenic tendency, been followed by serious 
impairment of the general health, and by the gradual 
development of well-marked neurasthenia, in whom 


total disappearance of the symptoms and restoration 
to health have followed nephropexy. The conse¬ 
quences of movable kidney, moreover, are sometimes 
much more serious than the production of neura¬ 
sthenia. We occasionally meet with acute sym¬ 
ptoms due to rotation of the organ upon its 
horizontal axis, followed by occlusion of ite- 
vessels and consequent intense congestion, or twist¬ 
ing of the ureter may lead to hydronephrosis, or, 
lastly, the previously movable kidney may becomo 
fixed in an abnormal and physiologically incon¬ 
venient position. Movable kidney is a purely me¬ 
chanical lesion, resulting from a variety of causes, 
acting either alone or in conjunction. Sudden 
absorption of the perirenal fat, increase in size and 
weight of the kidney or downward pressure on the 
kidney by an enlarged liver or by copious pleuritic 
effusiona The last-named condit'on may be simn- 
latad by the effects of tight lacing. Traumatism 
especially in presence of one or more of these con¬ 
ditions, may, of course, be the immediate exciting 
cause of the displacement. In only a small 
proportion of cases of movable kidney are 
the symptoms so severe and refractory to milder 
measures that operative treatment is indicated. In 
many, probably in most, careful attention to dress, 
the avoidance of tightly pressing stays or bands 
round the waist or over the hips, together with the 
use of a suitably padded corset, will be sufficient to 
render life tolerable without having recourse to the 
operation of nephropexy. With practice the dia¬ 
gnosis of movable kidney is less difficult to arrive at 
than is generally believed, the important thing is to 
be always on the look out for this abnormality. 


CANCER: ITS NATURE AND TREATMENT. 

A BEMABEABLB article (a) by Dr. J. H. Webb, of 
Melbourne, deals briefly with tbeideaswhicb its author 
holds on the subject of the sstiology of cancer, and, at 
greater length, with the method which he has adopted 
for its cure in certain cases. The etiology of the dis¬ 
ease, acoordingto the author, may be briefly stated as 
follows:—In the first place Dr. Webb demands the 
granting of three postulates—(1) All secretions must 
have their uses; (2) consequently, the loss of any 
secretions, save such as are required for temporary 
requirements, must mean some sort of disorder; (3) 
all reproduction is subject to control, or else, given 
nutrition, it would be indefinite. ” Now, in obedience 
to this law, there must be something that regulates 
the proliferation of the cell. It can only be a secre¬ 
tion, subjected to a higher power.” This secretion is 
cholesterine, which is kept in solution by ite natural 
aqueous solvent soap. It is the loes of this soap that 
permits cholesterine to separate from the living cell 
and cell-cancer to start. The uncholesterine cell 
is the uncontrolled cell.” “If I were asked 
what is malignancy, I would reply, it is the 
oiystallisation of cholesterine from the living cell.” 
Working on these lines, Dr. Webb first came to the 

D -Tiiized by CjOO^Ic 


SMUmJftdUai andSurffUaiJournel, Seiitcmber IStb, 1001 . 


420 Th« Medical Prkss. 


NOTES ON CURRENT TOPICS. 


■conclusion that the cause of cancer must be tbe loss 
of tbe controlling effect of tbe cbolesterine, and with 
that idea he injected cholesterine, at first—thought* 
lessly, as he saje—dissoWed in ether. It then struck 
him that as the ether evaporated the cholesterine 
crystals reappeared, were absorbed and, were carried 
off in the urine. After some time he found ^tbat 
soap was the natural aqueous solvent, and accord¬ 
ingly he dissolved some crystals of cholesterine in 
soap solution, and injected the drug in this form. 
At the same time he administered thyroid extract, 
a,nd also another substance—animal gum—which he 
afterwards discarded. The case was one of epi¬ 
thelioma of the face, which had been operated upon 
and had recurred. It got well in a month. The 
second case was an unnamed form of cancer, on 
account of which the patient had had half of his 
lower jaw removed. Dr. Webb injected the same 
eolution which he had used in the former case, and 
-the man rapidly improved. Then a curious thing 
happened. Dr. Webb discovered that the supposed 
solution of cholesterine was not a solution at all, as 
the crystals “ unless they be crushed will not dis¬ 
solve.” Accoi'dingly he, thinking well, “ innocently 
injected” a new solution which be believed to be 
more perfect. The results were most disastrous, 
as the disease returned with great rapidity 
and the patient died. His next case was one 
of malignant disease of tbe breast of two years’ 
standing. Hete he again injected, as he thought, 
the cholesterine solution, which he subsequently, as 
has been mentioned, proved not to be a solution, and 
administered thyroid extract, discarding the animal 
gum. " In less than six weeks the whole tumour 
bad disappeared, leaving a firm cicatrix, and this 
fibrous tissue in turn dissolved, so that in three 
months one would have hardly known that there had 
been any disease.” For fifteen months the breast 
remained well, and^then the patient returned with a 
suspicious spot upon it. He reinjected her, and in a 
few days a slough came away—presumably from 
where the suspicious area had been situated—leaving 
an ulcer the size of half a crown. The injections 
were continued and the condition disappeared. 
After this Dr. Webb treated two cases with a 
stronger solution of cholesterine—a case of epi¬ 
thelioma of the hand and a breast case. In both 
instances be failed to check the course of the disease. 
At this point Dr. Webb's aiticle fails to describe 
with sufficient accuracy tbe form of soap solution 
which he adopted in subsequent cases. We rather 
fancy that there is a misprint, and that he 
means to convey that he omitted tbe choles¬ 
terine. So far as we can understand, all subse¬ 
quent cases were treated by the injection of 
soap solution alone, and tbe administration—when 
possible—of thyroid extract. In this manner he 
treated seven cases. Three recovered and four died. 
Two of the cases which died were advanced cases of 
cancer of tbe tongue, and in both the patients had a 
complete reprieve from pain. A fifth case died from 
an over-injection of the soap solution—a danger to 


Oct. 16, 1901. 

which tbe author calls attention. One case recovered 
in which ” the whole of the interior of the mouth 
and cheek was one mass of cuncer. The soap solution 
used is best made from Allen and Hanbury’s super¬ 
fatted soap. Not more than a teaspoonful may be 
injected at tbe time, and various precautions must 
be adopted. Such in brief is Dr. Webb’s treatment 
and its results. Presumably tbe rationale of his 
treatment is that the soap solution by re-dissolving 
the crystallised cholesterine enables the latter to re¬ 
sume its ” controlfunction. It is much to be 
regretted that tbe form in which the treatment is 
placed befo^'e its readers is not more methodical and 
systematic. Dr. Webb says that as he does not belong 
to any medical society he could only show bis cases 
to his friends, and this being so we think that when 
he came to seek an opportunity for laying these 
cases before the medical profession generally, he 
should have taken more pains with tbe form of his 
communication. All through his article there is 
evidence of close and acute reasoning—if we grant 
the truth of the postulates which he lays down—but 
there is not evidence that he properly appreciates the 
importance of his subject. Otherwise, be would sorely 
have dealt more carefully with it. Space compels 
08 to withhold further criticism. We can do no more 
than call attention to an omission which in our 
opinion vitiates much of Dr. Webb’s work. In no 
single case is there a record that a microscopical 
examination of the growth was made, and its nature 
thus definitely determined. This is mnch to l>e 
regretted, but it can in tbe future be obviated. Will 
Dr. Webb have such an examination made in bis 
subsequent cases, and then communicate the results 
of the treatment of cases the nature of which is 
beyond doubt? 

JUrttB on (Etimnt 

Pantherapeutiets and Others. 

Ak American writer, discussing the present 
aspects of the practice of medicine, groups prac¬ 
titioners into allopaths, bomceopatbs, quacks, and 
pantherapeutists, tbe last-named being those intelli¬ 
gent members of the medical fraternity who “ draw 
their information from any and every source that is 
conducive to lessen the cause of disease and restore 
health to the afflicted.” In this sense we imagine 
eveiy practitioner may be described as a pantbera. 
pentist. It is not in accordance with general ex¬ 
perience that professed allopaths, if there be any 
such, refuse or display reluctance to avail them¬ 
selves of any remedy or mode of treatment which 
comes to their cognisance, whatever may have 
been its origin, provided it bolds out reasonable 
hope of achieving tbe desired effect, which 
is the cure of disease; indeed, many even appear to 
dispense with this proviso, and forthwith give a trial 
to every new remedy which chance or skilful adver¬ 
tisement briogs to tbeir notice. Nor, on the other 
hand, have we found, in our limited experience of 
homceopatbs, that they evince a distressing obstinacy 


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_yOTES ON rURREXT TOPICS. Th. p,,.. 421 


in adopting such measures and medicinal treatment 
as appeared best suited to atbun their object; in 
other words, the^, or some of them, recognise but 
one law, their duty to their patient. Eyenthe quack, 
we may give him this credit, does the best he can, 
his usefulness being limited onlj by his extreme 
ignorance. It follows then that we are all panthe* 
rapeutisU within the limits assigned by nature to 
our intelligence, and by the opportunities at our 
disposal, and farther classification therefore appears 
supererogatory. 

The Resignation of Professor J. M. Purser, 
of Dublin University. 

Thb School of Physic of Dublin Uniyersity has 
suffered a severe loss by the resignation of Dr. J. M. 
Purser, King's Professor of the lobtitutes of Modi* 
cine. The news has come as somewhat of a surprise 
to bis many friends throughout the United King¬ 
dom. Dr. Purser has held the chair which be now 
vacates for close on twenty-eight years, and it is not 
too much to say that to his persistence and deter¬ 
mination the medical class of Dublin University 
owe the physical opportunities they possess of 
acquiring a knowledge of the institutes of medicine, 
and to his scientific ability and power of teaching 
the knowledge itself. Dr. Purser has for years con¬ 
tended with the Board of Trinity College for ade¬ 
quate recognition of the importance of the subjects 
he taught, and be has contended with success. The 
necessar; alterations, structural and otherwise, in 
his laboratories, have just been completed, and 
a sum of money has been granted to equip 
them in a manner consonant with the advances 
and requirements of modem science. For this Dr. Pur¬ 
ser has fought for yeais, and it is on the eve of the 
fruition of bis toil that be has chosen to resign in 
order that bis successor may have the opportunity of 
personally equipping the new laboratories. There 
are few men who would voluntarily make such a 
sacrifice, and there are none in Dr. Purser'a position 
fiom whom it could be asked. To most men, it 
would appear to be only right and fair, that, after 
the toil, they should have an opportunity of leaving 
their personal imprint on the rtsult of their toil. 
Truly may his successor say: " Another man has 
laboured and I have entered into his labours.’’ Dr. 
Purser’s old pupils proved some couple of years ago 
that they were not unmindful of their master, and 
a medal—The John Mallet Purser Medal—was 
founded “ to permanently record their appreciation 
of him as a teacher, their respect for him as a 
scientist, and their regard for him as a friend.’’ Is 
it too much to hope that the Board of Dublin Uni¬ 
versity will be seized by a similar impulse to honour 
the man who has given his life’s work to advance by 
every straightforward way in his power the purpose 
for which their School of Physic was founded, the 
teaching of medicine P Dr. Purser has denied himself 
the opportunity of placing his personal imprint on 
the enlarged laboratories. Cannot the Board of 
Trinity College permanently I'ecord his relation to 
them, and by creating “ The John Mallet Purser 


Physiological Laboratories *’ perpetuate the memory 
of the man to whom the existence of the laboratories 
is due, and at the same time bring honour to them¬ 
selves by so perpetuating his memory. 

Profesaor Virchow’s Eightieth Birthday. 

Or all tbe distinguished figures in the world of 
medicine there is none more revered than that of 
Professor Rudolf Virchow. As a pathologist and a 
sanitarian he has long occupied a foremost place in 
science, which he still purenes with unabated ardour. 
Last week a number of distinguished persons met at 
Berlin to take part in the International festivities in 
honour of the aged professor, on the occasion of his 
eightieth birthday. The United Kingdom was repre¬ 
sented by Lord Lister and Sir Felix Semon. Pro¬ 
fessor Virchow delivered a brilliant address of 
two hours’ duration at tbe Pathological Insti¬ 
tute, and chose as the subject of his discourse 
“ The Progress of Pathology.” Daring bis career he 
has been prominent in politics, and in lb65, as a 
Liberal, be defeated Prince Bismarck’s project for 
converting Germany into a great maritime power. 
It is interesting to note that he was, in consequence, 
challenged to a duel by the Iron Chancellor. He 
retired from politics in 1878, when he resigned his 
seat in the Reichstag. Since that time be has 
devoted himself entirely toscientific work. Virchow 
was made an honorary member of the Medical Society 
of London so long ago as 1856. His appearance in 
this country a year or two ago will doubtless be re¬ 
membered by many of our readers. His life has, 
indeed, been one of enormous value to mankind at 
large, and merits any distinction that it is in the 
power of man to confer. 

Small-Poz and the Consoienoe Clause. 

In an exceedingly able article on tbe subject of 
vaccination and the conscience clause, the Saturday 
Review deals in characteristically trenchant style 
with the absurd idea of recognising so-called con- 
scientions objections in this connection. Tbe intru¬ 
sion of conscience into an affair of this kind, says 
our contemporary. ” is a wicked anachronism. We 
are done with the days when a man for the sake of 
bis own conscience could conscientiously bum bis 
neighbour. Let us be as conscientious as we 
please for ourselves; if we must, let us bum 
ourselves, with as little advertisement of our 
reasons as may be; but let us see that we do It in 
such a fashion that our funeral pyre or tbe fumes of 
it do not offend our neighbours. Were it possible 
that rejection of vaccination brought no risk except 
to tbe rejecting person, it might be possible to give 
a guarded support to the conscience clause. But 
that support would have to be hedged about with 
restrictions and precautions almost impossible to 
carry out. At a time like the present, the conscien¬ 
tiously nnvaccinated person should not be allowed in 
public except ringing a bell and clad in a warning 
garb. All means of public conveyance should be 
closed to him ; all shops, schools, theatres, churches, 
hotels, public-houses, and restaurants should refuse 


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422 Tui Mbdioal Prms. 

to barboar bim; bis linen sbonld not to the wash, 
bis aboea to tbe cobbler, nor bia letters tbrongb tbe 
poat. Only on terms such as tbeae abonld be be 
allowed to anifer for conscience sake.” 

Aeoites. 

Slight ascites is frequently a very early symptom 
occnning in coonection witb malignant growth. By 
the usual diagnostic methods it is, however, extremely 
difficult to appreciate and recognise small quantities 
of free fluid in tbe peritoneal cavity. A characteristic 
sign, known as Landou’s sign, affords in some cases a 
valuable help in the recognition of tbe presence of a 
small quantity of fluid in tbe abdomen. Landou 
claims to have been greatly assisted in arriving at a 
diagnosis by observing whether it was possible or not 
to grasp tbe uterus bimanually, that is to say, to make 
the fingers meet at tbe sides of tbe pelvis. With tbe 
patient lying flat on tbe back tbe uterus is slightly 
depressed and is described as giving tbe impression 
of resting on a cusbion of air or a small collection of 
fluid. Continuing the examination, the patient is 
placed in the raised pelvic position and tbe thighs are 
flexed when the uterus can be examined bimanually 
without difficulty, and tbe fingers are found to meet 
at tbe sides of tbe pelvis, thus indicating that tbe 
fluid has gravitated in the direction of the diaphragm. 
It will be easily seen that for tbe success of this 
manoeuvre tbe bladder must be empty. There is no 
malady in which it is more desirable to improve the 
chances of correctly diagnosing the condition as 
early as possible as in malignant disease and Lan- 
dou's suggestion is sure to excite a considerable in* 
terest on this account. 

The Inadequacy of the Lance. 

In the earlier days of tbe war one of the illustrated 
papers depicted two Boers, riding on tbe same horse, 
being pierced through by the lance of a British 
soldier. Tbe illustration did not give one the idea of 
the lance being a gentle weapon, bnt we understand 
that tbe report furnished to tbe German Government 
by the medical expert sent out by them to South 
Africa is to the effect that the lance is too gentle a 
weapon to immediately stop a man or disable him for 
a reasonable time. The medical man in question,' 
Dr. S. Schaffer, tells his Government that tbe lance 
is such a humane weapon that its efficacy in real war* 
fare is greatly diminished, and therefore, if tbe Ger¬ 
man cavalrymen are to have a useful weapon in tbe 
lance tbe shape of tbe point must be changed; it cer¬ 
tainly must not remain a round-pointed weapon. In 
Dr. Schaffer’s report be gives details of the examina¬ 
tion of several Boers who bad been pierced tbrongb 
by British lances, and bis opinion is that because of 
the roundnesB of tbe point it is possible for the lance 
to penetrate internal organs without very severe in¬ 
jury. In fact, tbe lance neither stopped nor fatally 
injured a large number of the Boers whose bodies 
bad been penetrated by that weapon. Since in war 
tbe object of bearing weapons is to kill, or at any rate 
to disable, the sooner the lance is transformed into a 
more lethal instrument tbe better. 


The F^ht Againat Malaria. 

Lobd Bbasbet is to preside over tbe meeting of 
those interested in tbe Seamen's Hospital Society. 
Oocatdon has been taken of the opening of the tbiid 
winter session of the London School of Tropical 
Medicine to draw attention to the mission under¬ 
taken by Sir Francis Lovell to tbe East on behalf of 
tbe School, to which we briefly alluded last week. 
Lord Brassey promises us some particulars of this 
trip, and it is to be hoped he will not omit an expla¬ 
nation of the objects of Sir Fi'ancis Lovell’s journey. 
This gentleman’s mission is to elicit support and 
raise funds for the Seamen’s Hospital Society, and 
for this purpose he is to visit Egypt, Aden, Zanzibar, 
India, Burmah, Ceylon, Perak, Borneo, Sarawak, 
Siam, Hong Eong, Japan, New Zealand, Fiji, Canada, 
and many other places. It is hoped that his 
efforts to raise money for scientiflo investigation in 
tropical hygiene and pathology will meet with a 
cordial support from the medical men in tbe towns he 
visits. Sir Francis Lovell is a very keen advocate 
for tbe education of medical men in tropical diseases, 
and if his success is in any way commensurate with 
the reasonableness of the cause he pleads there will 
be no disappointment in the ultimate result of his 
endeavours. 

Detectives and Doctors. 

OuB readers will remember some strong remarks 
made in this journal on the conduct of tbe authori¬ 
ties at San Francisco on the occasion of the occur¬ 
rence of plague In that city. The State Board of 
Health of California have just paid a bill to a de¬ 
tective for shadowiag the medical gentleman who 
had acted as Bacteriologist to the State Board of 
Health, and who was apparently obliged to leave 
that Board because be bad dared to tell tbe truth 
and report tbe existence of plague. Tbe attentions 
of detectives were also bestowed on Dr. J. M. Flint, 
Bacteriologist of tbe Marino Hospital Service, and 
on Dr. J. H. White, tbe quarantine officer. Assum¬ 
ing these facts to have been accurately I'eported it 
is clear that tbe Californian autborities exceeded tbeir 
rights to a very considerable extent. It is simply 
disgraceful that medical men should be shadowed 
like common thieves because their duty forced them 
to disclose tbe disagreeable fact of the presence of 
plague in San Franciso. It is perhaps hopeless to 
expect anything to be done to have this matter pro¬ 
perly inquired into, bub at tbe very least the 
charge for the expenses incurred should be borne 
by those who set tbe spies to work. 

-The opening meeting of medical session of the 
Meath Hospital took place on Monday last, when an 
address was delivered by Mr. William Taylor, 
F.R.C.S., Visiting Surgeon to the hospital, on abdo¬ 
minal surgery. 

The annual meeting of tbe Royal College of 
Physicians of Ireland will be held on Friday next, 
being St. Luke’s Day. Tbe annual dinner will take 
place in the College hall on the same evening. 


Oct. 16, 1901. 


NOTES ON CURRENT TOPICS. 


'raa MisiciL PsiBS. 423 


Drinking Water and Bad Teeth. 

It is a pretty widely recognised fact that cirilisa- 
tion brings bad teeth. The why and the wherefore 
of that association is not altogether clear, although 
it seems fair to look upon the teeth as an organ of 
the human body which is gradually deteriorating 
because of the comparative falling-off in the exercise 
of their full function. In other words, savage man 
uses his teeth a great deal more than his civilised 
descendant. Other and more direct causes nndoubt* 
edly contribute to the decay of teeth, such as mouth* 
breathing, the use of hot and cold foods, and the 
manifold evils of the dyspepsia fiend. Some wise¬ 
acre dentists lately endeavoured to raise a scare by 
asserting that in Wales the prevalency of 
bad teeth was accounted for by the general 
softness of the water. In the first place, it may 
be very much questioned whether teeth are worse in 
Wales than in the two other countries of Great 
Britain. As for Ireland, if common belief is to be 
upheld, the people of the Emerald Isle are blest with 
remarkably good teeth as a nation. What hard 
drinking water has to do with the resistancy or 
otherwise of teeth to the processes of decay is nut 
apparent. So far as modem dental science has 
solved the problem, the most important point in the 
care of the teeth is to have them well looked after 
not only in childhood but at all ages. The science 
of bacteriology has thrown its powerful light upon 
this as upon all, or nearly all, diseased processes in 
the human body. To clear out and fill a carious 
cavity is to remove from the mouth an infective 
centre of destruction and decay. In this matter an 
ounce of practice is worth a ton of theory. 

Lorgton—a Sanitary Scandal. 

Despite the great improvement that has taken 
place in the national health during the post genera¬ 
tion or two there nevertheless remain places that 
more or less merit the title of plague spots." 
Among the latter may be included Longton, that is 
to say, if we mayacceptthe startling charges brought 
forward some months ago by Dr. Allen, the Chair¬ 
man of the Longton School Board, against the 
Sanitary Committee of the town. In order to sub¬ 
stantiate bis position Dr. Allen has published a 
pamphlet, in which he cites the local Medical Officer 
of Health, Dr. Dawes, and Dr. Fletcher, of the Local 
Government Board, as bis authorities. He pointed 
out that Longton had almost consistently, from year 
to year, the highest death-rate of the towns in the 
Potteries, including Newcastle. With only three excep¬ 
tions it bad the highest infantile mortality each year 
for ten years of all the Potteries and Newcastle, and the 
highest of all towns in England and Wales on several 
occasions, and was always near the top of the list. 
Last year it was easily first, having the enormous 
rate of 327 deaths per 1,000 infants bom during the 
year, as against 172 per 1,000 for (he thirty-three 
largest towns. In 1899 Dr. Fletcher had reported 
upon the epidemic of diphtheria, but his recommen¬ 
dations bad not been carried out, especially as re- 


I garded the establishment of an isolation hospital. 
Under these circumstances it certainly seems that 
Dr. Allen has fulfilled a public duty in bis outspoken' 
criticism. It is to be hoped that the Local Govern¬ 
ment Board will take decisive steps with regard to- 
the health of Longton. 

How Diphtheria is Spread. 

Fbom time to time there are reported incidents 
which display the profound ignorance of many of 
the poorer classes with regard to the spread of in¬ 
fectious diseases. In the case of diphtheria it often 
happens in the heart of London, as elsewhere 
throughout the United Kingdom, that numbers of 
children visit the body of a playmate who has died 
of that terribly infectious disease. Again and again 
official investigation has shown that social gatherings 
in infected houses have been one of the active causes 
in fomenting an outbreak. Sometimes a prayer 
meeting is held in the house of the bereaved friends, 
but we are glad to learn that the custom is beingaban- 
doned among the minera of Dowlais, under the 
advice of Dr. Thomas, the Merthyr Medical Offi:erof 
Health. That gentleman states, however, that the 
practice of viewing the body of the infections dead is 
still very common. In some instances he had beard 
of the children of neighbours actually being allowed 
to kiss the dead body. Comment on such a state of 
affairs is needless. How are the poor to be educated 
on such matters, which are of vital importance to 
their own welfare P A general knowledge of the laws 
of health and of disease, with special attention to in¬ 
fection, should form part of the education of 
every school child. At any rate it cannot be too 
widely known that it is imwise to kiss anyone 
who is suffering with, or has lately recovered 
from, a sore throat of any kind whatever. 

Employer's Responsibility for a Siok 
Servant. 

A NOVEL question came up for trial at the Bir¬ 
mingham County Court a few days since, in which 
the employer's responsibility for his servant pre¬ 
sented itself in a fresh light. A lady having been 
invited to visit a friend brought her servant with 
her. The girl fell ill with typhoid fever, entailing a 
long and, no doubt, somewhat costly illness. When 
it came to settling matter the lady paid the doctor’s 
bill, but repudiated any liability for collateral ex¬ 
penses, including nursing, attendance, stimulants, 
&c. The case was settled by payment by the defend¬ 
ant of an agreed upon sum, so that the legal aspect 
of the question at issue was not adjudicated upon. 
Under ordinary circumstances one would expect one’s 
guest to defray all out-of-pocket expenses incurred 
under such circumstances. The risk of being 
saddled with considerable expense in the event 
of the visitor or his servant falling ill is cer¬ 
tainly not contemplated by householders who 
invite their friends to stay with them, to say nothing 
of the inconvenience and woiry associated with an un¬ 
toward event of this sorb. In any case it is well 
within the power of the host to terminate the visit 


424 Ths Midical Pavsti. 


NOTBb ON CURRENT TOPICS. 


Oct. 16, 1901. 


forthwith, and it follows that any expense, even for 
maintenance, after that date might conceirablj form 
the subject of an action at law. The guest, on the 
other hand, can hardlj expect to £nd himself in a 
better position if his servant falls ill in a friend's house 
than he would if a similar accident happened at home. 

If the servant is incapacitated from work at home 
the master would be entitled, we imagine, to send her 
away, to a hospital if ill, but if be kept her, willingly 
or otherwise, he would not have any claim against the 
servant for maintenance, indeed, he would in all pro* 
bability be constrained to accept liability for medical 
fees incurred on his servant's behalf. 

The Cape Medical Council. 

Accobdino to the Annual Report of the Cape 
Medical Council the dentists in Cape Colony are the 
most law-abiding and obedient class. It was brought 
to the notice of the Council that dentists and other 
registered persons were actually advertising in the 
newspapers. Thisntate of things, which isnotuuknown 
elsewhere, received the very careful consideration of 
the Council, and they came to the conclusion that 
they would call upon all persons who were behaving 
in this manner to immediately cease from their un¬ 
ethical conduct. To make the matter qiute clear the 
Coutcil passed a resolution declaring in set terms 
that advertising in a newspaper was improper and 
unprofessional conduct The report of the Council 
states that in consequence of passing this resolution 
the dentists and other registered persons have with¬ 
drawn the objectionable advertisements. So com¬ 
pletely did the resolution effect its purpose that 
formal proceedings were only necessary in one case, 
and in that one the administration of a caution was 
all that was requisite to secure the fulfilment of the 
Medical Amendment Act. 

Careless Death Certification. 

A WOMAN was sentenced last week at Glasgow to 
three months' imprisonment for having falsely re¬ 
ported the death of her child to the Registrar and 
making use of the medical certificate to obtain 
money from an insurance office. The judge 
sharply criticised the carelessness of the prac. 
titioner who gave the certificate on the mere I 
affiimiation of the mother, in apparent ignor- ^ 
ance of the fact that this is the usual practice. 
Obviously the practice is one to bo deprecated, but 
until the legislature renders it incumbent on the 
certifying practitioner to satisfy himself by personal 
iospection of the fact of dtath having taken place, 
and provides for his being suitably remunerated, this 
slipshod custom is likely to maintain. Although 
the number of such cases which come to light io com¬ 
paratively small the ease with which the fraud can 
be perpetrated and the improbability of detection 
auggest the probability that this particular form of 
fraud is much more common than the figures would 
lead one to suppose. When the question of reform¬ 
ing the present system of death certification comes 
before Parliament no doubt this lapsus will be 
remedied. 


The Differential Diagnosis of Small-poz and 
Chicken-pox. 

In a letter addressed to a contemporary Dr. G. S. 
Perkins calls attention to a simple means of distin¬ 
guishing chicken-pox from small-pox, which deserves 
to be more widely known. He points out that the 
vesicles in chicken-pox are unilocular, whilst in 
small-pox they are multiloculai*. The practical result 
of this pathological fact is, that if a chicken-pox 
vesicle be pricked with a needle its contents can be 
completely evacuated and the cell will collapse, 
whereas in small-pox if one makes twenty pricks with 
a needle the vesicle will not collapse, because, being 
mnltilocular, it is impossible to empty it. There 
are, of course, many other points of difference 
between the two; indeed, small-pox is only likely to 
be mistaken for the less serious malady when the 
practitioner is not alive tothe possibility of a mistake 
in the diagnosis. In small-pox, even in ita modified 
form, varioloid, the initial constitutional symptoms are 
early and well-marked, with a considerable rise of 
temperature and cerebral disturbauce. In small-pox 
the eruption is most abundant on the face and limbs, 
whereas In chicken-pox it is most abundant on the 
trunk, and its distribution is more discreet and 
general. Moreover, in cbicken-pox the eruption ap¬ 
pears in crops and not, as in small-pox, within a few 
hours of the first appearance of papules. Then, too, 
there is the characteristic fall of temperature on the 
appearance of the vesicles. An absolutely charac¬ 
teristic feature of chicken-pox is the appearence on 
the body of vesicles of different degrees of evolution, 
some being fully matured, while others have just 
made their appearance. In spite of these usually 
very distinctive features cases now and then occur in 
which even the most experienced may hesitate to 
formulate a definite opinion. In such cases twenty- 
four hours* observation will almost invariably clear 
up the mystery, and allow of a correct diagnosis. 

A Lethal Coin. 

A WORKING MAN at York met with his death last 
week as the result of inhaling a half sovereign. The 
history of the case, as revealed at the inquest, pre¬ 
sents several points of unusual interest. The man 
was admitted to the York County Hospital in a 
state of impending asphyxia. In view of the history, 
the house-surgeon performed tracheotomy, and for 
three long hours searched for the coin, but in vain. 
Ultimately the man died of acute bronchitis. Post¬ 
mortem, the coin was found in the stomach, where 
its piesenoe was explained on the assumption that 
the man had coughed it up and then swallowed it, 
death being due to the irritation set up by ite sojourn 
in the trachea, in oonjunotion with pre-existing 
bronchitis and emphysema. The fact of the 
house surgeon having operated instead of sending 
for his senior elicited some comment, but every one 
conversant with hospital usages is aware that no 
medical officer would be justified in delaying inter¬ 
vention in an nrgent case of this kind, especially 
I when the operation is a simple one, such as tra -heo- 


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NOTES ON CUfiHENT TOPICS. Tin Medical Pbssb. 425 


Per. 16, 1901. 
tomj. No doabt the discovery of the half-sovereign 
in the stomach caused a doubt in the minds of the 
jury as to the wisdom of an operation having for 
object its removal from the trachea, and, after all, it 
U jast possible that the respinitory embarrassment 
was caused by impaction of the coin in the 
OBSophagoB. On the other hand, it hardly seems 
probable that so small a coin would become arrested 
in the gullet. On the whole, the case was evidently 
one presenting considerable difficulty and calling for 
instant treatment, and the house surgeon is to be 
complimented on his courage and presence of mind. 

The Small-pox Bpidemio. 

Thk number of cases of small-pox under treatment 
in the hospitals of the Metropolitan Asylnms Board 
has risen to 185, in spite of the constant discharge of 
valescents. This is, of course, to some extent, a 
satisfactory indication that the epidemic is not 
mahing very rapid headway. Some local excite¬ 
ment has been created in the district of St. 
Fancras by an excess of zeal on the part of the 
assistant public vaccinator, Dr. Purdie, who, it 
appears, vaccinated two children without having 
taken the precaution to demand the parents’ consent. 
The magistrate refused to grant a summons for 
assault, but the guardians took a very serious view 
of the matter, and meted out to the too zealous 
officer a severe censure. Obviously, in a matter 
of this kind it is advisable to conform rigidly 
to the letter of the law, especially in dealing 
with the poor and uneducated classes. Where 
the reason is weak the prejudice is strong! The 
Press in general has criticised the pusillanimous 
action of the liondon School Board with the rigour 
it richly deserved. It is certainly both disconcert¬ 
ing and disappointing to witness such a lamentable 
want of moral courage on the part of a body of this 
kind, composed presumably of intelligent and 
earnest men. We will make bold to say that indi¬ 
vidually the great majority of the members of the 
Board believe in, and avail themselves of, the pro¬ 
tection afforded by vaccination, yet they shrink from 
the idea of appearing to approve of a practice which 
they know or fear to be unpopular with a noisy but 
active minority of their constituents. "Thus con¬ 
science doth make cowards of us all! ’’ The fault 
really lies with the Government, who lack the 
courage to act op to their own convictions by plac¬ 
ing the carrying out of the Yaccination Act in the 
hands of a separate and independent authority. 

New-Laid Bggs. 

It seems not a little curious that no plan has been 
devised long ere this to prevent eggs from decay. 
The process is a perfectly simple one of putrefaction, 
due to the ubiquitous microbe, which gains ready 
access through the porous shell. What follows is 
only too familiar to all of us from painful experience. 
To prevent this peculiarly offensive putrefaction 
various plans have been tried from time to time, but 
nothing has hitherto answered the purpose sufficiently 
well to come into general favour. The main effort 


has been usually in the direction of making the shell 
impervious to air and microbes, but it is quite 
likely that the interior of the egg contains 
micro-organisms before it is launched into the 
outside world. A more scientific procedure would 
clearly be to sterilise the whole egg in some way or 
other. That is sud to have been done successfully by 
a Mr. Ellis, a chemist, of Stratford, New Zealand* 
Heat is clearly out of the question, on account of its 
coagulating or cooking the egg albumen, but he has 
perfected a cold sterilising process whereby eggs can 
be kept fresh in any climate and in any ordinary 
temperature from nine months to three years. If 
that be the case the egg trade, which has attained 
enormous dimensions in the United Kingdom, is 
likely to be revolutionised. It is quite common, at 
the present time, to find one or two bad eggs in 
every dozen bought at a shop, even when purchased, 
at a fair price of a respectable dealer. By the way, 
an ingenious apparatus has lately been patented for 
testing eggs by exposing them rapidly to the light 
in a revolving frame. ——~ 

Wet Nurses. 

Thb fashionable ladies in Paris are labouring 
-xmder considerable difficulty in procuring wet nurses 
for their infants in consequence of a decree issued 
by the Chief of the Paris Police rendering it inctim- 
.bent on wet nurses to give their own infants p re- 
I cedence in the matter of nourishment. Under certain 
circumstances the Prefect of Police grants permission 
for the child of a wet nurse to be partly bottle-fed, 
but this relaxation of the rules is allowed to such a 
limited extent that the practical effect of the new 
regulation regarding wet nurses in Paris is to secure 
the bringing up of the infants of wet nurses almost 
wholly by the breast. The pleasure-loving ladies of 
the leisured classes are face to face with a serious 
difficulty in consequence of the great scarcity of wet 
nurses, for they must either consent to their babies 
being brought up on the bottle, or else they must 
abandon their fashionable engagements and suckle 
their own offspring. Those who are acquainted with 
the ways of Parisian dames contend that the Prefect 
of Police will in the end find his order overruled. 

Fatal Amateur Preecribrng. 

The readiness with which some people swallow 
nostrums prepared or recommended by fellow- 
ignorami is astounding. The prescription is some¬ 
times merely filthy, sometimes inert, but sometimes, 
unfortunately, it errs on the side of inconvenient and 
even dangerous activity. At an inquest recently held 
at Manchester, a labourer, who complmned of pain in 
his back, died soon after drinking a solution of pearl- 
ash supplied by a neighbouring bleacher who dabbled 
in medicine. This amateur physician, it appeared, 
had collected a bookful of recipes and treatments 
which he doled out to inquiring friends. The inquest 
was adjourned for further evidence of the exact 
nature of the poison, and it seems not unlikely that 
this unauthorised practitioner may find, to his cost, 
that the practioe of medicine has its responsibilities 
as well as its privileges. 

Dldiii/en 11'.' 



426 Thu Msdical Pbxss. 


CORRESPONDENCE. 


Gutter Journalism. 

It is Barprising to what lengths the editors of certain 
cheap dailieB will go in the endeavoar to conciliate 
the goodwill of the gutter population—for their 
utterances cannot possibly be addressed to persons 
of any refinement or intelligence. In last Monday’s 
issue of The Morning Leader, to which a correspondent 
directs our attention, the editor asks, anent the St. 
Pancras unauthorised vaccination case, whether 
medical practitioners are " to be let loose in private 
houses to try all their unclean experiments upon 
ohildren in the absence of those children's natural 
protectors,” and, later, whether the pi'aotitioners 
nforesaid “may make defenceless youngsters the 
victims of their fads.” We cannot legislate for good 
sense any more than good manners, and if this half* 
penny publication following Dogberry elects to write 
itself up an ass, it is not a matter which concerns us. 
At the same time, it is difficult to see what useful 
purpose can be served by this irresponsible coarse¬ 
ness. 

The Notification of Chicken-pox. 

A CIBCULAB letter has been sent to the medical 
practitioners in the borough of Holbom intimating 
that on and after the 16th inst., the provisions of 
the Public Health (London) Act with regard to the 
notification of infectious diseases, and for a period 
of six months thereafter, will apply to chicken-pox. 
This is a yery timely departure in view of the diffi¬ 
culty which exists in distinguishing between cases 
•of varioloid and chicken-pox, a circumstance which 
is in large meaenre responsible for the extension of 
ihe present outbreak in the metropolis. 

The medical session of St. Yincent's Hospital, 
Dublin, was opened on October 8th, by an inaugural 
address by Dr. Micbael Cox, P.R.C.P.I., Yisiting 
Physician to the hospital. Dr. Cox's address dealt 
mainly with the present condition of the Poor-law 
nursing system in Ireland. 

jDa. William Catlxt has resigned the appointment 
of senior physician to Middlesex Hospital, which he has 
held for many years. 

Da. D. J. 6. Watkins has been elected honorary 
surgeon to the Lincoln County Hospital, consequent on 
‘the retirement of Mr. W. Y. Cant, who baa been made 
'Ooninlting surgeon to the institution. 

Thb officials of the borough of Thornaby-on-Tees last 
week commemorated the completion of Dr. Tbos. 
Watson’s twenty-one years of service as Medical Officer 
• of Health of the town by presenting him with a silver 
salver, suitably inscribed. 

(EfirrfBpoitbtna. 

{.We do Bot hold oorselTestespoBBible for th« opinions of onr 
■ correspondents.] 

“LACHNANTHES TINCTOEIA.” 

' To the Sditor of Thk Mbdical Pbsss and Cibcdlab. 

8ib,—” Ubique ” has thcught fit to tieat my letter to 
yon with rldi(^e, and as he shelters himself under a 
nom de pititne, I need not reply to his absurd criticisms 


Oct. 16, 1901. 

My only object in writing was to aid, if possible. Colonel 
Tienoh's generous offer of A1,000—made in gratitnde 
for the recovery of his wife—towards obtaining an 
“ official test ” of the treatment in question. I can give 
the addresses of the oases I mentioned, it reqnir^. 

As regards Morton—to whom *' Damocles " (again a 
nom de plume) refers—I can state he was a diwharged 
secretary, not “ aeeiitant,*' of Dr. Alabone’s. Had 
“ Damocles ” followed the case up he would have seen 
that in Morton’s bankmptoy examination he, on oath, 
contradicted all the statements he had previously made i 
Like *' Damocles,” I am surpriaed the Public Prosecutor 
did not take the case np. 

I am, Sir, yours truly, 

Hbnbt J. Buck. 

Clapton Common, N.E, October 7th. 

P.S.—I must deblioe farther correspondence. The 
question after all is, “ Is the treatment in question 
effectual in restoring phthisical patients to perfect 
health P ” I contend that it is so in a remarkable per¬ 
centage, and shall continue to adopt it. 

[The medical staff at the Brompton Hospital for 
Consumption are empowered to give a thorough trial to 
any treatment advanced as a remedy for pnlmonary 
tuberculosis. The managers even offer to allow the 
discoverer to follow up the effects of the treatment in 
the wards. Here, then, is a ready-made opportunity to 
obtain a complete and impartial investigation of the— 
it appears to us—extravagant claims made for this 
particular treatment.—E d.] 

THE CONGEES3 ON TUBBECULOSIS. 

To the Sditor of Thb Medical Pbbss and Cibculab. 

Sib,— If Colonel Le Poer Trench had read the whole 
of the correspondence on the above subject which has 
appeared in Thb Mbdical Pbbss and Cibcdlab he 
might hot perhaps have fallen into the error of beHev- 
ing that my letter in your issue of the 16th alt. was 
written ” for the pnrpose of bring^g contempt npon a 
proposal he has put forward in the interest of sufferers 
from consumption.” For me to have done this would 
have been a work of absolute supererogation. The 
“ Iscbnanthes treatment” for which Colonel Le Poer 
Trench asks the attention of the scientific medical 
world has all along been, is now. and is certain in 
the future to remain an object of contempt to that 
world without the help of any words of mine. It has 
been treated either by sdence or with contempt in the 
editorial columns not only of Thb Mbdical Pbbss and 
Cibcdlab, bnt of all the other leading medical journals, 
and hts neither now nor at any previous time received 
the smallest serious attention from the profession or 
from professional organa of foreign conutries, where, as 
also in these islands, thonsands of practitioners are 
ready eagerly to examine and try any remedy giving 
the smallest promise of utility in the cure of pulmonary 
tuberculosis. 

The laohnauthes treatment has been regarded with 
contempt for the same reason that So and so’s pills and 
ointment had been so regarded, namely, that its claims 
do not rest on scientific observation and experiment, but 
are solely supported by the testimony of *' gratefol 
patients ’’ and philanthropic lookers-on of the intellectnal 
calibre of Colonel Le Poer Trench. The treatment is 
further regarded with contempt because although—as I 
have said—our knowledge of the physiology.snd patho¬ 
logy of the lungs may not be complete, we have 
yet more than enough of solid scientific facts ti 
enable us to perceive that it would be some¬ 
thing like a miracle if advanced tubercnlosis 
of the lungs were curable by internal administration of 
lachnanthes combined with inhalation of any form of 
vapour deriv^ from that herb. Medical men of the 
world do not believe in miracles of that kind, especially 
when only wrought for gain upon patients attracted by 
advertisement. No, sir, my letters were not composed 
with ^e object of bringing contempt npon Colonel Le 
Poar Trench’s proposal—if it has not bad contempt 



Oct. 16, 1901. 


MEDICAL NEWS. 


Thv Mcdical Pbbss. 427 


showered upon it by me or others it is only beoaose it 
has been largely lookvd npon as beneath contempt—but 
to 01 ^ attention to his attitude, among a rast nnmber 
of the pnblio, towards onr profession as a body. It was 
I who, in yonr issne of August 28th, dealt with his 
letter of August 20th in TXe T<nwt. In that letter 
he seriously expressed the belief that owing to 
prejudice or professional etiquette, or trades union 
mlee fram^ by the General Medical Council and 
obeerr^ by the whole profession, a great discorery had 
been kept from the public since “ the suspension of Dr. 
Alabone fifteen years ago, with the result that many 
'thousands pronounced hopeless and incurable under the 
recognised treatments bad been left to die." Colonel 
Trench’s argument amounted to this, that Dr. Alabone 
was unjustly expelled from the profession for infamons 
conduct, whilst in truth the whole profession had been 
engaged in a conspiracy most infsmoos and murdt^rous 
in withholding from their dying patients a remedy likely 
to save them and restore them to health. The profes* 
aion was either too ignorant and stupid to be able 
to recognise a great discovery of inestimable value to 
suffering humanity, or too brutally selfish to avail them* 
selvas of it. This was a monstrous charge, and that it 
should be deliberately formulated by a man in Colonel 
Le Poor Trench’s position was the fact which seemed to 
me to deserve prominence as indicating the estimation 
in which the profession is held by great masses even 
among the so-c^ed educated upper clasoofl of society. 

I am, Sir, yours truly, 

October 10th, 1901. Ubiquu. 


^ctos. 

Da. Dubhax, of the Liverpool School of Tropical 
Medicine. left on the llth inst. on a scientific mission to 
Christmas Island, to investigate an outbreak of beri-beri 
sunong the coolies. Mr. B. Manson, son of Dr. P. Man* 
eon, chief medical officer of the Colonial Office, is expected 
to follow Dr. Durham in about two months. A s'ay will 
be made on Christmas Island, and the mission will then 
proceed to visit some of the Polynesian Islands to make 
pathological investigations. It is expected that these 
inquiries will extend over a year or eighteen months. 

Explosion In a Laboratory. 

A SERIOUS accident has occurred at the Cambridge 
Chemical Laboratory to Mr. W. T. N. Spivey, M.A., of 
Trinity College, Demonstrator to the Jacksonian Pro¬ 
fessor of Natural Experimental Philosophy. Mr. Spivey 
was doing some research work, and from the nature of 
his injuries it seems that he was shaking the contents 
of a flask when it exploded. Wo was severely burnt 
under his arm tmd on his chest and back, and his arm 
was severely out with the broken pieces of glass. The 
flask in which the experiment was being m^e was un¬ 
corked at the time, and the cause of the explosion is 
inexplicable. 

Shorthand for Kedioal Students and Practitioners. 

Axomo the students who have just commenced their 
medical studies there ate probably some wbo are 
acqxtainted with shorthand, having learnt it at school. 
The attention of such students is specially invited to the 
Society of Medical Phonographers. The object of this 
Society is to increase the practical service of shorthand 
to its members hy publishing a monthly periodical and 
other shorthand medical works. Also, any medical 
practitioners who use shorthand and have not yet joined 
the Society are cordially invited to do so. No skill in 
shorthand is necessary for membership. The annual 
subscription for students is 5s .; for practitioners, Ts. fid. 
A detailed prospectus of the Hoolety will be sent on 
application to the hon. sec.. Dr. Fletcher Beach, 79, 
Wimpole Street, W. 

The Local Oovernmeut Board Bsport (1900). 

Amono other items of interest, the Anwnftl Report 
of the Local Government Board gives some startjing 
figures bearing on the working of the Vaccination Act 
of 1898, nnder whi^ oompnlsion was abolished on con¬ 
ation of a statutory declaration of " conscientions objec¬ 
tion." Twelve years ago the retnru showed that of 


903,818 children bom 754,059 were snccessfoUy vac¬ 
cinated. We now leam that of 923,059 children ^m in 
1698 only 682,787 have been vaccinated. People do not 
even take the trouble to make the “ oonsoientions" 
declarations; being alive, it may be, to the farcical 
character of a proo^nre which providjsd for the inflic¬ 
tion of a fine, not for non-compllMoe with the law, but 
for failure to make a representation to petty sessions as 
to the condition of his “ oonsoience." In I^ndon littie 
more than kalf the children bora in 1898 were vaodnated, 
and in particular unions, snoh as Shoreditch, Mile End, 
Bethnal Green, and Poplar, the proportion of vac¬ 
cinated children was quiie insignificant. So, too, in 
certain parts of the provinces. In Bedfordshire there 
were 4,201 births, hot on)y 828 vaccinations. In Leices¬ 
tershire there were 12,878 births, but only 1,228 vaccina¬ 
tions. On the other hand, in many rural districts, and. 
even in a few large towns like Liverpool, Birkenhead, 
Kidderminster, and Portsmouth, the local authorities 
manage to get nearly ^ the children vacmnat^ with¬ 
out much difficulty. But the outlook generally is dis- 
quieting, especially in London, having repeatedly been 
a prey to ai^l-pox in the past, seems to ^ now receiv¬ 
ing unvaodnated additions to its population at the rate 
of over 40,000 a year. If this goes on there will soon 
be a tolerably wide field for the epidemic which has for 
for some time been threateniog. 

Medical Sickness and Accident Society. 

The nsnal monthly meeting of the Executive Com¬ 
mittee of the Medical Sickness Annuity and Life Asanr- 
ance Society was held at 429, Strand, London, W.Q., on 
27th alt. There were present—Dr. de Havilland Ha.I1 
(in the chair). Dr. 0. E. Herman, Dr. J. B. BaU, Dr. 
WsJter Smith, Mr. H. P. Symonde, Dr. M. Greenwood, 
Mr. J. Brindley James, Dr. St. Clair B. Shadwell, Mr. F. 
S. Edwards, Dr. F. J. Allan, Dr. J. W. Hunt, Dr. Alfred 
8 . Gubb, and Dr. Frederick 8. PsJmer. The aooonnte 
presented showed that the claims experience of the 
summer months had been light, as, although the uumber 
of claims received had been about the same as usual, few 
oases bed beeu of a severe nature and of long duration. 
A considerable addition has therefore been made to the 
funds, which now amonnt to over ^150,000. Of this 
a snbstantial amount is required to sec’ire the liberal 
provision made by the society to those of its members 
who become permanently incapacitated. The amount 
allowed is nsoally one imndred gnineas a year, and 
nearly twenty members will probably draw this annuity 
until they reach sixty-five, or till death befors that age. 
Prospeotases and all particolara on application to Mr. F. 
Addiscott, Secretary, Medical Sickness and Accident 
Society, 33, Chancery Lane, London, W.C. 

Society for Belief of Widows and Orphans of Medical 
Men. 

A Quabteblt Court of the Directors was held on 
Wednesday, October 9tb, Mr. Christopher Heath, Presi 
dent, being in the Chair. Two new members were 
elected, and the death of a member reported. There 
were no fresh applications for g^rants. The death of a 
widow was announced, who had been in receipt of 
grants since 1882, and had received ^1.084 10s. from 
the society, her husband having paid ^28 as subsorip- 
tions. Applications for renewal of grants were read 
from fifty-one widows, tbirteen orphans, and five recipi¬ 
ents from Copeland Fond, and it was was resolved tlmt 
£1,188 be distribnted among them at the next Court. It 
was determined to make a Christinas present to the 
widows and orphans on the fund, the amount £589 to be 
divided among them, thus disposing of the surplus 
income. The expenses of the quarter were £88. 

Society of Apothecaries of London. 

The following candidates have passed the Primary 
Examination, Part I.;—Biology: J. C. Fletcher. 
Chemistry: H. W. Phillips. Materia Medica and 
Pharmacy: G. C, M. Davies, A. B. Gosseu G. H. Henry. 
P.8. Hopkins. 

Primary Examination, Part II.—Anatomy and Phy¬ 
siology : R. S. Dollard, G. H. Henry, A. C. Jenkins. J. D. 
Staley. Physiology only: H. Bennett, P. J. Martin, 
J. 0. Sergeant, D. A. Stepney, B. J. S. Yerity. 




It 



4 28 ThV MlDtCAL PBSSfl. 


NOnCBS TO COBEBSPONDByTS. 


Oct. 16, 1901 


^totices to 

CorrwuottbnttjB, S»kort IDttera, 

CousiPOVDsnt reqnirinf a nplj is thia eolsms an par. 
tianlarlx raqsaatad to aiaka oaa ol a diiNnetim tiptiatura or 
iaittato, aad aroid the praotiea ot aifsloff thoBualTOo " Baadar,'* 
'‘Saboarfbar,” "Old Bobaorlbar/’ te. Msoh oOBfodon will bo 
aparad by attaotios to tbia mla, 

Osionrai. AsncLsa or Lsmas istesded for pnblioation aboold 
be written on one alda of tbe paper only, and mnatbe anthantieated 
with the name and addiaaa of the writer, not naoaaaari^ for pnbUea- 
tion, but aa eridenoe of IdantitT. 


SOME XEDICAL APH0EISH4. 

1. Lira la abort, patianto are faatldioiia, and iha brethren 
daoei^re. 

8. Piaettoa la a fold ot which taot la the manure. 

5. Patianta are oompanble to flannal—neither can be qoittad 
without danyer. 

4. The pl»aician who aboenta hlmaelf rnna the same riak aa the 
lorar who mrea bia ml at re ae ; he ia pretty aura to find himaelf 
anpplanted. 

a. Would you rid yonreelf of a tiraaome patient, preaant your 
biU. 

6. The patient who paya hla attendant ia butencling: he who 
doea not is a deapot. 

7. The physician who depends upon tbe giatitade of his patient 
for his fee is like tbe ^Teller wbc waited upon tbe bank of a river 
until it would flniih flowinir that ha might cross to tbe other aide. 

8. Bamambar always to appear to do aomething'-aboTe all when 
yon are doing nothing. 

9. With eanal, and even inferior, talent, the cleanly and gra* 
teeUy-dreosM physician has a great UTuntago over tbe untidy one. 
—DieUtie and Hwienie Oaittte. 

Da, J. W, MaariK.—Tour letter la unaroidably crowded out. 

Qunuva.—The Wolfe-Krause method of akin grafting consist* in 
taking plecea of the entire thieknees of the akin and transplanting 
them to ^a part to be grafted. 

A coaanspovDBKT calls our attention to the fact that the man 
Cubbin, (Uitu Robert WUwn, who.in thepoUoo reports, is deacribed 
as a medical practitioner, has no sort of rlaht to that bonuurable 
tit's beyond the fart that be was dnad at Oarstang in 1900, at the 
instance of the Medical Defence Union, fur falsely reprcaentlng 
hlmaelf to be a registered medical praotitioncr. 

Dr. F. C. FiraoERALD (Newtownbutler).—Wo regret that wa are 
unable to accede to your request 

CLBMsirr H. Sebb.—T our letter will appear in our next. 

Mr. LiTXBiDOE.—Tbe mortality from typhoid fever in this 
country ia about 15 per cent. 


JflMtinga of the §0ci£tica. 

WBDREBnsT, Ocr. Idrn. 

Cbittral Lordoh Thbost, Nose, smd Eae Hobfitsl (Gray's 
Inn Bead, W.C.).—8 p.m. Introdm toiy LecinreMr. L. Browue: 
The Belationship to General Mediome of the Special Oiaeasee 
treated at the Hospital, also to other Diseases oonstitutiug separate 
Speoialiime. 

Tborsdat, Ocr. ITtb. 

Harveisk Societt or Lohdos (Stafford Booms, Titebborne 
Street, Edgware Boad, W.).—B.SOp.m. PaperMr. C. Wllllame: 
Hsenaturia in Childhood. 

Opbtualicoiooicai. Societt of the United Kinodoh.- 8 p.m. 
CasesMr. B. Marene Gunn: Persistent Double b eratitis, mainly 
suMficial, without Teudency to Ulceration. Hr, 8. Stvpbenson: 
A Case of Congeuital Dietichissis. Mr. E. T. CoUios: A Case in 
which Mooren's Bodent Ulcer had bia yean previously involved 
the Whole Snrfsce of bach Cornea. Mr. N. B. Harman ; Choroid 
Angio-Sclerosia, and Paralysis of Thir-1 Nerve with Unusual 
bymptoms Presidential Addresa: - Some Clinical Experieuces of 
PrlnuiT Chronic Qlancoma aad the Value of Iridectomy, Papers: 
—Mr B, J. Taylor: Notes of a Case of Bodent Ulcer ot the 
Cornea in a Child. Mr. E. Nettleship: Chronic Serpiginous Ulcer 
of Cornea (Mooren’s Ulcer). 

Fridat, Oct. IStb. 

Societt for the Studt of Disease in Cbildrbh.—5.30 p.m. 
Cases:—Dr. Garrod (introduced): A Cass of Bpastlo Faraptegia 
with Atsay and Betinltis Pig'aentoea: Urine from Cases of Alkap¬ 
tonuria. Mr. H. S. Collier (introduced): A Case of Neoroais of tbe 
Frontal Bone; A Caae of Laryngeal Stenosis. Dr. D. B. Lees: A 
Case of Bheumatic Heart, Becoverr from Brachial Thrombosla; 
A Case of Arsenical NeuritU caused W Liquor Arsenioalls ; A Cm 
with Large Nodulee, Beoovery. Dr. Hntohlson: A Case of Double 
Facial Paralyeis from Middle Eir Disease} Cases showing Con- 
geni^ Abnormalities. Paper:—Dr. Chaffey: A Case of Diff ose 
Lympboms, terminating in Pernicious Aniemia, in an Infant. 
SpecimensDr. Theodore Fisher: Covsenital Mitral Stenosis 
from a ebild, aged fifteen months; Oongenital Aortic Stenosia horn 
a child aged four months. 

Monday, Oct. 2Sth, 

OnoNTOnooicAi. Soctttt or Great Beitain.—8 p.m. Tbe Pre- 
eident will deliver hie Inaugural Addresa. Communications will be 
given by Mr. F. C. WalUe on “Misplaced, Unerupted Wisdom 
Teeth treated by External Operation.” Mr. J, O. Turner on “ The 
Teeth of Cretins and MicrocMhalics.” The President and Mr, 
Lewln Payne: “ Notee on the Dentition of Sphenodon.” 


.ILppffnrtments, 

Bonnet, W. F. Victor, M.D.. M.SXond.. F.B.C.8.Eng., PhyHoian 
to Out-Patients, Chelsea Hospital for Women. 

Btford. W. F., M.B.C.8.Eng„ t.B.C.P.Lond., Medical Offloer of 
Health of the Borough of Bntbln. 

Cotrrrs. F. J. H.. M.D.Viet, D.P.H., Medical Ofleer of Health of 
the Borough of BlaekpooL 

Dobbs, K. D. B., L.R.C.F., L.B.C.S.IreI., Medical Offieer of Health 
ot Tntbury. 

OEirriTHB. A. F., M.D.Harvard, Glluical Asaistaat, Chelsea Hoe- 
pitat for Women. 

Lebnanv. J. E.. M.B.Toronto, L.B.C.P., M.B.C.8., AsaiEhuit 
Surgeon to the German Honital. London. 

Maeskali,, Lboh-Bicbicond, Xi.S.A.Lond., Medical Offloer 
Public Vaccinator to the Mary TAvy District of the Tavistoek 
Union. 

McCaudel, E. j., M.D.. Ch.H.. K.B.C.8.Biig., Clinical AseUtant, 
Cbelaea Hospital for Women. 

SHiaaBV, Janes, F.B.C.8.EDg., Surgical Begiatrar to tbe London 
Hospital. 

Von Hueal^ Willt, 9f.D.ZuTteh, Clinical AmUtant, Chelsea 
Hospital for Woman. 

WAnniNOTOB, W. Hbtwood, M.B.Viet., L.8.A., Medical Offloesof 
Health for Scarborough. 

Wnitbbocbb, W. H., M.D.Durh., D.P.H., Honorary Medical 
Officer to tbe Birmingham Lying.in Charity. 

WiLLUNS, Lbonabd, M.D.GIssg , Asaistaat Physician to the 
German Hoapital, London. 


lacancuB. 

Belfast, Boyal Victoria HospitaL-Medieal Superintendent. Salary 
oommeacing at £300 per annum, with board and resldeoce. 
Applicatione to the Hon. See. (Sm Advt.) 

Birmingham General Dispensary.- Beeident Surgeon, unmarried. 
Sslan AlSOperannnm, with rooms.fire, lights andattendauoe. 

Bristol General Hoepital —Assiatant House Surteon. Salary £70 
per aunnm, with board, reeidSDoe, Ac. Applications to the 
Secretary. 

Chelsea Hoapital for Women, Fulham Bead, 8.W.—Begistnr. 
HonorarTuro, 80 guineas p*r annum. 

City Asylum, Birmingham.—Junior AsHstant Medical Officer, nn- 
msrried. Salary £150 a year, with hoard, epaiteent^ and 
washing. 

Cornwall County Asylum, Bodmin.—Junior Assiatant Medical 
Officer, anmarried. Salary £180. rising to £150, with board, 
apartments, laundry, Ac. 

Denblghahire Infirmary, Denbigh.—House Surgeon. Fr ef arence 
given to one having a knowledge of the Welsh language. 
SoloiyAlOOto commence, with board, residence, and washing. 
Applioatiuos to the Secretary. 

Essex County Asylum, Brentwood — Junior Assistant Medical 
Officer. Salary £140 per sunum. Apply to the Medical 
Snperintendeot. 

HospihU for Women, Soho Square. W.—Assistant Phyaicisn. 

Ingham Inflrmsrv.-Senior u<inse Surgeon wanted. Salary £100 
pw annum, with residence, board, andwasblug. Applications 
to the Secretary, 74, King Street, Sooth Shields. 

Manchester Monssll Fever Uoamtol.—First Medical Offloer. 

Salary £150 per annum, with board and lodging. 

Middleeet Hospital, W.—Honorary Physician. 

Morpeth Dispensary.-House Surgeon, unmarried. Salary £180 
per annum, with rooms, oools, gas, and attendance. 

Plymouth Borough Asylum.— Assistant Medical Officer, unmarried. 
Salary £150 per annuni, rising to £200, with apartments, board, 
and washing, 

Boyal National Hoe^tal for Cousumption and Diseases of the Chest. 
Ventnor.—Beeident Medical Officer, unmarried. Salary £150 
per annum, with board and lodging- 

West Riding Arylum, Wakeflelo.-Locum Tansna for three 
months from Nov. lot next. Salary £3 3s. a week, with apart¬ 
ments and board. 

York County Hospital.—House Surgeon. Sslary £100 per annum, 
vrith board, residence, and washing 


fikihs, 

FooLDS.— On Oct. 8th at Asblea, Droitwich, tbe wife of Francis H. 
Foulds, M.B.O.8., L.HC.P.Loud., of a daughter. 


(kxirEB-FsBOUSsoN.-On Oct. 10th, at the Presovterian Church, 
Cardiff, by the Bev, Alexander MscmiUau, W. Herbert Cooper, 
MB.C.S.Eng., L.B.C P.Lond., of Staveley, Weetmoreland, eon 
of Asttev Cooper. Dep. liiepr..GeD. B.N., ot Exmontb, Devon, 
to Mabel Kate, second daughter of John Feigusson of Cardiff. 

JONiB— Watts.— On Oct. 10th, at St, Mary Abbot's, Kensington, 
by tbe Vicar, tbe Bev. Canon Peunefathe'', Walter Paul Joneo. 
M.D.. of 1, Walton Place, Hans Boad, 8.W., eeoond eon of 
Willem Harry Jones, of Casteloau Uouee, Barnes, to Georglana 
Pranoae. elder daughter of George Nelson Watts, ot “ Wood- 
cote,” Ciutelnan, Barnes. 


DicxiNSOH.—On Oct lOtb, at 8, Grove Pork, Liverpool, In his SOth 
year, Edward Hmnimtn Dickinson. M.D., F.B.C.P. • -4 

Thohbon. - On Got. 9th, at Beechhurst, Camberley, Snrrey, Bur- 
geon-Major-OsneiiU William Arthur Thomson, Hoooruy 
Physieian to the King, aged 71. 

jogie 


Dkiim '■ 


tm aai Cirnilat 



VoL. CXXIII. 


WEDNESDAY, OCTOBER 23, 1901. 


No. 17. 


CDnginal <2r0mtmnucdti0nB. 


HEMATURIA IN CHILDHOOD, (a) 

By CAMPBELL WILLIAMS, F.B.C.S. 

Mb. Fbbbibbnt and Obntdbmbn,— The rabjeot of my 
paper this eveaing u one with which moat medical men 
are from time to time brought in contact. Frequently 
the anxious parents expect a decided opinion on, so to 
speak, the spur of the moment, not only as to its etiology 
and source, but also as to the prognosis. In many oases, 
owing to obvious corroborative signs, or assisted by the 
incontestable presence of disease with which hematuria 
is apt to be associated, it may be possible to answer their 
queries off-hand, not only as to the cause, but also, judg¬ 
ing from the appearance of the urine, as to the source of 
the blood. In certain instances, even with constant ob¬ 
servation, and after the kindly assistance of the sound, 
microscope, skiagraph, and cystosoope, if it can be iotro- 
duced, there may m considerable difficulty in making 
op one’s mind, if not as to the source of the hsmorrhage, 
at least as to the cause thereof. One is sometimes able 
to diagnose, by watching the patient pass water into a 
glass beaker, as to whether the blood proceeds from the 
urethra, the bladder, or kidneys. Again, the character 
of the blood or dots in the voided urine may give a 
fair^ accurate clue as to the site of origin. But this is 
not always so. The classical naked eye appearance of 
urine impregnated with blood from the kidneys is de¬ 
scribed as varying from a smoky tint up to the colour 
of dark porter. Whenever one meets urine of this nature 
there can be no doubt as to its renal origin. But it must 
be remembered that when there is copious renal hsmor. 
rha^, which is not in the cat^^ry of congestive relief, 
for instance, as in tuberculosis or with sarcomatous im- 
plicatioD, that the macroscopic picture of the extruded 
kidney blood may closely simulate the appearance usual 
to a vesical or even an urethral source. Hsematuria 
may depend either upon purely local causes, or it may 
form but one symptom of some general systemic disorder. 
It is seen in the department of the physician as an 
attribute of many of tiie complaints of infancy or child¬ 
hood. Thus, it is met in conjunction with rickets, infan¬ 
tile scurvy, and hnmophilia. Or the htemorrhage may 
be associated with anemia, with or without tuberculosis, 
purpura, Raynaud's disease. Again it occurs in con- 
nection with renal infarction, pneumonia, acute nephritis 
typhus, variola, malaria, diphtheria, and scarlet fever. 
It is sometimes due to the presence of the bilharzia 
hematobia, either in ^e pelvis of the kidney or in the 
vesical veins. Another parasitic cause is the filaria san¬ 
guinis hominis,or it may result from the intravesical pre¬ 
sence of migratory intmtinal worms. The administration 
of such drugs as chlorate of pota9h,canthAride8, or turpen¬ 
tine may be the provocative cause. It is alw stati^ to 
have been sequent to the admioistration of piperasine and 
urotropine. I have seen a case where the appearance of 
hematuria was ascribed as secondary to heavy doses of j 
boracic acid. I have purposely excluded reference to I 


paroxysmal h8Bminglobinuria,Winkle*s disease, and other 
blood dysorasie, for the obvious reason that they are 
not corpuscular, but rather of a pigmentary nature, and 
should be regarded as hematinnric. 

The domain of surgery is also prolific in osuses, and it 
is to the consideration of these to which this paper is in¬ 
tended. If at times I trench upon ^e medical aspect 
of the subject I must claim as my excuse that it is abso¬ 
lutely imperative for the surgeon to review oases of 
hematuria, not only from his special standpoint, but 
also from that of the physician. Hematuria may result 
from traumatism of any portion of the urinary tract, or 
it may be due to the presence of a renal, uret^, vesical, 
or urethral calculus. It is likewise a symptom of 
tubercle or sarcoma of the kidney or blad^r. Rarely 
the blood may be extruded from a v^ons vesical growth, 
mucous polyp, or from an urethral caruncle. It is some¬ 
times an acoompaniment of oxalnria, or it is oon- 
sequent upon the excretion of highly acid urine. 
Cystitis is also a factor in its production. Its presence 
hM been ascribed to phimosis, in that the effort of the 
contracting viscus to overcome obstruction induces an 
hypersemio condition of the vesical mucous membrane. 
Personally, 1 have never met with it dependent on 
phimosis alone. Mention must also be made of foreign 
bodies that have been introduced within the blad^ 
from without. Occasionally one meets with oases in 
which the chOd, though suffering from a moderate 
amount of bsmatnria, displays nothing definitely wrong 
with the general health, or otherwise to account for the 
phenomenon. In the few cases that I have seen of this 
nature the bleeding has undoubtedly been of vesical 
origin. This can be gauged by the glass test. The 
first portion of the urine passed is, to the naked eye, 
quite clear; but as the bladder empties itself, and con¬ 
sequently the muscular contraction becomes more pro¬ 
nounced, the appearance of blood is noted and can be 
seen to increase in quantity with the Jinalt of the act of 
micturition, being as it were extruded from the mucous 
membrane just as water is sqneesed from a sponge. 

Traumatism .—In cases of bsmatnria of traumatic 
origin there are usually the external signs of injury to 
guide one as to the probable source of toe hsmorrhage. 
It may be that there is the mark of the wheel, or 
pmehanoe the discovery of a fractured pelvis or rib 
givesacluetothedamf^ that has occurred within. Take 
the case of a child who has been run over by a vehicle. 
The amount and persistency of the shock, together with 
the degree of the bleeding, may also afford some light 
in cases of intra-abdominal injury, such os rup¬ 
ture of the kidney, ureter, or bladder. The subs^ 
quent mode of passage of clots in the urine has a certain 
diagnostic value. For instauce, a long c'ot which passes 
ajter the commencement of a voluntary urination would 
infer that it was not formed in the urethra, otheririse 
it would have been expelled at the very start of miotn- 
rition. Its contour su^^ts formation in the ureter 
prior to its descent into the bladder, and would be strong 
presumptive evidence that it was either the resultant of 
an uretal laceration or that it had been moulded in the 
tube by blood trickling down, and subsequently coagu¬ 
lating, from a contused or ruptured kidney. These clots 
are somewhat similar in shape to those formed in the 
penile urethra when that has been injured, la the latter 


(a) Bead before the Harreiao Socletr, October 17th, 1901. 






430 Thx Medical Fbibs. OfilQII^AIi COM21UJSIGATOI7S. 


case the hasmatoria is dae, if it be pre«ent at all, to the 
refiaz of blood into the bladder. In a recant uaee of 
urethral injnry there is nsnallf a more or less oontinn* 
oae ooeing of blood from the penis, either independent 
of the act of micturition or which persists after the 
bladder has emptied itself. In reoal injury, partioalarlj 
laceration, the heemorrbage may be very profnee, so that 
the bladder may be fully distended by ooagulat^ blood, 
which imperatively demands removal. In mptnre of the 
kidoey the shook is necessarily proDOxmced. A certain 
amount is traceable to contusion of the sympathetic plexus. 
But if the prostration be of a gradually deepening 
character, and out of proportion to the amount of 
visible biematuria, it is strongly suggestive of some ad¬ 
ditional and progressive retro- or intraperitoneal 
hsmorrbsge. It must be borne in mind that the renal 
lesion and its concomitant hsematuria may form but a 
portion of the abdominal damage, and that there may be 
equally grave injury to other organs. In oases of 
traumatism of the ureter the amount of blood voided 
varies in relation to the nature of the injury. By this 
I mean whether the tube is simply oontus^ or tom. 
The diagnosis of this condition, though suspected, is 
exceedingly uncertain. Should, however, the patient 
survive, obliteration of the uretal lumen supervenes 
when it has ^n lacerated, as evidenced by the appear¬ 
ance of an hydronephrosis, a oondition wliich calls for 
nephrectomy. I well remember a case of this kind, a 
little girl who bad been run over, and was admitted into 
University College Hospital under the late Berkeley Hill. 
A larm hydronephrosis rapidly followed the injury. 
Yeeical htematuria, the result of direct violence, may ^ 
sequent to penetrating wounds of the perinesum, rec¬ 
tum, or abdomen which reach the bladder. The escape 
of blood-stained urine from the wound would disclose 
the nature of the mischief. If the hsematurio state be 
due to internal laceration, without external breach of 
surface, such as occurs from displaced fr^ments of the 
pelvic ^nes, it will be disclosed, if it has not already 
revealed itself, on the passage of a catheter. This pro¬ 
cedure is in accordance with the fuDdsmental law of 
systematic examination in abdominal injuries. 

In cases of rupture of the bladder the contents usually 
escape within the abdominal cavity, except in those rare 
instances where restraint has been exercised by a more 
or less intact peritoneal covering. The collapsed viscus 
is found to be practically empty, and unless the instru¬ 
ment happens to be guided through the rent, so that the 
extravasated urine is reached and tapped, there is very 
little bloody fluid drawn off. These cases are fortunately 
rare, owing perchance to the greater mobility of the 
bladder from its position, in childhood. Shock is pro¬ 
found, and the issue, notwithstanding surgical inter¬ 
ference, when permissible, is usually fatal, either directly 
from the injury or from subsequent peritonitis. As re¬ 
gards operative measures, every case must be judged on 
its own merits. Surgical instinct would, in view of the 
highly probable lethal results of non-interference, impel 
one to run the risk of the superimposed shock of an 
operation for stitching up the rent In the bladder, com¬ 
bined with continuous urethral drainage of the secreting 
urine. 

The symptoms, causes and treatment of mptnre of 
the urethra in children differ in no way from a like con¬ 
dition in the adult, except that the accident is of rarer 
oocurrenoe, possibly owing to the falling weight of a 
child's body being less than that of a grown-up person, 
and consequently the force of impact is proportionately 
decreased. Moreover, the infantUe or immature urethra 
is undoubtedlv more elastic and compressible. 

Calculi .—Toe presence of a calculus in the pelvis of 
the kidney, ureter, or bladder may give rise to haema- 
turia, in addition to other significant signs. In oases of 
impacted stone of the urethra, causing either total or 
partial obstmotion to vesical outflow, there may or may 
Dot be a certain amount of bloody urine passed or drawn 
off after tile extraction or repression of the calculus. 
Such, however, as is present is caused either by a regur¬ 
gitation of penile blood or arises from some laceration 
occasioned by pushing the stone back into the bladder. 
Hemorrhage is more consistently met with, in my experi¬ 
ence, as a diagnostic sign of calculus in connection with 


Oct. 23, 1901. 

the kidney and ureter rather than with the bladder; 
more particularly so, if the stone ^ of the rough, 
mulberry, or oxalate of lime variety. In a great 
number of cases of vesical oaloulns the only symptoms 
may be painful and i^frfqMe'nt micturition. Tbis is appa¬ 
rently due to the child refraining from passing water as 
long as p(Mible owing to the attradant pain. Frequency 
of micturition is met with in older <mildren or when 
cystitis bas supervened. It is more often one of the 
signs of stone in the renal pelvis. The explanation pro¬ 
bably is that in these cases its presence stimulates 
secretion, and since evacuation of the bladder does not 
cause pain, but rather relief, micturition is unhesi¬ 
tatingly resorted to. I have been struck by the fact 
that the symptom of heematuria is absent in many 
oases of proved vesical caloulns, and that the chief 
diagnostic signs have been djsnria and in/requeut 
urination. In the case of a baby boy, st. 18 months, 
from whom a stone was removed by Mr. Pickering 
Pick, the only symptoms were pain and restraint. It 
was at first thought to be due to a tight congenital 
phimosis. But as the painful micturition continued 
after circumcision I sounded bim and found this 
atone. The naked eye appearance of urine im¬ 
pregnated with blood from a lenal or uretal 
source is one of equal and intimate diffusion. By 
this I mean that the last ounce passed during 
an individual micturition is of the same hue as 
the first drops. Not as in some oases of vesical bsema- 
turia wherein the blood appears as a rosy tint and in¬ 
creases to a bright scarlet as the bladder empties and 
compresses the hypersmio or, perchance, excoriated 
mnoons membrane upon the stone. Ilie colour of 
renally extruded blood varies considerably. This depends 
partly on source, the causation, the amount, and the 
chemical action of the constituents of the urine on the 
bsematin. Thus it may range from a smoky upto adark 
porter tint, or it may give a rosy or red appearance to 
the urine. Broadly speaking, the smoky and du'ker 
colours are indicative of a central origin, with escape 
through the nriniferous tubules, whilst the brighter ones 
have a more superficial birth-place in the actual or 
immediate vicinity of the renal pelvis. Until compara¬ 
tively recently the diagnosis of calculi was dependent 
upon clinical evidence, needling, sounding, or the sense 
of touch. Now the assistance of the skiagraph renders 
positive, by photography, what was frequently a matter 
of differential and uncertain diagnosis. In renal cases 
it is of the greatest possible value and serves to eliminate 
all doubt as to the presence or absence of a stone and, 
moreover, as to its situation. If a chUd cannot be made 
to understand the necessity for lying still during skia¬ 
graphy, then resource must be h^ to an anmatbetic to 
keep it quiet for the few seconds required for the under¬ 
taking. 

Sarcoma is the type of malignant disease which affects 
the urinary organs in infancy and childhood. In infan¬ 
tile life the kidney is practically exclusively involved, 
but with advancing years the bladder becomes less liable 
to exemption. In certain instances the disease is un¬ 
doubtedly congenital and of a myo sarcomatous nature. 
As an acquired condition it is most commonly met with 
during the first seven years of life. In the majority of 
oases attention is drawn to tbe state of affaire by the 
appearance and rapid development of an abdominal 
swelling. In others it is the hematuria which causes 
alarm. The invasion of renal sarcoma is sometimes 
marked by the advent of precocious puberty. The tumour 
growth is rapid and secondary imection ocmrs ear:y. 
For this reason, quite apart from the fact that abdominal 
major operations are badly borne by children the pro¬ 
gnosis cf a nephrectomy is most glooxry. Becnrrenoe in¬ 
variably ensues in those that survive operative measures. 
Hematuria may appear quite early in renal sarcoma, but 
more frequently ito presence is d^yed until tbe disease 
is far advanced or it may remain ab^nt throughout the 
case. The structure of the growth and its Nation to 
the pelvis of tbe kidney are probably the determining 
factors of influence. By this I mean the histolr^cal com¬ 
position and its situation, whether it is encapsuledor the 
reverse, or whether it arises as a perinepbritio or inter¬ 
stitial in^tration. The outlook of vesical sarcoma is 


O 



Oct. 23. 1901. 


ORIGINAL COMMUNICATIONS. Thi M.dicxl Tm. ASl 


equally bad, and the condition oanies more dUtrees to 
the patient. Bematnria is a more constant pbenome* 
non. In tbeee cases there is the snperadded pain, 
canoed by the periodic compreSMon of the growtn by 
the contncting bladder. The amount of blood lost is 
fr^nently severe and pr<^re8si7e, and occurs with each 
miotoritioa, so that the sufferer is soon worn out. 
Cystotomy may have to be employed, either as a dia¬ 
gnostic or palliative measure, to clear out clots or to 
relieve pain and cystitis. One would be guided as to 
whether a median perineal or a suprapubic incision 
should be made, by the probable site of the growth as 
disolosed by rectal and abdominal examination. 

Papilloma, or villous tumour of the bladder, is an ex- 
ceedingly rare oconrrenoe in childhood, la fact, it may 
be said, if we exclude saroomr., that the bladder is not 
liable to tumour formation during Use early years of 
life. Conrequently, a muoous polyp or an adenomatous 
growth, when met with, will probably form the solitary 
experience of a life-time. In the case of villous tumour 
the cause of the hsematuria would be revealed by 
microscopical detection of a detached epithelial frag¬ 
ment, or, if the urethral lumen permitted, by oystoecopio 
examination. TTrethral caruncle is aim a condition 
nuely seen. It only affects female children. I had a 
case in a girl, st, 8. The little growth was situated on 
the floor of the nrethral orifloe. It was about the size 
of a No. 6 shot. Whether it arose from a former 
strumous vaginitis I cannot say. 

Tubercle is a frequent cause of hematuria. Usually 
this is directly dependent upon tuberculous invasion 
of some portion of the urinary tract. Occasionally it 
appears to be indirect as the residtof anemia consequent 
upon distal tuberculosis without there being any definite 
evidence of a local lesion. The hemorrhage seems to 
be of a passive natnre similar to what is met with in 
oonjunction with anemia, hemophilia rickets, or 
Bonrvy. The bleeding in these cases seem? to be of 
vesical origin. It is of moderate amount and is usually 
discovered accidentally as it causes no inconvenience. 
It is also transient, subsiding either of its own accord 
or under appropriate treatment. In this it differs 
markedly from the hsematuria due to local tuberculous 
foci, which has a progreesive tendency to get worse, 
with the appearance sooner or later of pus in the urine. 
In the majority of oases of urinary tuberonlods pus 
precedes the advent of blood, or at least is discovered 
synchronously with it. Occasionally hsematuria is the 
first noticed sign, at least in ren^ if not in vesical 
tubercnlosis. With a tuberculous pyelitis oue finds 
what one would expect, namely, pus primarily to blood. 
Bat with an initial implication of the body of theorgan, 
a central deposit, one may get hsematuria preceding the 
pyo-uria. The blood in tbeso oases is intimately mixed 
with the urine, which is of uniform colour. If, how¬ 
ever, the bleeding bas been severe some clots may be dis¬ 
covered. The bacillus is usually to be found iu the pus 
cells, or its existence can be gauged by experi¬ 
mental methods which would confirm the indications of a 
carefully kept temperature chart. Tubercle of the bladder 
when it haa preceded to ulceration may be the oanse of 
severe btemorrhage, so that a clot may be formed which 
fills np the entire cavity and requires removal, for the 
distension causes great agony. When the bladder i.s 
the chief seat of the tnbercnlona infection, which is often 
widely spread rather than restricted to one par¬ 
ticular organ, it will be seen that the character 
of an individoal micturition varies as to the 
amount of blood passed. This is not constant. 
Sometimes there is comparatively little lost, and 
then the following act of micturition will contain a 
considerable volume. In fact a severe hemorrhage is 
sometimes followed by a quantitive respite of bleeding, 
probably owing to enfeebled oiroulation or to clot block¬ 
ing of the pat-nt vessel. In vesical hematuria the last 
drops voided are of a brighter colour than those at the 
commencement of urination. Should the rudimentary 
prostate be involved pare blood usually follows the 
fifiole of the act. The question of treatment of vesical 
tnberouloeis by local means resolves itself into whether 
yon shall proo^ to operative measnres—open the 
bladder, scrape the ulcers, and give rest to the organ by 


drainage, or whether one shall treat the intact vtsetu 
with irrigations and the injection of iodoform emulsion. 
Usually the latter method is tried first. Sometimes it 
snoceeds, bat more often it fails r-ither to check the 
hsematuria or to ameliorate the existing oanse thereof. 
Suprapnblo cystotomy does hold ont some hope of, any¬ 
how, local benefit I have had personal experience of 
two cases in adults whose bladders got quite well after 
operation. 

Hsematuria is occasionally met with in rioketty sulv 
jects, but personally I have only seen it associated with 
the acute form of the disease—scurvy rickets, or, as it 
is called, infantire scurvy. In these cases the bleeding 
is most frequently of renal origin, and forms but one of 
kindred exudations from various mucous surfaces. The 
hsemorrhagio gams, epiphyseal enlargements with per¬ 
chance subperiosteal extravasations and pseudo para¬ 
lysis of the affected limb, either dne to tension from 
effusion or to pain, would materially go towards form¬ 
ing the diagnosis. Id hsmophilia the hsmaturia may 
be the first evidence of the existence of the condition. 
In snob a case the only method of diagnosis would be 
one of exclusion, bearing in mind the sex of the patient, 
together with a history of a similar diathesis in other 
members of the family. But too much reliance cannot 
be placed upon this, for although beemopbilia is apt to 
at ack, if not all, anyway a large percent^e of the 
males of a family, nevertheless it sometimes excludes 
certain of them, so that it may bs confined to only one 
member thereof. If, however, there was a suspicion 
that slight scratches in this particular child bad 
been followed by persistent oozing then a hint might be 
gleaned as to the true nature of the case. In these 
cases chloride of calcium in five g’ain doses, frequently 
repeated, has been of great service. Of more recent 
date is the treatment of the condition by supra-renal 
extract. This is used locally as a slyptio lotion 6 psr 
cent., and is also administered internally in two to five 
grain doses, a careful watch being kept for cardiac 
phenomena. Blood in the urine sometimes proceeds 
from an excoriated meatus arinarins. The stinging 
produced by the acid urine passing over the raw spot 
causes the child to cry—this draws attention to the 
urine. Blood is discovered and advioe is then sought 
for the infant in the belief that there is something more 
serious the matter than this simple condition. If 
any doubt be entertained as to the prese'ice of 
blood in the nrine resort can be had to mi¬ 
croscopical examination or to spectrum analysis. 
When blood is present, even in infinitesimal quan¬ 
tity it shows absorption lines in the yellow and 
green of the spectrum, between D and E (Frauenhofer’s 
lines). The most usnal chemical tost, though open to 
fallacy, is to add a few drops of tincture of guaiacom 
to a little urine, and then to pour in an excess of ozonio 
ether. This is ether containing in solution peroxide of 
hydrogen of thirty volume strength with some alcohol. 
If blood be present, a bright bine colour appears, due 
to the oxidation of the guaiacum by the ether through 
the presence of the bsmoglobin. 


THE ASPHYXIzVL FACTOR 

IN 

NITROUS OXIDE AN^STHESIA.ca, 

By T. PERCY C. KIRKPATRICK, M.D., 

Anssthetisq DenUI Hospital, Ireland. 

Gsntlxhen, —I propose to bring before you some 
points in connection with the administration of anses- 
thetios, bat before doing so I wish most seriously to im¬ 
press on yon the importance of the subject. If you 
propose in your practice undertaking the administration 
of these drugs, or merely operating on patients while 
under their influenoe, it is your bounden duty to make 
yourselves thoroughly conversant with the methods of 
their administration, with the dangers attendant on it, 
and with the means which are at your disposal for meet- 


fa) Being a Paper read at the Opening Meeting of the Dental 
Stndente'Society of Ireland, October 9th, 1901. 

"ti n c 



432 Thb Mbdicbl Pbxss. 


OBIGINAL CUMMUNIOATIONS. 


Oct. 23. 1901, 


ing these. It is, I fear, commonly thought that the ad¬ 
ministration of an aneesthetio is nothing, merely a means 
to an end—the abolition ofpain->and familiarity breeds 
contempt. If, howerer, yon wish to become good 
aoseathetists, to do the best for the patients who submit 
themselves to yonr care, yon mnst get completely rid of 
this idea and recognise that, in the majority at all events 
of surgical operations, the patient runs a greater rish 
from ue anssthetic than from the operation. In the 
administration of an ansathetic you alwlish for the time 
many of the vital functions of your patient by means of 
a powerful nerve poison, and the margin between the 
loss of these and the lose of those which are essential to 
life is by no means wide. If you thoroughly grasp this 
idea and, noting on it devote to yonr patient yonr full 
care and attention, yon go a very long way towards the 
avoidance of the many dangers which beset this import¬ 
ant branch of practice. It is hardly possible for the 
operator to give that attention to the patient which the 
administration demands, and hence the reason why most 
men now prefer to share the responsibility with a doctor. 

I believe that it will be more useful to you if I direct 
your attention tonight to one or two problems which 
present themselves to the anesthetist rather than give 
you a general dissertation on the subject, and as I 
suppose yon are more likely to be interested in the 
administration of nitrous oxide than of any other 
anesthetic I shall confine my remarks chiefiy to it. 

As yon are all donbtlees aware, Sir Humphrey Davy 
first «liscovered nitrous oxide gas in 1799, but it was not 
till the year 1844 that it was first piactioally made use 
of in savory, when Horace Wells, an American dentist, 
perform^ the first dental operation quite painlessly on 
a patient who was under its infinenoe. It was not till 
twenty years later (1868) that its use became at all 
general, but since that time it has fairly held its own as 
the safest and, for short operations, by far the most oon- 
veuieni anseathetia 

Although the anesthetic properties of the drug were 
thus early discovered its true physiological action, and 
consequently the proper methc^ for its administration, 
were not known till after the classical researches of 
Panl Bert in 1878, and even yet, to jndgeby the methods 
which one commonly sees adopted they are not at all 
fnlly appreciated. The great stambling block in the 
way of nitrons oxide as an anseathetio was the asphyxia 
which attended its use and which was considered essen¬ 
tial to it. Even within my own memory it was commonly 
taught that the exclusion of air, abwlntely and com¬ 
pletely, waa of the first necessity in the proper adminis¬ 
tration of gas. Now this is the point which I wish to 
draw yonr attention to-night, for there isnotthe slightest 
donbt that when accidents arise from the nse of this 
drng in the great majority of oases they are dne to the 
asphyxia which is associated with it. This being so, if 
we can abolish altogether the asphyxia! element, or at 
all events keep it well nnder our control, we shall at the 
same time abolish moat of the danger attendant on its 
nre, and here moat truly prevention is better than cure. 
If then yon wish to properly control the asypbyxiid 
element, which is quite unessential to good gas anaes¬ 
thesia as is shown by the nse of ni^ns oxide and 
oxygen, you must have a clear idea of the symptoms and 
siraa of its onset, of its physiological and pathological 
relationships and the indications which they afford for 
its treatment. 

Asphyxia may be defined as that condition into which 
an animal paaaes when for any reason the dne oxygena¬ 
tion of its blood is interfered with. The condition is 
the result of the want of oxygen rather thmi due to the 
accumulation of COj in the blood, for sneh an aconmu- 
tion in the presence of a sufficiency of oxygen acts as a 
narootio poison not unlike nitrons oxide itself. This, 
then, is the cardinal point which yon mnst bear in mind, 
aspbyxial phenomena are the expression of the want of 
oxygon by the organism and the indication for treat¬ 
ment is clear and definite, supply oxygen, or what is 
the same thing, atmospheric air. 

When the snpply of oxygen is completely out off from 
an’animal the condition of asphyxia develops, and the 
symptoms which it presents are nsoally grouped into 
three st^es as follows- 


1. Stage of exaggerated breathing or hyperpncea, as 
it is called. The respirations are increased in frequency 
and depth, the inspiratious being at first particularly 
prolonged and exaggerated. The respiration is accom¬ 
panied by a distinctly audible sound, the lips get blue, 
the eyes prominent, and the blood pressure IwRins to 
rise. This stage lasts for about a minute or louger, ac¬ 
cording to whether the deprivation is gradual or sudden 
and complete, and gradually parses into the sfcond 
stage, the chief characteristics of which are dyspnoea or 
difficulty of breathing and oonvulfaious. All the sym¬ 
ptoms of the former stage become more marked, and 
soon the respirations become convulsive while the other 
mnsblee of the body are thrown into a state of clonic 
convulsions, or what in gas anaesthesia is known as 
jactitation. This stage is slightly shorter than the pre¬ 
ceding one, and the blood pressure continues to rise con¬ 
siderably while the cyanosis becomes very marked. 

The third stage of exhaustion follows, the spasms give 
way, the mnscles becoming relaxed, and the patient is 
insensible, with widely dilated pupils. The blood pres¬ 
sure now falls rapidly below normal, and the poise is 
scarcely perceptible, paralysis of the respiratory centre 
takes plaM, and death ends matters. If the heart be 
examined at once after death it is found that the right 
side with the pulmonary arteries and systemic veins 
are gorged with dark-coloored blood, while the left eide 
of the heart is empty, as are also the pntmonary veins 
and systemic arteries. Small hmsaorrhages may be 
found nnder the serous membranes. 

This, then, is a picture of asphyxia, one which fortu¬ 
nately we seldom see in its entirety, but which in parte 
is common enough in gas ansBethesis, how often yoa 
will recognise if yon compare with it the aatesthesia of 
nitrons oxide and oxygen, though the only difference 
between the two is the admission of oxygen in the 
latter, and its exolosion in the former. When oxygen is 
administered with the gas we get an anesthesia charac¬ 
terised by a quiet sleep-like breathing, with a natural 
colour, quiet pulse, relaxed masolee, fixed eyeballs, aod 
normal pupils. 'When you have fnlly grasped the 
difference iMtween these two conditions and recognise 
that this difference is dne simply to the admission or 
deprivation of oxygen you will Im in a better position to 
appreciate the signs of asphyxia, even in the slightest 
degree, and so either avoid it altogether or keep it 
properly nnder your control. When you are able to do 
this you will be able to avoid what is by far the com¬ 
monest cause of all the accidents and untoward cirenm- 
etauces which are likely to arise from the administration, 
not only of nitrons oxide, but also of ether and chloro¬ 
form. Yonr anesthesia will in eve^ case be better, and 
shonld any accident arire your patient will be in a far 
bettor position to meet it than would be the case were 
the asphyxial factor also added to the dan^r. 

Let me now try and Ulostrate these principles by a 
few examples, and point oat to you some of the protean 
forms in which thi^ asphyxial element appears in actual 
practice. There is no difficulty in recognising it when 
it appears in its native bideousness, as was the case in 
the old method of gas administration. Here esygen 
was excluded till the patient had passed well into the 
second stage of asphyxia; then the operation was begun, 
and by the time the asphyxia bad passed off the patient 
had regained oonsoionsness. Experiments have shown 
that after breathing nitrous oxide for a period of 106 
seconds, the oxygen in the blood is redneed from 21 to 
6'2 vols. per cent.; in other words, more than tbre^ 
quarters of the oxygen in the blood bad been used op 
by the tissues, and since oxygen is essential to the life, 
not only of the organism as a whole, but to each cell in 
that organism, yon see how near death a patient may be 
brought by this method of the administration of gas. If 
then, i^ter such an administration, the respiration cessed 
from any cause, there is but a small margin of time 
during which it is possible to restore the patient. For¬ 
tunately, in the vast majority of cases this margin, 
though small, is sufficient, and by artificial respiration 
it is possible to introduce a fresh supply of oxygen. In 
snob casee the signs are so evident and so aggressive 
that there is no possibility of mistaking them, and no 
difficnlty in recognising what treatment is necessary. 




Oct. 23, 1901, OPIOINAIi COMMUNICATIONS. The Medical Pbiss. 433 


Tbe sDcoeBB oPtbis treatmeat, however, depends on the 
fact that nsnally tbe action of (be heart continnes in 
spite of tbe cessation of tbe respiration, for not only 
most tbe oxygen get to the blood, but also tbe oxyge* 
nated blood most get to tbe tissnes, and especially 
to those tissnes tbe integrity of which is essential 
to life, that is the great nerve centres of tbe 
mednl'a. One of tbe conditions of asphyxia, 
however, we have seen is that the right side 
of the heart becomes distended with blood, while tbe left 
side becomes empty. The emptv ventricle, however, 
cannot contract, and in the distended ventrio'e the force 
which is necessary to expel tbe blood increases as the 
cnbe of the radios of the cavity, so that tbe work 
thrown on the heart is greatly increased. If the heart 
is healthy it may be able to meet this extra strain, bnt 
if it be debilitated or degenerated it may be quite un¬ 
able to do so, with tbe resnlt that death takes place. 

In the earlier stages of asphyxia we have seen that 
there is a very considerable rise in blood pressure. This 
means more work for the heart and considerable strain 
on the walls of the arteries. If the arteries are degen¬ 
erated, as is BO commonly tbe case in old people, they 
may i nptnre, and possibly a fatal cerebral hsemorrhage 
resnlt, as has aotnally been recorded in practice, and 
hence old age has been given as a contraindication for 
gas ansestbesia. Ihe only remedy here, it is needless to 
say, is prevention. 

'Ilieee are extreme conditions, and, fortunately, not 
commonly met with in practice; there are, however, 
others, not so dangerons perbays, but sufficiently ob¬ 
jectionable to justify] considerable trouble to avoid 
them. As such may be mentioned the jactitation so 
commonly met with in gas anaesthesia, and which is so 
inconvenient to the operator. This is really the clonic 
convulsions of tbe second stage ot asphyxia, and may 
easily he abolished by the simple expedient of allowing 
the patient more air. There is another phenomenon 
perhape more annoying, but which is not so well recog¬ 
nised as dne to the want of oxygen, I refer to the 
struggling often met with in the earlier stages of tbe 
administration before tbe patient is “ off.” Yon are ail 
familiar, by reputation at all events, with the struggles 
of the drowning man, that is the violent consciona efforts 
which are stimulated by the feeling of smotheriog or 
want of oxygen, tbefeeling that one must get air at any 
cost. I am convinced that the cause is the same in the 
two oases—the want of oxygen. This struggling is not 
so commonly met with during the administration of 
nitrous oxide as it is dnring that of ether, for the simple 
reason that, in the case of the former, consciousness is 
nsnally abolished before the want is felt, while in tbe 
latter it is not. In proof of this 1 have foond that in 
the case of men who often require a considerable quantity 
of gas to anssslhetise them straggling is likely to take 
place. Bence the old teaching was that the way to sub¬ 
due these struggles was to press the anssthetie, whereas 
tbe truth is they can be much more qniokly, effectually, 
and pleasantly abolished by the admission of some air. 
This 1 have found to be true after some bitcer experience 
in my own practice, and now always endeavour to antici¬ 
pate their onset either by a rapid antestbetisation with 
gas or by the free administration of air with tbe azfecs- 
thetia 

In many cases the only evidence of a 8 ph 3 rzia which 
will be present is the great increase in the frequency 
and depth of the respirations - that is, the hyperpnoea of 
the first stage. It is, however, very important to recog¬ 
nise this, not only as a warning of what will certainly 
follow if it is neglected, but also beoanse often this over 
stimulation of the reepiiatory centre is apt to be followed 
by a period of apneua or absence of respiration, which 
before it passes off may indnee a very profoand degree 
of asjphyxia causing considerable trouble and ^arm. I 
have seen patients in this condition become almost black 
in the face to the great alarm of the bystanders before 
respiration was again re established. Under ordinary 
oircnmstances the condition is devoid of danger, bnt in 
the case of a weak heart or degenerated vessels it might 
possibly lead to a fatal resnlt, besides, in my experi¬ 
ence, it is almost always followed by very violent head¬ 
ache after recovery. 


Many of you will have found when beginning extrac*' 
tiona under anaesthetics that tbe ewoUen sta^ of the' 
tongne considerably impedes yonr manipulations in the 
month, Ihis condition resnlts from the fact that in 
the conscious state the muscles of which tbe tongue is 
composed are in a state of tonic contraction, while 
doriogansesthesia they are more or less relaxed. Kow 
asphyxia, even in slight degrees, leads to the stagnation 
of the blood in tbe veins, snd thus in tbe tengne the 
swelling due to tbe relaxation of the muscles may be* 
greatly increased so much so that any operation- 
in the mouth is rendered very difficult. This venous- 
congestion also favonrs hsemorrtasge from the sockets of 
the extracted teeth which further obstructs the operator. 
This is a matter of no little importance when the time 
available for operation can only be counted in seconds. 

I have said perhaps enough to convince you of tbe 
advisability of avoiding the aspbyxial element in anes¬ 
thesia, and these remarks apply with as mnch force to 
the administration of e^ber as that of gas, while in tbe 
administration of chloroform any asphyxia is attended 
with great snd special risks. In the case of nitrons 
oxide anesthesia it is not always possible to avoid it 
altogether, and often it may be advantageously made 
nse of as a help, bnt this should only be done knowingly, 
and in so far aa it is possible to keep it properly under 
control. In many cases it is not easy to get a sufficient 
depth of anestheeia without it, that is, to administer 
enough gas to ansestbetise the patient wbUeatthe same 
time we give enough air to supply his oxygen needs. 
This was the reason why tbe intr^uction of nitroue 
oxide and oxygen aneesthesia was such an improvement 
on that of the pure nitrons oxide. Ton will remember 
that the atmospheric air contains some 79 per cent, of 
nitrogen, which for respiratory purposes is absolutely 
useless, so that to give 21 vols. of oxygen one most give 
100 vols. of air. It is not at an ’easy matter to give 
this large quantity of air and still give enough gas to 
maintain annsthesia, so that a slight limitation of the 
oxygen may not only be useful bnt necessary, this should 
only be done, hosever, with a fall ktowledge cf its 
effects, and tbe limitation isbould never be permitted to 
go on till tbe dangerous symptoms of asphyxia arise. 

As regards treatment the indications are plain and 
nnmist^able. Supply oxygen either by permitting the- 
patient to freely breathe air, or by oompelling him to 
do Eo by means of artificial lespiration if the natural 
function is in abeyance. In order to accomplish this it 
is nserssary to see that the air way is free and unob- 
stmeted, either by tbe tongue falling back, or by blood' 
or other foreign body in tbe air passages. As long as 
tbe circulation is maintained, and the air way clear, one- 
or two respirations are sufficient to lessen the cyanosis 
and indicate the onset of recovery. If this does not ah' 
once take place yon may conclude that either the air 'm' 
not entering the Inn^ or that the heart is not ^ving; 
the oxygenated blood.mto the peripheral arteries. That, 
if the pulse continues to beat yon are justified in the' 
conclusion that the air is not passing into the longs, 
and that either there is some obstmetion in the mr 
passages, or yonr method of artificial respiration iei 
inefficient. In tbe former tracheotomy she aid be per^- 
formed at once unless the obstmetion can be removed;, 
as any delay is attended with the very greatest risk. 
If it is tbe oiionlation that is at fault tracheotomy is- 
nselesB, or worse than useless, being absolutely harmful 
as adding a farther and noneoessary shock to the 
patient. Tbe condition will in this case be the resnlt of' 
one or two canses: either syncope from the want'- 
of a snfficient supply of bi(^ in the heart and' 
great vessels, or obstruction of the heart from- 
over-distension. It is of great importance to dia> 
gnose which of these conditions is present, as the treat-- 
ment of each is diametrically opp(»ed. ‘^is diagno.>i8 
in many cases is by no means easy, but with due omre- 
and attention can generally be made. If the condition- 
has arisen early in the administration after struggling, 
and is attended with marked congestion of the face and 
deep cyanosis the probability is that the case is one of 
over-distension, while if it ocenre later after the adminis¬ 
tration has continued for some time, and then comee on 
suddenly without warning, being attended with pallor 


ORIGINAL COMMUNICATIONS. 


. Oct. 23, 1901. 


434 Tn IfiDicAL Pbbbs. 

ratber than oyanosis it ia most likely doe to synoope. 
In the latter case complete inversion of the patient is 
'the best remedy, while if there is over-distension of the 
heart this proo^ore w^U only a^^vate the condition. 
In cases of over-distension one shonld endeavoor to 
empty the heart by intermittent pressnie over the pre- 
•ooraial area, and possibly also open one of the jngalar 
weins, artificial respiration being kept up continuously 
in each case. Drags here are probably quite nseless, for 
if the circulation have stopped it is impossi ble to convey 
them to the organ on which it is wished that they shoold 
act. Electrical stimulation ia also useless, for if it 
reaches the heart at all, which is doubtful, it would 
probably inhibit its action. From this yon will see that 
the curative agents at our disposal are not very numerous, 
■nor are they very efficacious, hence there is all the more 
reason for avoiding the necessity of using them by proper 
preventive treatment. 

If by these remarks I have been able to stimulate your 
interest in this subject, and force on your reoognition a 
sense of the responsibility which one undertakes who 
administers a general ansesthetio I shall have the satis¬ 
faction of feeUng that 1 have done a good evening's 
work. Let me warn you, however, that it is only by 
actual practice that one can become a good aossathetist, 
and practice, too, with unremitting care and watchful¬ 
ness of the cases that oome under one's charge. No 
case is so simple t'lat complications may not aiise, no 
case so ordinary that something may not be learned 
form it by careful study. 


THE VALUE OF 

AGE AND SEX AS ETIOLOGICAL FACTORS 

IN THE 

DIFFERENTIAL DIAGNOSIS 

OF 

GASTRIC ULCER and CARCINOMA. 

By WILLIAM MURRELL, M.D.. F.R.C.P., 

PhyBiclsn to the Weetminster Hospital; Lecturer oq Clinical 

Medirine; Joint Lecturer on the Priticiples and Practice 
of Uedioine and Examiner in the Cnirersitj of 
Glasgow. 

The diagnosis between ulcer and cancer of the 
stomach as a rule presents no difficulty, but age and 
sex are factors of some importance. It is often said 
that gastric ulcer is a disease of young women and 
follows in the wake of ansemia, whilst gastric car¬ 
cinoma affects chiefly middle-aged men. Let us see 
to what extent this opinion is confirmed by statis¬ 
tics. 

I. The Relative Frequency of Oastric Ulcer in 
Men and Women.—! have examined the reports of 
the Westminster Hospital from 1884 to 1900, a 
period of 17 years, and find that of 397 cases of 
gastric ulcer seen in the wards 69 were in men, and 
328 in women. This gives a ratio of I to 1*475. 

Welch, as the result of 1,699 cases of gastric 
ulcer met with at autopsy, found that 40 per cent, 
were in men, and 60 per cent, in women, which works 
out 680 cases as against 1,019. 

Fenwick, at St. Mary's Hospital, out of 383 cases, 
found 95 in men, and 288 in women. 

Lebert, of 209 cases diagnosed during life, found 
47 in men, and 162 in women. 

Habersbon, out of 201 cases found 74 in men, and 
127 in women. 

Martin, from the records of 171 oases at University 
College Hospital, gives 27 cases in men, and 144 in 
women. 

Anderson, of 35 cases, found 3 in men and 32 in 
women, whilst Steiner, of 19 cases, fonnd 8 in men, 
and 11 in women. 

Tabulating these results, we get the following 
fignrea 



No. of Cases. 

Hen. 

Women 

Welch... 

... 1,699 

680 

... 1,019 

Murrell 

... 897 

69 

... 327 

Feu wick 

... 888 

95 

288 

Lebert... 

... 209 

47 

162 

Habersbon 

... 201 

74 

127 

Martin... 

... 171 

27 

144 

Anderson 

>•6 

3 

32 

Steioer 

19 

8 

11 


3,114 1.003 ... 2,111 

This gives a ratio of 1 man to 2*10 women, but, ex¬ 
cluding Welch’s autopsies, we get 1,415 cases with 
323 men and 1,092 women, which gives a ratio of 1 to 
3-38. 

II The Agee at which Gastric Ulcer occurs. —The 
following is the result of the analysis of the 397 
Westminster Hospital cases 
Under 5 years 
6-10 .. 


10-20 
20 30 
30-40 
40-60 
50-60 
Over 60 


0 

2 

62 

162 

104 

82 

10 

6 


Total 


397 


Welch gives the following table of 607 cases col- 


1 -10)ears ... 



... 1 

10 20 . 



... 32 

20-30 „ 



... 119 

30-40 ,. 



... 107 

40-60 



... 114 

60 60 „ 



... 108 

60 70 ,. 



... 84 

7a80 . 



... 35 

80-90 „ 



... 6 

90-100 „ 



... 0 

Over 100 ., 



... 1 


Total 607 

Martin in bis table distinguishes between males 
and females, but by adding the cases together we 
get the following figures;— 

Under 20 years . ... 15 


20-30 
30-40 
40-50 
60-00 
Over 60 


75 

38 

25 

14 

4 


Total ... 171 

Fenwick differentiates between acute and chronic 
ulcers, and takes as his standard the age at death, 
but by grouping his cases we arrive at the following 
results:— 


10-20 years 
20-80 „ 
30-40 „ 

40-60 „ 

60 60 „ 
60-70 „ 

70-80 ., 


... 9 
... 17 
... 16 
... 28 
... 12 
... 6 
... 1 


Total 


89 


His conclusion Is that whereas acute ulceration is 
almost confined to yoimg women, the chronic form 
is much more common in men. 

By combining these results we get the following 
totals:— 


Under 20 

2C-30 

30-40 

40-50 

50-60 

Over 60 


Welch ... 

88 

119 

107 

114 

108 

126 == 

607 

Murrell ... 

64 

182 

104 

32 

10 

6 = 

397 

Martin ... 

16 

76 

38 

26 

14 

4 = 

171 

Fenwick 

9 

17 

16 

28 

12 

7 = 

89 


121 

893 

266 

191 

144 

142 = 

1,264 


This gives the preponderance of cases in the 

Diijiiized b'; ooge 


















UCT^ 28, 1901._OBIGINAL COMMUNICATIONS. Tbi Medical Feme. 435 


decade 20-30, which is in accordance with the view 
commonly entertained. 

III. The SeJative Frequency of Gaetrie Cancer in 
Men and Women. —Let ns now apply the same mode 
of inveet^ation to gastric carcinoma. At the West* 
minster Hospital in the serenteen years—1884-1900 
—there were 92 cases in the war^, and of these 
60 were in men and 32 in women, a ratio of 2 to 1. 

Beiche reports the statistics at Hamburg (1872- 
1898), and nods that of 4,237 deaths from cancer of 
the stomach 2,387 were in males and 1,850 in females. 

Welch, of 2,214 cases collected from hospital sta¬ 
tistics, and nearly all confirmed by autopsy, gives 
1,233 males and 981 females. He adds that if to 
these accurate statistics be added collections of cases 
from heterogeneous sources, iucluding mortuary 
returns, there results a total of 5,426 cases, with 2.8^ 
males and 2,583 females. In this record is not in¬ 
cluded any of the other cases here mentioned. 

Osier and McCrae, out of 150 cases, give 126 in 
males and 24 in females, a proportion of 5 to 1. 

Martin found in 53 cases ^ in men and 21 in 


women. 

Combining the numbers we get:— 

No. of Cases. Men. Women. 

Welch . 6,426 ... 2 843 ... 2,688 

Beiche . 4,237 ... 2387 ... 1,850 

Oder and McCrae... 150 ... 126 ... 24 

Mum-U . 92 ... 60 ... 32 

Martin . 63 ... 32 ... 21 

9.958 5.448 4.610 

This gives a ratio of 1-20 to 1, or 6 to 5. Brinton 


thought that gastric cancer was twice as common 
in men as in women, but Welch, with his much larger 
statistics places the ratio at about 5 to 4, and con¬ 
siders that the difference is so slight that no im- 
ortance can be attached to it, especially as in many 
ospitals the men are in excess of the women. 

1V. The Age at xohich Oatirie Carcinoma Occurs.— 
Taking the ninety-two Westminster Hospital cases, 
I find that there was no patient under the age of 
30. In the decade 30-40 there were 11 cases; ^-50, 
33 cases; 50 60, 25 cases; and over 60, 23 cases. 

Brinton collected 600 cases from various sources, 
but does not tabulate the results. He states, how¬ 
ever, that the average age at death was 50, and that 
the maximum nnmMr of cases, 162, or 2-7th, oc¬ 
curred between 50 and 60. Both Welch and Reiche 
have published series of cases, which are tabulated 
below:— 



Welch. 

'Keiche. 


10-20 years 

2 

0 = 

2 

20 30 

65 

6 = 

61 

80 40 „ 

271 

17 = 

288 

40-50 

499 

38 = 

637 

50 60 

620 

40 = 

669 

Murrell 

Two 



60-70 

428 

36 = 

464 

70-80 

140 

4 = 

144 

80 90 

20 

_ — 

20 

Over 90 „ 

3 

— = 

30 


2,038 

150 = 

2,186 


From this it will be seen the majority of cases 
occur between the ages of 50 and 60. 

The conclusions at which we arrive are that gastric 
ulcer is from two to three times as common in women 
as it is in men, and that it is most frequent between 
tbe ages of 20 and 30. On the other hand, gastric 
cancer is slightly more common in men, and tbe 
majority of cases occur over the age of 50. 

It is stated that the Secretary of State for Indi i 
has sanctioned an increase of .twenty-six officers to 
the Indian Medical Service in order to mitigate tbe 
difficulty in respect of obtaining leave. 


THE 

TREATMENT OF INOPERABLE 
CANCER, (a) 

By ALFRED COOPER, F RO.S., 

Frvsident of the Weet London Medioo-ChiniTgicnl Sodetj. 

Gentlemen, —The honour which you have done 
me by electing me as your President is one of the 
greatest which I have yet received, for, although the 
West London Medico-Cbirurgtcal Society is youngin 
years, it is, 1 believe, by far the most active in workand 
growth of all tbe medical societies in London. 

On taking tbe chair for the fiist time, I follow the 
example of my predecessors by giving a short ad¬ 
dress on some suoject which will m of interest to all 
the members, and I have thought that I cannot do 
better than draw your attention to a consideration of 
the present treatment of inoperable cancer, a disease 
which has attacked tbe highest in the land, and which 
is certainly becoming more prevalent. 

It is in tbe cases of so-called inoperable cancer 
that it is not only justifiable, but wise to try reme¬ 
dies other than operation. During tbe last decade 
attention has been drawn to a num^r of methods of 
treatment, aod I will briefly give yon tbe informa¬ 
tion which 1 have been able to collect on tbe sub¬ 
ject, and shall refer to the following methods:— 

1. Tbe inoculation with the streptococcus of ery¬ 
sipelas; 2, subcutaneous injections of Coley’s fluid; 

3, subent^eouB injection of anticancerous serum; 

4, oophorectomy; 5, thyroid feeding; 6, lymph 
gland feeding; 7, by Rontgen rays, and by Finsen’s 
light treatment; 8, by tbe injection of various irri¬ 
tating substances and the production of aseptic sup¬ 
puration ; 9, by electricity; 10, by drugs. 

The Cure of MaHgnant Diseases by Erysipelas .— 
Nearly 200 years ago it was observed that a certain 
number nf malignant growths disappeared after an 
attack of erysipelas, and attention has particularly 
been drawn to the subject by Fehliesen and Bilroth 
who have reported cases of inoperable sarcoma cured. 
W an attack of erysipelas. Quite recently 
Escbmeiler, of Bonn, collected a series of fift^-nine 
cases of malignant disease associated with erysipelas,, 
occurringeither Bponianeously or produced by inocu¬ 
lation. Of these fifteen, or 25 per cent., recovered, 
while six of the others died of eiysipelas. After tbe 
discovery of the streptococcus Fehliesen suggested 
that an inoculation of a cultivation of tbe organism 
might be used to produce a like result; he obtained 
a cure in a case of cancer of tbe breast, and in four 
other cases there was temporary atrophy of the 
tnmour. In other bauds, however, several fatal 
cases occurred. Tbe next advance was made by 
Lassar, of Berlin, who injected the toxin of erysi¬ 
pelas alone, after steriltBiog the culture by steam. 
This fluid was found to bet^ weak. Finally Coley, 
of New York, introduced tbe use of the mixed 
toxins of the streptococcus of erysipelas and the 
bacillus prodigioBus, a preparation based on the dis¬ 
covery of Professor Roger, of Paris, who found that 
tbe addition of bacillus prodigiosus greatly enhanced 
the virulence of certain pathogenic organisms, and 
among these organisms was the streptococcus of 
erysipelas. Coley has used this fluid in 148 cases 
and out of these twenty-fonr, or 15 per cent., im¬ 
proved. Six of these cases afterwards recurred, but 
tbe remaining 12 per cent, were permanent successes, 
some of the cases having remained well for six years. 
It is found that tbe greatest chance of improvement 
is in spindle celled or mixed-celled sarcoma. Gole^^ 
considers tbe results in carcinoma as unsatisfactory.. 

(<() ANitnet of as Address delivered before the West Loodon. 
Medi o-Ci.irargtoal Society, on October 4tb, at tbe Opening of tb« 
SersiOD, ISui-ltKhi, ^ ^ 





436 Thk Medical Press. 


ORIGINAL COMMUNICATIONS. 


Oct. 28, 1901. 


Treatment by Antieaneerove Serum.—Last year 
TIaiefl introduced in Paris a method of treatment of 
advanced malignant diseases by inocnlation with a 
special anticancerous serum. In two cases of epi' 
thelioma of the tongue an improvement followed. ^ 
.a more recent paper Ylaieff states tbathe has treated 
sixty cases of human carcinoma by this method. 
When it was administered early, before ulceration 
and glandular enlargement, the serum was capable of 
exercising a curative effect. 

O&pkorectomy .—Much of ourknowledge on this sub* 
ject we owe to Mr. Stanly Boyd, from whose paper in 
the Brit. Med. Jown. 1 have freely drawn in the 
following remarks. 

According to Mr. Boyd, Dr. Beatson, of Glasgow, 
-was led to consider that oOphorectomy would be 
useful in treatment of inoperable cancer of the 
breast by the following considerations: “In lacta¬ 
tion there is rapid multiplication of mammary 
epithelium. Beatson learnt that certain farmers 
spayed lactatory cows in order to maintain per¬ 
manently or for a long time the secretion of milk. 
In cancer also the mammary epithelium multiplies 
rapidly, but instead of undergoing fatty degeneration 
or being cast off, it distends the acini, penetrates 
into the lymph spaces of the breast, and tnere float¬ 
ing in a nutrient fluid, continues multiplying and 
forcing its way onwards towards the lymphatic 
glwds. As oophorectomy in the cow maintains 
fatty degeneration of the epithelium of the lactatory 
breast, Beatson thought it might induce fatty de- 

f eneration of the epithelium of the cancerous breast. 

[r. Boyd last year collected fifty-four cases of 
oOpborectomy for cancer, which were in no way 
selected cases, but included the whole experience of 
several surgeons. As a conclusion, he considers that 
life was prolonged an average of six months by the 
operation. Out of the fifty-four cases nineteen 
or 35 per cent., were more or less markedly benefited 
bv the operation, and only one died. Although one- 
third of the cases derived benefit from the operation, 
in the majority of these the cancer began to re¬ 
appear or to increase within from six to twelve 
months. A curious part is that the average age of 
the cases improved by operation was higher than 
that of those who were unaffected, and therefore the 
operation seems most favourable when performed 
near to the time of the menopause; it is also found 
that chronic cases are more likely to be benefited 
than acute ones, but the quantity of supeiffcial 
disease does not appear to have any influence. As 
the practical results of his investigation, Mr. Boyd 
thinks that oophorectomy should be offered in all 
cases, other than the very acute, of inoperable 
mammary cancer in women over forty with no 
visceral or bony lesions, and before the menopause. 

Thyroid Feeding.—This method is also due to Dr. 
Beatson, of lilasgow, who considers that the so* 
called cancer bodies are not pai'asites, but are cells 
undergoing mucoid degeneration, and he therefore 
thought that a free administration of thyroid extract 
might influence them greatly, and in time effect a 
cure. Dr. Bell, of Glasgow, was favourably impressed 
with the use of thyroid feeding, and tried it in two 
cases of epithelioma of the cervix, and states that he 
obtained satisfactory results. Butlin, on the other 
band, tried it in a good many cases, but has not 
obtained even temporaiy benefit in a single case. 

Lyvmh Gland Extract .—Somewhat analogous to 
thyroid feeding is the treatment by means of lymph- 
gland extract, recommended by Dr. Snow. Snow 
states that he has used that treatment in several 
cases of mammary cancer which resulted in consider¬ 
able improvement. 

Treatment by “X" Rays .—Several cases of rodent 
ulcer have been treated in the West London Hospital 
by means of exposure to the “ X ’’ rays. The ulcer 


is usually treated after about a month or six weeks; 
the treatment, however, should be continued until all 
induration has disappeared. Sequeira has tried the 
treatment in twelve cases. Out of the twelve cases 
four are under observation, the ulcers having healed, 
while eight are still under treatment. Dr. Abraham, 
our dermatolo^st, has treated two cases, and both 
have been cured. Mr. Andrew Clark has recorded 
a case of chronic cancer of the breast treated for 
two months by the X “ rays with beneficial results. 
The action of the B.ontgen rays is almost similar to 
that of Finsen's light treatment, and several cases 
of rodent ulcer have been treated by that method; 
the treatment, however, is more painful than that 
by the “ X ” rays, and does not possess any advant¬ 
ages. Too few cases- have been treated oj either 
method to form any definite conclusion. 

Irritating Injections—A.iaonft these are: 1, the 
parenchymatous injection of acetic acid; 2, the 
parenchymatous injection of alcohol; 3, the paren¬ 
chymatous injection of methyl violet; 4, the paren¬ 
chymatous injection of cobra capella venom; 5, arti¬ 
ficially produced suppuration by (a) oil of turpentine, 
(b) arsenious acid, (c) calcium carbide. 

1. Treatment hy Parenehymatow Jnjectionof Acetic 
And.—More than thirty years ago, in ISro, my 
attention was drawn to this method by Sir William, 
then Dr., Broadbent. It was interesting to note that, 
though the injection of acetic acid is extremely pain¬ 
ful in healthy tissues, when injected into a carcinoma 
it gives little or no pain, and that while It produces 
no effect on normal structures, it acts energetically 
on cancer, producing solution of portions of the 
tumour. Broadbent employed about eighty minims 
of a mixture of the strong acetic acid of the B.P. 
with three or four parts of water. It was not claimed 
for this method that it was curative, but that it pro¬ 
longed life, and rendered the patient's sufferings less 
severe. Bemembering the success that Sir William 
Broadbent had obtained, I wrote to ask him if he 
could give me any further results. I think that his 
reply will interest you. He says:—“ 1 had a great 
many cases afterwards, and had to give it up, not 
because it was a failure, but because I did not want 
to get a reputation as a cancer doctor. I gave my 
syringe to a surgical colleague, but he prefeiTed the 
knife. The injection always relieved pain. The 
strength of the add I eventually came to use was, I 
think, one in seven.” 

2. Parenchymatous Injection of Alcohol. —This was 
first advocated by Schwalbe and Hesse in 1872. A 
30 per cent, solution of alcohol was used at firsi, the 
strength being gradually increased to 40 or 50 per 
cent. Although it has been used a considerable 
number of times in thib country, it has apparently 
not been very successful. 

3. Parenchymatous Injection of Methyl Violet. —Von 
Maestig Moorhof introduced this method; 1 in 50 
watery solution was used. This treatment has been 
tried in the West London Hospital without produc¬ 
ing any beuefit. I have been unable to find any 
evidence of a cure following the treatment. 

4. Parenchymatous Injection of Cobra Capella 
Venom. —The diy venom was employed by Repin in 
doses of a 40th of a milligramme, injected hypoder¬ 
mically. The I'eoiedy was found to be both painful 
and dangerous. 

5. Artijicially Produced Suppuration. —(a) By oil of 
turpentine. Crynski treated some cases of advanced 
carcinoma by this method, but the advance of the 
disease was in no way checked, (h) By aiaenious 
acid. Winth produced profuse suppuration in a 
sarcoma of the abdominal wall by this method, and 
the tumour disappeared. Ten years later there had 
been no recurrence. 

(c) By carbide of calcium. Etheridge, of Chicago, 
treated carcinoma of the uterus with this substance 


C 




Oct. 28, 1901. 


CLINICAL BECORD8. 


Tss Vkdioal Pans. 437 


wbich in tbe presence of water produces acetylene 
gas. In two cases a core was obtained. 

EUciri&ily. —Dr. Parsons bas treated several 
cases bj means of currents bavins a high electro* 
motive force. Altbougfa some of Dr. Parsons’ canes 
improved, one patient at least died from tbe shock of 
tbe ose of too strong a current. Hassej employed a 
zinc electrode heavily coated with mercniy, tnenega¬ 
tive pole being connected with another part of the 
body. Eight cases were treated, and improvement 
was seen in alL I should like to mention that two 
gentlemen are at present experimenting on several 
cases of cancer with electric currents of very high 
voltage. Tbe treatment is absolutely painless, and 
tbe results show marked diminution in tbe size of tbe 
tumour and great improvement in the general health. 
Tbe cases have only been under treatment a short 
time, but we may find in it an important addition 
to our treatment 

Treatment by Drugs .—Cbeledonium Magos (Celan¬ 
dine).—Splrak bas collected sixty-one cases treated 
by fourteen different surgeons in ibis way; of these 
tbirty-tbree showed improvement and twenty-seven 
di i not. 

Mention should be made, too, of tbe great benefit 
following tbe exhibition of large or increasing doses 
of morphia in hopeless cases. 

As a result of this review of the different remedies 
which have been recommended we may, 1 think, 
arrive at tbe following conclusions :— 

1. That in cases of inoperable sarcoma, more 
especially tbe spindle-celled variety, tbe patient 
should have the option of Coley's fluid given to him. 

2 . In cases of inoperable cancer of the breast in 
women of about forty years of age, in whom tbe 
menopause has not occnired, the operation of 
oophorectomy should be proposed, and this treat¬ 
ment may be combined with thyroid feeding. 

3. In cases of inoperable rodent nicer, and in the 
superficial malignant ulceration in other parts, the 
Sdntgen rays give a good hope of improvement. 

4. In cases where these other methods are declined 
or are inapplicable, the internal administration of 
celandine is worthy of trial, and when the case 
appears quite hopeless morphia should be pushed 
without ht-sitation. 

5. Tbe par<>ncbymatou8 injections of acetic acid 
are also worthy of trial. 

In conclusion, I should like to express my thanks 
to my friend, Mr. L. A. Bidwell, for the able assist¬ 
ance he has given me in investigating the subject. 


Clinical ^ecorbs. 

INTESTINAL OBSTRUCTION CAUSED BY UN¬ 
SUSPECTED UTERINE PIBROMYOMA. SIMU- 
LATINO APPENDICITIS, (o). 

By 'William Tbavcbs, M.D.Durh., F.R.C.S.Eng. 

I WAS summoned, a few months since, late at night, 
to see a lady's-maid suffering from very acuteabdominal 
pain—this was the fourth day of the attack. She was 
a martyr to constipation, and despite strong aperients 
and ennmata, bad bad previously several severe attacks 
of'* obstruction," in one of wfaicb, two years since, a 
fatal consequence was feared ; the pain and tenderness 
accompanying them was always ia the right side. I 
found a tall, slightly built woman, tet. 40, with an 
anxious flushed Lee expressive of much pain, decubitas 
dorsal with flexed knees, respiration quick and shallow, 
pulse 100, temperature 100'>. She bad beoo once 
fiick. The abdomen was slightly tympanitio, scarcely 
moving in respiration, and not at all over right 
iliac quadrant, dreading to bo touched, and very tender 
all over, especially in this region. There was a 

(«} B( ad before the British OjDtecolozical Society, Oct. 10th, 1901. 


geneial resonance, bat wooden over tbe same part, where, 
loo, althongh pain prevented at all oarefnl palpation, 
there was dist'not feeling of resistance and as if there 
mnst .be some solid matter beneath. Tbe affected part 
was bounded superiorly by a distinct roonded line. The 
attack had begun with more than usual constipation and 
pain: severe treatment with dmgs bad produced two 
free evacuations on this Isst day, with exacerbation of 
all the symptoms. The lower iMwel was empty and 
ballooned; on the right side high np some fnlnesscoold 
be felt. On very careful inquiry I could ascertain no 
history of any past or present uterine fault, and as she 
was now mens! mating no v^inal examination was made. 
The symptoms points to appendioial trouble, and her 
oondition was snfficieotly severe to call for sunrical 
interference. At this late hour of the night, now 11.30 
p.m., and nnder the novelty of tbe ciroumstanoe to those 
about her—all her friends, too, living a long way off—I 
felt jostifled in leaving her (or the night, giving opinm 
gr. I, oodeia gr. ex. bel'adoni gr. i at onoe, the dose 
to be repeat^ each fourth boar. The abdomen was 
carefully swathed in cotton wool. 

I saw her again at 8 a,m., al^ongh her symptoms 
were not more argent no one bad abated. Tbe poise 
and temperatnre were the same as on tbe previous night. 
Tbe acute pain bad been relieved by tbe pills and she 
had had some very broken sleep; however, she looked 
certainly worse, even to her mistress’s eyes. She had 
been sick once again only, and there was more disten* 
sioo, no fiatolence had passed. I nrged an operation at 
once, emphatically, hot under the circumstances sug¬ 
gested that she should have the benefit of another 
opinion and wished that Dr. Schacht should see her with 
me; this was cordially agreed to, and he met me half 
an hour l«ter. H's views coincided with mine as 
to the oourse to be pursued and as to the probable 
oanse of the condition. 'W'e proceeded to operate, 
my friend Mr. Barton kindly giving the aneestbetic. 
A four inch corvUinear incision outside tbe right rectus 
muBoIe and ending about tbe middle of Ponpart's liga- 
! meat, was made down to the peritoneum; this latter 
I membrane was injected and thickened; on incising it 
the subperitoneal tissae was found very adherent to the 
bowel nndemeath by recent and earlier adhesions, care¬ 
fully separating these with the fingers a large mass of 
Bcirrhns-like hardness, was felt closely attached to the 
bowel, to its outer side, and adherent to tbe pelvic wall; 
by ca^ully tearing through tbe adhesions tbis^owth 
was with some diffionlty brought through th/^ound, 
now increased in length for tbe purpose, when it was 
found to be closely bound to but not incorporated with, 
the colon wall; tbe ascending colon and cscoufe were 
very injected and dilated, but otherwise healthy. There 
was a good deal of free oozing—tbe mass, evideml^ 
fibroid, was carefully cleared Irom its surronndings, a 
kind of pedicle formed, tied, and tbe tumour removed. 
Tbe wound was carefully closed and the patient placed 
in bed. She gave me no anxiety thronghont her con¬ 
valescence ; she gained strength slowly, and we bad 
some trouble at first with tbe action at tbe bowels, but 
at no time was there tbe difficulty she had found pre¬ 
viously. 

I have seen her on ri^eral occasions since; she is 
performing all tbe duties of her office without discom¬ 
fort, and her constipation is easily negotiated with. At 
the time I saw her it w« impossible to palpate suffi¬ 
ciently carefully to discover the growth even of this 
size (tomour shown) and noae of her earlier symptoms 
led me to expect snch a canu for her severe attack. 
She had no nervous suspH^i that any abdominal 
tumour existed. 

On after examination the fibroid was found to have no 
real pedicle. The one ligatured consisted only of a rope 
of thickened cellular tissue containing blood-vessels. 

The ICiNGr; -who was recently graciously pleased to 
become patron of tbe new Dental Hospital of London, 
Leicester Square, bas now commanded that in future 
the Institution shall be known as tbe Royal Dental 
Hospital of London.^ 




438 Tai Mioiou. feiss. 


GERMANY. 


Oct. 23, 1901. 


Sfpadnunt of J^unatij. 

TWELFTH ANNUAL BEPOBTOP TBE ASYLUMS* 
COMMITTEE OF THE LONDON COUNTY 
COUNCIL, 

This rfport is now to band, and deals with varions 
matters of interest in ]anac 7 affairs for year ended 
March 3lBt. Tbete is first of all discussed tbatperen* 
nisi topic of interest tbe iocrease of lunacy. DeduMions 
are drawn from returns by tbe clerks to the guardians. 
These returns comprise information regarding all 
classes for tbe mentally affected, of wbats^ver degree 
and social position, and it is gratifying to know ^at 
this is the first time that an actual rednction in tbe 
total number of pauper lunatics has been recorded by 
the Committee, though it does not always follow that 
this is doe to a re^ reduction, but to alteration of 
statistical areas. While it cannot be said that there is 
any appreciable reduction going on, there appears to be 
a diminution in the rate of increase during tbe last few 
years, which, of itself, is very satisfactory. 

A plan of an epileptic colony appeals in this report. 
Tbe Committee has entered very fully into this new 
question, and provision has been made for a working 
colony of 300 male epileptics at a cost of about £90,000. 

Tbe general review of the year is short in its para* 
graphs, and the incidents there recorded present 
nothing specially new. Evidence, however, is still 
abundant of a high degree of efficiency and much 
thoroughness in the administration. 

Tbe several reports of the various superinten* 
dents are, as usual, full and interesting, and to 
most readers, and, especially to those who are' 
not associated with asylum work, the report of Dr. | 
Mott, the pathologist, will be found, as usual, most 
interesting. He seems to have attracted more and more 
disciples to hie laboratory, and we notice that several 
have come from America. He is still working with a 
good deal of competent assistance at such subjects as 
syphilis, general paralysis, epilepsy, idiocy, and the 
pathology of herpes zoster, and pursuing bis interest in 
colitis or asylum dysentery. Dr. Mott has long 
wished to find some one competent to undertake an 
experimental psychologies! inquiry of mental diseases, and 
he reports ** that W. O. Smith, M.A.Edin., Ph.D.Leipzig, 
who has worked for upwards of two years in Germany 
in tbe psychological laboratories of Professor Wundt 
and ProfesFor Munsterberg, and studied mental diseases 
under Professor Flecbsig, baa undertaken charge of 
this department. The papers which he has already 
published deal chiefly with the subjects of memory, 
association of ideas, and reaction to stimuli. He wishes 
now to carry on tbe study of i syohological phenomena 
in their pathological relations, a line of inveetigation 
which is being promoted in an increasing degree in in- 
stitutions for the treatment of the insane in Germany. 
The problems which he proposes to study in tbe labora¬ 
tory are (1) the pathological changes in mental states, 
such as memory and association of ideas, particularly in 
individuals suffering from alcoholic dementia; (2) tbe 
phenomenon of reaction time in normal and abnormal 
individuals, as studied both by tbe measurement of the 
duration of mental processes and by analysis of the 
motor phenomena by the graphic method. A short 
preliminary paper upon one of these subjects will appear 
in tbe Arobives.'* 

FORTY-THIRD ANNUAL REPORT OF THE 
GENERAL BOARD OF COMMISSIONERS IN 
LUNACY FOE SCOTLAND. 

Fusukd, as usual, this report is on interesting lines, 
tbe whole scheme of description of the movement of 
lunacy administration is very interesting. It is lees 
dry and statistical than the English report, and more 
practical in its evident purpose. Tbe statements made 
in the appendix “B" regarding different asylums are 
useful and interesting. In ths case of the Argyll 
Asylum we notice a remark by the Commissioners ex- 
presBing regret that there is a disinclination on tbe 
part of many of the parish councils in the district to 


board out their patients. The Commissioners regard 
this as unfortunate both in the interests of the rate¬ 
payers and many of the patients. We are glad to see 
this, because we feared of late years that the scare 
occasioned by an unfortunate ocouirenoe in a boardlng- 
ont district, had too much damped the entbusiasm of 
the Commissioners in the matter. There is always con¬ 
siderable industrial af-tivity iu this asylum, and the 
medical administration seems very good. 

The Commissioneis have during the past few years 
p.iven special attention to the subject of asylum dietaries. 
They have mode a most active and intelligent move in 
the matter, and have obtained by Government sanction 
the employment of Dr. Craofnrd Dunlop, of Edinbni^h, 
to assist them in preparing a report on the dietary of 
pauper lunatics iu Scottish lunatic asylums. 

It is gratifying to observe that the Commissioners 
have taken an interest in the pathological work of the 
Scottish Asylums’ Laboratory. Here, as in other indi¬ 
vidual efforts of our Scotch asylum men, they have given 
tbe full benefit of tbeir moral and intellectual support, 
and, without donbt, will help to the b^t of their ability 
in this new movement. 


Serntanp. 

[PEOM ODB OWN COBBB8PONDXNT.] 

Beslis, October IStb. ISOX 

Tbsathent op Pbolapsus Utxbi bt a Simple 
Opbbatiom. 

Pbofessob Dubhfsen (D. Mtd. Zeif., 74, 1901) recom¬ 
mends a simple operation for the treatment of the above- 
named distreesiog complaint. After amputatioo of the 
cervix, if called for, the anterior vicinal vault is incised 
trsnsversely, and tbe writer add» to ibis a longitudinal 
incision. The vagina! part is separated from tbe bladder 
either by tearing or cutting, when the bladder presents 
itself connected to the cervix and the parametriumby a 
layer of fascia. The central part of this may often be 
severed by a blunt instrument. Its remaining lateral por¬ 
tions, which are teuse, are then ligatured and cut 
through. The bladder may now be pushed away from 
the parametrium, both at the sides and centrally, and 
when pushed upwards and the whole body of the uterus 
pulled down by forceps tbe bladder wall comes well into 
view. If no further pregnancies are etpectedthe fundus 
is drawn down and fixed into the vagina by three catgut 
sutures. The vaginal flaps are then replaced, the fixa¬ 
tion sutures tied, and the wound drained by gauze. 

The same jonrual contains sn account of a 
Fatal Ruptubb of Tobal Pbbonamct at the Sixth 
Wbee, 

reported by Dr. Stranch. The fatal result is believed to 
have been due to an error in diagnosis on the part of the 
pnotitioner who saw tbe case first. The patient, a young 
woman, st. 23, had been married six months, and her 
last period bad come on six weeks before the onset 
of the illness. At this date, in the evening, after 
partaking of fish at supper, she fainted whilst at 
stool, and this was followed by violent vomiting. Tbe 
medical man who was called in found her pulseless, and 
attributed tbe illness to poisoning by the eating of the 
fish for sapper. The reporter first saw the patient at 
four o’clock the next day ■, diagnosed ectopic gestation, 
and proceeded to operate at once. A large quantity of 
blood was found in the abdominal cavity, which appeared 
to have escaped from the ruptured tube. Tbe operation 
' wa« easily performed, and only took up ten minutes, 
' but the patient died half an hour afterwards. He was 



Oct. 23, 1901. 


THE OPBBAm’G THEATRES. 


Thb Ukdical pBxeB 439 


of opinion that the life ooold hare been Baved if tbe 
operation could hare been performed suffioiently early 
after the accident The teaching of the Lyons School 
to the effect that ruptured tubal geetation is not fatal 
before the fourth month is erroneous, as proTed by the 
case recorded. 

Tbe D, Jfed. Woch., 20/1901, has an article on 

COKCBALBD QaSTRIC HfMORBBAOB, 

by Dr. J. Boss. Hemorrhages from the mucous 

surfaces of tbe stomach occur in two forms;_ 

first, as copious hemorrhages; secondly, as small 
hemorrhages proceeding from capillaries, or uloere, 
or nloerating tumours. In either case the blood may 
retain its normal colour, or be of the well>known 
coffee-ground shade. If the hoemorrhage is slight there 
may be no discernible change in tbe appearance of tbe 
contents of tbe stomach if these be acid. The writer's 
attention was drawn accidentally to the occurrence 
of snob occult hemorrhages, and since then be has 
observed it in eighty-three cases of tbe most varied dis¬ 
turbances of the (tomach and intestines on ezamicing 
the contents of the stomach. A survey of the material 
collected shows three groups of cases: first, diseased 
conditions in which bcemonbages are never present; 
then diseases in which htemorrhage is occasionally pre* 
sent; and, thirdly, cases in which hemorrhages are 
oonstantly or repeatedly found on ezaminatioa. Tbe 
first group comprises all the nenroses, a'l the cases of 
gastritis anai-ida, a case of gastritis subacida, cases of 
hyperacidity, hypersecretion, and benign ectasy. The 
cases of occasional hemorihi^ie comprise those of gastrio 
ulcer and stenosis of the pylorus. Among them blood 
was found repeatedly in four cases, but not constantly. 
To tbe three groups belong first a case of gastritis with 
stenosis and all cases of carrinoma of the stomach. In 
these latter, independently of the character of the 
chemical and motor functions blood was always found in 
tbe gastric contents, mostly in pronounced quantities 
by the gnaiacnm test. In certain of the cases the 
appearance was more or less suspicions, but in most of 
them even on careful inspection there was no retsou to 
believe that blood was present. In the ra<eB where 
blood could be suspected from the appearance alone, it 
was often found in the stools also, even when there was 
no noticeable change in their colour. 

'Why Does Csbxbbal Syphilis Appbab Difficolt of 
Curb ? 

is the title of an article by Dr. 0. Ziemssen in the 
Seri. Klin. 18/1901. 

Tbe first reason given by the writer is tbe fear of 
many physicians that the quantity of mercury required 
Has a tendency to cause neurotic diseases. Another 
reason is the difBculty of diagnosis in tbe early stages. 
A further reason lies in the course of recovery 
itself. Possibly there is an idea that brain disease, the 
same as spinal disease, does not depend on syphilis when 
after three or four weeks’ treatment results do not show 
themselves and no apparent retrogreesion takes place. 
This idea is erroneons, as the appearances may really 
depend on the natural course of recovery. In fact, in 
recovery from brain syphilis an interesting insight is 
afforded into tbe complicated relationships wi bin the 
brain. It is undoubted that every second of waking 
life must leave a lasting impression on the brain. A 
simple calcnlatien shows that tbe brain of a man of 
thirty or forty receives a milliard different impressions 


and must bear traces which may recall any given moment 
even after many years. The recovery from brain 
disease often brings back these traces in most variegated 
series. Whilst in other syphilitic diseases the dark 
changes of the eyes or the sense of touch are noticeable, 
when the brain is the seat of the disease they are shown 
in incoherence of thoughts, in loss of memory, and 
sometimes even in opposition to the laws of pro¬ 
bability. 

The chief condition for recovery from syphilitic 
brain disease is a very energetic and long continued 
course of mercury combined with potassium iodide. 
For this tbe inunction treatment is tbe only one possible. 
The treatment demands the greatest carefulness. This 
intensive treatment must be continued, or resumed 
if necessarily interrupted, so long as any traces of 
syphilitic brain disease remain. Among these the 
writer places not only headao'ie, giddiness, nenialgis, 
pareses, aphasia, amnesia, sharp hunger, attacks of 
langhing and crying, diabetes ofboth kinds, and similar 
easily diagnosed symptom8,but also mental dTstnibances, 
down to a degree of weakness that can only be discovered 
by the writing test. He remarks that local applications, 
such as ice bags, three or four daily, and the constant 
current, are in some cases useful adjuncts and expedite 
improvement. Mental exercises are also sometimes 
nsefnl, such as reading and writing, in cases of great 
mental weakness, jast as gymnastic exercises are io 
locomotor ataxy. What strikes the observer most, how¬ 
ever, in recovery, which often requires years for its ful¬ 
filment, is tbe conviction that brain syphilis, jast likethe 
total of the symptoms of constitutional syphilis, even 
when it appears to be mild in character, should be treated 
with all possible energy, as he'ein lies the best 
method, both as regards the brain disease itself and alsc 
as regards propbj laxis. 


CDptrating ^heatree. 

HOSPITAL FOE SICK CHILDREN, GEEAT 
OEMOND STREET. 

Opbration for Iliac issciss.—Mr. Ebllock ope¬ 
rated on a girl, et. about 4 years, the subject of tuber¬ 
culous caries of the lower dorsal region of the spine. 
An abioess had developed in coxsmnnication with this,, 
and was occupying the right iliac fossa, but bad not ex¬ 
tended below Foumart’s ligament. Tbe incision was 
made in the right ingninal region about an inch above 
and parallel to, tbe outer third of Poupart’s ligament;, 
the skin and muscles of tbe abdominal waU having been 
divided in the line of this incision and tbe subperitoneal 
tissue exposed, this last was pushed back with tbe peri¬ 
toneum, so that tbe finger could be passed down to tbe 
abscess; it was found to occupy tbe greater portion of 
tbe iliac fossa and to be sitnated deep to tbe iliac fascii. 
Retractors having been placed in tbe wonnd, the abscess 
was brongbtintoview; an incision was th^n made throngb 
the iliac fascia, and a oonkiderable quantity of tnberen- 
lons material escaped. The cavity of tbe abscess was 
next examined wiih the finger and then thoroughly 
scraped ont with a sharp spoon, which brought away a 
large amount of pulpy granulation tissue. The cavity 
was then irrigated with a considerable quantity of 
1-6000 perchloride of mercury solution, and subsequently 
with sterilisei water, being afterwards diied ss com- 


440 Tbb UiDiciL FBifte. 


LEADING ARTICLES. 


Oct. 23. 1301. 


pletelf BB poBBible b; meaziB of bsibII Bw&bfl pacseu in 
by long pain of forceps. Tbe opening in the iliac 
fascia was first closed by means of three internipted silk 
stitohee, and themnsolee of tbe abdominal wall brought 
together layer by layer with antares of the same material $ 
A continnotiB boifehair stitch closed the opening in the 
skin which wastben dreseed with collodion and ganre. Mr. 
Kellock caidthat the great point to be noticed abont the 
operation was tbe way in which the cavity of the ab¬ 
scess had been closed. He pointed out that it wae jnst 
as important in deading with collections of tuberculous 
material as with healthy structures to preserve rigid 
asepsis. To do this the avoidanoe of drainage of such 
-cavities was important, and to prevent the track of 
the operation wound becoming tuberculous it was essen¬ 
tial that before dosing the supeificial structures firm 
sutures should be put in the iliac fascia. When the 
tuberculous material had been removed from these ab¬ 
scesses tbe walls fall together, and the cavity as such 
ceases to exist; in the most favourable cases no re-collection 
takes place; even should this occur the contents are gene¬ 
rally quite fluid and can be removed by aspiration, or, if 
necessary, tbe operation can be performed again. Mr. 
Kellock further pointed out the enormous difference to 
these patients whether after operation primary rmion 
in the wound was obtained, or whether the wound broke 
down and became infected; it the latter case a sinus 
would persist for years, possibly the bone trouble in tbe 
spine would become septic, and the patient condemned to 
a long period of suppuration and danger, which can thus 
best be prevented by tbe avoidanoe of drainage and the 
observance of the most strict astiaepsis. 


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'* 8AL08 POPULI 8UPBBMA LBX.” 


WEDNESDAY, OCTOBER 23. 1901. 


FLAWS IN REGISTRATION. 

Reoistbation, in its general application, naay be 
regarded as a first step in the great science of pre¬ 
ventive medicine. Without its aid there would be 
no possibility of arriving at tbe facts of tbe birth¬ 
rates and the mortality rates, not to mention the 
relative destructiveness and prevalence of various 


diseases, infectious or otherwise. Indeed, registra¬ 
tion as applied to public health is tbe coi ner-stone 
of tbe foundation npon which is erected the edifice 
which is of sneb vast importance to the community. 
It behoves the medical profession, therefore, 
to keep a watchful eye npon tbe registration 
of births and deaths, as well as tbe notifications of in¬ 
fectious disease and tbe vaccinatirn returns, for both 
of the latter are virtually registrations. With regard 
to tbe present methods of administration it can 
hardly be said that they have attained perfection, 
either in tbeir thoroughness or tbeir universality of 
application. The area covered by tbe notificat'on of 
certain communicable diseases, for instance, is 
ludicrously inadequate, inasmuch as it fails to include 
measles, whooping-cough, and diarrheea, which rank 
among the most deadly of the zymotic diseases in 
tbe United Kingdom. The vaccination returns are 
upon tbe whole satisfactory, but a recent incident 
in connection with the epidemic that has for 
the present secured an apparently firm foothold in 
Xiondon, baa shown that the field of vaccination is 
practically limited by the extent of birth registra¬ 
tion. To put the case objectively, a family cf four 
or five unvaccinated children were discoveied to be 
suffering from small-pox. Inquiry showed that they 
had not been brought under tbe notice of tbe Yac- 
cination Officer, because their births bad not been 
notified for the purpose of registration. The regis¬ 
tration of births is a duty left to the parents, and 
failure in that respect renders them liab'e to a 
penalty of five pounds. No machinery is in exist¬ 
ence, however, for finding out it the law is 
evaded, and in the instance above quoted there 
has clearly been no difficulty in avoiding the 
obligation, an omission which was brought to light by 
tbe merest chance. In some cases the non-registra¬ 
tion of birth is discovered when tbe child reaches 
school age and comes under tbe control of the school 
board. It is then the duty of tbe school authorities, 
if there is no certificate of birth foitbcomiug to com¬ 
municate with tbe registrar, by whom a prosecution 
is, or ought to be, enforced. A check of that kind, 
however, is dilatory, uncertain, and especially unde¬ 
sirable, from the fact that it throws the onus of prose¬ 
cution upon vicarious shoulders. Moreover, in tbe 
case of which such frequent allusion has already been 
made it was of no value whatever, as some of tbe 
children were actually attending a board school. It 
seems clear, then, that some sort of house-to-house 
visitation is needed, at any rate in crowded centres 
of population, in order to ascertain that all births 
have been duly notified. With regard to deaths there 
is need for a great deal of reform. Tbe Registrar- 
General's department might by a stricter revision of 
death certificates exercise a great check anon unqua¬ 
lified practice. At tbe same time it is onlyfair to say 
that a great deal has been done of late years in that 
direction by local registrars. Then the verification 
of death by the certifying medical practitioner should 
be insisted upon, as well as a statement of the dura¬ 
tion of attendance on deceased. This service on the 

Diniiized b) -ooQ e 



Oct. 28, 1901. 


LEADING ABIICLES. 


part of tbe medical man slionld be paid for by the 
State, which woald thus be in a position to attach 
conditions to tbe process of certification. As things 
go, tbe State demands and tbe pablic have learned 
to regald as a gratnitone light tbe granting of a 
responsible legal document by tbe medical man. 
Tbe whole question of death certification is a 
wide one, and its full discussion would be beyond 
the scope of tbe present article. Enough has been 
said, however, to show that the reform of death certi¬ 
fication is a social matter that presses for Parlia¬ 
mentary attention. When tbe nation has time once 
more to turn its attention to domestic affairs it is to 
be hoped that a short but comprehensive measure 
will be passed to amen d tbe flaws in tbe present sys¬ 
tem of tbe registration of births and deaths, upon 
tbe efficiency of which largely depend tbe pn^ress 
and tbe security of public health administration. 


THE EXTBA-MURAL SCHOOLS OF THE 
SCOTTISH UNIVEBSITIES. 

It was weil-nigh inevitable that many people 
should be dissatisfied with any arrangement that 
might be settled in connection ivith tbe magnificent 
gift of lifr. Carnegie for tbe advance of education in 
Scotlard. It requires little argument to show that 
unless the greatest care and foresight be exercised 
tbe amount of benefit to education to be derived from 
even a lar^e sum of money may be very great'y 
minimised, that indeed such a subsidy may produce 
retrocession in certain directions. A plea on behalf 
of tbe extra-mural schools in Edinburgh and Glas¬ 
gow is very ably put forward by Dr. B. J. A. Berry, 
in the September number of the Scottish Medical 
and Surgicut Journal. According to Dr. Berry, no 
fewer tlan one-tLird of the medical studenta of 
Edinburgh and Glasgow Universities receive instruc¬ 
tion outside the Universities; not from tbe Pro¬ 
fessors but at tbe extra-mural schools. At neither 
Aberdeen nor Dundee do such schools exist. It is a 
pity Dr. Berry did not include statistics showing 
the total number of students txught in tbe extra¬ 
mural Echools, and also tbe number taught in the 
Universities. He says there baa been a steady 
decrease in tbe number of students coming up for 
Scotch degrees, especially at Edinburgh, and that 
this decline was manifest before tbe five years’ curri¬ 
culum was established. Not only do one-third of the' 
University medical students of Edinburgh and Glas¬ 
gow go to the extra-mural schools to be taught, 
but tbe number has been steadily increasing. 
Dr. Berry seems to attribute this extraordinary state | 
of affairs to the undermanning of the teaching staff 
and the overcrowding by the studenta at the Univer¬ 
sities, this congestion of students being due to the 
reputation of tbe Professoriate. The prosperity of 
tbe extra-mural schoola would from this appear to 
aiise from their being used as a sort of overflow 
from tbe University class-rooms and theatres. On 
the other band. Dr. Berry, referring to the extra¬ 
mural teachers, affirms that “ In almost every de¬ 
partment of medicine . . . are to be found men of 


Thb Mxdical Passe, 441 

European reputation literally working for their lives 
against their own poorly equipped and undermanned 
University, as the latter knows to its own finsnmal 
cost.’’ Tbe question is, then, anticipated, Why, 
then, do not the Scottish universities increase 
their staff P ” . . . and the answer given 

is, “Want of funds," but many will scarcely be 
convinced by this answer. According to Dr. Berry’s 
showing tbe University allows students to go to 
rival institutions bringing with them tbe money 
which ensures tbe vigorous life of the opposition, 
because, forsooth, tbe Universities have not money 
wherewith to provide a sufficiently large teaching 
staff. Surely if the Universities be overflowing with 
students they should be able to increase their 
teachers so as to be able to cope with tbe work 
required of them without pleading for charitable 
assistance. Dr. Berry finds a solution of the diffi¬ 
culty presented by tbe unfair disadvantage tbe extra 
mural schools will in future suffer from in conse¬ 
quence of tbe subsidising of tbe Universities in a 
scheme of amalgamation which be believes might be 
effectively carried on with the aid of another £60,000 
a year. It is remarkable that this article should 
be followed by another in the same journal entitled 
“ Difficulties in the Way,’’ from the pen of Dr. D. D. 
Buchan, in which the following passage occurs:—“It 
is perhaps unfortunate that tbe Universities Commis¬ 
sioners found it necessary to put (he professors on 
fixed salaries, and to remove entirely tbe very obvious 
incentive of payment by results through the class 
fees.’’ He recommends tcork (the italics are Dr. 
Buchan’s) as a cure for luxury and laziness on tbe 
part of tbe teachers. Having laid down a scheme by 
which he thinks this might be brought about, he says* 
“ Whatever may be the justiceof current complaints 
of professional sterility, such could, under the scheme 
indicated, not long endure.’’ 


THE DELIVERT OF THE PLACENTA. 

Professor A. B. Simpson has lately brought 
into prominence once more tbe long-disputed ques¬ 
tion of tbe origin of the method t f effecting the 
delivery of the placenta by external manipulations. 
To this method—a method the introduction of which 
was one of tbe historical advances of midwifery— 
has been attached by some the term “Tbe Dublin 
Method,’’ by others the term “Crede’s Method.’’ 
Dr. Simpson proves himself in his article to be an 
upholder of tbe latter title, but we cannot think 
that he has advanced any proofs of great weight 
in support of his belief. In the main, he quotes from 
two authors in support of his contention -M’CUntock 
and Churchill. M’Clintock. who was one of the first 
to point out that tbe method subsequently introduced 
into Germany by Crede bad been practised “ from 
time immemorial ’’ at the Dublin Lying-in Hospital, 
wonld at first sight not he a very promising witness 
on Crede’s behalf. Dr. Simpson, however, endeavours 
to destroy tbe value of the evidence which M’Clintock 
and Hardy’s “ Practical Observations ’’ afford (1848) 
by the remark that the paragraph—which to our 
Digiiized ; ^ 



\JCT. 28 , 1901 * 


NOTES ON CUBBENT TOPICS. 

(jC0t«s on Current topics. 


442 .Thb Mbpioal P»«b 8. 

mind describes the method of placental expulsion ex* 
actly— “ discusses the management, not of the third 
stage, but of special cases.” And this be states be¬ 
cause the paragraph in question is headed Heemor- 
rhage between the birth of the child and the 
expulsion of the placenta.” It is, however, the only 
place, so far as we can determine, where any method 
of obtaining the delivery of the placenta is discussed 
save in cases where manual remot a1 is necessary, and 
consequently may justly be regarded as describing 
the treatment adopted in normal cases. Dr. Simpson 
prefers to rely on the teaching of Churchill, "as a 
representative of the Dublin school,” but Churchill 
definitely says: “ Before applying the binder . . . 
the uterus should be firmly grasped and firm pres¬ 
sure made in the direction of the axis of the brim. 
In most cases, as the placenta has been detached by 
the last pains, it will be felt to recede under the 
hand, and the after-birth will be found in the vagina 
or bed. ... If not we should make firm, but 
steady, and not excessive, traction by the cord.” This, 
to our mind, is very negative evidence in favour of 
Dr. Simpson’s contention that traction upon the cord 
was associated with expression in the “Dublin 
method.” It appears to us to say plainly, only in 
other words: “Express the placenta; if this cannot 
be done, pull upon the cord.’’ The question of pulling 
on the cord or not—in case of the failure of expres¬ 
sion—has nothing to say to the question of who 
originated the method of delivery by expression. 
There are some writers who state that Credo's method 
differs from the Dublin method in that it is 
adopted at an earlier or later period in the third 
stage of labour. There are others who find 
that Orede’o method differs in that it is more 
severe or less severe than the Dublin method. 
These points, however, are mere matters of detail— 
changes in technique which have been introduced 
from time to time, but which have nothing to cay to 
the method as a method. Credo’s method and the 
Dublin method are terms applied to the delivery 
of the placenta by external manipulations, as opposed 
to its manual removal or its delivery by traction on 
the cord. In the Dublin method “the organ must 
be grasped firmly and pressure exerted upon it in 
the axisof the pelvis” (M’Clintock, 1848). InCrede’s 
method, “ we seize with one or two hands the fundus, 
and when the contraction arrives at its maximum 
intensity we press upon the fundus and the walls of 
the uterus, at the same time driving it down into the 
small pelvis” (Crede, 1853). The whole question is 
one of priority, and reference to the literature of the 
period will, we think, clear it up. The Dublin 
method was brought prominently before the notice 
of medical men twelve years (1848) before Ciede 
brought a similar method prominently before the 
medical world in Germany (I860). In Dublin the 
method bad been practised at the Dublin Lying-in 
Hospital “from time immemorial.” In Germany, 
Crede had taught its value clinically for seven years. 
Orede is fully entitled to the credit of having evolved 
his method de novo, but be is not entitled to the 
credit of being first in the field. 


Caetiog out the Mote. 

Wb heartily congratulate the Pharmaceutical 
Society of Ireland on the very sensible and practical 
address of their President, Mr. Beggs. His apolo¬ 
getic statement that it was want of time alone pre¬ 
vented him from reading a scientific paper was un¬ 
necessary. For the encroachments of the grocer 
and draper and quack medicine vendor on the rights 
and privileges conferred on the Pharmaceutical 
Society of Ireland by Act of Parliament Mr. Beggs 
bad more than enough for his opening address. He 
compared the activity of the Inland Avenue autho- 
nties in hunting down delinquents; they allow none 
tu escape—no fish is strong enough to break their 
net or so small as to slide through its meshes. Bight 
loyally be criticised the mistaken sympathy that the 
lo^ magistrates in Ireland bestow on druggists who 
are caught illegally compounding prescriptions, not 
being licensed to do so, and he uiged on the Society 
the wisdom of seeking power from Parliament for 
dealing with the evil. In all this he is worthy of the 
warm approval.of the Society. It is bis duty to see 
that the rights of the licentiates shall not be filched 
away from them, and magistrates should come to 
recognise that the law is for the public good and ought 
to be properly put in force. Patent medicines and 
proprietary preparations he mentioned simply to be 
condemned. The President cannot see why the local 
pharmaceutical chemist cannot put up his own pre- 
, parations. Why not stock his glass cases and 
counters with bis own remedies for indigestion, 
ansmia, bronchitis, tuberculosis, rheumatism, sore 
eyes, sore nipples, epilepsy, and every other 
ill that flesh is heir to? We quite agree with him 
that the quackery of the local pharmaceutical che¬ 
mist is as dangerous as that of the wholesale 
manufacturer. Blank’s nostrums are quite on a 
level with the Trench remedy or the Sequab magic 
cure, and are all alike to be condemned. There aie, 
nevertheless, some proprietary preparations of known 
formula that the manufacturers have attained to 
excellence in their production that other firms have 
not equalled; with these we think the local pharma¬ 
ceutical chemist cannot compete, and from the 
experience of the medical profession with such we 
b lieve the prescriber will favour them. There is 
yet another Richmond in the field—the itinerant 
vendor of drugs, who attends country fairs to sell 
his “ blessed ungente, rare extractions. To fortify 
the most indigest and crude stomach”—who, pos¬ 
sessing a tongue like Scot’s Mantuano, diverts cus¬ 
tom from the prescribing pharmaceutical chemist of 
whom the worthy President made no mention in all 
bis enthusiastic defence of the rights of their Hcen- 
ciates. He warmly defends “ meum," but we fml to 
see any acknowledgment of “ tuum” In firm, un¬ 
mistakable language he calls for the prosecution of 
the grocer or draper who would sell a bottle of 
chlorodyne or essence of linseed. For such law¬ 
breakers there is no forgiveness—their ignorance 

^ -OOg C 



NOTES ON CUBi?ENT TOPICP, jh. Mtotcal Fb*m. 443 


Oct. 28, 1901. 
might cause death; thia is quite true. But whj be 
silent on the many deaths that the counter-presoriber 
has caused through his ignorance? Will the pre* 
scribing chemist pursue his path unrebuked, happy 
in the thought that in casting out the mote of his 
brother’s eye he has fulfilled the law ? 

Bailway “Tube" Ventilation. 

Of late a revolution has been effected in under¬ 
ground railway travelling by the introduction of 
electrical “ tu1>e ” railways. One of the chief draw¬ 
backs of all subterranean roads of the kind must 
be the difficulty of efficient ventilation. The earlier 
underground railways are still rendered noxious by 
the sulphurous smoke from the engines, together 
with the fumes and mephitic vapours that 
are associated «vith passages borrowed in tbe 
bowels of tbe earth. The electric “tubes” are 
free from sulphurous fumes, it is true, but they 
have a peculiar odour and stuffiness of their own. 
Tbe fact of the matter appears to be, to put tbe 
thing shortly, that tbe engineers of tbe last 
Metropolitan nndertaking—commonly known as 
the “twopenny tube”—have not paid sufficient 
attention to tbe all-important question of venti¬ 
lation. There is at most of the stations a wind¬ 
ing staircase, which, however, will not act as a 
ventilating shaft unless means are taken to establish 
an extracting draught. Even the lifts, which by 
their constant to-and-fro passage would serve to 
some extent to cause a circulation of air, are ren¬ 
dered practically useless by the closely-fitting en¬ 
trance and exit doors placed both at the upper and 
tbe lower levels. Tbe top panels of these doors are 
glazed, and we would respectfully suggest to the 
directors that the glass be at once removed. There 
should be no difficulty in securing perfect ventilation 
of these “tubes” with suitable appliances. Tbe 
train nearly fills its tunnel, and propels before it a 
great mass of air, which by a little management 
could easily be directed through up-cast shafts. 
Independent air inlets and outlets are clearly re¬ 
quired at proper intervals. Before long the “ tube ” 
system is sure to te adopted in many of tbe great 
towns of the United Kingdom, so that it is well to 
be forewarned as to a grave defect. 

i^rtiflcial Hospital Debts. 

Ever since tbe management of medical charities 
attained tbe dignity of a fine art it has been recog¬ 
nised as a leading principle that every such institu¬ 
tion should have its own debt. For some occult 
reason tbe rules of ordinary business-like thrift and 
prudence do not apply to the average charitable hos¬ 
pital or infirmary, at any rate so far as tbe adjust¬ 
ment of income to expenditure is concerned. In this 
connection tbe We$tem Mail of October 10th has 
some stringent criticisms upon the financial arrange¬ 
ment of the Cardiff Infirmary. From the report 
I'ecently adopted by the Board of Management we 
gather that, by closing tbe books earlier than usual, 
certain subscriptions would be pushed over into next 
year’s account. The sum thus dealt with is stated at 


£2,000 by the Mai7, and after applying £1,118 con¬ 
tributed by a special fond to meet the balance on 
the income accon nt, the result is a nominal balance 
of £114, which, according to the chairman, is all 
that ts in band for tbe carrying on of tbe work of the 
institution for the next three months. Were that 
the case then the affairs of the Cardiff Infirmary 
would indeed be in a parlous condition. The chair¬ 
man, however, quickly re-establishes conBdence by 
the usual appeal for contributions. The Mail calls 
these methods of finance “ devious,” and there cer¬ 
tainly appears to be some little justification for the 
taunt. “ Although nothing could be clearer,” it re¬ 
marks, “ than the policy which the Committee ought 
to adopt in order to keep the institution out of debt, 
the members persist in turning into bye-ways, in 
order, apparently, to accumulate liabilities which 
are certainly preventable if ordinary prudence and. 
foresight are observed.” This is tbe sort of finance 
; almost universally adopted by the “business” men 
who think medical men should be excluded from hos¬ 
pital managemet t. - - 

Bacelli’s Treatment for Tetanus. 

One of the moat disconcerting features of thera¬ 
peutical research is the curious divergence in the 
results obtained by different observers. Thus a 
method which has given what may, without exaggera¬ 
tion, be called brilliant results, in the hands of 
another has no success at all, or even proves in¬ 
jurious. Bacelli's method of treating tetanus, which 
consists in the injection of carbolic acid, baa been 
highly spoken of by experienced observers in various 
parts of tbe world, and we were entitled at one time 
to hope that a remedy of some value had been made 
I available in tbe treatment of a disease which has 
proved refractory to every kind of medication, not 
excepting tbe fashionable serum. Some contradic¬ 
tory experiments carried ont on goats by Dr. Josiaa, 
of Paris, with this agent, and brought before tbe 
French Academy of Medicine, seem to show that 
carbolic acid is rather barmfxil than otherwise. Dr. 
Josias, having ascertained that two grains per kilo¬ 
gramme was a lethal dose of tetanus virus in respect 
of goats, injected 2 cc. of a 2 per cent, solution of the 
acid as soon as tbe characteristic symptoms of 
tetanus made tbeir appearance. Far from checking 
the further evolution of the symptoms tbe animals 
which had received the carbolic acid injections suc¬ 
cumbed more rapidly than tbe other inoculated 
animals. Even more remarkable is tbe fact that tbe 
inoculated animals appeared more susceptible to tbe 
toxic action of tbe acid than normal healthy animals. 
It will be noted that tbe test consisted in injecting 
the acid a/ier the appearance of the symptoms, and 
we are left in doubt as to the effect of injections 
made concurrently with tbe inoculation or soon 
after. In practice, of course, it is hardly possible to 
institute any anti-tetanus treatment until tbe symp¬ 
toms point to infection, and this is why even tbe 
semm, which confers immunity if injected before¬ 
hand or even concurrently, fails to afford relief after 
the poison has gained a firm hold on the organism. 

... ■ -oog e 



4ii Th» Midical Pbmm. NOTES ON CURRENT TOPIC.®. 


The Injection of Quinine. 


Oct. 28, 1901. 


It is stated in a well.known text*book of medicine 
that the hypodermic injection of quinine is the most 
effectual and economical way of treating malarial 
fevers, and wbat is known as Benson’s method is 
strongly advocated. Benscn’s method is reported to 
have been adopted in over 1,385 cases, and in these 
the form of quinine used was the sulphate dissolved 
in water with the aid of hydrochloric acid in the 
proportion of fifteen grains to the drachm, twenty 
minims being injected into the outer surface of the 
arm. In 614 consecutive cases treated in this man* 
ner one injection usually sufficed, and not a single 
untoward accident occurred. Dr. R. M. Townsend, 
of Buluwayo, 1 as had a very different experience. 
The site of the injections in bis cases became 
slougby, and in one instance, in which the patient 
was also receiving hypodermic injections of strych¬ 
nine, the sites showed no signs of inflammation what¬ 
soever. Dr. Townsend's views are also borne out by 
the evidence of Mr. James Gantlie, who protests 
against tbe method of treatment. Many medical 
men wno have abandoned the subcutaneous injection 
of quinine on account of the inflammatory trouble 
which resulted, have been accused of want of cleanli¬ 
ness and care, and this charge has up till now effectu¬ 
ally silenced any attempt to call attention to the for¬ 
mation of abscesses following tbe iogections. Mr. 
Gantlie records that he saw several persons in Hong 
Kong with abscesses on the outer aspect of the left 
forearm, who had all been treated by a Frtnch 
physician practising in a French possession near 
Hong Kong. Tbe severity of tbe resulting abscesses 
may be judged by the fact that they are reported to 
have penetrated deeply through the deep fascia with 
serious ulceration. Healing is very slow, and per¬ 
manent disfigurement is by no means an uncommon 
sequel. Though this matter cannot be termed one of 
extreme urgency, it is, nevertheless, of sufficient 
importance to justify our questioning the advisa- i 
bility of adopting this method. 

The Proposed Malaria Cure for Cancer. 

' It may be confidently anticipated that sooner or 
later the cure or, better still, tbe prevention of cancer 
will be brought within tbe grasp of scientific medi¬ 
cine. A host of observations have been made as to 
the racial, geographical, climatic, geological, and 
other aspects of tbe distribution of the malady. 
Among various striking facte is tbo high degree of 
immunity enjoyed by malarious countries, amount¬ 
ing practically, so it was stated long ago by Pro¬ 
fessor Trinka, of Hungary, even to total freedom. 
That statement, however, would have to be accepted 
with caution, and only after a careful definition of 
wbat is meant by the term “malarious" as applied 
to a district. The idea, however, has been recently 
revived by Professor Loeffler, of Greifswald, whose 
name is so well known in connection with the famous 
Klebs-Loeffler bacillus of diphtheria. He advocates 
tbe possibility of curing cancer by injecting patients 
suffering from that malady with blood taken from 
malarious persons. He further suggests that tbe 


trial should be made at once in hospitals in all parte 
of the world. Should there prove to be any real 
foundation for bis induction he will achieve a triumph 
indeed, for it would be hard to imagine any greater 
benefactor of the human race than tbe discoverer of 
a cure for cancer. The plea for the endowment of 
state laboratories folly equipped for scientific medi¬ 
cal research in all its ramifications could hardly find 
a better justification than in our present ignorance 
of the ultimate pathology of so common and so fat»I 
a disease as cancer, and our helplessness when called 
upon to stay its ravages. 

Bpidemio Jaundice. 

Epideuics of jaundice, although not unknown, 
are by no means of frequent occurrence. Special 
interest therefore attaches to an outbreak which is 
being investigated under the instructions of the 
Local Government Board at tbe villages of Pools- 
brook and Speedwell, near Staveley. A somewhat 
similar outbreak is recorded as having occurred at 
Rotherham about a quarter of a century ago, 
described as epidemic catarrhal jaundice. On thab 
occasion, nowever, tbe febrile phenomena were 
marked, whereas in tbe present epidemic fever has 
not been a prominent symptom. Its infective nature 
is shown by its having been carried to neighbouring 
districts by persons suffering therefrom, and it is a 
noteworthy fact that males suffered more than 
females, in the proportion of three to one. 
The outbreak commenced during the hot 
weather in August, tbe first indication of 
infection being extreme drowsiness and lassitude, 
sometimes amounting to prostration, associated with 
aches and pains all over tbe body, suggesting an 
attack of influenza until the supervention of the 
jaundice cleared up tbe diagnosis. Tbe total number 
of cases is about 300, but only three proved fatal. 
The average duration of tbe malady was about a 
month, this being about the same as in catarrhal 
jaundice of the ordinary non-infective kind. It is 
authoritatively stated not to be due to the defective 
water supply, but doubtless we shall be better able 
to form an opinion on this point when the inspector 
issues his report. 

Permanganate of Potash as an Antidote 
for Morphine Poisoning. 

The value of the discovery of the antidotal proper¬ 
ties of permanganate of potassium in cases of poison¬ 
ing by opium and its derivatives has been somewhat 
discounted by contradictory reports from various 
sources. Every case in which this drug has been 
tried is, therefore, of interest. One such is pub¬ 
lished in a recent number of the N. Y. Medical 
Record, by Dr. Leonard Weber, of New York. The 
victim was avery obese man, thirty-eight years of age, 
who had received a hypodermic injection of a third of 
a grain of morphia soon after having swallowed 
two powders, each containing a sixth of a 
grain of the drug. He promptly fell into 
a comatose condition, and respiration became 
imperceptible. The injection of two grains of the 

D, oog e 



Oct. 23, 1901. 


NOTES ON CURRENT TOPICS. 


Tbi Mbdical Pbess. 445 


permanganate, in divided doses, brought him round, 
and be eventually recovered. The case, as reported, 
is not absolutely convincing, beosuse an interval of 
an hour apparently intervened between the injections 
and restoration to partial consciousness, and the 
usual methods were also resorted to. The author 
insists on the value of the hypodermic method in 
addition to administration of the salt by the mouth, 
and this view commends itself since the salt taken 
by the mouth cannot do more than neutralise by 
oxidation that portion of the alkaloid which has not 
undergone absorption. 

“A Lethal Coin"—Was it Radiographed? 

A COBBESPONDBMT, referring to the case men¬ 
tioned in our last issue of a working man operated 
upon at the Tork County Hospital for a coin 
lodged somewhere in the air passages, which 
foreign body was not found until after death, 
when it was discovered in the stomach, the in* 
ference being that it bad been coughed up by the 
patient and swallowed. Our correspondent asserts 
that this point could have been settled in a few 
minutes by an examination with the fluorescent 
screen, which in a matter of this kind replaces infer¬ 
ences that are open to dangerous fallacy by direct 
evidence offered in objective form to the senses of the 
observer. Has the York Connty Hospital no Bdntgen 
ray apparatus, be asks, and if not, why not? We 
have no hesitation in saying that any modem hos* 
pital which is not equipped with a proper set of X* 
ray apparatus and the services of a competent radio* 
grapher cannot do justice to its patients. Instances 
of coins and other foreign bodies detected in the 
trachea, gullet, and alimentary canal are reckoned 
by scores and hundreds. A reference to the last 
edition of Dr. Walsh’s book “The Bontgen Bays in 
Medical Work,” will furnish a variety of interesting 
information on that and kindred points. The fact of 
the matter is that the Bontgen methods have placed 
in the hands of medical men an additional weapon of 
exact diagnosis. Any surgeon who endeavours to 
treat on purely clinical grounds a patient who is 
said to have swallowed a coin, the whereabouts of 
which is not absolutely clear, is not working with 
the best available tools. Not only should every 
medical institution have a good set of modem 
apparatus, but should also secure the help of a com* 
petent medical man as an expert operator. 

The Present State of the Carcinoma 
Question. 

In an interesting paper from the pen of Dr. Senn, 
of Chicago, published in a recent number of the 
JotAmal of the American Medical Aseodaiion the 
author reviews the literature of the subject and die* 
cusses the lines on which future researches should 
be conducted. If carcinoma is, as we have every 
reason to believe at tbe present time, the produce of 
an erratic cell proliferation beyond tbe limits of the 
influences which preside over and regulate normal 
tissue growth, it appears rational to search for some 
remedy which wonld affect tbe 'parenchyma of the 


tumour in one of two ways: 1. An agent or agencies 
which would destroy tbe epithelial cells by causing 
speedy and early degeneration of tbe imperfectly de¬ 
veloped epithelial cells. 2. Tbe employment of a local 
or general remedy or remedies possessing tbe powerof 
converting embryonic into mature epithelial cells» 
Ligation of tbe principal arteries supplying the 
tumour tissue with blood, and the employment of 
sclerogenic substances have been resoi-ted to for the 
purpose of accompliching the first object, but so 
far only with indifferent results. Very little,if any¬ 
thing, has been accomplished in the conversion of 
tbe low type of epithelial tissue into mature tissue,, 
that is, in transforming a carcinoma into a benign 
epithelioma. It is, however, not beyond the range of 
possibilities that future experiments and observations 
will open up a wide field of usefulness by tbe dis* 
covery of agents capable of exerting a beneficial' 
or curative effect on the essential tumour elements, 
by inciting degenerative processes, or by converting, 
them into tissue of a higher, mature type. 

Latent Fibroids. 

It is not an uncommon experience for an operator 
to dilate the uterine canal and attempt the removal 
of submucous fibroids. However carefully tbe proce¬ 
dure be conducted, and no matter bow thoroughly 
the walls of tbe cavity are examined for minute- 
fibroids no honest assurance can be given to tbe 
patient that other fibroids will not grow in her uterus.. 
This subject of latent fibroids has lately been a 
matter of careful investigation and study by modem, 
gynsecologists, and the views of Mr. Bland*Sutton 
though not universally accepted by all his colleagues, 
certainly stand the brunt of criticism. Botaniste 
apply tbe adjective “latent" to buds which remain- 
undeveloped or dormant for a long time, but may at- 
length grow, and it is precisely In this sense that 
the word “ latent" is used by Mr. Bland*Sutton when 
pointing out the significance of latent fibroids 
in regard to the operative treatment of such- 
tumours. Careful consideration of the great fre¬ 
quency of seedling fibroids, and their multiplicity 
when compared with the number of fibroids which 
attain proportions sufiBcient to I'ender them clinically 
appreciable, makes It undeniable that tin enormous 
proportion of them remain latent. The fact that, 
they may remain dormant through a long life, or 
assume active growth and become formidable 
tumours shows that they may very appropriately be- 
compared to “latent” buds. One observation that 
has been made by Mr. Bland-Sutton is that preg¬ 
nancy may exert a quickening influence on latent 
fibroids, and in his practice be has enucleated 
fibroids from tbe uterus on very many occasions; in 
four of tbe patients there has been a recrudescence 
of the fibroids which has necessitated a second 
operation. Similar cases have occurred to other 
burgeons, hut there is very little trustworthy in¬ 
formation available to enable even an approximate 
estimate of their frequency to he made. Under cer¬ 
tain conditions, which easily suggest themselves to- 
Dlf.m/ '^^3 ^ 



446 Thi Midical Pbkbb. NOTES ON CURRENT TOPICS. _ Oct. 23, 1901. 

the minds of those who are engaged in performing his workpeople. For all that, it may be noted that 
these operations, this may have a very important Dr. Thorpe, the Home Office authority on this sub* 


bearing when an operator is deciding whether to be 
content to enucleate a uterine fibroid, or whether it 
is best in the interests of the patient to remore the 
uterus. 

Enteric Fever. 

The opinions’of those most capable of forming a 
correct judgment on the question of the efficiency of 
inoculation against typhoid fever, are gradually be* 
coming known to the medical public, sometimes by 
written communication to the papers, and sometimes 
by word of mouth in the course of the clinical teach¬ 
ing. Dr. J. W. Washboum, who has had a very wide 
experience, in the course of his duties in South Africa, 
of the effects of enteric fever on soldiers, nurses, and 
civilians, pointed out in the course of a clinical lec¬ 
ture delivered at Guy’s Hospital, that the theory of 
typhoid inoculation is that which corresponds to a 
mild attack of the disease is produced, and the idea 
is that this mild attack will protect against another 
attack. Inoculation against typhoid fever consists in 
injecting the dead product of the bacilli into the 
body. With regard to the practical results of inocula¬ 
tion, Dr. Washbonrn’s experience is that it is of very 
little value, and he is quite satisfied that it does 
not modify the course of the disease. He has not 
observed any material difference in the nature of the 
attack between the inoculated and the non-inoculated. 
The fact that enteric fever does not protect to the 
extent that was previously thought must, it appears, 
be accepted as the explanation of the unsatisfactory 
results from inoculation. To a very great extent 
one attack of enteric fever may be said to protect 
against a second, but it certainly does not protect 
absolutely. Although in England a person rarely 
getp a second attack of enteric fever, in South Afi'ica 
second attacks are not uncommon. The reason 
appears to be that exposure to infection is greater 
in South Africa than in England. 

Leadless Glaze. 

Thebe can be no more terrible toll paid to capital 
by labour than that exacted by lead poisoning from 
the worker in china and enamel ware. Yet not only 
is poisoning of the kind preventable, but it is abso¬ 
lutely wanton and unnecessary. It has long been 
known that a perfect glaze can be obtained without 
the use of a particle of lead. Some of the modern 
Worcester waie turned out by Messrs. Hadley, for 
instance, has a beautiful soft gloss procured solely 
from leadlesB glaze. How, then, is plumbism to be 
abolished from our china and enamel factories P 
Clearly, reform is not to be looked for from the 
spontaneous action of employers. Nor is it 
to be expected from the influence of pur¬ 
chasers, who rarely interest themselves in anything 
concerned with the production of the articles they 
require. The only apparent hope lies in legislative 
action which will make it illegal for the manufacturer 
to use lead, in any shape or form, to the detriment of 


ject, says that the matter may be settled by the 
public, if only they will insist on being supplied with 
leadless glazed china. Here, at any rate, is a simple 
way in which the women of the United Kingdom may 
with little effort do a great deal towards rescuing 
many of their countrywomen from a terrible risk. As 
everyone knows, the worst cases of plumbism are 
commonly met with in young women who are sus¬ 
ceptible to the poison. 

Leukaemia and Pregnancy. 

Leukaemia, is a condition associated with enlai^e- 
mentof the spleen, and women who are suffering 
therefrom obviously run certain special risks in con¬ 
nection with pregnancy. Apart from the possi¬ 
bility of rupture of the spleen in the event of com¬ 
paratively slight traumatism, these women expe¬ 
rience, as one might expect, mncb greater discom¬ 
fort from the abdominal distension associated with 
the development of the uterus than is usual. The 
leuksemia itself is intensified by pregnancy, and 
this creates a liability to abortion or premature 
labour. These points were very clearly brought 
out at the last meeting of the Obstetrical Society 
of London in a paper by Dr. G. Herman on this sub¬ 
ject, and the conclusion he arrived at is that when 
pregnancy is complicated with leuksemia the indica¬ 
tion is to empty the uterus. The procedure is not 
unaccompanied by risk because of the danger of un¬ 
controllable ba^moiTbage; indeed, when death takes 
place it has generally been attributable to this cause. 

The Influence of Spermotoxin on Repro¬ 
duction. 

The therapeutical arsenal comprises a plethora of 
aphrodisiac agents or reputed such, but there is a 
lack of substances which exert an inhibiting effect on 
the reproductive functions. We are not aware of the 
existence of a demand for eiiherclass of agents, butas a 
matter of scientific cariosity we may note that 8p>ermo- 
toxic serum obtained from the guinea-pig, if injected 
into mice, inhibits reproduction for a period of three 
weeks or thei'eabouts. If, however, the semm be 
deprived of its alexin constituent no such effect is 
produced. The serum does not act by inhibiting the 
secretion of semen, the artificial sterility being prob¬ 
ably of nervous origin. We are unable for the 
moment to suggest any practical application of 
these interesting observations, anaphrodisiacs not 
commanding a ready sale in the Eastern Hemisphere. 

Diabetes in Infante. 

Diabetes in infants is not very frequently met 
with bat when this disease does attack the young it 
usually runs a very acute course. By a curious 
coincidence two inqneste have been held at East 
Ham within a few days of each other on chil¬ 
dren who bad succumbed to this malady. One 
was a female child, two years of age, and the other, 
also a female, was somewhat older. In the first case 
I there was a history of diabetes going back at least 


Dioittzed by 


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Oct. 23, 1901. NOTES ON CURRENT TOPICS. Th* Msi>ical Pbisb 4f47 


eighteen months, and the child suffered from fre¬ 
quent epileptiform attacks presumablj of ursemic 
nature. So protracted a course is scarcelj compatible 
with the text-book description of acute diabetes.” 

Water Supply and Pollution of Rivera. 

In the course of the discussion on water supplies 
and river pollution which took place at the Conference 
held bj the Sanitary Institute on October 17th, 
several speakers referred to a passage in Dr. Bideal’s 
paper, in which he said that the most important point 
in judging of the purity of a water supply at the 
present time is certainly the typhoid fever death-rate 
and next to it the general bacterial purity of the 
water. Mr. Caink.of Worcester, attempted to inform 
the Congress of his experience on this very point of 
the typhoid fever death rate, but for some reason or 
other a portion of his audience declined to allow him 
a hearing. Those who were near enough to him 
found that he bad something very interesting to talk 
about, and it is worth recording. The City of Wor¬ 
cester before 1894 bad an indifferent water supply. 
Since 1894 the water supply has been excellent. 
Before 1894 the typhoid case rate in Worcester was 
about 50 per cent, above the average case rate of the 
principal towns throughout the kingdom. Thenumber 
of cases of typhoid for the winter part of the four 
years preceding March, 1894, when the improved 
water supply was instituted, averaged in Worcester 
fifty-two. This number fell during the half-year 
ending March, 1895, to six, and this remarkable drop 
has with very slight exceptions been maintained 
ever since. The City of Worcester must be con¬ 
gratulated on this satisfactory state of affairs, and 
we are glad to put the facts on record because they 
are not only important in confirming Dr. Rideal’s 
views, butthey also have a wide practical bearing. 

Ringworm in Schools. 

A YBBT pressing question demands settlement in 
connection with the prevalence of ringworm in the 
London schools. At the various hospitals for diseases 
of the skin it has been noticed that the majority of 
the subjects suffering from this condition contracted 
their ringworm in the board schools. 8o pronounced 
has the evil become that Dr. Fbineas Abraham made 
a special point of drawing attention to the subject 
in the course of his remarks to one of the post¬ 
graduate classes at the West London Hospital. The 
time has certainly arrived when something should be 
done in the matter. We quite agree that it is not 
fair that poor people should be forced by law, as 
they are, to send their healthy children to institu. 
tions where there is a nsk of their contracting such 
a disease. Under the present system infected 
children may, and often do, attend schools for weeks 
or months and spread ringworm, pediculosis, Sic., 
unchecked. The obvious remedies are that in the 
first place provision should be made for periodical 
medical inspection. The suggestion made by Dr. 
Abraham that all cases of ringworm should be 
isolated from healthy children and taught in separate 


rooms from the others is a perfectly reasonable idea, 
but we fear that the proposal is a little too drastic for 
it to have much chance of immediate adoption. 

The Medical Service at St. Paul's. 

The annual medical service at St. Faul's Cathedral, 
Organised by the Guild of St. Luke, attracted a very 
large attendance of members of the medical pro¬ 
fession, a great number of whom donned their robes 
for the occasion. The number of women doctors was 
strikingly large, and a I arge proportion of them showed 
by their academic gowns that they were graduates of 
universities. The scene from the seats at the end of 
the choir was a very striking one. The music was 
rendered by the London Choir Association under 
the conductorship of Mr. H. Walford Davies, organist 
of the Temple Church, and the selection of the music 
was admirable. The sermon, preached by Canon 
Gore, was an appeal to members of a great profession 
to realise the responsibility of their calling. Canon 
Gore drew a striking parallel between the work of the 
parish priest and that of the doctor. Though con¬ 
troversial matter was touched upon whei^ he sug¬ 
gested that only the opinion of the expert in either 
profession could be taken as law, the sermon was of 
thrilling interest, and was listened to very closely by 
the congregation. 

A Just Punishment. 

“A CANCEB curer ” at Dunedin, New Zealand, 
has been fined £50 for assuming the title of doctor 
of medicine. Mr. Wm. Stanton, the person in ques¬ 
tion, was doing a large practice, and as is the custom 
with such persons, issued thousands of handbills 
telling of the wonderful cures his remedies effected. 
His most striking statement was as follows:— 
“ Where Dr. Stanton fails to relieve pain, or cure 
disease, other medical men may stand aside and weep.’* 
On hearing the sentence of the court “ Dr.” Stanton 
immediately drew a cheque for the amount, and then 
notified his intention to discontinue the title ” Dr.*' 
and adopt that of “ Professor,” as be publicly teaches 
and exercises for pay the occupation of a ** cancer 
curer.’’ And so much abused has this ancient and 
honourable title become that be may with dancing 
masters, phrenologists, balloonists, jugglers, acro¬ 
bats, and boxers, assume it without fear of incurriug 
legal penalties. It is, however, satisfactoryito know 
that the quacks’ imposition on the public cannot 
legally be carried on imder the cloak of medicine. 

Truth, in the course of some remarks on the re¬ 
fusal of the magistrate to grant a summons against 
Dr. Purdie, the assistant public vaccinator for St. Pan- 
eras, for assault, suggests that an application should 
be made for a mandamus, or that a civil action 
should be taken to recover damages. We fancy the 
plaintiff would have some difficulty in convincing 
an average British jury that the children had sus¬ 
tained damage by being vaccinated at a time when 
small-pox is epidemic, but this is what we may 
expect when journalists take to giving legal advice 
gratis. 

DiU'iizeti by 




448 Tex Medical Pbxss 


SCOTLAND. 


Oct. 23, 1901. 


Royal Academy of Medicine in Ireland. 

The annual meeting of the Rojal Academj of 
Medicine in Ireland is to be held in the Hall of the 
Bojal College of Physicians on Friday next, the 25th 
inst. The session of the Academy will then com* 
mence, and the first sectional meeting will take place 
the following week. For many years past we have 
found it a matter of great difficulty to obtain the re¬ 
ports of the proceedings of the sections with sufficient 
regularity and at an early enough date to make them 
of interest to our readers. This, we are glad to say, 
will now be changed. We have much pleasure in 
announcing to our readers that in the future The 
Medical Pbbss and Cibculab will occupy an 
official relationship to the Boyal Academy of Medi¬ 
cine. We shall ourselves be responsible for the 
reporting of the proceedings of the sections, and 
with the assistance of the sectional secretaries of the 
Academy we can undertake to lay the proceedings of 
the Academy and the abstracts of papers before our 
readers at a very early date after the meeting has 
been held. We trust that the arrangement which 
has been entered into between the Academy and 
ourselves will be a lasting one and result in mutual 
benefit. 

London School of Tropical Medicine. 

Fbom the description supplied by Dr. Patrick 
Manson of the conditions under which the students 
work at toe London School of Tropical Medicine it is 
quite clear, as Lord Brassey said in his opening 
address at the Boyal United Service Institution, that 
the school is in need of further funds for the purpose 
of enlargement to enable the medical staff to carry 
on tbe work of teaching. The accommodation is so 
scanty that students have to either wait their turn to 
join or else go elsewhere. It is so self-evident that 
facilities should be afforded to medical men to obtain 
a knowledge of tropical diseases before taking up 
duties abroad that we hope a satisfactory response 
will be made to Lord Brassey’s appeal for funds. 
The sum of £100,000 asked for seems at first sight an 
excessive demand, but the school is intended to 
supply medical teaching in tropical diseases for tbe 
preservation of the health of persons residing in tbe 
tropics, and this means a most extensive spheie of 
influence. 

A Vaccination League. 

The movement for the creation of a league to 
promote and popularise vaccination is oertain'y most 
opportune. Its objects are to spread a wider know, 
ledge of tbe benefits derived from vaccination and a 
better understanding among the general public of 
tbe advantages arising from preventive medicine and 
practical sanitation. Tbe League already numbers 
among its supporters a goodly array of influential 
laymen interested in the subject, and numerous emi¬ 
nent medical men, including Mr. Jonathan Hutchin¬ 
son, F.R S., member of tbe recent Royal Commission 
on Vaccination; Sir Alfred Garrod, F.R.S., Pbysi. 
cian Extraordinary to her late Majesty Queen Vic¬ 
toria; and Professor Charles Stewart, F.R.S., of the 


Boyal CoUege of Surgeons. The temporary offices 
of the League are at 110, Strand, London, W.C. 

PERSONAL. 

SIE Waltxe Fostxe will preside at a conference on 
the housing of tbe working clssses, to bo held at the 
Westminster Palace Hotel on December 3rd. 

In the grounds of the Hotel Dien, Nantes, two busts 
were recently uncovered. One to M. Chassaigaao and 
one to M. Maisonnenve, by M. Onyon. 

Thi French are qniok to hononr science. MM. Pelle¬ 
tier and Coventeau have within the past few months been 
so hononred. It is not so in this country. As yet there 
is no statne to Sydenham or John Hunter, and Dublin 
is still without a statne to Bartholomew Mosse. 

Db. Jakxb Musobovb, formerly l^eotnzer in Anatomy 
in St. Andrews University, has been installed in the 
Chair of Anatomy endowed by the late Marquis of Bute. 

Miss Mabion Boss, M.D., who in April last was ap¬ 
pointed Jonior Bouse Surgeon at Uacolesfleld Infirmary, 
has resigned, the Hoose Surgeon having resigned six 
weeks previously. 

PaorBssoB John Cbibnb, U.D., F.B.C.8.Ed , will take 
the chair at the antnmn dinner of the Edinburgh Uni¬ 
versity Club, which is to take place at the Criterion 
Restaurant on November 13th. 

SiB Fbsdbbicb Tbbvbs, K.C.V.O., C.B., will open the 
new bacteriological department at the Bristol Boyal 
Infirmary on October 25tb, and will afterwards preside 
at the annual dinner of the Medical School. 

Mb. Chbibtopbxb Hbath will deliver the Onthrie 
Leotnre at the Westminster Hospital on Thursday, 
November 2l8t, at 8.30 p.m., taking as his subject, “ The 
Westminster Hospital Forty-five Tears Ago." Mr. Heath 
was appointed Assistant Sargeen in 1862, and was for 
some years Lecturer on Anatomy in the Medical School. 

Thb Ring has been pleased to approve the appoint¬ 
ment of Surgeon-General W. Taylor, M.D., C.B., to be 
Director-General Army Medical Service, and on the 
retirement on tbe Slst of December next of Snrgeon- 
General H. B, Muir, C.B:, that of Lieutenant-Colonel A- 
Keogh, M.D., C.B., to be Deputy Director-General with 
the temporary rank of Surgeon-General. 

Db. W. B. Mabstom, of Flint, has been presented 
with the certificate of the Royal Humane Society in 
lecx^ition of his gaUant attempt to save the life of 
a man who was drowning in the Dee in Joly last. The 
presentation was made by the Mayor who recalled the 
fact that this was not the first occasion on which Dr. 
Marston had risked his life to save that of others. 


Scotlanb. 

[PBOH OUB OWN COBBE6PONDXNT,] 

JAMES FOULIS, M.D, F.B.C.P.E. 

Db. Jahxb Foulis (pronounced as Fowls), a well- 
known practitioner in Edinburgh, succumbed after a 
short illness at the comparatively early age of 65. 
Although born in New South Wales, Dr. Foulis belonged 
Digitized b. 



Oct. 28. 1901. 


CORKESPONDENCE. 


Thi Mkdical Pb»s. 449 


to a branch of the ancient honee of Fonlie, closely con¬ 
nected for lon^ with Ediabnreh in that the family 
estates lie adjacent to it—in 1634 the then head of the 
family had conferred npon him a baronetcy, a far-off 
ancestor of the late physician. Electing to enter the 
medical professisn. Dr. Fonlie, at a rawer elder age 
than nsnal, began his studies in Glasgow; later in 
Edinborgh, where he took his degree in 1872, when 26 
years of age; obtained the degree of M.D. two years 
after, and was elected a Fellow of the Royal College of 
Physicians of Edinburgh in 1888. 

After graduation he chiefly devoted himself to an 
elaborate research into the minute anatomy of the 
ovaries in woman and in many other mammalii, and 
into the phenomena characterising development of the 
ova under all their eventful circumstances. This work 
stamped him at once as an original and able investigator, 
and it is a pity that he abandoned original research 
work to a great extent soon sdterwan^ and never 
seriously resumed it. 

Sncceeding to the greater part of Dr. George Keith’s 
practice, whom he had assisted, on his retirement. Dr. 
Fonlis soon found himself busily occupied with the cares 
of a large family practice; and not only kept it together 
bnt increased it. 

A man, endowed with a most gracious manner and 
courtesy, with a nft of spee^ almost too plain for his 
profession, he had many admirable qualities, bnt at least 
one drawlmk, vis., tbs too perfervid advocation of some 
plan or theory without r^ard to environment, or 
nature. 

Glasgow Soitthkbk Mbdical Socistt. —The above 
Society held its annual dinner in the St. Enoch's Station 
Hotel, on Thursday evening, the 17th inst. The Pre¬ 
sident of the Society, Dr. John Stewart, occupied the 
ohair.and wassnpport^by Professors McCall, Anderson, 
Stockman, and Glenisterl Dr. Bruce, of Dingwall, Dr. 
Clnokie, Greenock, and others. The croupiers were Drs. 
Hacgrilvray and Richmond. An extremely enjoyable 
evening was spent by the company, which numbered 
over sixty. The usual loyal toasts were proposed and 
duly honoured. Among the other toasts were “Our 
Society," proposed by the Chairman; " The University 
and Other Medical Schools,” by Dr. Richmond, and 
r^ied toby Professor Stoctesn and Dr. T. E. Monro; 
"Our Gneets,” proposed by Dr. Lindsay Steven, and 
replied to by Dr. Clnokie and Mr. John Lindsay; " The 
Chairman,” proposed by Dr. J. Fraser Orr, the inde¬ 
fatigable and much-esteemed recretary. The toast 
which perhaps had the greatest interest for the Society 
was that of ” The Gene^ Medical Council,” proposed by 
Dr. C. E. Robertson. In the course of his remarks Dr. 
Robertson pointed out that this was the first occasion 
in the history of the Society that such a toast had 
been put npon the list. Its appearance on the list of 
toasts that night was due to the fact that for the first 
time the Society had been honoured with the presence 
aa a guest of the representative of the general medical 
practitioners of Scotland. Dr. Robertson doubted if at 
the present time the General Medical Connoil conld 
expect that the toast would be received with the enthu¬ 
siasm and sincerity which its importance ought to com¬ 
mand. Keepiog in view the reception by the Medical 
Connoil of a serious and infioeotial deputorion in June 
last, representing over 400 practitioners in the West of 
Scotland, he conld not conceive how this august body 
could hope to possess the ooufidenoe and respect of the 
medical profession in the West of Scotland. He bad no 
besitaiion in sayirg that the oonstitution of the General 
Medical Council was unsound from the very foundation. 
What iafiueoce, for example, conld the general practi¬ 
tioners in Scotland have when they were represented by 
only one man, and when the bulk of the members were 
responsible practically only to tbemselvee ? It was the 
general practitioners of the country who were most in¬ 
terested in ibe work of the General Medical Council, 
aod the majority of the members should, in his opiaion, 
be elected by them. Then assuredly would the Connoil 
attend to ibe wants and desires of ] ractitioners. He 
coupled with ihe toaat the name of Dr. Bruce, who had 
loBg been their worthy representatiye on the Connoil. 
Dr. Bmoe, in replying, remarked that, in his opinion 


the General Medical Council waa composed of too many 
memhera, and he thought that a change waa desirable 
in its constitution. He expressed himself in favour of 
altering the Connoil in such a way as to make one-half 
of its membere ^e representatiree of general medical 
practitioners. 

Opxminq or THI Mbdical Sbssion in Glasgow.— 
The winter session at the University of Glasgow, 
Anderson’s College, and St. Mongo’s College commenced 
on the 17tb lost. There waa no formal introductory lec¬ 
ture at the University, bnt Dr. Gibson, Edinburgh, 
delivered an introductory lecture at Anderaon’s College, 
and ProfesBor Laurie that at St. Mungo’s College. 

” Pass ahd Pldce.*' —At the professional examina¬ 
tions held recently there were more than the nsnal 
number of students " down in their luck ” in pathology 
and medical jurisprodenoe. Of somewhere about fif^- 
eight candidates in pathology only twenty-four or 
thereabouts passed. In anatomy one poor fellow has 
come down for the seventh or eighth rime! Not very 
long ago a very good student waa plucked aeveral times 
in anatomy. 

Tax Fobthcoxing Elictiom to the Ginbbal 
Mbdical Council.— It is proposed to preeent Dr. C. E. 
Robertson, Glasgow, with a requisition asking him to 
come forward as a candidate to represent the general 
medical practitioners on the General Medical Council. 
The name of Dr. Lindsay Steven, Glasgow, has also hpen 
mentioned in the same oonneotion. 


®mrrt£i|ioitben£e. 


[We do not hold oonelreeteeponsible for the opinions of onr 
correspondents.] 


THE BACTERIOLOGICAL TEST. 

To lh» Editor of Tax Mbdical Pbbss and Ciboulab. 

Sib,— Mr. Berdoe not having responded to my last 
letter has caused me some disappointment beosnse, in 
the first place, 1 wanted to hear more as to what he Ksbd 
to say aa a fnlly-fledged antivivisectionist; and in the 
second I had not oompleted my own observations owing 
to the consideration that I hM already encroached on 
your valuable space. I now, however, crave leave to 
oonolude as far aa vivisection is conoemed, although I 
intend later on to offer some remarks on the reliability 
of the bacteriological test, anticipating that you may 
kindly insert them, as the consideration of this 
is a matter of great importanoe, oonceming the 
highest and most humble of medical men, and I 
may add at once that I am not altogether at 
variance with Mr. Berdoe on this score. So we may 
hope at least to run for some distance together in 
harness amicably, it being only the extreme views which 
he appears to hold to which 1 object. In a word, he seems 
to me to brush the science of bacteriology altogether on 
one side, as I think he entertains the idea that it does 
more harm than good; bnt I mn»t say I felt very sur¬ 
prised that after bis confession that he was no bacterio¬ 
logist he should dare in the same breath to make the 
sweeping assertions which are palpable enough in his 
lettors. 

With regard, then, to the utility of vivisection pure 
and simple (and it will be obeerved that we have dis¬ 
cussed inoculation and vivisection aa though synonym¬ 
ous), Hr. Berdoe and myself are at complete loggerheads. 
I am anxions, however, to coax this gentieman, or all or 
any of bis followers, if open to conviction, to turn from 
the error of their ways by means of bringing the matter 
befoie them iu a purely hypothetical light, because some 
minds appear to me so constituted that they can readily 
assimilate suppoaitioas or illnstratioos, somethiog after 
the fashion of the infantile intelligence, whereas they 
become nauseated when brought face to face with naked 
facte. 

1 have already stated that I know little or nothing 
about vivisection—that is to say, in pamphlet or book 
form; bnt I do feel sufficient confidence in my own in¬ 
tuitive faculty to know that it serves a very valuable pur¬ 
pose, and notwithstanding I am placed at consideralle 



450 Tbb Mkdical Pbkbs- 

diBadranti^ in this respect (t.e., not haring read the 
snbject) with the antirisectioniste I must rely on hypo¬ 
thetical naeoning, as Mr. Berdoe rejected the beef tea 
experiment on the ground that the results in animal 
and man are not identical. 

To begin with, therefore, as an example, I believe that 
the operation commonly known as extirpation of the 
entire stomach has been performed on one or two occa¬ 
sions, and possibly more since I read the aoconnta, 
altbongh not certain on this point. Let us suppose, 
therefore, that the bold surgeon who fir^t conceived the 
feasibility of the performance upon turning matters over 
in his mind is confronted with a physiological doubt 
as to whether the viscne in question is a vital organ or 
not; in other words, whether, in the event of recovery 
from the actual operation, the digestive functions could 
be sutBciently carried on along the intestinal tract as 
to prolong life for a sufficient period to warrant the ope¬ 
ration ; and supposing further, with a view of arriving 
at some decision on the point, the surgeon oonsulto 
physiologists, the latter, however, being unable to decide 
the question off band, resolve to test it by having re¬ 
course to vivisection and in oonsequence the physiolo¬ 
gists give s n order to vivisectionists to narcotise and open, 
say, a doeen sheep and await events. And let ns sup¬ 
pose still farther that the majority of these sheep sur¬ 
vive the operation or the immediate effects thereof, and 
graze abont as usual, yet after a short period they suffer 
from an atrophic condition of system and ere long die. 

I now ask Mr. Berdoe or other antiviviseotionists, to 
adopt the Tooabnlary of the former, whether they oon- 
aider the results of this experiment of '* infinitesimal ” 
u>e P Surely the experiment would, to say the least, 
afford evidence to a very light degree of pro^bility that 
the visous iu question is essential to life, and hence 
a vital organ, whereas, on the other hand, 
supposing these sheep had permanently recovered 
it would to an equal degree of probability prove the 
reverse, and I venture to say that any surgeon on the 
face of this evidence, if endowed with common sense, 
which some very able men do not possess, the sui^eon 
would be deterred from undertaking the operation 
except for the purpose, perhaps, of giving temporary 
relief from suffering. 

I now conceive the antivivisectionists attempting to 
upset or invalidate my hypothesis by advancing an 
objection to the analogy between the sheep and man, 
insomuch that they might contend that the diet of a 
vegetating animal is, as in the case of sheep, so different 
from mao, that although the digestive function in one 
case, viz., the sheep, might not sufficiently replace the 
fanotion of the stomach to retain life, nevertheless it 
would not follow that this would be so in man, owing, as 
I have said, to the difference of diet, and I am ready to 
admit that this objection weighs to some degree against 
the exactitude of we analogy; but when we conai&r, aa 
I apprehend, that other vital functions in sheep, such as 
the reepiratory, renal, hepatic, Ac, so much resemble 
those of man, we can assume, I submit, without much 
risk, that if an animal can not live without a stomach 
neither can a man, hence the value of the experiment. 

I am. Sir, yours truly, 

Clbhbmt H. Serb. 

Queen's Boad, Peokham, 8.E., October 10t'>, 1901. 


MET IN RELATION TO THE CAUSE AND CURE 
OP CONSTIPATION. 

To the Sdxtor of Thx MinicsL Press and Cikculxe. 

Sib, —I have read with much interest Dr. Oldfield's 
communication upon the above snbject in the nnmbur 
of your journal for October 2Dd, 1901, page 362. 

The wide prevalence of constipation, its importanoeaa 
bearing on the health and well-being of the individual 
and the great difficulties of dealing with it without rt»- 
souroe to the routine employment of purgative and 
laxative drugs, must command attention to any com¬ 
munication or discussion which has a bearing upon it. 

Personally—and I feel sure that I may speak for 
others as well as myself in the matter—I think that Dr. 
Oldfield would have greatly increased the interest 
and value of hia communication, had he entered into 


Oct. 28, 1901. 

more details in connection with the special form of 
dietary he advocates. 

The restrictions are clear enough; but when be says. 

Give R fair proportion of milk and cereals, and give 
salads or conservatively cooked greens twice a day, aud 
a melange of fruit daily,” to my mind the directions 
are too general; views might differ as to quantity and 
quality. 

The questions arise ; — 

1. What does Dr. Oldfield hold to be a fair proportion 

of milk ? ^ 

2. Wbat oere^, and how cooked and served, does 
he give ? 

S. Of what does he compose his salads in the varying 
seasons of the year to secure an all-the-year-round 
supply ? 

4. What is meant by "conservatively cookedgreens”? 

I hope Dr. Oldfield may be iuduced to return to the 
subject, and to favour us with the benefit of hia expe¬ 
rience in providing for variety in the menus for the 
different meals. 

I trust Dr. Oldfield will not for one moment think 
that these remarks are written in any carping spirit. I 
consider the subject one of the greatest importinoe, and 
we cannot have too much light thrown upon it; his 
paper is most suggestive, and must lead to further 
observations and experiments, with a view to solving 
the difficulties to be met with in this troublesome class 
of cases. Of the value of regularity as to time iu solicit¬ 
ing an action of the bowels and of auto-abdominal mas¬ 
sage, I can speak in the highest terms; both are most 
helpful in securing a free evacuation of the rectal con¬ 
tents. 

I am. Sir, yours truly, 

John W. Martin. 


THE CURE OP LEPROS?. 

To the Sditor of Tbb Medical Press and Circular. 

Sib, —Allow me to observe, regarding yonr editorial 
allusion to the questionable oUim of Dr. Ehlers, that the 
Guber springs of Bosnia are onrative in leprosy, that 
almost identical springs in Japan have been found not to 
be. Eblers gives toe composition of the Bosnian waters as 
arsenic, alnm, iron, Ac. The arsenic baths of Japan, 
according to a report on them in the ” Transactions of 
the Asiatic Society” are about the same. Those Japanese 
baths have been appealed to by thonsands of Japanese 
lepers for cure, but witoont avail, for hundreds of years. 
To-day, toe Eusatzu hot springs are in higher favour, 
their remedial influence being greater. These last are 
distinguished by a very strong onrrent of free mineral 
acids. In a full bath of ^X) litres there are 440 
grammes of free mineral acid, 280 grammes of 
snlphatic earths, 45 grammes of snlphatio iron. 
The baths, three to five a day, for a month or 
longer, are taken at a temperature of 45 to 60 0. But 
even these are not considered by Japaneee leprolc^psts 
aa rurariv«—only beneficial. The dry treatment of 
leprosy is preferred to the moist. Hot acnpunctare, or 
dry air treatment, is much more efficacious, as has been 
proved in China since 2,000 years before Christ. It 
remains to be seen whether the hot American geysers 
and mud baths of our Yellowstone Nstional Park, will 
prove beneficial in leprosy. I have already applied to 
the Government for samples of those waters and muds 
for analysis and experimentation. The Yellowstone 
Park—that is, one mile square in the centre of it (it is 
sixty miles square)—is the site proposed for oar 
National Leper Home by the provisions of the Ashmead- 
Mulhane Leper Bill now before the American Congress. 

I am. Sir, yours truly, 

Albert 8. Ashnbad, M.D. 

October 9to, 1901. 

CANCER: ITS NATUBE AND TREATMENT. 

To the Editor The Medical Press and Circular. 

Sib,—A s you so sptly remark. Dr. Webb's paper is 
I full of interest and suggestive ideas, but toe one thing 
needfnl is a microscopic examination of every case sub¬ 
mitted to bis treatment One important point reqniree 
Di;- C 


CORRESPONDENCE. 



Oct. 28, 1901. 


LITERATURE. 


Ths Msdical Pbibs. 451 


further elnoidfttion: Were the lymphatic gl&nde affected 
in any of his cues, t . g ., the case in whi^ “ the whole 
interior of the month and cheek was one mass of cancer "? 
To what extent ? What was the effectof the treatment 
npon the glands P 

Cholesterine is found in the bile and protoplasm of all 
cells—it is largely represented in nerrous tissues and is 
found in blood oorpr^es. The cause of crystallisation 
of cholesterine from the living cell may be organismal, 
the products of the organism acting chiefly upon the 
nervous system. 

We should like also a farther examination, micros* 
copioal and chemical, of the blood of the patient before 
and after the treatment. 

Does the formation of gall stones in which cholesterine 
is largely present point to the presence of " nnoontrolled 
cells ” in tme neighbourhood of the gall bladder or bile 
ducts ? 

Again, we should like to know more of the action of 
thyroid extiact as an adjonct to the soap treatment. Is 
the whole process the result of a quarrel between 
I^ithin and cholesterine ? 

I am. Sir, yours truly, 

8. J. Boss. 


« A LETHAL COIN." 

To Editor of Thb Medical Pbess and Cibculab. 

Sib, —In your sensible comments in your last issue 
upon the d^th of a working man at the York County 
Hosp'tal no mention is made of the application of the 
X-rays. Are we to conclude that the house-surgeon 
performed an operation with the object of searching for 
the coin upon such evidence as ooidl be gathered from 
ordinary signs and symptoms? Was a Bontgen ray 
apparatus called into requisition, or did the York 
County Hospital fail to famish the unfortunate patient 
with tbis most modem and marvellous aid to accurate 
surgical dii^osis ? If that institution does not possess 
the proper apparatus the sooner its CommittM take 
steps to procure a modem set and an expert medical 
radiogra^er. the better for everyone concerned. Medi¬ 
cine and surgery are progressive arts, and require the 
best and most modem appliance for their due exercise. 

I am. Sir, yonrs truly, 

Badioobaphbb. 

London, W., October 17th, 1901. 


^eraturt. 

BOBSON AND MOYNIHAN ON DISEASES 
OF THE STOMACH (a). 

The name of Hayo Bobson by itself is a tower of 
strength in connection with the surgery of the stomach; 
its power, moreover, cannot but be enhanced by the sup¬ 
port received in this work from that of Mr. B. O. A. Moy- 
aihan, who has been so loi^ and so honourably oonneotM 
with the labours of the forma- eminent Leeds sui^^n. 
It is most satisfactory to read in the preface: “ We 
consider that we are jnstified in saying that our joint 
record shows that the risks of such surgery " (that of the 
stomach) are far less than has been genei^y believed; ” 
in the examples of operations given in the course of the 
book this dictum is amply verified. All surgeons will 
agree with the author’s fint sentence in speaking of 
diignosis : " Although diseases of the stomach natui^y 
come under notice of the physician at first, the time has 
passed when the surgeon can feel content to acc^t and 
act on the diagnosis already made for him by his medical 
ooUeagne." Inspection, palpation, peronssion, ausculta¬ 
tion, instrumental aids, vomited matters, and contents of 
the stomach, exploratory incision are all ably con¬ 
sidered and analysed in reference to their con¬ 
nection with the diagnosis of diseases of the stomach, 
a very pertinent remark in dealing with explora¬ 
tory incision being: "When the ti^onr is exposed 
the great gift of knowing 'when to stop* comes in.” 
Chapter I. is brought to a close with a very practical 

M "DUMMt of UwStoiaukaBdUiairBiirgioal Treatmnt.’* By 
a. w. Hayo Robson and B, O. A Msyplksfi Pp. SM BaUliora, 


and interesting dissertation on gastrotomy. Congenital 
stenosis of the pylorus is the subject of Chapter II., and 
the reader is carried as far as possible into the patho- 
logy of that rather obscure condition. Injury of the 
stomach is lightly dealt with in Chapta III., and in 
Chapters IV., V., and YI. simple tumours, canca, and 
sarcoma of the viscus constitute each an instructive 
study. The next six chapters comprise an exhaustive 
treatise on gastric ulcer and its complications, together 
with the various operations which may be undotaken 
for the relief of the patient. Chapter IX. on gastror- 
rhagia calls for special attention, and in a succeeding 
chapta perigastric abeoess is dealt with in a mastaly 
way: hour-glass stomach with its symptoms and treat¬ 
ment is then fully disouBsed, a large numba of illustra¬ 
tive cases being given ; the authors then pass on to the 
consideration of dilatation of the stomach, first as a 
complication of ulcer of the viscus, and secondly 
^th as acute and atonic dilatation. In speak¬ 
ing of perigastritis. Chapter XIY., the authors 
lay g^t stress on ^e advantages of gastrolysis 
many illustrative oases being given. Oasteio fistula 
and ^troptosis are lightly but satisfactorily dealt 
with in the next two chapters, and in the following as 
much light as possible is thrown on tuberouloeis and 
syphilis of the ^maoh. Witii regard to the latter the 
authors very wisely say: " From a surgical point of 
view the subject is great importance, since it would 
be easy to mistake a gummatous tumour of the stomach 
or pylorus for cancer, and perform gastrectomy when 
simple medical treatment would do all that is required 
. . . but while the question of syphilis is to be 
borne in mind it must not to forgotten that gummata 
of the stomach are extremely rare .... and that 
too much time most not be lost in medical treatment in 
a doubtful case^ lest the disease advance too far for 
surgical treatment to be of service." The copter is 
completed by a few words on phlegmonous gastritis. 
The last chapter should form an object lesson for every 
surgeon, and constitutes a worthy ending to a work 
replete with interest. It comprises a description of the 
various operations in which the stomach is concerned; 
the mode of operating is given, tc^ther wi^ the 
advantages and disadvantages of each. The book is 
well illustrated, and the type is exodlent. 


"FIBST-AID” DIAQBAMS. (a) 

" Inbtbuction in First-Aid " requirements is now so 
general throughout the kingdom that every assist¬ 
ance in the matta of illustration is sure to be 
appreciated. The provision of diagrams has always 
been a difficult question, for by no means every 
lectura is possessed of the ability to give graphic ex¬ 
pression to his ideas on a blackboard, and we have wit¬ 
nessed the most ludicrous failures in the attempt so to 
do. Hence we welcome the series of First-Aid Du^rams, 
advance proofs whereof have been submitted to ns by 
M^rs. Wright and Co., of Bristol. The entire setcom- 
prisee sixteen sheets, each sheet measuring (approxi¬ 
mately) ^ three feet by two. The total number of 
illusteations amounts to two hundred. Four sheets are 
devoted to anatomy and physiology, three to the use of 
the triangular bandage, and two to that of the roller 
bandage. Then we nave two sheets allotted to the 
treatment of hssmorrhage and wounds, and two more to 
dislocations and fractures. The remaining three illus¬ 
trate methods of artifioi^ respiration and means of 
transport. It will be seen that the series covers the 
entire ground, and as the drawings are of a site to be 
readily visible to an average audience, they can be 
safely recommended to the notice of those who are in- 
teteetod in this branch of public education. 


The Committee of the North London Hospital for 
Consumption, Mount Yemon, Hampstead, has received 
a donation of £1,000 to name a bed *' in memory of the 
late Mrs. Henry Claudet, who died at Cannes.” 


(a) “ * Fint-Aid' Dlununs for the Use of Lectnrera." Bristol: 
Johii Wright end Co. rnoe (complete set), 27a 6d. 

OOgli 


MEDICAL NEWP. 


Ocrr. 23, 1901. 


452 Ts> Mcdicai^b>88. 

Jttcbirrti (^etDs. 

Home Office and Pottery Blannfactnrers. 

Thb arbitmtion between the Home Office and the 
pottery manofacturers of Staffordshire as to the neces¬ 
sity for new rnlea in connection with the use of the 
lead glazes and the compolaory medical examination of 
the male operatives has been fixed for November 2ad, 
at Stoke-on-Trent. Lord James of Hereford will be the 
umpire. Professor Thorpe and Dr. Oliver, scientific 
experts, and Messre. Sntton and Conynham, counsel, 
will appear for the Home Office. Mr. Fletcher Moulton 
and Mr. Brongh will represent the manufacturers. 

A Herbalist's Defence. 

A FKw days since a Limehouse herbalist, one John 
Pardne, was sued by the Society of Apothecaries in the 
Bow County Court to recover a penalty of £20 from 
him for practising as an apothecary without a certifi¬ 
cate. For the defence it was urged that the Society was 
proceeding nnder one Act of Parliament, but his client 
was protend by another. He was a registered herba¬ 
list, and the Herbalist Act relieved him of any penalty. 
Cotmeel for the Society pointed ont that that was an old 
Act of Henry YIIL, which dealt with witches and 
soroerers. The case was adjoomed for the Acts to be 
examined. 

Barker Anatomical Prize. 

This prize of twenty gnineas, open to all medical 
students of the United Kingdom, has been awarded to 
Miss Susan Forster Dickson, a student of the Boyal 
College of Surgeons in Ireland. 

St. Kary'a Hospital Extension. 

It is annonnoed that St. Mary’s Hospital, Paddington, 
has at length saooeeded in raising the sum of £25,000 
required to seonre the Zunz bequest of £26,000, and that 
the Clarence wing fund has now a potential balance 
of £50,000. 

West London Hedloo-Chlmrgical Society. 

Taa opening meeting of the session was held on 
October 4th in the new building of the West London 
Hospital Poat-Oradnate College. Mr. Alfred Coo^r, 
F.II.C.S., delivered the presidential address on “ The 
Treatment of Inoperable Cancer,” an abstract of which 
we pnblish elsewhere. A vote of thanks was proposed by 
Mr, Keetley and seconded by Dr. BalL Mr. Swinford 
Edwards suggested that a special evening during the 
session might be devoted by the Society to the discus¬ 
sion of the interesting subjeot of the treatment of 
inoperable oanoer. Mr. MoAdam Eocles seconded the 
suggestion, and added that it might form an appropriate 
subject for the Society’s disouesion on February 4th, the 
subject for which he believed to be still unfixed The 
Prendeut, in reply, stated that this suggestion would be 
considered by tbe Council at their next meeting. 

Remarkable Charge Against a Medical Officer. 

At the Kettering Police Court Dr. William Mackenzie, 
Medical Officer of Health for the Baunds District Council, 
was summoned for aiding and abetting a shoe operative 
rmlawfully to expose himself when suffering from enteric 
fever at Baunds. It appeared from the evidence for tbe 
prosecution that two months ago an epidemic of enteric 
fever broks out in Bannds, which place was without pro¬ 
vision for isolating and treating patients. Dr. Maokentie 
sent one of the first patients to Kettering, which pos¬ 
sesses an isolation hospital. The authorities there re¬ 
fused to admit him, whereupon he was taken to a house 
in Kettering and left there. The Kettering Council the 
next morning were obliged to take charge of him, and 
he was accordingly admitted into the hospital, where he 
remained until be teoovered. A nnm^r of medical 
witnesses called for tbe defence stated that at the time 
the man was removed the fever had not reached tbe 
stage at which the patient could be a source of infection 
to others. The magistrates dismissed the case. 

Death nnder Chloroform. 

Thb Depnty-Coroner for Liverpool held an inquest 
last week relative to the death of Jane Jameeou, aged 
18. Chloroform and ether were used to produce an- 
tsstbeeia for the purpose of an omration on the face. 
She recovered from the influence (uthe ansaethetio, bnt 


about ten minutes later she vomited and ceased 
breathing. Medical evidence showed that death wav 
occasioned by an enlarged gland pressing on the wind¬ 
pipe whilst t-traiuing in vomiting. Tbe j ary returned, 
a verdict in accordance with the medical testimony. 

An inquest was held at the Brighton Throat and Ear 
Hospital, last week, on a man, sot. 39, who died while 
undergoing an operation for absoess of the ear. Arti¬ 
ficial respiration was employed for two hours in vain' 
Tbe usual verdict was returned. 

A LABOOBiKO man, aged 40, died under chloroform at 
the Boyal Infirmary, Halifax, last week. An inquest was 
held, when ” heart failnre ” was credited with having- 
produced the fatal result. 


Proponions of Alcohol in Various Beverages. 

Mb. AtrBBD H. Alukn, Public Analyst for the Weat 
Biding of Yorkshire, gives the following figures as, 
roughly speaking, tbe proportions of alcohol (per cent, 
by volume) confined in various beverage^, each kind of 
which is, however, liable to a certain range of strength :— 


Alcolio). 

ClDBB. CSut 

French, minimum of Pomological Society ... 4 

averse of sweet samplee .3'8 to 4*1 

„ dry . 6'4 

Paris municipal requirement average. 5 to 6 
„ „ „ minimnm. 3 

English—Bath and W. of England minimum. 4 


„ Norfolk, bottled . 

... 6to9 

„ Devonshire, bottled (extra dry) . 

... 6-7 

„ Herefordshire, bottled 

... 66 

American, dry . 

... 6-4 

„ sweet ... 

.. 25 to 4 

Bbbb. 

Ordinary draught.. . 

45 

Barton Pale Ale. 

63 

Guinness’s XX stoat . 

.. 66 

Pilsen Lager . 

35 

American Lager. 

... 28 

Wins. 

Bordeaux (vin ordinaire) . 

.. 7 to 9 

Beaune . 

18 

Bildesheimer ... . 

10 

Champagne; . 

.. 11 to 13 


The proportion of proof spirit ean be found by mul¬ 
tiplying the figure for alcohol by seven and dividing 
thepn^notby fonr, or, more aoonrately, by multiply¬ 
ing by 1*7616. 


Westminster Hoepltal Medical SchooL 
Thb following new entries—which we are glad to see 
in advance of reoent years—have been made at this 
school:—Fnll cnrriculum, 17 : partial entries, 27 ; dental 
students, 1; University of London course, 7. 


Dublin Death-rate. 

In the Dublin registration area the deaths registered 
dating tbe week ending October 12th, 1901, represenc an 
annn^ death-rate of mortality of 20'3 in every 1,000 of 
tbe population. In fourteen cases the cause of death 
was uuoertifled, there being no medical attendant in 
tbe last illness; 63 children under five years of age died 
dating the week. The great majority of these deaths 
were due to tbe filthy condition of the tenement houses 
of the city, the landlords of which appear callous not 
only to the comfort and health, bnt even to the livee of 
the poor who occupy their filthy houses. 

Boyal College of FhyslcianB of Ireland. 

Thb annual stated meeting of the Boyal College of 
Physicians was held on Friday, October 18th, for the 
purpose of electing the officers of the College, the 
examiners, and balloting for candidates for Fellowships. 
William Arthur Winter, B.A.,M.D.. -was elected a Fellow 
of the College: Sir Christopher J. Nixon was re-elected 
President, and Mr. J. M. Bedmond Vice-President. 
The following elections were also made :—Censors: Dr. 
B^mond, Dr. O'Carroll, Dr. E. H. Tweedy, Dr. Langford 
Symee. Additional Examiners to take &e place of an 
absent Censor—Medicine: Dr. Lennon; Medical Juris- 
prudence and Hygiene: Dr. S. T.Gordon; Midwifery: Dr 



MEDICAL NLWj^. 


Thb Mxdical Pbkss. 453 


Oct. 23, 1901. 


Jellett Examiners in Midwifery : Dr. Glenn, Dr. Wilson. 
Examiners, in addition to Censors, under the Conjoint 
Scheme — Biology : Dr. CoegraTe; Chemistry and 
Physics: Dr Bewley, Dr. Lapper j Materia Medica and 
Pharmacy: Dr. Falkiner, Dr. Drury •, Physiology; Dr. 
Earl; Pathology: Dr. O'Sullivan; Medicine: Dr. Cole¬ 
man. Dr. Peacooke; Hygiene and Forensic Medicine; 
Dr. Montgomery. College Examiners for the Conjoint 
Preliminarv Examination—Langn^ree: Mr. WiQiam 
Kennedy, P.T.C.D.; Science: Mr. W. E. Thrift, P.T.C.D. 
Examiners for the Conjoint Diploma in Pnblio Health 
—Meteorology; Dr. Falkiner; Hygiene : Dr. Bewley j 
Chemistry; Dr. Lapper. Bepresentatives on the Com¬ 
mittee of Management under the Conjoint Scheme—Dr. 
Finny, Sir J. W. Moore, Dr. Craig. Bepresentative of 
the College on the General Medii^ Council—Dr. Att- 
hill. Treasurer—Dr. Atthill. E^:iBtrar—Dr. Craig. 
Librarian—Mr. B. G. J. Phelps. 

A siaiooB outbreak of t^hoidfover is raging in the 
East Northumberland mining districts, many hundreds 
of cases being under treatment. 

At Partick, N.B., upwards of five hundred perrons 
hare been attroked with grave diarrhma and vomiting, 
consequent, it is believed, on the consumption of con¬ 
taminated milk. 

Zymotic Disease in London. 

On Monday morning 175 patients suffering from small¬ 
pox were under treatment in the hospitals of the M.A.B. 
The daily increment of oases remain about the same. Of 
the 6,106 other patients, 3,287 are suffering from scarlet 
fever, 1,523 from diphtheria, and 274 from typhoid. 

The Bogus Doctor Commlttod. 

Absolak W. Hkad, 63, who stands charged with 
manslaughter by gross and improper treatment, he 
having falsely represented himself to be a medicsl man, 
has been duly committed for trial. 

Victoria Dnlvarslty Fellowships. 

VicroBiA University Fellowships in Medicine, of the 
value of ^eiOO each, have been awarded to E. N. Con- 
Jiffe, M.B., Ch.B., Owens C<dlege, and G. W. Gelderd, 
M.B., Ch.B., University College, both of whom ^ 
undertaking research work in medical subjects during 
the coming year. 

C?oiilotnt Examinations in Ireland by the Boysl College 
of Physicians and Boyal College of Bnrgeons. 
Candidatbb have passed the Preliminary Examination 
aa undemoted 

Honours in order of Merit.—W. B. M. Orr, C. W. 
Greene, W. T. M. Browne, J. E. Hogan. (R. A. Barbour 
and A. C. Taylor, EuglauA) 

Pars, Alphabetically.—F. G. AUao, N. Allann, D. 
Auderson, J. J. Beeley, E. G. Carroll, L. Clifford, And. 
Cullen, E. M. Donovan, A. J. Faulkner. P. Foran, J. 
Gleeron, J. Halton, M. D. Healy, A. Hogan, G. M. 
Looghnan, J. Madden, T. N. Massey, W. S. L. Moor¬ 
head, C> M. Murphy, J. H. MoCrea, Jas. O'Brien, T. T. 
O’Farrell, W. Ogilvy, H. Pentland, W. G. G. Quinn, W. 
H. Soady, M. Walter?, P. I. Wigoder. 

The following candidates have passed the First Pro* 
fessional Examination:—(a) In All Subjects.—M. J. 
Ahem, C. W. N. Anderson, J. B. Dwyer, G. H. Gal¬ 
lagher, and D. T. O’Flynu. (b) Complete the Examina¬ 
tion : Miss H. O’D. M. Beamish, J. W. Bell, C. J. D. 
Be^io, B. J. Bonis, G. H. Caldwell, B. Caloan, P. M. 
Carroll, J. Daniel. O. S. Delsny, M. J. C. Kennedy, G. H. 
Kinmonth, C. H. Lambert, B. Martin, P. Mnllsny, E. C. 
MacDermot, J. J. McNeils, J. O’Donnell, J. M. J. Bhati- 
gan, F. J. Strahan, W. J. Tobin, N. B. Tlsshur, C. B. 
Wallace, andThos. Young. 

The Royal University of Ireland. 

Tax Examiners have recommended that the following 
candidates be adjudged to have passed the third exa¬ 
mination in medicine:— 

Upper Pass: *LHy A. Baker, Cath. Univ. Sob. Med.; 
Daniel J. Boyle, Oath. Univ. Sob. Med.; *Patriok 
Dwyer, Cath. Univ. Sob. Med.; Michael F. Farrell, 
Cath. Univ. 8^. Med.; *Duiiel Gillespie, Queen’s CoL, 
Self.; James M. A. Holmes, Queen’s Col., Belf.; 
*Thoma8 Lyle, Qneen’s Col., Belf.; *Joeeph 0. 


McPherson, Queen's Col., Belf.; *JameB N. Meenan, Cath. 
Univ. Soh. Med.; *James H. Moore, Queen’s Col., Belf. 

Those marked with an asterisk may present them¬ 
selves for the farther examination for boaours. 

Pass; Arthur P. Barry, Cath. Univ., Sch, Med.; 
Christopher Baylur, Queen’s Col., Cork; Charles J. 
Boucher, Queen’s Col.. Belf; Michael Cagney, Queen’s 
Col., Cork; James Campbell, Paeen's CoL, Belf.; 
Perewin T. Crymble, Qaeen’s Col., Belf. : Lillie E. 
Dano, Qneen’s Col., Belf.; Maurice FitzGerald, Cath. 
Univ. Soh. Med.; Dudley Forde, Qneen’s CoL, Gal.; 
Marie E. Hayes, Cath. Univ. Sob. Med.; Jacob I. Jaffe, 
Queen’s CoL, Cork; Edward B. Kenny, Cath. Univ. 
^b. Med.: Charles G. Lowry, Queen’s CoL, Belf.; James 
F. McDermott, Qaeen’s CoL, Cork; Daniel McGrath, 
Qaeen’s CoL, Belf.; Joseph C. MaoHugb, Cath. Univ. 
Sch. Med.; Bichard G. Meredith, Cath. Univ, Sch. 
Med.; William Minfdrd, B A., Qaeen’s CoL, Belf.; John 
W. Pitt, Queen’s CoL, Belf.; Jane E. Reynolds, Queen’s 
CoL, Cork ; Daniel J. Boantree, Cath. Univ. Sch. Med.; 
Francis C. Sampson, Cath. Univ. Soh. Med.; Mary E. 
Simms, Queen’s CoL, Belf., William A. Simpson, Qaeen’s 
Col., Gal. ; John Thompson, Queen’s CoL, Belf.; Cecil 
B. F. Tivy, Queen's Col., Cork; David H. Vickery, 
Cath. Univ.. ^h. Med.; Thomas Walsh, B.A., Qaeen’s 
Col., Gal.; James E. Wilson, Queen’s Col., Belf. 

Boyal College of Surgeons In Ireland. 

Thx following candidates, having passed the necessary 
examinabion, have been admitted FeUows of the College: 
Mr. J. M. Falkiner (Assam, India), Mr. G. A. Qanton 
(London), Mr. W. H. Langley (Nigeria, W. Africa), Mr. 
J. B. Maonamara (Assam, India). 

Boyal College of Sturgeons, Edinbargh. 

At the annual meeting, on the 16th inst.. Dr. John 
Halliday Croom was elec^ President for the easuing 
year. "The Victoria Jubilee Liston Prize" of XlOO, 
founded by His Excellenoy the late Dr. Robert Halliday 
Gnnning, of Bio de Janeiro and Edinbargh, for the 
greatest benefit done to practical snrgeir by any Fellow 
or Licentiate of the College daring the quadrennial 
period ending June 20lh, 1901, was awarded to Francis 
Mitchell CaM, F.B.C.S.Edin., Edinburgh. 

The Surgical Essay Prize of 100 guineas offered by 
the' College for an original nnpublisbed essay on surgery 
in any of its branches, on anatomy, physiology, thera¬ 
peutics, or pathology, in their relations to surgery, was 
awarded to James Veitch Paterson, F.B.C.S.Edin., the 
title of whose essay was " The Lymph Flow through the 
Eyeball." 

The following gentlemen, having passed the requisite 
exsminationa, were admitted Fellows of the College^ 
Francis Cublwa Rogers, L.B.C.S.E., James Adam Dick, 

H. D., Clement Somerton Clark, M.B., Ch B., Edwin 
Zembabel Davies, M B., L.B.C.S.E., William Henry de 
Silva, M.B., C.M., John Bobsrt Foster, M.B., C.M., 
Andrew Gibson, M.B., Ch.B., Sampson John Bodger 
Greville, L.B.C S.E , David Heron, L B C.9.E , William 
Llewelyn Jones, M.D., John Stuart Shepherd Lumsden, 
M.B., C.M., William John Orr, M.B., C.M., Ernest John 
Peiil, M,B., Ch.B., Bertram Croesfield Stevens, M.D., 
M.B.C.8.EDg., and William Young, M.D. 

Society of Apothecaries of London. 

Thi following caodidates passed in : — 

Snigery.—C. E. C. Child (Section II.), G. 6. Dixon 
(Sections I. and II.), P. J. FitzGerald. I. Griflich (Sec¬ 
tion I.), W. B. Hi«rrie (Section I.), D. Morrow (Sections 

I. and II.), W. Parker (Section I.). 

Medicine.—D. £. Lockwool (Section II.), E. E. 
Na^^iar (Sections I. and If.), W. Parker (Sections 1. and 
II.), F. M. Payne (Section II.). 

Forensic Medicine.—E. C. Curtis, B. Gillett, £. E. 
Naggiar. 

Midwifery.—T. J. M. Clapperton, A. F. Heald, P. 8. 
Hopkins, H. Johnson, G. F. G. De lAnbenque, T. O. 
Miles, W. Parker, H. Bichardson, C. W. Smith, A. 
Tamer. 

The diploma of the Society was granted to the follow¬ 
ing candidates, entitling them to practise medicin?, 
surgery, and midwifery:—C. E. C. Child, G. B.Dixon, 
P. J. FitzGerald, D. Morrow, E. E. Naggiar, and H. 
Biobardaon. 


Di 





464 Thi Midioal Pbsqs. 


NOnCBS TO OOBRBSPONDBNTS. Ocr. 23. lOOl 


4 tatice 0 t 0 
^[cwtspovUiaAe, ^h 0 rt 

CoBAStPOVDiVTB nqolriiiff m reply In thli oolnmn ue pu- 
tlenlnrly reqaeeted to nuke nee of a diiUnctivt liftMtwrt or 
i litiaU, and aroid the practice of aignliw themaelrea “ Beader,” 
'*Snbaoriber,” “Old Snheorfbar," Ac. Unoh oonfnaion will be 
apired by attention to tbia role. 

Oaioivax. AaTiCLBS or Lsttseb intended for publication should 
be written on one side of the paper only, and mnatbe authenticated 
with the name and addrees of the writer, not neoeaaarlly for publica¬ 
tion. but aa eridence of identity. 

BaraiMTS.—Beprinta of articles appearing in this journal can be 
had at a reduced rate, proridin; authors grire notice to the pub¬ 
lisher or printer before the type hss been distributed. This should 
be done when retnmina corrected proofs. 

Oca AtrsTsisH CoaaxspoiiDSNT's weeklr letter was receired too 
late for insertion in our present number owing to a postal 
irregularity. 

Da. F. N.—Tonr communication reached ns just as we weregoin? 
to preaa, and we were unable to make use of it. CiroumatanoeshaTe 
since ondergoue such further derelopment that your object may be 
regarded as attained. 

Da. W. A. P.—We shall not be able to arail oonelves of the M.8. 
unless it reaches us by Friday next. 

Velox.—I t is by no means a bad thtngfor a man, bun though be 
be, to have a '* fad ” to occupy his attration outride his bu^esa 
hours, even though that fad takes a statistical form, promptingbim 
to compute highly imaging quantities. One of these irrepressible 
atatiatioians amnsed himself by calculating the amount of coal sus¬ 
pended over London in the form of smoke, which he put at the 
Csbulona amount of three (or thirty) thousand tons, we are not sure 
which. Another (posribly the same) estimated that Glasgow saved 
£36,000 a year In soap since a supply of soft water has been rendered 
available. 8o long as these figures are not taken too seriously no 
bum is done, and sometimee, by exciting hostile criticism, UMul 
information is gained thereby. 

ALABONE AND HIS FBETENSIONS. ' 

ICa. ALSBOaa baa not thought fit to avail himself of our offer to 
make known the details of bis mncb-Tsunted treatment, nor has be 
given a favourable consideration to our angge'tion to have it tried 
at the Brompton HospitaL This latter foct is the subject of a letter 
to The Timet or Dr. J. E. Pollock, who suggests that Alabone should 
“ hitwg up his banner alongside the pill merchants,” as he declines 
to submit his pretensions to scientlno oontrol. Tbs carious thing 
is that a journal of the standing of The Time* should have allowed 
ite columns to be taken advantage of to advertise aa egregions 
quack. 

yxsAX.—We cannot tolerate personalities of the virulent tvpe 
contained in your oommunication, eepecia^ly under a pseudonym, 
although we should hesitate to give them publicity even if you were 
wllUag to append your signature. 

A HANDBOOK ON ShlALL-POZ. 

Miss FLoasHCC Wntra has just published a little volume on 
small-pox, which is intended to serve as a guide to its recognition 
and treatment. There is a chapter on vaccination, in which its 
valne is impa^^Iy discnsaed. Such a work oannot but prove use¬ 
ful at the present juncture, end as It only costs sixpence, it should 
find its way into the hoa>eholda of those who are likely to profit by 
the informstlon it contains. 


^«ting0 of the gocietica. 

WsDSKBDST, Oct. 23aD. 

DiBicaTOLOoicai. Socinr or Oaxar Banais axn Iaai.4XD (30> 
Hanover Square, W,).—4.30 p.m. Informal Exhtbitien of Cases- 
6 p.m. Meeting. 

HoxTSBias SociETT (London Institution, Finsbury Circus, E.C.). 
— 8.30 p.m. Clinical Evening. 

MsDicai. Graduiteb* Collxob asd Poltcliric ChenieB 
Street, W.C.).- 4p.m. Hr. Hutchlnaoni Clinique. (Surgica].) 

LoRdok Thboat Hospital (204, Great Portland Street, W.).— 
5 p.m. Dr. Stoker: Chronic Glandular Diseaaea of Naso-Pharynx. 
(Poet-Graduate Course,) 

FaiDAT, Oct. 25th, 

Clirical Societt or Lordor (20, Hanever Square, W.).—8 p.m. 
Exhibition of Clinical Casee followed by Diacuiaion. Patienta will 
be in attendance from 8 p.m. to 9 p.m. 

Medical Obaduates’ Colleob ard Poltcliric (SS, Cbenies 
Stieet, W.C.).—4 p.m. Dr. StClair Thomson: Clinique. ^(Throat.) 

Fbidat, Nov. Ibt. 

West Lordor Medico-Chuuboical Soarrr.—8 30 p.m. Ordi¬ 
nary meetiug in the Society's rooms. West London Hospital. 


Borrbt, W. P Victor. M.D., M.8.Lond., F.B.C.S.ERg., M.B.C.P., 
Phy^lan Aoooucheur to the St. Pimcias and No^em Dis- 
pecaary. 

Davis, Habbt.M B.C.S., L.B.C.P., L.S. A., D.P.H.Cutab., Medical 
Officer of Health for CoUington, ComwalL 


HoDOSOR, J. P., M.B., Ch.B.Vict, Besident Medical Officer of the 
Halifax Union Poor-law HospitaL 

MiTHBBOB, Bodxricb U., M.D., M.S EJin., Honorary Aaaiitant 
Surgeon to Noble's Isle of Man Hospital. 

PAaaoRB, John HiBaxaT, M.B., 6.8., B.So Lond., F.B.C.S., Cura¬ 
tor and Librarian to the Boyal London Ophthalmic HospitaL 

Fxoox, Epwasd VERHOH.L.B.C.P.Lond.,M.B.C.8..Medical Officer 
of Health for Briton Fenr, Olamorganshirs. 

BODoxae, B. Cbaio, M.B.C.S.. L.B.C.P.Lond., Honora^ Medical 
Officer to the Burnley Victoria HMpital, vice Dr. James 
Msekenzie, resigned. 

White, Mauricb Forbes, H.B.. Cb.B.Aberd., Besidrat Surgeon to 
the Birmingham General Dispensary. 


Iarandt0. 


Birmingham City Asylum.—Junior Assistant Medical Officer, ui 
uiarried. Salary £150 a year, with hoard, apartmenta, and 
washing. 

Birmingham General Dispensary.- Berident Surgeon, unmarried. 
Salan £150 per annum, with rooms, fire, tights, and attendance. 

Bristol General Hoepital —Assistant House Burgeon. Salary £70 
per aunnm, with board, reridenoe, Ac. Applications to tbs 
SMretai7. 

Cbel«ea Hospital for Women, Fulham Boad, 8.W.—Begistrar. 
Honorarium, 20 gnineaa per annum. 

Cornwall County Asylum, Bodmin.—Junior Assistant Medical 
Officer, unmarried. Salary £120, rising to £150, with board, 
apartments, laundry, Ao. 

Derby County Asylum, Miekleover.—Junior Assistant Medical 
Officer. Salary £ 110, rising to £130 per annum, with apartments, 
board, wasbiog, and attendance, 

Dublio, Trinity College.—King’s Profeasorahin of the Institute of 
Medicine (Pbyriology and Histology) in tne School of Physic. 

Essex County Asylum. Brentwood —Junior Assistant Medical 
Officer. Silary £140 per annum. Apply to the Medical 
Saperintendeot. 

Glasgow University.—Additional Examlnerships in Medicine and 
Science, with special reference to Chemistoy, Mat«la Medics, 
Zoology, Practice of Mediciue and Surgery, Partioulara as to 
dates, emolument, Ac., on reference to our advertiring columns. 

Hospital for Consumption and Diseases of the Chest, Brompton. 
— Berident Medical Officer. Salary £200 per annum, with board 
and reridenoe. 

HoeplUl for Sick Children, Orest Ormond Street, Lmdon, W.C.— 
HooseSutgeon, unmarried, for rix months. Salary £20, washing 
allowance ^ lOs., with board and residence; also Surgeon 
Dentist. 

Tw giiam Inflrmsrv.—Senior House Surgeon wanted. Salary £100 
per annum, with reridenoe, board, and washing. Applications 
to the Secretary, 74, King Street, South Shields, 

Morpeth Dispensary.—House Surgeon, unmarried. Salary £120 
per annum, with rooms, ooals, gas, and attendance. 

Plymouth forongh Asylum.— Assistant Medical Officer, unmarried. 
Salary £150 per annum, rising to £800, with apartments, board, 
and waahin^ 

Pretoria Civil Hospital, Transvaal.—Berident Asristant Medical 
Officer for three years, unmtrried. Salary £300, £350, and £tOOL 
with board, lodgmg, and washing. Allowance of £60 on arrival 
In Pretoria for travelling expenses. 

Boyal National Hospital for CoDsnmption and Diseaaea of the Chest, 
Ventnor.—Berident Medical Officer, unmarried. Salary £150 
per annum, with board and lodging. 

Boyal Victoria Hospital, Belfast,. -Medical Superintendent. Salary 
per annum, with board and apartments. 

York County Hospital. —Hoiiso Durgeon. Salary £100 per annum, 
with board, reridenoe and watblng 

York Dispensary. - Berident Medicstl Officer, unmarried. Salary 
£110 a year, with board, lodgiog, and attendance. 


CoLLCUTT.—On OoL 14th, at 2, St. Peter’s Place, Brighton, the wife 
of Arthur M. Collcntt, M.B., of a daughter. 

PxasBOuax.—On Oct. 13tb, at Chipohase, Hadley Wood, the wife of 
Plank Pershonse, M.B.C.S., L.B.C.P.Lond., of a son. 

Bat. - On Oct 11th, at 4A The Crescent, Salford, the wife of John 
Howson Bay, Ch.M., F.B.O.B., of a son. 


JftarrisgM. 

BaowR— Puller,—O d Oct 16th, at St. Helen's Ghnrch. Abingdon, 
Berks, by the Bev. H. T. Maitland, M.A., Thomas Henry wown, 
M.A., M.B., B.C.Camb., of Ham^eo-in-Arden, Warwickshire, 
to Isabel Mary, eldest daughter of Bicbard Pullen. 

OiLLESPix—K eddie.- On Oct, 17tb, sttbe Windsor Hotel Olasrow, 
by tbe Very Bev, John Pagan, D.D., 8. A. D. Oillespie, M B., 
C.M.Bd., of Dalbeattie, to Mary 8ybilla, eldest daughter cf D. B. 
Keddie, of Kelvinside, Glasgow. 

Harcoce Lbuchabs.— On Oct 15tb. at tbe parish church,Islewortb, 
by the Rev. J. H. Cbampton McGill, George Charles Hancock, 
M.B.C.8., L.B.C.P.,D.P.^Lond., St Maigaret’s, Twickenham, 
to Effle, only daughter of John Walter Leuchars, of The Chest¬ 
nuts, St Maigaret i, Twickenham, and of Durban, Natal 


^e^h0. 

Behthah.—O n Oct 15tb, at Ellerslie, Willesden, Bobert t^*****", 
M.D., aged 81 years. 

Dalsell. —On Sept, filet 4t tbe Gordon Memorial Misaion, South 
Africa, Bev. James Dalsell, B.D., M.B., C.M., medical mission¬ 
ary, aged 60. _ 

LiviHOSTORB. - On Oct. 4Ui, at 17, Hill Stzeet(WlthawAAnarkahire, 
Jamea Livingstone, M.b., L.iLQ.B,E., J.P., aged 67 years. 


ms and i^irntlar. 



<«SALUS POPULI 8UFBEMA LEX.” 


VoL. CXXIII. WEDNESDAY, OCTOBEB 3 0, 1901, No. 18. 


Jarifi CUttiral %uinnB. 

THE TREATMENT OF GASTRIC 
ULCER. 

Bj Dr. ROBIN, 

?lofeHor of Sfedioine at the Tacnl^ of HedioiiM of Faria. 

Fob many years CruTeilhier’s classical work was 
the basis of the rational treatment of gastric ulcer; 
but recent Tiews on the causation of this lesion have 
nised doubts in the minds of many experienced 
practitioners as to the value of pnrely medical treat* 
ment. Later on, surgeons, who at first only inter* 
vened in the event of complications such as per¬ 
foration and hemorrhage, beran to consider 
themselves justified in proposing the radical cure of 
gastric ulcer. This operation is certmnly called for 
in certain exceptional oases, but as a general rule 
the ulcer is perroctiy amenable to medioaJ treatment. 

Iiet us consider first of all the pathological 
anatomy of gastric ulcer. The ulcer is invariably 
sitnatea in one or other of certain special points to 
the exclusion of the rest of the organ, viz., the pre* 
pyloric region, the lesser curvature, and the posterior 
wall, specially in the inferior thii^ of the stomach, 
that is to say, the area where the food sojourns 
during digestion. The ulcer is generally single, 
although according to Brinton more than one ulcer 
is met with about once in every sixty eases. In my 
hospital experience, however, during the last ten 
years, in which 200 autopsies were made, I have 
never once met with a double ulcer. The ulcer is 
generally round, sometimes oval, and varies in dimen¬ 
sions between a sixpenny-bit and a crown. The edges 
are clean cut as by a knife; the erosion has the form 
of a truncated cone, invading successively the mucous 
membrane, the Bub*muoons, muscular and cellular 
coats; the last named is formed by the serous mem¬ 
brane, or, if perforation exists, by a neighbouring 
adherent oi^^. The ulcer heals by the production 
of cicatrici^ tissue devoid of glwds. It is ex¬ 
tremely liable to recurrence. 

Simple ulcer of the stomach appears to end in 
recovery in 90 per cent, of the cases. When of small 
dimensions the cicatrix does not cause much incon¬ 
venience, but when it affects a semilunar form 
occupying' the small curve and invading the posterior 
and anterior walls the contraction of the cicatrix is 
eometimes so marked, that the stomach may be 
divided into two compartments and has an hour-^lass 
ebape, to which the name of gastric binoculation ” 
has been given. 

When we ulcer is situated in one of the folds of 
the pylorus it provokes painful contractions, 
stenosis is the result with the immediate consequence 
of stasis of the contents of the stomach with conse¬ 
quent prolonged contact of the gastric juice, which 
has for result the further progn:e8B of the erosion. 


This condition is comparatively rare (1 to 3 per oent. of 
the cases). The treatment of this form lies in suigioal 
intervention, which alone can afford reli^. 

Let us pass now to the pathologic^ histology. A 
certain number of facts are now well-establish^ but 
^ are not ^rood as to their significance. The most 
important question is, however, easy enough to solve 
if we investigate the condition not only in the nmgh- 
bourhood of the ulcer, but over the entire surface of 
the organ. It is generally admitted that the ulcer is 
always associated with a pathological condition of 
the mucora membrane as a whole. The lesions of 
hyperpeptic gastritis are found (Hayem) as well as 
th(^ of chronic gastritis. In a word, all possible 
varieties of acute and chronic gastritis are present 
It is evident that these lesions are anterior to the 
formation of the ulcer. It is the chronic form which 
is first in date, and it exiats tn every case of eimple 
ulcer. 

Let ns now discuss the mtiology as bearing on the 
therapeutical indications. Simple ulcer of the 
stomach is, by no means, a rare Section. It is met 
with, on an average, once in every 100 autopsies. 
Females are more frequently affect^ than malM in 
the proportion of li to 1; its maximum frequency 
is between 30 to 40 years of age for man and ^to m 
for woman. In respect of causation, the influence of 
certain climates and certain callings, such as cooks, 
polishers. &c., have been incriminated, but as a 
matter of fact they go for little. The malady may 
attack indifferently individuals belonging to every 
class of society. The only cause whi^ by its con¬ 
stancy appears to possess a real value is hypersthenic 
and acid gastritis. It may safely be affirmed that 
there does not exist a single case of simple ulcer which 
has not been preceded by a period of dyspepsia 
and gastritis. There are two constant and well- 
estabushed facts: one of clinical chemistry, 
viz., the presence of an excess of hydrochloric 
acid in the gastric juice; the other, anatomo- 
pathological the existence of chronic gastric 
lesions in various stages of development I need 
only briefly refer to some of the numerous theories 
advanced by authors to explain the production of 
ulcer, as none of them al^Iutely fit in with the 
clinical facts : the vascular theory (Hirscbell) ad¬ 
mitted by many; thrombosis and embolism 
(Godinier); venous stasis (Rokitansky); hamor- 
rhagio infarction (Rindfleisch); and, lastly, the 
infective theory, which, although accepted by many, 
is not admitted by the majority of specialists 

The onset of simple ulcer of the stomach is generally 
as follows: a man suffers from his stomach tor a very 
long time (dyspepsia), he eats with a good appetite 
and digests tolerably well, but, curiously enough, be 
loses flesh and has a cachectic appearance. Imme¬ 
diately after meals the patient experiences a sensa¬ 
tion of comfort, but in the course of from three to 
five hours he is seized with pain in the region of the 




456 Th« lf»DicAL PB188._ORIGINAL COMMUNICATIONS. 


Btoznach. Sooner or later the scene cbanTOs, the 
patient begins to suffer immediatdy the food comes 
m contact with the mucous membrane of the 
stomach, whereas previously, there was an interval 
of comfort of three or four hours after eating. Con* 
seqoentl^ when you find the ingestion of food pro¬ 
voking immediate pain in a patient with a history 
given as above you may begin to think seriously of 
ulcer. Pain on eating is one of its first manifesta¬ 
tions. The dyspeptic symptoms become aggravated, 
the general health is affected, and the patient begins 
to vomit, at first food, and ultimately blood. Such 
may be regarded in a general way as the oourse of 
gastric ulcer. The fundamental symptoms which 
make up the clinical picture of ulcer are conse¬ 
quently three in number: pain, vomiting, and 
hemorrhage. We will pass them successively in 
review. 

Patn.—I have gust told you that its most important 
feature is its Ming provoked by the ingestion 
of food. But people attacked with ulcer suffer all 
the time, they are never one hour free from pain, 
more or less. Certain foods provoke this pain much 
more than others. All solids, for instance, acids, 
sometimes pastry, or fatty matter, this, however, 
varies with almost every patient. 

The second symptom is vomiting, which generally 
comes on three or four hours after the repast. It is 
exceedingly acid, irritates the throat, puts the teeth 
on edge, and the patients say that it has the taste 
of vineg^. Vomiting, however, is not invariably 
present, but its absence is exceptional. 

The third symptom is haemorrhage. This may 
be observed in three forms: grave hmmorrhage, 
moderate hsmorrhage, and slight htemorrhage. 
In the first form the patient is seized suddenly 
with a very distressing sensation in the epigastrium, 
turns pale and appears to be about to faint, 
then he vomits a very large quantity of blood. 
This hsemorrhage may prove immediately fatal, but 
according to the statistics of Salomon, of New York, 
this termination is only observed in three or four 
per cent, of the cases. Moderate hsemorrhage, which 
18 always of grave significance, is never fat^ unless 
repeats frequently. The patient experiences an 
uneasy sensation at the pit of the stomach, turns 
ale, has vertigo, hiccough, and suddenly vomits 
_ lood. In certain cases the patient retains the blo^ 
in his stomach, which, after digestion, is eliminated 
by the intestine. Consequently, whenever you see 
a patient suffering from ulcer, out in whom hsma- 
temesis is absent, turning suddenly pale and present¬ 
ing the aspect of acute anssmia, do not forget to ask 
him if his stools are black; he will generally answer 
in the affirmative. 

When you have examined the four orders of 
phenomena—pain, vomiting, btemorrhage, and dys¬ 
pepsia—you must next look for the physical signs. 
These are very important. 

We will now endeavour to apply to the treatment 
the various details mentioned aMve. You may have 
asked yourselves why I chose this subject since there 
exists the well-known classical treatment which 
Cruveilhier instituted for the first time in 1830, and 
which since then has been in daily use. It has 
indeed become so generally employed that it is 
almost impossible to-day to separate the idea of 
milk diet from ulcer of the stomach. It must be 
admitted that a method which during seventy years 
has resisted every attack and received the support 
of several generations of medical practitioners 
necessarily presses a real and indisputable value. 
Therefore, like all my eonfr'erea, I approve of it, 
employ it, and inculcate it. But from extensive ex¬ 
perience I have arrived at the conclusion that it is 
advantageous to precede the milk regime by a pre¬ 
liminary and preparatory treatment not comprised 


Oct. 1901 . 

in the original method. That is a point which 
renders this treatment worthy of our attention. I 
shall also have to discuss with you the use of certain 
remedies which have been proposed during the last 
few years as substitutes tor milk diet. I^istlf, 1 
sh^ have to discuss the important question now 
quite the order of the day, that of surgioil inter¬ 
vention in ulcer of the stomach. 

Here, in a word, is the treatment actually em¬ 
ployed. The fundamental indications on which it 
rests are tour in number. 

(a) Prophylaxis. We know to-day that simple 
ulcer is consequent upon hypersthenic gastritis, with 
excess of hydrochloric acid. 

(5) When yon meet with a case of simple ulcer, 
in which the diagnosis is dear, the first indication is 
to give the stomach absolute rest, in order to allow 
the h^ing of the ulcer on the one hand, and to 
diminish, on the other, all exmtement which might 
provoke the secretion of gastric juice (H Cl.). I&t 
of the stomach is consequently an essential factor, 
but at the same time the patient must be nourished 
sufficiently by appropriate means. 

(c) Treatment of secondary symptoms. 

(<2} Belief of the numerous complications which 
appear in the course of tiie affection. 

The first indication, as I have said, is functional 
rest. Formerly the milk treatment was commraoed 
immediately the existence of gastric ulcer was 
recognised. Well, the experience I have acquired in 
the treatment of the malady, and the results ob¬ 
tained by Fournier and Gros, of Lyons, during the 
last few years, have proved the necessity of putting 
the patients through a preparatory treatment, con¬ 
sisting in absolute rest, before putting them on a 
milk diet. The following is the treatment I adopt 
to fulfil this indication:—The patient is kept in bed; 
a towel steeped in hot water and covered with oiled 
silk and cotton wool is placed over the epi^trinm, 
and kept In position by means of a flannel band^<»; 
no nourishment is given by the mouth, not even milk 
or water. Each day the patient is fipven four enemata 
composed of two eggs b^ten up with two spoonfuls 
of peptone, thirty grmns of salt, a few drops of 
laudanum, and three ounces of glucose (20 per 
cent.). The whole enema should measure about six 
fluid ounces. Two other enemata of simple warm 
water are given during the day to supply the organism 
with the necessary amount of liquid. 

To accustom the patients to this treatment 
it is well to increase the number of enemata 
gradually until complete tolerance is obtained. 
Where intolerance is present (which happens in about 
one of every fifteen cases according to my own ex¬ 
perience). we must endeavour to overcome it by in¬ 
creasing the laudanum to twelve or fifteen drops, or 
by suppressing the salt and the peptone, which 
seem to be the substances which usually provoke the 
intolerance. 

According to MM. Fournier and Gros the treatment 
should be continued for a fortnigbt^, and in some 
cases for a month, but personally I have never 
found it necessary in my own cases to prolong the 
period of functional rest beyond twelve days at the 
outside, and frequently only for three or four days. 
The signs by which we may know that the rest cure 
should be amindonect, are the following:—Persistent 
rectsd intolerance, progressive enfeeblement of the 
patient, and when, in spite of the treatment, the 
cardinal symptoms of the ulcer, which I have already 
mentioned, persist. 

I need only mention sn paeeant the alternative for 
the rectal method of intr^ucing food, viz., the sub¬ 
cutaneous method, a suggestion which ^ve rise to a 
highly instructive debate at the recent Congress held 
in Paris, and the conclusions arrived, at were that 



ORIGINAL COMMUNICATIONS. Thi Mwical Paiee. 457 


OCT. 30, 1901. 

the snbctitaneous method wae not practicable and 
frequently gave rise to untoward eymptome. Per¬ 
sonally, judging from two or three triale I have given 
this method, the results were not such as to en¬ 
courage me to advise you to adopt it. 

Let us now discuss what takes place under the 
influence of the rest cure. In the majority of cases 
the symptoms are appeased, the gastric pain and 
the epigastric tenderness disappear, and the loss of 
weight is checked. 

The rest cure having come to an end, the patient 
should be put on a milk diet, gradually increasing 
the daily amount until we have reached four quarts. 
This regime should be continued nut less than six 
months. At the expiration of this period a mixed 
diet may be ordered for a fortnight, consisting of 
milk foods prepared with tapioca, arrowroot, rice, 
&o., and a few vegetables. After this period of 
transition the milk is suppressed and meat and fish 
ordered, as well as eggs, vegetables, and cooked 
fruit. 

Such are the fundamental indications of what I 
call the methodical treatment of simple gastric ulcer. 
The treatment covers seven or eight months. In the 
majority of ca^es the patients are completely cured, 
they suffer no more from the stomach, their general 
condition is excellent, and, in fact, better than before 
the malady. There are, however, a certain propor¬ 
tion of patients, five out of twenty, who will 
require a complementary treatment. These patients 
may be divided into two distinct categories; those 
who present a certain degree of nervous depression 
bordering on neurasthenia, and patients in whom 
signs of anasmia predominate. The treatment of 
these two groxips of patients is quite different. For 
those who suffer from anmmia the best medicine is 
certainly iron, and the best nreparation is perchloride 
of iron administered in pills of two grains, taken at 
meal time?. The neurasthenic patiente should be 
treated with preparations of arsenic. I used 
to prescribe with success intra-rectal injections 
of arsenic, but since Gautier’s discovery of caco- 
dylate of soda I employ this i>re- 
paration in subcutaneous injec¬ 
tions in doses of one grain daily 
for eight consecutive days, fol¬ 
lowed by an equal number of 
days of repose, and continued 
during fortydays.Thecacodyla'e 
of soda gives remarkable and 
ever unhoped-for results, in the 
gmvest cases accompanied by 
cachexia, and by its employment 
surgical intervention can some¬ 
times be obviated. 

\Ve will now briefly review 
certain methods of treatment re¬ 
cently proposed as a sxibstitute to 
the method of Cruveilhier. The 
first method is that recommended 
by Fleiner, and it is highly 
thought of in Germany. It con¬ 
sists in the administration of 
sub-nitrate of bismuth in the 
following way : a suitable quan¬ 
tity of this substance is intro¬ 
duced into the stomach by 
means of a tube, and left in con¬ 
tact with the stoniivch for a cer¬ 
tain time, the position of the 
patient being changed from time 
to time so as to ensure the con¬ 
tact of the bismuth with the gas¬ 
tric ulcer, after which the bismuth 
is syphoned off. The quantity of 
the powder employed by the parti¬ 


sans of this method is sometimes enormous; the 
most moderate employ six drachms, while others, 
Herschill, for instance, use six or seven ounces. I 
am unable to recommend this treatment on account 
of the risk to which the patients are exposed by the 
introduction of a tube into the stomacn. We may 
dismiss in a word or two the practice of washing out 
the stomach with a solution of nitrate of silver 
(Boards), with perchloride of iron (Bourget, of 
Lausanne), methods which cannot be recommended 
for the same reason. 

The employment of bicarbonate of soda in large 
doses has been proposed. Here no instrument is 
required and the principle seems rational. From 
two drachms to two ounces of bicarbonate of soda 
are ingested daily. This method is also illusory, 
because, as was proved by Claude Bernard, alkalies 
excite the secretion of nydrochloric acid. I am 
therefore opposed to the employment of bicarbonate 
of soda in the treatment of simple gastric ulcer. 

I have still two other points to deal with before 
terminating this study: The treatment of predomi¬ 
nating symptoms, pain, vomiting, constipation, or 
diarrhcca on the one hand, and that of complications 
of simple ulcer, with special regard to hccmatemesis 
on the other. These will be the subject of a future 
lecture. 


SOME 

UNUSUAL GYNECOLOGICAL 
CASES, (a) 

By H. MACNAUGHTON-JONES, M.D, 
M.Ch.R.U.I., F.E.aS.Irel. 

The tumour (fig. 1) which I show was removed from 
a young lady, mt. 2*2. She had been married for two 
years aod a half at the time of operation, and had 
completed her first pregnancy at the end of the first 
year of her married life. She was brought to me by 
Dr. Disney in January, 1901, and complained of con- 



Oct. so. 1901. 


458 The Medical Press. ORIGINAL COMMUNICATIONS. 


siderable and constant pain in the left side, with 
inability to walk and dyspareunia. The catameni>t 
had been regular and normal. On examination I 
found the adnexa on the left side much enlarged, 
softened, and very sensitive. The right were not 
enlarged, but 1 could distinctly feel adhesions. I 
advised immediate operation, either exploration by 
•colpotomy or abdominal cmliotomy, the affected 
:adnexa to be dealt with either by removal or resection, 
according to circumstances. This was practically 
agreed to, but, by the advice of a distinguished 
obstetric physician who saw her immediately after 1 
did, operation was declined, and who expressed the 
hope that by rest and a course at Woodhall Spa 
none would be required. 

I did not see the patient again until July 10th, 
1901. I operated on her the next day. Pain had 
then been tor some time agonising, and she herself 
demanded operation. The condition of the right 
adnexa can 1^ judged from the specimen (fig. 1). The 
Fallopian tube was distended with pus, forming a long 
crescentic swelling an inch and a naif in diameter at 
its widest part, the surface of the tube being ad* 
herent. The right ovary, though fixed by some 
adhesions, was healthy. A large perimetric cystoma 
had formed behind the meso'salpinx, between the 
distended tube, the ovary, and the adjacent viscera. 
Mr. Targett examined the specimen for me. The 
following is the conclusion of his report:— 

The external surface of the specimen is covered 
with thin fibrous adhesions in which many miliary 
tubercles are embedded. The lumen of the tube 
is filled with thick caseous pus, and the inner sur¬ 
face is shaggy from ulceration of the mucous mem¬ 
brane. There is very little thickening of the wall of 
the tube anywhere, and in some parts it is much 
thinned by distension and ulceration. Microscopi¬ 
cal sections of the undilated uterine end of the tube 
exhibit general thickening of the mucous membrane 
and infiltration with miliary tubercles. The epithe¬ 
lial lining is for the most part intact” 

This is the second case I have had of primary 
tuberculosis of the Fallopian tube in a young woman 
otherwise in perfect health, and without any heiedi- 
tary history of tuberculous disease. The first, which 
I elsewhere reported in full (a), was complicated with 
hsmato-salpinx. The particulars of this case speak 
for themselves. The patient made an uninterrupted 
recovery. 

Cask of Lasob Hebnia following Cieliotomt.— 
Operation. 

This was the largest post-operative hernia I have 
ever seen. The drawing, which was taken from a 
photograph, gives a fairly good idea of its extent. 
When 1 saw the patient in May of the present year 
the bowel was down in a large sac, which protruded 
over the pubes, covered only by the integument (fig. 
2). A large spaoe of several inches separated the 
recti muscks and fascia. The bowel appeared to be 
adherent in parts to the parietal covering. She bad 
been subject to recurrent attacks of severe pain due 
to attacks of sub-acute peritonitis, and had to be 
confined to bed for sever^ weeks before operation. 
The old ciatrix extended from a short distance 
below the umbilicus to about two inches above the 
pubes. I did not learn until the day of the opera¬ 
tion (Sept. 2nd, 1891) that the patient had been twice 
operated upon and that on the second occasion the 
abdominal wound bad been closed without sutures, 
the parts having been brought together by adhesive 
plaster. I determined to perform the following 
operation 

The steps may be understood by the accompanying 
diagram (fig. 3). Having carefully incised the skin 

(a) “ Diseases of Women." Eighth Ediion. Fp. 622. London: 
BailU^re, Tindall, and Cox. 


(c c) in the middle line over the cicatrix, by a cautious 
dissection vertical to the bowel, which was imme¬ 
diately subjacent and in parts adherent, it was re¬ 
flected back to the extent of some three inches at 
either side (c^). Some dense fascia (b) was then ex¬ 
posed, continuous with the peritoneum and the fascia 
of the rectus (a o). This fascia also was raised and 
reflected back, the dissection including a portion of 
the rectus sheath fascia, All bleeding points fiom 
adhesions of the bowel were secured. The omentum 
and bowel were covered with a sterilised napkin 
wrung out of warm formalin solution, and mattress 
sutures were then carried from side to side in the 
following manner:—Two straight ovariotomy needles, 
each threaded with fairly strong silver wire, were 
passed from before backwards through the inner 
border of the rectus including the fascia, across the 
space intervening between the recti, and then passing 
under the dissected fascia, were brought out at coire* 
spending points on the opposite side. Six of these were 
carried alternately in the mannershown in the drawing, 
and a single strong wire was passed at the npper and 



Fia. 2.—Before operation. (From photograph.) 


lower angles of the wound. The central sutures 
were separated, and the napkin I'eadily vritbdrawn 
between them. They were then tightened, and the 
ends, twisted and cut close, were buried in the 
rectus muscle. This brought into apposition the 
rectal fascia of either side with the muscle and the 
underlying peritoneum, leaving a raised flap of 
fascia which projected for the entire length of the 
incision. Tnis was paired, made to overlap, and 
then closed with silkworm gut sutures, which were 
cut short. The skin margins were then united. 
There was no trouble whatever after the operation, 
which the patient bore remarkably well, and she has 
since left this country on a long voyage. 

^Veey Large Fibromtoma—Hysterectomy— 
Becovery. 

The patient from whom this tumour was removed 
was a multipara, eet. 50. Her last pregnancy was in 
1890. She bad never suffered any particular pain, 
and cannot date the commencement of the growth. 
She noticed an enlargement some two years since, 
but only within the last few months bad there been 
a rapid increase in size. The catamenia bad been 
irregular in occurrence and quantity, and there was 
considerable loss a few days before operation. 

On examination, a large movable semi-solid abdo¬ 
minal tumour wasfound, apparently associated with the 





Oct. 30 . 1901. 


ORIGINAL COMMUNICATIONS. 


Tus Mkdical PitBBS. 459 


uteruB.thecavity of which wasoverfive inches inlength. 
The abdomen was enlarged much beyond the size of 
that of the full term of pregnancy. I operated on 
September 12tb, the patient having a full Knowledge 

Skin ,,-Skin 



of the dangers connected with its removal. The 
enormous tumour was found free from adhesions. 



Fio. 6. 


pedicle attached it to the left broad ligament, and 
there was a separate attachment to the uterus. The 
capsule having been completely detached by a cir¬ 
cular incision, and stripped down, the tumour was 
delivered through an incision reaching from below the 
ensiform cartilage to the pubes. A broad attachment 
to the uterus was first secured, and supra-vaginal 
hysterectomy completed. The broad ligament 
p^icle was then ligatured in segments, and the 
tumour detached. After removal it was found that 
the bladder had been opened. The wound was 
closed by cat-gut sutures and a catheter retained. 
The operation lasted altogether for two hours, and 
during the last half hour subcutaneous (sub¬ 
mammary) injections of artificial serum were main¬ 
tained. The anmsthetic given was chloroform. 
There was dangerous collapse on the delivery of the 
tumour, and again towards the close of the operation. 
As there was some bleeding from the bladder, it was 
washed out at intervals with a solution containing 
thirty minims of liquid extract of supra-renal capsule. 
The tumour proved to be a solid fibro-myoma, and 
weighed 2 SI lbs. Its size and shape can be estimated 
from the accompanying drawings from photographs 
(figs. 4 and 5). The table on which the tumour rests 
measures 16 ins. by 16 ins. (The uterus and adnexa 
are not shown). 

So far, with the exception of some cystitis and pus 
in the urine, the patient has made an excellent 
recovery. 

MODERN PROGRESS IN 
SURGERY, [a) 

By WILLIAM TAYLOR, F.B.C.S.I., 

Sur^eoD to the Weath Hospital end CoDDtj DubliD Infirmary ; Sar- 

freou to Cork Street Hospital; Demonstrator of Snatomv, Bojal 

College of Sorgeonaie I< eland. 

Aftbb a few introductory remarks aud words of wel¬ 
come the lecturer commenced his addre-s with the 
SOBQEBT OF THE BbAIN, 

Some few years this was a part of the body for¬ 
bidden to the surgeon’s knife, owing chiefly to defective 
knowledge of its functione, and I may say to almost 
total ignorance of cerebral localisation. Thanks to the 
indefatigable industry and perseverance of Ferrier, 
MacEwen, Horsley, and many others this ignorance has 
been replaced by a fairly accurate knowledge of func¬ 
tion and locaUtation, with the resnlt that the soj^eon 
now no longer hesitates to open the cranium and explore 
its contents. Surgical affections, such as tumours and 
abscesses, are now early recognised, accurately localised, 
and promptly treated with almost the same precision 
and accuracy as tumours or abscesses in any other part 
of the body, and that, too, with a large measure of suo- 
oess. Nor are tumours or abscesses the only conditions 
for which the cranial cavity is explored, for it is fairly 
common to see the operation of trephining performed 
for injury causing fractnte and hsemorrhage, leering to 
compressioo of the brain—a condition almost certainly 
fatal if left untreated. Epilepsy, that dreaded condi¬ 
tion, especUlly when due to injury, may also be radic¬ 
ally dealt with by operation. 

To such an extent have the risks of operation 
diminished that exploration of the cranial cavity in 
doubtful cases, rather than leaving the patient to certain 
death, is not only soggested but actually practised with 
excelifnt results by surgeons both at home and abroad. 
Many brilliant results have been achieved by operative 
interference in cases of gun-shot wounds of the skull on 
the battle-fields in South Africa. You may have heard 
some years ago that craniectomy was the procedure 
recommended and practised for micro-cephalic idiocy, 
but rightly this operation had only a short existence. 
In these cases the whole central nervous system is 
developmentilly defective, and no operation of taking 

(n) Abstract of an Address delivered at tlie Opming of the U9th 
Session of the Meuth Hospital on Monday ^ctober 14, 1901. 





460 Th> Vbdicil Pbib8. 


ORIGINAL COMMUMICATTON^. 


Oct. 30. 1901. 


ont slices of the bones of the skali coaid possibly remedy 
that defect. There seems to me to be but one condition 
left in connection with the brain, which may in the 
distant future, when its pathology is known, become 
amenable to sorgical interference. I allude to insanity. 
Here I may mention that although the resalts of 
injuries to the spinal canal and its contents are not 
benefited to the same extent by operative interference, 
still surgery can point with pardonable pride to brilliant 
achievements in some cases of fracture-dislocation and 
tumours causing pressure on the spinal cord —aye, and 
even in some oases of Pott’s caries. 

Th» Thobacic Cavitt. 

It is not so many years since the radical treatment of 
empyema became thoroughly establi'hed, and to Konig 
must be given a erood deal of the credit for having so 
persistently urged the necessity of resection of a portion 
of a rib as an essential part of every radical operation 
for empyema. 

If pua is present in the pleural cavity to any extent, 
unless operation is undertaken it can only be recovered 
from by spontaneously bursting exterrally or into a 
bronchial tube, and tl en expectorated—a by no mean* 
savoury way of draining a pus sac. In very old- 
standing cases the procedure required is the formidable 
one of resection of the entire bony wall of the chest. 
The proposal has been made, and actually carried ont in 
a few cases, to resect the affected apex of the lung in 
some cases of that disease, which is at present engaging 
the attenrion of not only the whole medical scientific 
world but the public at large, vix., phthisis. Such a 
surgical procedure seems to me unwarrantable from the 
results. Cavities in the lung in phthisis and bronchi¬ 
ectasis have been opened and drained with some 
measure of success in the latter condition. Abscess of 
the lung and gangrene of a localised nature have been 
Buccessfully dealt with by surgery. The perioardium is. 
frequently opened now for the drainage of purulent 
effusions which in former days were left untreated to. 
terminate in all cases fatally. The present position of 
surgery in these oases, so far as I can gather from the 
literature of the subject, is this: — Out oi fifty-one oases 
operated upon for pnruleot pericardial effusion twenty 
recovered—that'lis, 39*2 per cent, of cures. Nor does 
surgery stop with the sac in which the heart lies, for on 
no less than six occasions the heart itself has been 
sutured for wounds in man, two of which terminated 
successfully. Behn sutured a wound six tenths 
of an inch in the right ventricle with three silk 
sutures, while Parozani sutured a wound eight tenths of 
an inch at the apex with four sutures. These were the 
two recoveries. Oiordanl, another surgeon, sutured a 
wound eight-tenths of an inch in the left auricle with 
four Butures, and found the wound in the process of 
cicatrisation at the autopsy, death having resulted on 
the nineteenth day from empyema. Surely these re¬ 
sults of surgical interference in connection with the 
heart and the sac in which it lies must be looked upon 
as brilliant. 

Thk Subqxbt of thb Abdouen. 

It is, however, to the abdomen we must turn for the 
greatest ^vances of all in surgery within recent years. 
No region of the abdomen nor viscus therein can be 
claimed as exempt from operative interference. The 
stomach has been not only opened for the removal of 
foreign bodies, to supply nutrition in oases of cesopbageal 
stenosis, or to remedy the various other conditions of a 
surgical nature that are amenable to interference 
through direct incision of the stomach, and not only 
partially resected, and that with considerable success, 
too, for the relief of gastric cancer, but for that same fell 
disease, when more extensive, the entire stomach has 
been successfully removed. The first case of com¬ 
plete gastrectomy was successfully accomplished 
in September, 1891, by Carl Schla'.ter. of Zurich. 
Connor, of Cincinnati, effected the complete removal 
as long ago as 1883, bnt the operation was promptly 
bushed up on account of the death of the patient, 
and it is only since Schlatter’s success that other 
similar operations have been performed. As yet the 
numbar of cases in which the operation of complete 


gastreotoQiy was performed is too small (only twelve) 
from which to draw any deduction. Gastric ulcer, with 
all its complications and sequelte, has within recent 
years become an important somce of surgical inter¬ 
ference. Operation has now been proposed, and has on 
many occasions been succee>fuUy peifoimed, for copious 
and repeated heemorrhages from the ulcer. 

Operative procedures are now of frequent, one might 
almost say of daily, occurrence for others of its complica¬ 
tions and sequelco, ecch as the loosening of adhesions 
(gastrolysis), or for the relief of pyloric stenoeis 
(pyloroplasty or gastro-jejunostomy), for hour-glvs 
contraction (gastroplasty or gastro gastrostomy), while 
gastro-enterostozny is frequently performed for the cure 
of chronic ulcers that resist other lines of treatment 
Perforation, too, has been treated, and with great soc- 
cese, the only eisential to success in this latter condi¬ 
tion being early diagnosis and rapidity of operation, 
provided, of course, the surgeon be one experienced in 
abdominal surgery. Formerly, almost all cases of per¬ 
foration ended fatally, while now, by timely operation, 
70 p>er cent, at lea»t should be sav^. In fact. Keen 
gives a mortality of only 16 6 per cent, when operation 
U performed withio twelve hours, while for operations 
performed between twelve and twenty-four hours subse¬ 
quent to perforation the moitality in more than doubled. 

Perforation of the intestine in typhoid fever, formerly 
lo>ked npon ns absolutely hopeless, now shows from 25 
per cent, to 38 per cent, of recoveries after timely opera¬ 
tive interference. Indeed, in Professor Osier’s clinic 
during the past three years,out of elevei cases operated 
□pon five were saved a percentage of recoveries of 45'4 
This result is attributed to the early stage at which the 
operation was done. The only contra-indication to 
operative interference in these cases is extreme col¬ 
lapse. Resection of the intestine for injury, tumour, 
disease, or gangrene is of almost daily occurrence. A 
few years ago the infant mortidity from acute intus- 
susoeption was something appalUng. Now, in my 
opiaioD. there is nothing more successful than the treat- 
meat of this condition by laparotomy, provided, of 
course, the case be seen early and operate upon by a 
skilled surgeon before the infant is exhausted from pain 
and vomiting or poisoned by septic absorption from the 
iotestinep, and Iwfore ndhesiona have formed. Opera¬ 
tions for appendicitis have become, I might almost say, 
a ftehionable craze. Still, I am of the opinion that the 
earlier we operate for this very common condition the 
lees the risk and the fewer patients will die from general 
septic peritonitis. 

There is one condition in oonneotion with the alimen¬ 
tary tract that still shows an appalling mortality. I 
allude to acute intest nal obstruction. This seems to 
me to be due to the pernicious habit of meddleeome 
medication and delay until the patient is poisoned by the 
absorption of septic matter from his intestines, and thus 
rendered incapable of withstanding any 03 >eration. The 
sooner physicians and surgeons recognise that purgation 
and delay mean death, and that the only hope of recover? 
lies in early operation, the sooner this mortality will 
diminiah. The kidney has frequently been successfully 
removed, and msmy of yon have often seen this organ 
the subject of operations for the removal of calculi, Ac.; 
but at the present time conservatism cornea into sway, 
and portions only are excised in certain conditions, for 
which a few years ago the whole organ would have been 
sacrificed. 

Recently Mr. Reginald Harrison has been advocating 
the exposure through the loin and incision of the kidney 
for the relief of increased renal tension and vaECularity. 
In other words, he advocates operation, and shows from 
his own practical experience very go^ resnlts there¬ 
from in certain cases of Bright’s disease arising from 
scarlatina and cold. 

The gall-bladder has likewise been the subject of 
great surgical achievements in recent years, the pioneer 
in this respect being Mr. Mayo Robson, of Leeds. 

Operations on the liver for hydatids and abscess were 
of common occurrence, but daring the past decade it has 
been attacked and large portions removed for simple 
tumours, for cancer extending from the gall-bladder, as 


OBIGINAL COMMUNICATIONS. 


The Medical Pbbsb. 461 


Oct. 30, 1901. 


well as in a few cases of priosary malignant growth when 
of a localised nature and early recognised. 

In rupture from injury prompt operative action has 
diminished the rate of mortality from 85 per cent, to 66 
per cent. In gunshot wounds the mortality has been 
reduced from 45 per cent, to 80 per cent., and in stab 
wounds from 36 percent, to 25 per cent. 

In this connection I should mention that surgery is 
now invoked by the physician in cases of ascites due to 
cirrhosis of the liver rapidly recurring in spite of treat¬ 
ment, the object being that of promoting adhesions 
between the omentum and abdominal wall and between 
the upper surface of the liver and abdominal wall, 
and thus forming a new 'collateral circulation. The 
spleen,too, has been anchored in its proper place in cases 
of great mobility, while its conservative surgery in 
case of injury is now pretty well established, snd many 
cases of complete removal with success have been 
recorded. Nor has the snrgery of the limbs been neg¬ 
lected while these advances were being made in connec¬ 
tion with the body cavities. Conservatism has largely 
replaced ampntation. Antiseptic and aseptic surgery 
have frequently succeeded in dealing successfully with 
conditions and complications that hitherto were con¬ 
sidered ample to justify a mutiliting operation such as 
an amputation is. All other things being equal, the 
surgeon who has the lowest amputation statistics is the 
one who is most useful and successful. He who can 
save a limb is deserving of more credit than the roan 
who can remove it by a brilliant operatun peifoimcd 
with lightning rapidity. 

Time prevents me enteting more fully into the 
achievements of surgery of the present day, but what I 
have mentioned will suffice, I hope, to rouse your 
enthusiasm in connection with the work of the profession 
into which yon have elected to enter. The study of 
medicine has been divided into two divisions—the first 
relating to practical nsefulneas, the second the scientific 
part. 

The former is that which yon will chiefly learn and 
study within these walls, while it is npon this part of 
your profession most of you will have to depend for the 
wherewithal npon which to subsist. The secondfumUhes 
you with the desire for investigating new phenomena, 
and establishing on a scientifio basis such phenomena 
as are not already so founded. Surely in either of these 
you will have sufficient motive to work. Do not imagine 
from what I have said of the great advances of surgery 
dur'Bg the past few years that finality has been reached. 

Let me mention to yon one subject in which the 
public are intensely interested, and one which we Eee 
more of now than formerly—this increase may be only 
apparent owing to more accurate diagnosis—a subject 
the cause of which, in spite of all the observation and 
investigation wbich have been expended on it, is still 
obscure, and consequently the treatment of which, until 
the cause is definitely settled, cannot be placed on a 
more scientific basis than with our present knowledge 
t already rests upon. The malady to which I 
allnde is cancer—a word that conveys tremendous 
significance to the public-a word that generally 
heralds to the unhappy sufferer bis death knell, 
an extensive and often a dangerous operation alone 
giving him orbera small hope of recovery without recur¬ 
rence, and that only when the op jration is performed 
at the earliest stage of the disease. No sphere of life 
is exempt from the ravages of this malady. It is no 
respecter of persons, from a ruler to his humblest sub¬ 
ject. For him who places the causetive factor beyond 
dispute, and establishes a cure, which it is quite pos¬ 
sible may be accomplished by other means than the use 
of the knife, I may safely predict a place among the 
greatest discoverers and benefactors of mankind the 
world has ever known. Scientific fame, social distinc¬ 
tions, and wealth will all be heaped upon him. To 
acquire a practical knowledge of your profession a fair 
knowledge of anatomy and physiology, with their ancil¬ 
lary subjects, will be necessary. Then, and then only, 
will you be in a position to study injuries and diseases, 
and their immediate and lemote results, as exemplified 
in this and kindred institutions. From the moment 
you enter the wards or dispensary train your eyes, ears. 


and fingers—ibrte of your five gateways of knowledge. 
You must then learn to draw deductions from the informa¬ 
tion thus acquired, founding these deductions on your 
anatomical and physiological knowledge, and thus make 
yonr diagnosis This ability to make a correct dianoeis 
is the essential difference between an accomplished phy¬ 
sician or surgeon and a quack; consequently, nnless you 
can learn to make correct diagnoses, your treatment 
must be mainly quackery. After this follows the pro¬ 
gnosis, to make wbich, with anything approaching 
accuracy, can only be done by knowing the different 
courses the dUosse may take, by experience acquired by 
previous accurate observation of similar oases, and by a 
careful study of the constitution of your patient. In 
an introduc^o'y address, delivered here in 1887 by the 
late Dr. Arthur Wynne Foot, he took as bis text on that 
occasion the three words, “Industry, Energy, and Per- 
severance.’’ Any one of these he advised his hearers to 
take and make it menially his watchword, and it would 
prove an amulet or talisman against idleness, waste of 
time, slothfalness, and all the snares and toils which 
beset students, and perhaps more especially a btuient 
of medicine. 

Lord Lytton has we^l said—“ A man will always be 
eminent •cc'irdingto the vigilance with which he ob¬ 
serve* and the acuteness with which he inquires.” “To 
this, ’ he says, “ must be added perseverance." “ I am 
no believer in genius without labour, but I do believe,” 
he says, “that labour, judiciously and continuously 
applied becomes genius in iteelf.” Dr. Arnold has said 
that the difference between one boy a d another was not 
so much in talent as in energy. “ Perseverance is 
energy.” Perseverance then, yon will find, if_ you 
look around and inquire, is the chai'acteristic of 
all those great men who have attained eminence, 
whether as statesmen, military or naval, professional 
or mercantile. Ask Lord Rob rt; to what he attributed 
his success as our greatest military general, and he will 
tell you it was a “ tireless attention to minutim, the un¬ 
dismayed pursuit and study of an idea and all its 
developments.” Ask Lord Lister—one of the greatest 
benefactors of the race that ever lived—to what he 
attributed his success in the discovery of antiseptics— 
a discovery that has so revolutionised surgery, and saved 
countless lives all over the world—and he will tell you 
it was perseverance. What was said by Lord Lyt on 
well nigh half a century ago is no less true to-day. Dr. 
Foot, in the address already alluded to, said: “There 
is no funeral so sad to follow as the funeral of our own 
youth, which we have been pampering on selfish or ignoble 
aims to the n^lect of good and wholesome food.” 

Study then, I implore of you, while yet you have 
time and opportunity, for every hoar and every day you 
spend in idleness will rise up and confront you with a 
demand for payment from you of ceaieless yet unavail¬ 
ing regrets. Try and fill your mind with information 
which will enable you, when necessity and eroergenciM 
demand it, to deal effectually and scientifically with 
the problem before yon-a problem which in many 
cases brooks of no delay, for it is that of life or death. 


ON TRAINED NERSES IN 
WORKHOUSES, (a) 

By M. F. COX, M.D Hon.Causa.R.U.I., F.R.C.P.I., 

Visiting Physician to St. Vincent’s Bospitol. 

Fob some years it has been the custom with each 
lecturer, at the commencement of the session, to select 
some topic of general public and professional interest; 
some abuse to be reformed, or some improvement to be 
effected in medical educitioa or in professional statne. 
Army Medical Reform, which I discussed on the last 
occasion that I had the privilege of addressing you, has 
been dealt with not wholly satisfactorily, in the 
recently issued warrant. Time and experience will 
show its shortcomiogs. Education, from primary to 
University, is in the melting pot. We can only hope 
that something better and more satisfact ory than the 

(a) Ad iDtioJuctor/ Address delivered at the Openiug of the 
Winter Session, at St. Vincent's Hospital, Dublin. 



462 Thi Medical Press. ORIGINAL COMMUNICATIONS. 


past systems may be erolved. There is ose question of 
great and geneiaJ,pnb]ic and professional, intorest which 
stands ready, or indeed clamonrs for settlement. 1 allnde 
to the question of Nursingin our|Poor*lsw system. The 
Poor-law system of Ireland has been a subject of almost 
constant abuse since its foundation. Modelled on the 
English Poor-law system, perhaps wrongly modelled, it 
was a subject of bitter attach from the Mginning. Its 
introduction, urged by Dr. Doyle, the famous J. K. L., 
was bitterly opposed by O'Connelhand by the House of 
Lords ! And yet, Bssurcdly, some measure of relief was 
necessary for the teeming misery of Ireland in the early 
part of the nineteenth century. I will not go back to 
the miseries which followed in the wake of the wars of 
the Mzteenth and Berenteenth centuries in Ireland. The 
condition of appalling misery and degradation which 
existed in the eighteenth century excited the pity of 
Arthur Young, and the savage scorn and fierce indigna¬ 
tion of Swift. With a vastly increased population the 
misery of Ireland in the first half of the nineteenth 
century was still greater. It was estimated, long before 
the great famine, that for the greater part of every year 
the enormous number of 2,385,COO people suffer^ dis¬ 
tress, and required relief, in Ireland. This was the 
estimate of the Commissioners appointed in 1833 to 
inquire into the condition of the poorer claesesin Ireland. 
They issued their fiist report in 1835, the year in which 
this hospital was founded, and a second in 1636. In this 
latter they thus described tbe condition cf the bulk of the 
people. '* Their habitations are wretched hovels; several 
of a family sleep together upon straw, or upon the bare 
ground; some'imos with a blanket, sometimes even 
without so much to cover them ; their food consists of 
dry potatoes, and with these they are at times so scan¬ 
tily supplied as to be obliged to stint themselves to one 
spare meal in the day. There are even instances of 
persons being driven by hunger to seek sustenance in 
wild herbs. They sometimes get a herring or a little 
milk, but they never yet meal except at Chri»tv>aa, Easter, 
and Shrovetide/’ 

That some measure of relief—a great, large, and 
generous measure—was required to cope -with this 
shockisg misery must have bran apparent to everybody; 
and yet, as I have said, tbe introduction of any 
Government measure was bitterly opposed by many. Dr. 
Doyle was one of the earliest pioneers of the movement, 
and the Irish Poor-law Bill, after much oppo 8 iti<n, 
especially in tbe House of Lords, ultimately passed, and 
received the Royal assent 00 July Slst, 1837. Itwasnot 
long, however, before tbe system was destined to be put 
to an awful test. It is not too much to say that in the 
world’s history no nation has ever been subjected to a 
more dreadful visitation than Ireland wa*, in the 
Famine and Pestilence which ragod with slight inter¬ 
mission from 1816 to 1851. Words utterly fail to 
describe the horrors of that fearful time. Myriads 
died cf famine, the dead and dying lay by the road 
side, preyed on by birds sod beasts, and, in some 
instances, as after tbe Elizabethan wars, by one 
another. Famine and pestilence swept over the country 
like the breath of a destroying angel, 8 ir Wm. Wilde, 
to whom Ireland owes so much, in his invaluable 
Report on the Census of Ireland for 1851, says: “ It is 
scarcely possible to exaggerate, in imagination, what 
people will do, and are forced to do, before they die 
from absolute want of food. For not only does the 
body become blackened and wasted by chronic starva¬ 
tion, but the mind likewise becomes darkened, ihe feel¬ 
ings callous, blunted, and apathetic; and a peculiar 
fever is generated which became but too well known to 
tbe medical profession in Ireland at that time, and to 
all those engaged in administering relief. In this state 
of what may almost be called Mania, before the final 
collapse takes place, when the victim sinks into utter 
prostration from inanition, some instances may have 
occurred, at which human nature in its ordinary 
healthy condition, revolts. Thus a Stipendiary 
Magistrate stated, in extenuation of the crime 
of a poor prisoner brought up for stealing 
food, that to his own knowledge before be was 
driven to the theft, he and his family bad actually 
consumed part of a human body lying dead in the cabin 


Oct. 30 , 1901. 

with them. Generally speaking, the starring people 
lived upon the carcases of disea^ cattle, and on dogs 
and deiui horses, but ptincipally on the herbs of the 
field ; on nettle-tops, on mustard and watercressee, and 
even, in some places, dead bodies were found with grass 
in their mouths.” 

The entire social system of Ireland was then up¬ 
turned; we have it on the authority of Wilde and 
other competent observers that the people also became 
entirely changed; the Encumbered Estates Act was in¬ 
troduced, and a social revolution began which still 
speeds “down the ringing grooves of change.” Ysn 
Helmont, writing in the seventeenth century, said that 
the Irish T>oor were belter treated by their physicians 
than the Italians by theirs. 

Our medical men nowadays are, happily, better 
trained and better educated than formerly. It is also 
true that the sick are better cared for, and more 
quickly, as well as more plea.'aotly, cured. In Dublin 
and in our large cities and towns throughout Ireland 
there is, I think, little to be desired in the care of the 
sick. Throughout the country, however, there is still 
need for improvement. For the care of the sick poor 
throughout the country tbe Irish Poor-law System is 
responsible; it has been much condemned, and not alto¬ 
gether without cause. That it faihd in the bileful 
blight of the famine is not a matter of wonder; that it 
was slow to get apace with the times may readily be 
admitted. 

The condition of the workhouses of Ireland until 
recent years was a disgrace to civilisation and to 
hnmanity. Human refuse was shot there with the 
object, apparently, of getting rid of it, or of hiding it 
out of sight. Whoever has visited a workhouse, iu the 
past, must have been struck by its cheerlessness and its 
gloom. There were huddled together Youth and Age, 
Innocence and Crime, Sane and Insane, no order save 
tfaatcf tbe barrack-room Lazar, or pest-honses—thesa 
mis-called Workhonsrs were in reality. What now are 
they to become ? Are the deformed to be transformed ? 
The answer rests on three bodies—on the people, wbo 
now control them; on the Local Covernroent Board, 
who control tbe controllers; and on the Xursing System. 
I put the last first, leaving the Local Bodies and the 
Xiocal Oovernmenc Board to fight it out between them, 
like gladiators. 

Modern Nursing differs from the nursing of the past 
as modem Surgery differs from Barber-Surgery. I do 
uot mean to say that there were no good, kindly, nurses 
in tbe rfiet, or no great Surgeons. “ There were great 
men before Agamemnon,” and we still reverence the 
names of Ambroise Pare and of Florence Night-ngule. 
For the religious Sisterhoods, who, with such splendid 
devotion and self-sacrifice, take care of the sick and 
Eufferiug in town and country, I have nothing but 
praise and admiration. The Sisters of Charity have 
made this hospital what it is, and I cannot better 
indicate tbe relations which exist between them and 
the staff than by saying that for twenty 3 ears, during 
which I have worked with them, I have known nothing 
but the most perfect harmony and cordial oo-operation. 
They areever ready to recognise the need for improvement 
and reform. Religion, and relig oo alone, can control and 
govern, and give order and cleanliness to those institu¬ 
tions, the Workhouses, which are tainted with tbe evil 
traditions which they inherit from the past. And work¬ 
ing with tbe Nuns, as allies and assistants, I look to tbe 
Nurses who are being trained throughout Ireland, he-a 
and elsewhere, to carry on the eood work. I hold in the 
highest esteem and respect tbe profession of Nursing. 
It is an honourable and an arduous calling, which re¬ 
quires many great and high qualities. E-iucaHoa, 
health, fitness, training, patience, tact, self-control, 
sympathy—these are among the qualifications which go 
to make a good nurse. Z regard nurses as our allies and 
friendv, our assistante and lieutenants, co-ordinate 
rather than subordinate. I should like them to be our 
equals in education and social standing, tather than our 
inferiors. I desire, therefore, that their training should 
be as complete and perfect as possible, as thorough as it 
is sought to be made* here, and in the other hospitals 
around us. The higher and more severe the standazd, 

C 



Oct. 30, 1901. 


therapeutic notes. 


Tbb Medical Pbb8B> 463 


tbe better for the curees and for the medical profession. 
Before a probationer is accepted here, she has to satisfy 
the Superioress and the Lady Superintendent of the 
hospital. After a month’s trial she signs an indenture 
to serve for four years, two in the hospital, and two in 
private nursing, if thought fit. In her year of proba¬ 
tion she serves in the various wards, under different 
sisters, and in the theatre under the eye of the Lady 
Superintendent. She receives lectures by the Lady 
Superintendent, and is examined by her periodically. 
In the Wards she is expected to be an attentive listener 
to the special instructions given to junior students. A 
systematic course of lectures is delivered by the physi¬ 
cians and surgeons, extending over the entire year. At 
the end of the year examinations of a searching character, 
oral and written, are held, and whoever fails to obtain 
50 per cent, is rejected. Truly it is a searching ordeal. 
It seems to me that such a system of selection, and of 
teaching and eiamination, is as perfect and complete 
as can be devised or desired. 1 know we find it to 
work satisfactorily. It trains the hands and eyes and 
brains in the varied methods of different men. Such 
a system is, I think, likely to produce better results 
than could be obtained throughout the country in the 
Infirmaries or Workhouse Hospitals, where the material 
is not usuallv so varied, and where, as a rule, the services 
of a skilled Lady Superintendent cannot be retained, and 
the medical and surgical staff is generally limited to 
one member. Z know the claim has been put forward 
on behalf of some of the hospitals throughout the 
country to train nurses. 

Ic has been advanced by men of the highest ability 
and attainmentsisuch as Dr. Laffan, of Cashel, and Dr. 
Thompson, M.P., of Omagh. No one recognises more 
fully, or more gladly, the exceptional ability of these 
men than I do. They are men who, by their ability 
would have commanded a foremost place in this or any 
other city. But I would respectfully suggest that ade¬ 
quate opportunities are wanting to the one, and that 
the absorbing duties of a Parliamentary representative 
can scarcely yield leisure to the other Even so it 
might be conceded to tren of their ability, did it not 
follow that the like conces-ion should be made to all. I 
think the Loml Oovemment Board have shown a wise 
reserve in requiring that a trained nurse, having charge 
of a hospital, must be one who has resided for not less 
than two years in a general clinical or other hospital 
recognised by them ; wh^ after examination has obtained 
from snob hospital a certificate of proficiency in Dursing: 
whilst, as qualified nurse, or assistant, they recognise 
any person who after examination has obtained a certi¬ 
ficate from any public, general hospital or workhouse 
infirmary. Fever hospital, or nursing institution, recog¬ 
nised by them as an efiScient school for medical snd sur- 
gtcalNurses. As aproof of their zeal and determination 
we find that the Local Oovemment Board have lately 
appointed, as an Inspector to inquire into the general 
nursing of the Workhouse Hospitals throughout Ireland, 
Dr. Smith, of Naas, one of the ablest of the Poor-law 
Medical Officers in Ireland. In this hospital we have no 
interests in the matter save those of the public weal, 
inasmuch as none of ournursesholdappointments, so far 
as I know, in the vorkhouse service. I personally regret 
this, for I should much rather they remained at 
home in Ireland and served their own people and their 
own country than serve strang rs. The workhouse 
system still needs reforms and reformers, and I should 
be glad to see some of the work done by the capable 
hands of those wbnm we have trained. I fear, however, 
until the sphere of these duties, is made somewhat more 
attractive, that there will be a difficulty in obtaining 
the services of high-class Nurses. A lady, unless 
she has a very special mission, does not like, or 
rather hitherto did not like—for the system is now 
changed, and she is only responsible to the medical 
officer and to the board of guardians—to subject 
herself to the control of inferior officers, and to isolate 
and separate herself from companionship with her 
equals. Besides, boards of gusrd ans, like tbe rest of 
US, are not always ideally perfect, and are apt perhaps 
to consider that the Nurses are having too fine a time 
of it, and may be giving themselves airs. In this respect, 
and in many others, lady gnardians will be, and are, of 


the greatest service. If every Workhouse Hospital 
could have the generous and self-sacrificing services of 
such ladies as Miss Bathbome and Mrs. Cosgrave, in tbe 
North Dublin Union, the problems which have con¬ 
fronted the Irish and the English Poor-law system 
would not long present such difficulties. 

Tbe Irish Poor-law system will not, in my opinion, be 
satisfactory nntil;— 

1. Tbe nursing of the sick poor is completely separated 
from the so-call^ workhouses. Most of the infirmaries 
are now part of the workhouses, and are so badly con¬ 
structed. and 6a*.urated with the material of disease, 
as to be unfit for hospital work. 

2. Every dispensary district should have its district 
nurse or nurses, and cottage hospitals, from which, if 
necessary, cases might be forwarded to central, well- 
equipped hospitals. 

3. Central hospitals should be manned with a proper 
staff like our town hospitals, so as to secure healthy 
rivalry and emulation, and to stimulate to zeal in work. 

4. Properly qualified midwifery Nurses should be 
obtainable in every district. It has recently been sworn 
that a great sacrifice of tbe lives of infants and of mothers 
takes place in remote country districts for want of 
proper nurses. 

Lastly, so far as possible, Consumptive coses should 
be kept apart from other patients. Tbe Local Govern¬ 
ment Board, I am glad to see, has recently issued 
leaflets on this point to the medical officers and to tbe 
district and other councils, acd have sent posters sup¬ 
plying information with regard to tbe prevention of 
Consumption to tbe people at Isrge. They are thus 
best performing their duty of safeguarding the public 
health, and at the same of acting as an educational 
body. It should be the wish of all of us that they may 
continue to spread the light in this, and in other such 
respects, and so earn the respect and confidence of the 
people with whom, and for whom, they have to work. 
But it comes, however, to this : that tbe final authority 
resides in, and springs from, the people, and on them 
rests the responsibility, from which they cannot escape, 
of properly providing for and watching over the siok 
poor, who are their own kith and kin; of subordinating 
personal and class interests to the public weal, thus 
showing their fitness and capacity for the responsible 
duties conferred on them; by trying to realise in tbia 
important matter the great old Bom\n tradition of the 
time when none were for a party, but all were for tbe 
State.” 


therapeutic ^otes. 

By George M. Fot, M.D., F.R.C.S., 

Su^eon to the Whitworth Hospital, Druincondra, Dublin. 

DORMIOL. 

The introduction of fancy names for tbe modem 
synthetical compounds has tbe advantage of supply¬ 
ing a word possible of remembrance and one that 
may be readily written. Of this class of words is 
dormiol: dimethyl-carbinol-chlorai, which Fuchs 
discovered and which MM. Combemale and Camus 
so named from its physiological action. The pre¬ 
paration is a good example of tbe gradually acquired 
knowledge ot the effects of organic radicles of tbe 
methyl, ethyl, series of organic radicles, and substi¬ 
tution products of the amide and ester types. To 
the student of such groups, from their physiological 
side, the salt from its composition recommends 
itself as a trustworthy hypnotio. 

This theoretical opinion is fully borne out byth® 
practical experience of Metzer, Schulze, Pollitz, 
Peters, and Claus. In the product the sleep-pro¬ 
ducing effects of chloral are obtained without any 
of its toxic effects. 

The physico-chemical properties of dormiol are as 
follows:—It is a clear liquid, of a rather strong 
peppermint flavour, miscible in alcohol, ether, and 
chloroform, and soluble in equal measures of 
water. I'his allows of a concentrated solution being 


464 TgB tfamcAL Pb«83- TRANS A.CTT0N5 OF SOCIETIES. _^Oct. 30, 1901. 


adminietered in capsules, which conceal the un¬ 
pleasant, pungent taste of the chemical. 

The cases most suitable for its administration ai*e 
those of insomnia from neurmsthenia, melancholia, 
and delirium, and in such cases its effects are supe¬ 
rior to those of sulpbonal, trlonal, or chloral. It has 
heen submitted to a prolonged trial in La Charity 
de Lille, and in the clinic has displaced the older 
hypnotics. 

Ketly tried the drug on fifty-three patients, and in 
six cases, four of hysteria and two of tuberculosis, 
there was no benefit. In a case of epilepsy the drug 
was beUered to have diminished the number of the 
attacks. 

Given in fifteen grain doses daily, Uiink used it 
with benefit, and in doses half the above he found it 
to relieve the insomnia of cardalgia and asthma. 

The pain of enteralgia appeared to be relieved by 
it, and it was found to lower the temperature of a 
typhoid case 0’6 to 

We think there is sufficient clinical evidence to 
justify a tentative use of the hypnotic, and if it equals 
the good report published of it, the profession is to 
be congratulated on a sleep producer as potent as 
chloral without its toxic properties, and more than 
equal to those of the sulpbonal series without their 
imcertainty of action. 


Clinical 5K.ccovi)5. 


LIVERPOOL (MILL ROA.D) INFIRMARY. 

Cast of Jtvptured Spina Bifida Liiin'>ali$—Immediale 
Operation for Badical Cure—Be overy. 

By R. Duhcan Clare, M.B., Ch.B.Aberd., 
Senior Assistant Medical Officer, Mill Boad In&rmirjr, Liv erpool. 

On August 22nd, 1901, H. L, ait. 30, was admitted in 
labour. At 6 a.m. on the following day she was de¬ 
livered of a female child, who was found to have a 
meningocele in the lumbar region, which had ruptured 
either in ute'o or during birth. From the rnptored 
tumour, which measured about three inches each way, 
the oerebro-spinal fluid was fiealy flowing, a consider¬ 
able quantity of the exuding fluid being collected. The 
wound was, of course, foul. 

Six hours after birth the child was inbjected to 
general ancesthesia, ether being admini^tered. 

Dr. Nathan Raw operated, the method employed 
being incision followed by excision of the eao. The 
opening in the sk'n was enlarged the skin dissected up, 
and a good deal of what was surplus removed from the 
edges. 

The sac having been removed, the arches of the de¬ 
ficient lumbar vertebrm (2nd, 3rd, and 4tb) were united 
by deep catgut sutures. The skin, together with the 
muBcIee and fascise, were then approximated by care¬ 
fully-placed catgut sutures. 

The future progress of the case was speedy towards 
recovery, the wound healing by first intention. 

The points of interest in this case were: — 

1. Regarding the cause. Prominent writers differ in 
opinion as to whether the defect in the vertebral arches 
is a primary one, or is conditioned secondarily upon 
inflammatory effusions or increase of fluid in th^ verte¬ 
bral column. In this case, in which the mothf-r stated 
she had a fall some time previous to the birth, the history 
points distinctly to its being of inflammatory origin. 

2. The absence of paralysis. In accordance with 
the location of the tumour, one would have expected 
to find paralysis of the lower extremities aud of the 
bladder and rectum. This was absent, the child 
being able to move its legs freely, and to micturate and 
defaecate without difficulty. Was this accouuted for by 
the tumour having ruptured, and this relieving the 
pressure which would otherwise have been exerted upon 
the spinal cord ? 

8. Pressure on the tumour caused no bulging of the 


anterior fontanelle, nor did the fontanelle seem of 
greater size than normal. 

4. Grenetal autesthesia. I administered ether by the 
open method six hours afterbirth. Theanssthetic was 
well borne, and the child made a good recovery, seeming 
to suffer from no bad after effects. As far as I am 
aware this is the youngest age at which a general 
anesthetic has been given. 

I am indebted to Dr. Nathan Raw for permission to 
publish the case. 


CANCER HOSPITAL. 

Case of Double Jlydrotalpinx. (a) 

Under the care of Charles Rtall, F.R.C.S., 
Sor^oon to the Cincer Hospital and to the Gordon Hospital for 
Diseases of the Bectum. 

A.H., et. 35, married, was admitted into hospital com¬ 
plaining of great abdominal pain, vomiting, and excessive 
loss at the menstrual periods. 

Hittory of Present lUneat .—Five years ago she was 
seized with sudden acute pain in the abdomen, vomiting, 
and copious bleeding from the vagina. At this time her 
period was not due. This attack lasted three weeks, and 
since then she has had repeated recurrence of this 
trouble. The attacks have beeu coming on with in¬ 
creasing frequency and severity, and one attack may 
follow another after only an interval of two weeks. 
There baa been much loss of flesh. The catamenia are 
irregular, excessive, last seven to eight days, with the 
passage of large clots. 

Her past history was fairly good with the exception of 
three miscarriages, the last being seven years ago. 

On examination there was great tenderness in 
the right iliac fossa. An elastic, uniform rounded 
tumour could be felt rising out of the pelvis to within 
one and a-half inches of the umbilicus. Bimanually it 
was found presenting in Doaglas's pouch, and even its 
very limited mobility showed it to be intimately con¬ 
nected with the uterui. The sound could be passed 
three aud a-half inches. 

Operation, October Ist, 1901.-~The abdomen was 
opened in toe median line, the omentum was found 
adherent to the parietes. The tumour was hidden fn>m 
view by adherent coils of small intestine, and on freeing 
these a double hydrosalpinx was found, the right dis¬ 
tended tube lying at the bottom of Douglas's pouch, 
and tightly adherent there, and overlapping this was 
the left hydrosalpinx. The latter was first dealt with 
and removed by enucleation after division of the 
peritoneum of the meso-salpinx. The right tube 
was removed en tt'aaae. The tumour on the left side 
was about the size ot an average cooia-nut, and that os 
the right as large as a big pear. There was a good deal 
of oozing from the breaking down of adhesions, and 
also from the sac of the left distended tube, so drainage 
was resorted to. This was accomplished by making an 
opening through the posterior fornix into the vagina, 
and the oozing sac was also drained by making an open¬ 
ing through the posterior surface and carrying a strip 
of gauze from this into the vagina. The abdomen was 
closed in three layers, the drain removed in forty-eight 
hours, aud the patient made an uninterrupted recovery. 


‘^ratiBartions nf §odctic0. 

CLINICAL SOCIETY OF LONDON. 
Mbztino held Fbidat, October 25th, 1901. 
Clinical Evening. 

Mr. Howard Marsh, P.R.C.S, President, in the 
Chair. 


BIGHT SIDED HEM1PARB8IS WITH ATROPHY OF LIFT 
OPTIC DISC. 

Drs. Eatner Batten and Leonard Guthrie showed 
a boy, let. 12, who fractured left femur in October, 1900. 
Whilst laid up had a doubtful attack of acute rheutna- 

(c) Bcail before tlie Brit. G;n. Society, October lOtb, 1901. 

DiniTi^-' • ‘ 


Oct. 30. 1901. _TRANSACTIONS OP SOCIETIES. Thi Mmical 1>bm8. 465 


tism. In Febinary, 1901, noticed weakness (gradual) of 
right arm and lege, difficulty in writing and walking. 
When seen on April 80th, 1901, weakness, ataxy, and 
intention tremors noted in right arm. Bight leg wasted, 
knee-jerk exaggerated, ankle-clonus marked, and typical 
Babinski's plantar reflex present. Sensation normal. 
Gait hemiplegic in type. No facial paralysis. Faint pre- 
systolic bruit present. Dr. Batten noted (June) that “the 
left optic disc was pale and excarated. Ciibriform plate 
exposed at bottom of excavation. Disc not filled in nor 
opaque. No blurring of vessels or of margins of optic 
disc. Well-marked central scotoma for white (no 
colour perception). Betina in macnlar area and up to 
optic disc showed signs of disturbance and a number of 
fine white dots. Veins somewhat large, dark, and 
tense.” The right optic disc was normal. No hemia¬ 
nopsia. lUmtrkt .—Nature of case is obscure. Patient 
may have had thrombosis in neighbourhood of left 
motor tract with recto-bulbar neuritis of left optic 
nerve, or the condition may be due to early disseminated 
sclerosis. May be compared with case shown at Clinical 
Society's meeting, October 28th, 1898, vol. xzxii., 
page 228, in which complete left hemiplegia and white 
optic disc existed. The condition followed convulsions 
(post-partum), and was believed to be dne to embolism 
or thrombosis of right Sylvian artery and of arteria 
centralis retina. 

Dr. F. £. Battbk recalled the case of a girl, 
a?t. 25, who developed very similar symptoms, but 
recovered to some extent, though she remained 
aphasic and with left-sided loss of vision. Mr. Oonn in 
this case reported whiteness and flatness of the disc, 
which bad sharp margins, suggestive of thrombosis and 
ba'morrhage into the sheath of the nerve. She died 
some months later, and post-mortem there was found 
thrombosis of the left and middle cerebral artery with 
thrombosis of the vessels of left optic nerve, which was 
much degenerated. 

A CASK OF OLEKABD's DISEASE. 

Dr. J. P. Pabkinson showed a married woman, set. 40, 
the mother of five children, who came to the hospital for 
symptoms due to stenosis and regurgitation of the 
mitral valve and cardiac dilatation. The abdomen is 
very large and flabby from relaxation of the mnsoles of 
the abdominal wall. When lying on the back the lower 
limit of the finger can be felt a finger's breadth below the 
level of the umbilicus, and its dulness above extends to 
the costal margin, but in the erect position it falls to a 
much lower level. It can be freely moved about between 
the two hands. The spleen is also felt to be somewhat 
enlarged, prolapsed, and movable. The right kidney can 
be easily felt as a movable mass below the right limit of 
the liver, from whence it can be pushed back into the 
loin. The left kidney appears to be normal in position. 
The stomach seems to lie somewhat below its usual level, 
and to be slightly enlarged. For a week in the middle 
of June the patient suffered from a constant pain in the 
right loin, which extended from thence to the anterior 
superior iliac spine, and during this period the urine, 
which previously bad contained only a trace of albu¬ 
men, diminished to half its usual amount, and contained 
two-fifths of albumoo. When the pain ceased the 
albumen and, for a few days, the amount of urine 
increased to three or four pints daily. This temporary 
ii terfereoce with the functions of the kidney was the 
only symptom referable to the large amount of viscero¬ 
ptosis present, 

CASE OF CONGENITAL AUSENCR OF BOTH CLAVICLES. 

Dr. Sethocb Tatlob showed a man, mt. 20, clerk, in 
whom both clavicles were incompletely developed. On each 
side the sternal ends, with the attachments of the stei no- 
mastoid muscles tnereto, can be felt; and there would 
appear to be some attempt at development towards the 
acromial end. The iaterveniog space is cccupied by 
what would appear to be fibrous structure, possibly 
representing the costo-ooracoid membrane. The upper 
limbs are not impeded in their various movements; 
indeed, the patient had no previous knowledge of his 
defects. Ou the other band, he can throw a ball and 
play cricket as well as most youths. Both shoulders 
can be so far approximated to the middle line that the 


eminences of the deltoid muscles can be made to touch 
each other. The condition thus approaches that of the 
carnivora. 

A CASE OF HTDBOPS ABTIC0L1. 

Mr. F. C. Wallis showed an elderly man who was 
the snbject of hydrops articuli omplicating osteo¬ 
arthritis. His ligamentum patellae had been ruptured ; 
previous to that the patella had been twice fractured ; 
it can now be felt some distance up the tb-gb. The 
large fluid swelling in front of the joint has been 
aspirated three times, and pressure has been applied. 
This had had no effect in reducing the fluid, and he had 
ceased to trouble about it. The comparative ease witn 
which the man gets about with so disorganised a joint 
was, be thought, no donbt helped by this fluid condition 
of the joint cavity. 

CASE OP ACDTE INTUSSUSCEPTION. 

Mr. F. C. Wallis showed an infant, .Tt. 7 months, on 
whom be bad operated successfully for acute intussus¬ 
ception of the ileo-ciccal variety. Was admitted with 
somewhat obscure symptoms of intestinal obstruction, 
and the operation was performed thirty-three hours 
after the first onset. On section the intussusception, 
which occupied the situation of tbe hepatic flexure of 
the colon, was drawn out of tbe incision, and by gentle 
traction and pressure it was gradually reduced. The 
intussnscepted gut was seven inches long, quite col¬ 
lapsed, somewhat congested, and thickened. After 
reduction the intestine was returned to the abdomen, 
and the abdominal iccisions doted by one row of sutures 
Tbe operation lasted twenty minutes. Tbe bowels 
acted next day. Recovery was uninterrupted except 
that the infant was enable to digest any peptonised or 
other milk, but when the mother recommenced to feed 
ib this trouble ceased. 

Mr. Babkbb suggested a small incision, and the intro¬ 
duction of one finger, for the gradual reduction of tbe 
intussusception by tbe method advised long since by 
Mr. Jonathan Hutchinson. 

CASE OF LSONTIASIB 068SA, 

Mr. H. Bbthau Bobinbon showed a male, aet 26, who 
displayed very hard, almost symmetrical swellings on 
the nasal bones and adjacent parts of superior maxilla. 
The nasal chambers are almost completely blocked, the 
turbinates being pushed towards tbe septum. The 
swelling first appeared on the left side in 1897, and pro¬ 
gressed slowly. No pain. No watering of the eyes. 
No history of syphilis. He his been in South Africa 
since the lesions appeared. The remarkable feature of 
tbe case is its strong likeness to “benpnye” or “dog- 
nose ” of Cape Coast Colony. 

Mr. Charters Stuonds referred to a very similar case 
in which nasal obstruction was a prominent symptom, tbe 
intra-nasal swelling being symmetrical though more 
marked on tbe left side, and it extended into the upper 
jaw. The condition was of some eight or ten years 
standing. He cleared tbe nostrils and the man derived 
much benefit, the ultimate result being very satisfactory. 
No recurrence had taken place. In another case opera¬ 
tive intervention also greatly benefited the patient so 
that evidently something could be done to afford relief 
in these cases. 

Mr. Bowlbt suggested that probably many cases in¬ 
cluded io this term bad little or nothing in common with 
true leontiasis. Some were cases of what liad been 
called generalised Osteoma, while in others the growth 
wai strictly localised to a particular portion of tbe 
snperior maxilla on each side. 

Mr. Kbetlet had operated on two ca^es of one-sided 
nasal obstruction, and remarked that in tLe author’s 
case the growth was at first uuilateral. In neither case 
was there any tendency to recurrence. He commented 
upon tbe difliculty of knowing how much bone to remove 
when the soft tissues bad been detached. 

PULSATING TUMOUR OF THE SACRUM. 

Mr. Cbabtxbs Stmonds showed a man cet. 65, who came 
to Guy’s Hospital complaining of pain in tbe saemm. On 
rectal examination a pulsating tumour could be felt high 
up, covering the whole width of the sacrum, and reaching 
ratberfurtherto the right. The pulsation was controlled 

C 


466 Ths Medical .t^ss. 


GERMANY. Oct. 30, 1901. 


by compressiou of the aorta. Throngb the aaoram a load 
sTstolio bmitwas heard. Ihe patient bad also outward 
-Jisplacement of the left eyeball, and this was associated 
with antral sappnration. It has remained stationary 
for a long time. The rectal wall is quite smooth, and the 
edge of the growth is sharp. It was suggested that the 
puTsatingtnmonr was a growth secondary to that in the 
ethmoid. 

Mr. Wallis thought the tumour might possibly be of 
a Dsevoid character. He asked how long the eyeball bad 
been displaced, and whether the displacement was in* 
creasing ? 

Mr. Babesb asked if the rectum had been examined 
with a speculum, which would enable the niEToid 
character to be perceived, and be refened to such a 
case in a man, age 40, who ultimately died of beemor- 
rbage. 

SYPHILITIC MTOBITIS OF THE EXTENSOR CRURIS. 

Mr. Chabtebs Stuonds also showed a man already 
exhibited last session. Doubt was thee expressed as to 
the nature of the case, some thinking the condition to be 
a new growth. In the interval rapid improvement 
has taken place, preceded by involvement of the 
skin. The patient was unable to submit to treatment 
by rest, and for a time was without medicinal treat¬ 
ment. When he returned there was effusion into the 
knee, and signs of advancing disease, and the skin was 
broken in several places. Large doses of iodide pro¬ 
duced rapid improvement, so that the diagnosis can no 
longer be regarded as doubtful. 

arthbofatet in a case of bronchiectasis. 

Mr. H. E. Stubs Thompson, M.B., (for Dr. Percy 
Kidd) showed a young women, mt. 26, single, who since 
eighteen months has had symptoms of chronic 
bronchitis, the sputnm being offensive from the first, i 
Twelve months ago the sputum became more offensive 
and more copious, and about this time the ankle joints 
first became affected. Subsequently the wrists and knees 
were involved. Both wrists are now swollen, stiff, and 
tender. No creaking. The fingers are also somewhat | 
swollen. Much muscular atrophy. Knees slightly 
swollen and contain a little fluid. Ankles eolarged, bnt 
not tender at present Muscnlar wasting well marked. 
Physical signs of bronchiectasis well marked at left ba‘e. 
Sputum, formerly very offensive, has now no feetid 
odour, and the quantity has greatly diminished. 

Mr. Bowlbt remark^ on the iuterest of the case, in 
that it threw light on a group of cases closely allied in 
appearance to osteo-arthritis, but which were of septic 
origin. 

Dr. 8 . Tatlob asked how the antbor explained the 
present absence of feetor in the spntum, and to what 
cause he attributed the patient’s recovery ? 

Mr. Wallis recalled a case of niceration of the rectum 
in which there bad been several well-marked attacks of 
arthritis. As the ulceration healed the arthritis snb- 
sided, and in spite of exposure bad not since recurred. 

Mr. Stuonds recalled a case of severe septic throat 
culminating in abscess in which the patient developed 
septic arthritis of several joints. 

MABVEIAN SOCIETY OP LONDON. 

Mbetino held Thubsdat, October 17th, 1901. 

The President, Dr. D. B. Lees, in the Chair. 

Mr. Caupbell Williams, F.B.C.S., read a paper on 
ha;uatubia in childhood, 

which appeared in onr last issue. In the discnsston that 
followed. Dr. Sidney Phillips remarked that hsmaturia, 
arising from tuberculous disease of the urinary organs, 
especially when the kidney was affected, might be very 
profuse. He bad not seen beematuria in scarlet fever 
except as part of an acute nephritis. In a patient 
suffering from typhoid and scarlet fever at the same 
time fatel beematuria had occurred, and was shown post 
morttm to have arisen from the bladder wall. Id 
children it was not infrequent to get hematuria which 
seemed attributable to the mechanical action of crystals 
of oxalates or of uric acid found in the urine. He thought 


hematuria and epietaxis might result from the rhenma- 
tio poison. 

Mr. Buckston Browns referred to the complete¬ 
ness of the paper, and said he could only think of ooe 
source of hematuria in children which had not been 
mentioned, namely, the bursting into the bladder of an 
abscess, connected either with the hip or the spine, and 
he instanced a case where be had removed part of the 
body of a vertebra from the bladder into which it had 
been discharged from a spinal abscess. He mentioned 
a case of infanile hsemataria seen with Sir Thomas 
Barlow, where the cessation of the use of sterilised 
milk, and tho taking of a little orange juice, were fol¬ 
lowed by excellent results, and be asked Mr. Campbell 
Williams if after juvenile snprapubio cystitomy hecom- 
pelled bis patients to assume any particular attitude, 
some surgeons having insisted upon the prone position, 
while be preferred to allow the child to lie as it liked. 

Dr. (^. A. Sutherland agreed with the author that 
hsDmaturia did not occur in uncomplicated rickets. In 
scurvy hsmatoria might occur from renal or vesicil 
haemorrhage, and was directly dependent on the general 
disease. In some oases, however, he thought a local 
cause existed in the form of mechanical irritation of the 
kidneys by uric acid crystals. These were frequently 
passed in large amount in eenrvy, as in moat affections 
characterised by profound anaemia. So that, if bsma- 
turia were the sole evidence of the haemorrhagic ten- 
deocy during an attack of scurvy, it was advisable to 
examine the urine carefully for uric acid. 

The Chairman and Mr. Batmond Johnson also took 
part in the discussion, and Mr. Campbell Williams 
replied. 

(SfrmaitB. 

[from our own correspondent.] 

Berlin, October 26ib, 190L 

At the Society for Psychiatry and Nerve Diseases, 
Hr. Cassirer related a case of 

Abscess of the Medulla Oblonoata and Pons. 

The first certain case was described by Meynert in 
1863. Then followed two cases by Eisenlohr and one 
case by Lorenz and Dagliotti. The case now recorded 
was observed in the Charlottonbnrg Hospital. A man, 
mt. 30, was received into the hospital on January 20th ; 
he bad then been suffering from fever since the 8th of 
the month. On January 22nd pareeithesia appeared in 
the left arm and leg, and on the 24th there was diplopia. 
The sensorinm was free. On the left side there was 
hyper cesthesia from the head to the foot from tho middle 
line ontwards. The facial was free, and there was slight 
pareeis of the abducens of the right side. Both tem¬ 
perature and sense of pain were mneh disturbed. There 
were subjective feelings of creeping and cold in the left 
leg. Mobility was undisturbed. The temperatnre rose 
to 41‘6° C. On the following day optic nenritis came on 
with increase of the paresis of the abducens, and right 
facial paralysis. Death took place on the29bb, bsfore 
which, however, right-sided keratitis had come on. 

On transverse section through the pons, near the 
right of the trigemious, a collection i f pus was found 
tho size of a cherry. There was some pns in the fourth 
ventricle, no meningitis. Microscopical examination 
showed that a pns collection had formed at the right 
dorso-lateral comer of the medulla, at the level of the 
origin of the facial nerve, and immediately below the 
floor of the fourth ventricle. In many places was an 
almost immediate transition from normal to purulent 
decomposed tissues withont the intermediate stage of 
red softening, and in other places the characteristic ap¬ 
pearance of the latter without purulent breakdown. 

Dm,.. ^ t 



AUSTRIA. 


Thk MimcAL Pbxsb. 467 


Ocr. 80, 1901. 

Hr. Ora^itz reported oo the clinical features of the 
case. As regarded setiologj, there were no points from 
which any conclusion could be drawn. The patient had 
a cutaneons emption that reminded one of syphilis. 
There was extraordinarily high temperature, ansBSthesia 
of one side, and symptoms on the part of the 
abducens and facial on the other, symptoms on the 
part of the trigeminus that drew attention to the part 
found later on to be affected. On his attention being 
drawn to the great rarity of abscesses o! that region 
the thought came to his mind that the case was one o^ 
multiple abscesses, and it was interesting to note that 
multiple abscesses were found in the lirer, although 
clinically there had been nothing to indicate their 
presence. The whole intestinal tract was unaffected, 
except that in the vermiform appendix a fish bone, con* 
siderably changed, was found. A distinct ulcer was 
also observed there. The speaker was of opinion that the 
patient had passed through a masked attack of perityph¬ 
litis, giving rise to septic infiammation which bad passed 
from the liver, and bad then led to multiple abscesses. A 
pyiemio process had now been set up in the lungs and in 
the medulla and pons which had eventually pre¬ 
dominated over all other symptoms. 

The Disinfection of Cutting Instruments bt 
Means op Spirit of Soap. 

The Deut. Med. TToch. contains an account of the 
method of disinfection by Dr. J. H. Polak, of Amster¬ 
dam. First of all the author satisfied himself by actual 
experiment that the most certain of all practicable 
methods of disinfecting cutting instruments was by 
boiling in a soda solution in a closed vessel. For com¬ 
plicated instruments and such as are not damaged by 
boiling this method remains the best. Spiritus sapouia 
kalinua destroys direct staphylococci within fifteen 
minutes. It therefore became a question whether this 
material should not 'replace boiling, which certainly 
damages cutting instruments. The soap spirit is also 
an excellent material for the mechanical cleansing of 
instruments, when carefnlly performed and continued 
for at least half a minute. The cleansing takes place 
not only when the instrument is rubbed with a cloth 
soaked in the soap spirit, bnt also in a soap bath, which 
causes the blood or pus to swell out and soften. The com¬ 
bined chemical and mechanical method can therefore be 
safely recommended for disinfecting cutting instruments. 
Alcohol 50 per cent, in strength is more, effi'dent in dis¬ 
infecting than a weaker or stronger solution. The 
author forming his conclusions from the observation 
mentioned proceeded to d sinfect his cutting instru¬ 
ments by means of Straub’s soap spirit. It soon became 
evident that the instruments did not lose their sharp¬ 
ness as they did when boiled. 

The method now adopted is the following:—After 
every operation the instruments are placed in the soap 
spirit and kept in at least fifteen minutes. They are 
then taken out and carefully cleaned. Before an opera¬ 
tion they are again placed in the soap spirit for fifteen 
minutes. They are then wiped with a sterile cloth. 
The soap may also be removed by placing them in a 
50 per cent, solut'on of alcohol or one of sterile boracic 
acid. It is of great importance to place the instru¬ 
ments before and immediately after an operation in a 
8 per cent, sterile solution of boracic acid. Geron’s 
advice is also considered excellent, viz., to wrap them 
in a cloth soaked in the scap spirit; so that disinfection 


takes place whilst they ard carried about, or at any rate 
they are undergoing a preparation for the final cleans¬ 
ing. 

An Unusual Case of Silf-Injuey. 

The .il/th7ororif, 26/7/1901, relates the following:—A 
recruit was admitted for treatment suffering from 
numerous ulcers on the feet and lower limbs. The cir- 
oumetance that all the ulcers had dry, brownish-red 
scabs, firmly adherent at the edges, led to the conviction 
that they were caused by some corrosive anbstance. In 
the man’s haversack the leaves of a kind of ranunculus 
were found, and a head of garlic. He now confessed that 
he had used these plants in the hope of being dischareed 
from military service on account of the nlcera they set up. 

The ranunculus contains a volatile oil-like material 
of a yellow colour, which decomposes into ammonic acid 
and ammonium, the latter being an irritant. The garlic 
contains mustard oil. Both plants are therefore capable 
of oanaing snpeificial ulceration. 

JLuetrw. 

[from oub own OOBBEBPONDENT.] 


Viesra, October 2dbh, IfK)]. 

Synthetic Formation of Ubic Acid in the Animal 
Economy. 

WsiNEBbas been experimenting on birds and dogs, 
which he fed on nitrogen—free aliments—at the same 
time injecting nrea, and be ficds that uric acid is formed 
in the urine with other nitrogenoue compounds without 
affecting tissue metabolism. 

The sobstancee used for food were glycerine, oxi— 
and keton—bibasic acids, with a combination series of 
three atoms of carbon, which greatly increased the 
amount of uiio acid normally eliminated. 

The greatest amonnt was passed with the bibasic 
acids, or those nearest allied thereto in chemical compo- 
aitioc. Similar results were obtained in the mammalia, 
bnt the quantity was smaller, while the urine contains 
turbatea and urates in the form of dialurates. In the 
normal condition this chemical change does not take 
place, but only in a pathological state such as gout, Ac. 

Tetanus from AntidIpthebitic Sebum. 

Peterka related the history of tbiee cases of tetanus 
resulting from the employment of anti-diphtheriticserum 
In many cases whole groups of muscles are attacked, 
such as the quadriceps femoris, abdominal aud dorsal 
muscles, according to eite selected. The facial, mastica¬ 
tory and neck muBoles are secondarily affected. It is 
not, however, common for the tetanus to commence in 
the immediate neighbourhood of the injection wound in 
children, as it is more rapidly diffused, although the 
reason thereof cannot be clearly explained. 

Cutaneous Actinomycosis. 

Eopfetein relates a case of actinomycosis occurring on 
the hand of a female, from a cut between the thumb and 
index finger, which was inflicted while binding sbeavea 
in harvest time by a spike penetrating the skin. The 
wound rapidly healed, bnt five weeks after a hard, non- 
painful swelling, about tbe size of a walnut, formed 
over the site of the wound. After nine months it was 
extirpated and found to be composed of sclerotic tissue, 
within the meshes whereof was found a fine gi'anular 


tissne, with a few drops of pus containing the radiated 
fnnguB and fine grannies. t 

Digitized by njOO^IC 



468 Thb Medical Fbbsb. 


THE OPERATING THEATRES. 


Oct. 30. IDOL 


Auscultation or Muscus. 

Herz has long been applying himself to the diagnosis 
of disease by the tone of the contracting mnscle, jostas 
it is obserred in the oontraotion of the cardiac mnscle, 
the energy whereof can be meamroi from the lowest to 
the highest grade. In pathological conditions these 
changes can be observed by the ear in every muscle of 
the body. 

He . admits having met with one case of Thomsen’s 
disease in which no sound could be discovered. 

Diagnosis of (Esophageal Saci. 

Zweig assures ns that he has solved the difficulty of 
diagnosiug diverticula of the asophagus when located 
down the canal. He places one catheter in the sac and 
a second in the stomach. Throngh the second he passes 
a solution of methyl blue and then withdraws the first, 
which should contain some of the fluid if in the stomach- 
If it be simply a dilatation of tbe canal the coloured 
fluid must be found in the stomach. He records four 
cases of diverticla which could only be diagnosed in 
this way. 

Politzeb’s Ohrenheilkundb. 

Another edition of Folitzer's text-book, with 710 pages, 
has just appeared. Many of the subjects have been re¬ 
written, such as Chronic Affections of the Middle Ear, 
Ac., while Meniere’s disease is critically examined as 
an apoplectiform affection which requires to be dis¬ 
tinguished from the complex symptom of the same name. 

Ptoctanbo-plasmin. 

Honl and Bukovsky have been engaged in some 
practical experiments with tbe bacterial flora that pro¬ 
mises to be of some use in tbe treatment of ulceration 
of tbe legs and other solutions of cutaneous continuity. 
On examining the product of these ulcers, they found 
small numbers of bacillus pyocyaneus, staphylococcus 
protens, bacterium coli. and Friedliinder’s pnenmo- 
coccns. 'With tbe hope of removing these they tried 
the proteids and products of tbe different bacilli. The 
most effectual of these experiments was conducted with 
the products of the bacillii pyocyaneus, which they have 
designated pyocyano-plasmin. or pyocyaneo-protoin- 
If two or three compresses of this product were applied 
daily to the ulcer, healing could be obtained in sixteen 
to fifty-seven days. Within twenty-four hours of tbe 
application of the toxin the secretion becomes very 
scanty, and in from one to ten days there is a clean 
granulating eniface, which soon becomes covered with a 
permanent layer of epidermis. 

To illnstrste tbe advantage of this treatment they 
have taken Prof. Janovsky's results for five years to com. 
pare with the pyocyaneo-p’asmin treatment. 

In 1892, 56 per cent, were healed, 

In 1893, 60 „ „ 

In 1894, 47 „ 

In 1895, 62 

In 1896, 67 „ » 

while the toxin-therapy has 90 per cent, to its credit. 

%ht (!)|i«rating ^hcatrce. 

GBEiT NORTHBEN HOSPITAL. 

Opbeations fob Suppurative Pbriosteitis of the 
Feuub. —Mr. Peyton Beale operated on a girl, a;b. 
about 10, whose history was as follows:—Four days prior 
to admission she had received a b'ow about the middle 


of the left thigh. This was followed by a good deal of 
swelling of the soft parte, and intense pain deep down 
in the thigh and in the knee. On admission tbe girl was 
found to have a temperature of 103*^, with a large in¬ 
flammatory swelling occupying the middle third of the 
thigh; the patient had the appearance of being very 
acutely ill. It was decided to make an incision down 
to tbe femur at once, and this was done on the antero- 
external aspect of tbe limb with the escape of about a 
teaepoonful of thin pus; on the finger being inserted 
into the wound, the periosteum was found stripped 
from the bone around its whole circumference for a 
distance of about five inches. A counter-opening 
was made on the posterior aspsct of the thigh, and 
a plug of gauze passed right through and the wound 
dressed in the ordinary way. After this first 
operation there was very little improvement in 
the child’s general condition, tbe temperature reaching 
every night to 103° or 104°; she was put upon large doses 
of brandy (12 ounces in twenty-four hours), and during 
the next week or two several metastatic abscesses 
appeared in the scalp, in one ankle, and in one wrist. 
These were dealt with by being opened and drained in 
the usual way and soon healed. The child continued in 
much the same general condition, and abont four weeks 
after tbefirst operation nearly the whole of thediaphysis 
of the femur, &c. (six inches in length) was found to be 
quite loose, and was easily removed by enlarging the 
original wonnd upwards and downwards. The large 
cavity thus formed was washed out aud drained with a 
gauzs plug, and an extension put on the leg. After 
this operation the patient very rapidly improved, the 
temperature at onoe fell to normal, and tbe wound 
healed completely in abont three weeks time. The 
extension was rigidly enforced until six weeks after tbe 
second operation; at this time tbe shortening was 
not more than two inches, and as new bone was 
felt filling up tbe whole interval left by the 
removal of the seqnestinm, the child was allowed 
to get up and walk by the aid of one crutch. Mr. Beale 
said that this belonged to a class of cases often now 
known as acute necrosis; the cases were very remark 
able owing to the pathological conditions which were 
fonnd to be present. The patients were generally chil¬ 
dren between the ages of three and twelve in an nn- 
healthy condition; tbe long bones, such as the femur, 
bnmems, and tibia were tbe ones generally attacked. 
There was often a history of a slight injury snchas a 
blow or a kick, but very rarely was there a wound pre¬ 
sent. It was also noticed that the disease was frequently 
epidemic in a certain neighbourhood. The disease ap¬ 
peared to start by bacterial invasion of the p?riosteaI 
blood vesse's, for it was generally to be noted that when 
the fiist incision down to the bone was made in these 
oases a large extent of the periosteum was found to be 
stripped, and at this early stage there was very little pu?, 
in fact often nothing but slightly turbid fluid. He be¬ 
lieved that tbe stripping of periosteum did not as a rule 
advance after an incision for the relief of ten¬ 
sion had been made, obviously, therefore, it was 
of the utmost importance to diagnose such caises as 
early as possible, and to make an incision straight down 
to the bone; if an incision was not made early, he 
pointed out that pus generally burst through the peri¬ 
osteum and spread along the intermusoular plan^ if the 


Diijiiized b) 


oog e 


Oct# 80, 1601# IjBADINO ARTFCLEP# The Midicai< Pbbs^# 469 

patient lived loDg dDottgh for that to occur. It might 1 for the discUBsion of the circumstajices of the 
be urged, he remarked, that [the best treatment waa to | position. The recommendations of Mr. Balfour’s 


remove at once as much of the bono as was found to be 
denuded of periosteum, but he said the following were 
the objections to this method: 1. It involved a very 
large incision through healthy tissues which were almost 
certain to then become infected, and the shock of so 
extensive operation was'generally fatal. 2. It was inu 
possible to teU how much bone to remove, for in many 
cases the periosteum might become adherent again at 
the upper or lower ends or both, and the bone would not 
necrote. Again, if one removed only a small portion a 
subsequent operation would become necessary in order to 
take away necrosed fragments. 3. The disease was a 
general and not a local one, as shown by the almost 
invariable formation of metastatic abscesses, and under 
those conditions one would not get rid of the diseace by 
any radical operation at the outset. He knew quite well 
that by leaving the bone in ritu until it had separated 
as a sequestrum, the patient's general condition must 
remain bad, bu^ brandy in large doses was extremely 
well borne by children in this condition, and bis ex¬ 
perience in many cases of the kind proved that they 
never succumbed to t he t ffects of bone which was under¬ 
going neoiosis being left ingiiu. Directly the seques¬ 
trum was found to be quite loose it was easy to remove 
it tbrongb a comparatively small wound, as it coold be 
broken up into fragments [by strong cutting pliers, 
and generally there were very few, if any, spicules left 
behind. When this had been done tbs patient always 
appeared to recover very rapidly, and if extension were 
carefully and efBciently maintained exceedingly good 
resnlts were to be obtained. It may, be remarked, be 
noted in the above case that although six inches of 
femur bad necrosed, the amount of shortening was com¬ 
paratively small. He also pointed out that the disease 
rarely, if ever, attacked the epiphysis of a long bone. 

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'*8ALD8 POPULl 8UPRBMA LBX.” 

WEDNESDAY, OCTOBER 30. 1901. 

SANITATION IN ARMY MEDICAL 
REFORM. 

Now that there appears to be some prospect of 
reducing the Army Medical Service to the standing 
of a busIness-Uke organisation the time seems fitting 


Committee may be summed up shortly as an attempt 
first, to induce outside medical men to join the 
Service, and, secondly, to raise the scientific status 
of the Army medical officers by choosing those 
who have passed the high-standard examinations. 
As to the first proposal it would clearly be more to 
the point if attention were concentrated mainly 
upon removing existing grievances and making 
the Service as attractive as possible to those who are 
already in its ranks. As to the second point we alto¬ 
gether refuse to believe that the brilliant reflector-like 
brains of the high-standard pass man are likely to 
furnish good soxind practitioners for the Army or for 
any other kind of general practice. The trustworthy 
man in the battle against disease is he who is armed 
with principles against details pure and simple. An 
encyclopiedic knowledge of the latter is (be sole test 
demanded by the high-standard examiner. To 
our mind it ia beginning at the wrong end 
of the stick to seek to fix the capability 
and fitness of candidates for the Service by 
their simple capacity for cramming wholesale 
the minutim, often purely theoretical, of other men’s 
speculation and knowledge. The newly-qualified 
man baa done nothing more than lay the foundations 
(f his professional knowledge, and if he found his 
future career upon the shifting sands of a high- 
standard examination then his edifice is likely to be 
of an unstable nature. As we have pointed oat on 
previous occasions, the later or post-qualification 
educational opportunities of the Army medical cfficer 
are limited. For one thing, he lacka the incentives 
of competition and of the struggle for existence that 
are imposed upon bis civilian brethren. That part of 
the situation has been recognised in the report of the 
Committee by the recommendation to increase the 
facilities for study-leave. The great flaw in the sug. 
geationa of that body of inquiry, however, appears 
to us to be in the point of sanitation. There is no 
single matter, either in times of war or of peace, in 
which the Army medical officers are required to play 
a more important part than in that of the pre¬ 
vention of disease. The mortality to our standing 
army in military quarters, not only in India and tropi¬ 
cal stations, but also in the midst of the great centres 
of life here at home in the United Kingdom, consti¬ 
tutes a reproach to the Service whose duty itis toattend 
to such things. The absolute and utter breakdown 
of the Army Medical Service in dealing with enteric 
fever in the camps of South Africa need not be 
dwelt upon. In spite of the whitewashing of Mr. 
Balfour's Commission and the public utterances of 
distinguished medical consultants “ back from the 
war,” the main facts of the scandals exposed by Mr. 
Burdttt-Contta stand unshaken. Recrimination, 
however, we are happy to believe, is not the 
mood of the British nation any more than it 
is of the medical profession. The demand for 
Army medical re-organisation is now universal, 
and clearly there can be no point that de- 
Digiiized t 



470 Th» Medical Press. 


LEADING ARTICLES. 


Oct. 30, 1901. 


serves more wisdom and thoi'ougliness than tbe 
subject of sanitation. Here, again, in our opinion, 
wbat is wanted above all things is practical experi¬ 
ence. Tbe art of sanitation can no more be leamt 
from books than any other branch of applied medi¬ 
cine. Tbe brilliant man in spoken and written dis¬ 
quisition, as all practitioners know, is apt to be 
useless at tbe bedside. Away from tbe patient be 
knows everything that even a bigb-standard 
examiner could wish him to know, but when 
brought into action bis attack is ill-directed, 
feeble, and wavering. No amount cf book learn¬ 
ing will make a competent sanitary medical officer 
either in or out of tbe Army. Tbe way out of 
the wood is not altogether easy to find. With 
a little management, however, it would, perhaps, be 
possible to aiTange that at some period of their 
career every army medical officer should pass a year 
or more under tbe nearest civilian medical officer of 
health. In London, for instance, and in other great 
garrison towns there would be little difficulty in the 
officer devoting several hours daily to such a purpose. 
Or six months of sanitary pupilage might be made a 
condition of entrance to the Service. In any case we 
think that the department should be strengthened 
by the selection of a certain number of experienced 
medical officers of health who should undertake the 
general supervision of all military quarters, and 
whose duty it would be to maintain the sanitaiy 
competency of all medical officers. Tbe details of 
this important part of Army administration can be 
worked out without any great difficulty if the War 
Office can only be induced to recognise the supreme 
importance of sanitary knowledge in maintaining tbe 
health of the Army. 


THE SURGICAL TREATMENT OF ASCITES 
DUE TO HEPATIC CIRRHOSIS. 

The ordinary treatment of ascites due to cirrhosis 
of the liver has always been regarded, and with 
reason, as beyond the scope of practical medicine. 
We are confronted with more or less extensive 
organic changes which seem to defy medicinal or other 
treatment. A mechanical obstacle has been intro¬ 
duced in one arm of the circulation over which all 
therapeutical measures are of no avail, and afford at 
most but a fleeting and fallacious relief. It is 
indeed so unsatisfactory that physicians have 
every reason to be grateful to surgeons for seeking 
to afford a relief which is not obtainable by medi¬ 
cinal means, that is to say, by modifying tbe ana¬ 
tomical relations of the abdominal viscera, or some 
of them, in order to permit of the re-establishment 
of the circulatory equilibrium. The method under 
consideration has for object to relieve the circu¬ 
latory embairassment by setting up adhesions 
between the surface of the liver and the surrounding 
structures with the object of establishing a collateral 
channel for the return of the blood. Theoretically 
this plan offers a means, and so far as our know- 
ledge goes, the only means of providing an alterna¬ 
tive passage for the blood which is dammed back by 


tbe cirrhosed parenchyma of tbe liver, and although 
tbe results so far have not been altogether en¬ 
couraging, we are entitled to hope that further 
experience will show how the operation is best 
carried out and in wbat class of cases it is 
likely to be attended by success. It is necessary to 
draw a distinction between tbe cases according as 
there is ascites only or ascites associated with oedema 
or anasarca. The latter cases usually run an 
extremely rapid course to a fatal termination, and 
therefore do not afford much chance of a successful 
intervention. They are, moreover, for the most 
part cases in which there is concomitant disease of 
other organs, either as the direct result of tbe 
hepatic change or as part and parcel of wide spread 
tissue change of which cirrhosis of the liver is only 
the most prominent manifestation. This latter con¬ 
dition is, indeed, the gravest argument advanced 
against the probable efficiency of surgical interven¬ 
tion. It is stoutly maintained by certain authorities 
that cirrhosis of the liver is but one factor in a con¬ 
stitutional impairment in the same way that gi'anular 
kidney is one of a number of organic changes which 
together determine the symptoms associated with 
this disease. There is unquestionably some truth in 
this contention, and it remains for sui^eons to 
demonstrate by results that tbe collateral changes 
are not in themselves incompatible with prolonga¬ 
tion of life if only the mechanical obstacle to the cir¬ 
culation through the liver can be circumvented. One 
reason why the operation has not so far given the 
results that had b^n hoped of it is doubtless that it 
has hitherto only been undertaken on patients as a 
last resort, patients who were almost moribund 
before they were offered this last chance of re¬ 
lief. The operation itself is simple enough. It 
comprises a small incision in the median line 
above the umbilicus, the higher the better in 
order to avert the risk of ventral hernia 
which has carried off more than one of tbe patients 
reported as cured. The surface of the liver is then 
scmbbed with a plug of gauze sufficiently to excite 
agglutinative inflammation which brings that organ 
into vascular intimacy with the adjacent structures- 
The evidence points to the necessity for undertaking 
the operation much earlier in the course of the disease 
than has hitherto been attempted, in fact as soon as 
possible after the presence of fluid in tbe abdomen has 
been made out. The onset of ascites marks the ter¬ 
minal stage of hepatic cirrhosis, it indicates that the 
circulation can no longer be efficiently carried on, so 
that there is no valid reason for delay. Anything 
would be pi-eferable to the miserable end which 
awaits these patients once the circulation fails, for 
the benefit of tapping, purgation, &o., is so ephe¬ 
meral as to be practically useless. 


Mb. G. Buxton Bbownb has been selected to deliver 
the Harveian Lectures before the Harveian Society of 
London, the first of which will be given on Thursday 
November 7th, the subject being “Twenty-five Tears’ 


I Experience of Urinary Surgery." 

Di(iiii/h(i oy 


Google 


Oct. 30, 1901. 


NOTES ON CURRENT TOPICS. 


Th* Mbdical Pbbss. 471 


^otcB 0it ^umnt ^opks. 

The Health of the Sling. 

The state of the health of His Majesty King 
Edward YU. has for months past been the snbject of 
comment in certain American and Continental jour¬ 
nals. Nearer home rumours of the most painful 
kind have been current for some time in commercial 
and social circles that hare the reputation of being 
well-informed in poMtical matters. The serious 
responsibility that rests upon journalism in approach¬ 
ing a question of rital interest, not only to the vast 
British Empire, but also to the world at 
large, might well account for the silence that 
has hitherto been preserred in English newspaper. 
That responsibility is not lessened, but many times 
multiplied, in the case of a medical journal. With a 
full sense of the difficulties and the delicacy of the 
situation, however, we feel that the time has arrived 
when a full statement of the facts relating to the 
illness from which His Majesty has recently been 
stiffering should be laid before the nation. In view 
of the fact that a detailed account has been pub¬ 
lished of several surgical operations performed in 
rapid succession, we feel it is no longer pos¬ 
sible to ignore the subject, however painful and 
pathetic the picture that it suggests. It is stated that 
papillomatous growths have on three occasions been 
removed from the left vocal cord, and that au imme¬ 
diate operation of another nature has since been ren¬ 
dered necessary. The anxiety and distress that these 
romonrs must cause throughout the British Empire 
will be incalculable. It is probable that no English 
monarch has ever attained a securer place in the 
affection of his subjects than that which has 
deservedly fallen to the lot of our present King. 
Under these circumstances, therefore, ic seems right 
and proper that the national anxiety should be at 
once met with a clear official announcement as to the 
truth or otherwise of these distressing reports. 

Trained Nuraes for Irish Workhouses. 

A FIERCE wordy war has been in progress for the 
peat couple of weeks over the question of the quali¬ 
fications which are required in trained nurses for 
Irish workhouses. It has been the outcome of, first, 
the Order of the Local Government Board of July 
btb, and,'secondly, the inaugural address delivered 
at the opening of the medical session of St. Yincent’s 
Hospital by Dr. Cox, an abstract of which we publish 
in our columns to-day. The Local Government Board, 
as our readers know, have decided that a woman to be 
a trained nurse must have resided for not less than 
two years in a general clinical hospital. This 
condition meets with the approval of Dr, Cox, and 
of a large number of members of the medical pi'o- 
fession who are well qualified to form an opinion on 
the point. It has, however, given rise to much indig¬ 
nation amongst the members of the staff of various 
cotmty infirmaries. Many of these gentlemen con¬ 
sider that their infirmaries have reached so high a 
standard that they are well fitted to be recog¬ 
nised as suitable training grounds for nurses. 


Dr. Thompson, of Omagh, and Dr. LaSau, of 
Cashel, have taken up this view very strongly, and 
have urged its CDrrectness with considerable force in 
the daily papers. The subject is oue pregnant 
with difficulties, and which admits of much truth 
on both sides. There is no doubt that there are 
some county infirmaries which are admirably suited 
for the training of nurses. There is equally little 
doubt that there are many others which are un¬ 
suitable. How is the distinction to be made ? 
If the rule of the Local Government Board 
is altered it must be altered so as to include all 
hospitals having more tbanacertain number of beds, 
and will that bring about the greatest amount of 
good for the greatest number ? We question it very 
greatly. The teaching capacity of a hospital is 
not merely a matter of the number of beds. There 
are other points of much greater importance. 
It may, of course, be said that the hold¬ 
ing of a public examination would render 
it possible to reject all insufficiently trained nurses. 
But with such an opinion we cannot agree. An 
examinition is an excellent test of the capacity 
of a candidate to answer the questions 
asked, but everybody knows bow absolutely 
fallacious it is as a test of the fitness of the 
candidate to make use of the knowledge he or she 
possesses. It is only by carefully prescribing the 
manner in which the knowledge is obtained that any 
guarantee of suitability is possible. It is this which 
makes it so important to ensure that the training 
which nnrees receive will be such that it will provide 
them not only with the requisite knowledge, but that 
lb will provide them with this knowledge in the requi¬ 
site way. 

Life Assurance for Women. 

The question of issuing policies of insurance on 
the lives of women is one of considerable interest, 
and presents problems of some complexity. If we 
take the general mortality returns it would seem 
that women, as a class, live longer than men, and 
this fact is explained by statisticians on the ground 
that they are less eiposed to wear and tear than 
males, upon whom devolves the task of providing the 
means of existence. If, oo the other hand, we take 
the returns of life insurance companies, which deal 
only with selected lives, we find that women who 
have taken out policies live shorter lives than men. 
This result Is in flagrant contradiction with the 
general returns and with the statistics of companies 
which grant annuities for life, annuitants being pro¬ 
verbially long-lived. The inference to be drawn 
from these figtires is that the medical examina¬ 
tion of women requires special attention in order 
to eliminate certain risks inherent to the sex. 
It has been urged, not without reason, that 
the examination of women in view of life insurance 
ought to bear particularly on the pelvic organs, and 
in a paper on this subject published in La Medecine 
Modtme, Dr. Mahillon, of Brussels, urges that no 
examination of a woman for life insurance purposes 
is complete unless it comprises the investigation of 


472 Tn Msdical Pbvm. 


NOTES ON CURRENT TOPICS. 


Oct. 30. 1901. 


tbe pelvic organs. He admits, readilj enough, that 
any sncb condition would have for effect to dis¬ 
courage women from contracting assurances, but he 
consoles himself with the reflection that in the ab¬ 
sence of this special examination such insurances are 
best avoided. As society is at present constituted it 
is evident that women have less incentive to insure 
their lives than men, as is proved by tbe compara¬ 
tively small number of women who have recourse to 
this form ofthrift. Tbe companies have therefore an 
interest in ascertaining tbe particular motive which 
induces a woman to solicit alife insurance. They would 
even be justified in exacting what is termed an in¬ 
surable interest' on the part of women, such, for 
instance, as the existence ef annuities terminable 
with the life of the insured, otherwise the proposal 
may be tbe outcome of a speculation on the part of 
third parties who hope to benefit by the policy. Tbe 
subject is one which merits special consideration. 
Not long since the Medical Sickness [Society had to 
consider the admission of qualified women to the 
benefits of this excellent organisation and concluded 
to refuse such proposals in view of the absence of 
data which would enable the risks to be estimated. 
Obviously, during the child-bearing period, women 
run many risks from which men are exempt, and as 
this category of risks cannot well be excluded, i^ 
would be imprudent to insure them at the same 
rates as men. We are unable to state what is tbe 
attitude of other similar societies in respect of 
female candidates, but we hardly imagine that they 
accept these questionable risks without a compensa¬ 
tory increase in the premiums. 


An Oxygen Fallacy. 

"When Scheele first directed public attention to the 
remarkable properties of oxygen gas, which he called 
“ vital air,” imagination ran i iot for a time, and the 
new gas was credited with tbe most extraordinary 
properties ; indeed, it was confidently predicted that 
health and lonfsevity were in future to be bad for the 
asking, or, at any rate, for tbe paying. These san¬ 
guine views unfortunately proved to be fallacious, 
and for a long period oxygen, as a therapeutical 
agent, fell into complete discredit. 'Within the last 
twenty years or so the possibility of obtaining the 
gas at a moderate cost gave a fresh impetus to its 
use, and it is now very largely employed in diseases 
associated with respiratory failure. It has even 
been vaunted as a remedial agent in the treat¬ 
ment of chronic ulcers, and a special hospital 
has been founded for the purpose of carrying 
this somewhat costly treatment into effect. The 
latest freak is the treatment of consumption by 
ozonised air, which is being tried at that incongruous 
institution, the Oxygen Home, in Fitzroy Square. 
The patient, we gather, is placed in a cubicle sup¬ 
plied with ozonised air, purified by filtration through 
cotton wool and dried by passage over chloride 
of calcium. Tbe initial error is the idea that con¬ 
sumptive patients suffer from defective oxygenisa- 
tion, whereas the very contrary is the case. As a 


matter of fact, these patients are suffering from 
true consumption; that is to say, over-combustion. 
Tbe respiratory changes, measured by the output of 
carbonic acid, are in excess of the normal; indeed, 
this excess is present long before any lesions are 
perceptible by auscultation, and constitutes a means 
of diagnosing what has been termed a pre tuber- 
culous stage. Under these circumstances, it would 
be interesting to know on what scientific data the 
treatment is based, especially as it has long sinc^ 
been put to the test and found wanting. 


liunatics at Large. 

The object of the lunacy laws is to secure the 
sequestration of all persons whose mental condition 
renders them dangerous to tbe community. Tbe 
records of the trials at the Central Criminal Court 
afford a tragic commentary on these laws, or, it may 
be, on tbe manner in which they arc administered. 
On Wednesday of last week no lees than four cases 
of murder, or attempted murder, terminated by a 
verdict of irresponsibility, the prisoners being 
ordered to be detained until his Majesty's pleasure 
be known.” In every instance there was a history 
which pointed to mental disturbance of a disquieting 
kind, yet in none was any step taken to place the sub¬ 
ject under restraint, with the result that they were 
left at liberty until the homicidal tendency had 
manifested itself at tbe expense of innocent victims. 
The information at our disposal does not allow of 
our apportioning the blame, but blame there must 
be, in a sense, though the negligence may have been 
due to sheer ignorance of tbe terrible significance of 
apparently mild departures from mental health. In 
every instance witnesses testified to the fact that tbe 
accused had been for a variable period prior to com¬ 
mitting the crime, “ peculiar in his (or her) manner,” 
yet it does not seem to have occurred to any of 
them that this peculisrity called for treatment. The 
most distressing feature of these cases is that no 
ready means suggests itself of detecting and restiain- 
ing the victims of mental aberration from criminal 
acts: but this position is so unsatisfactory that it is 
impossible to acquiesce in it as imavoidable. There is, 
however, no present machinery bywhich these poten¬ 
tial criminals can be recognised, and the necessaiy 
precautions taken, but their presence in our midst 
unquestionably adds another anxiety to existence. 

Plague at tbe Cape. 

The proclamation of martial law in South Africa 
and the close censorship of the press that has 
been so long established suggests some anxiety as 
to what may be the actual facts as regards the 
plague. From the first appearance of that malady 
at the Cape it was appaient that the situation had 
become complicated by the addition of a most serious 
danger. From time to time fresh centres of infec¬ 
tion have been reported in various parts of Cape 
Colony. A few days ago Dr. Kirton, plague officer 
at Port Elizabeth, succumbed to tbe disease. A 
Reuter’s telegram has given the curt informa- 


Ocr. 80. 1901. 


KOTE8 ON CUBKFNT TOPICS. 


Thx ViDicAL Pbsbb. 473 


tion that additional plagne regulations hare been pro* 
claimed in the Cape peninsula, and at all ports and 
coastal towns in Cape Colony. Beading between the 
lines of tbis information it may be asenmed that the 
plague has attained dimensions which the Press 
censor, for reasons best known to himself, thinks it 
wise to withhold from the nation at home. As 
we hsTe all along pointed out, when plague 
gets a foothold in a country that is badly provided 
from a sanitary point of view, then the course of the 
disease is likely to be lingering, widespread, and 
disastrous. The condition of the whole of South 
Africa from a health point of view is about as 
bad as it possibly could be, a fact that has been 
abundantly illustrated in the disease mortality of the 
British Army. Itwould be much better to announce 
officially the truth, the whole truth, and nothing but 
the truth with regard to the plague, and to take 
measures accordingly. 

Small-pox in London. 

Ths epidemic of small-pox in London, so far from 
abating, has suddenly shown a serious increase. At 
the end of last week the retums of the Metropolitan 
Asylums Board showed a greater number of patients 
under treatment, namely, 201, than at any previous 
period of the outbreak. The existence of so many 
centres of infection spread broadcast over London 
points to a grave state of matters that must continue 
to demand the earnest attention of those responsible 
for the public health. Yaccination and re-vac¬ 
cination have been widely resorted to in 
all districts, but more especially in the wealthier 
quarters of the town. There can be little doubt that 
the present invasion will serve a useful purpose in 
educating public opinion upon the value and neces¬ 
sity of vaccination. Should small-pox get estab¬ 
lished in some of the notoriously anti-vaccinationist 
districts, such as parts of Whitechapel and Shore¬ 
ditch, the results will probably be of a disastrous 
nature. As matters stand at present, it almost 
looks as if the Nemesis of a great outbreak of tbis 
terrible malady were closely dogging the footsteps of 
the Government responsible for the creation of that 
bugbear of scientific preventive medicine, the “ con¬ 
scientious objector.” 

In View of the Election! 

Mb. Geobob Bbown took advantage of the 
opportunity afforded him by last week’s meeting at 
Newcastle-on-Tyne to reply to the chaiges brought 
against him by Dr. Glover at the meeting of the 
Direct Representatives at the Cheltenham meeting 
of the British Medical Association. A reply of some 
sort was indeed to Im expected, since Mr. Brown was 
not likely to sit quietly under the imputation that he 
is not a fit and proper person to represent the pro¬ 
fession on the General Medical Council. At Chel¬ 
tenham, Dr. Glover, referring to the view urged in 
certain quarters that the General Medical Council 
should punish the members of the Obstetrical 
Society of London for granting certificates to mid¬ 
wives, observed that the Council bad only one 


punishment, viz., to remove the uante from the 
Regiaier, He asked whether the most advanced 
medical reformer, Mr. Brown himself, for example, 
would venture to make a definite proposal to that 
effect in the Council, a step he might have taken 
any time in the last five years, but had not done so. 
Now for Mr. Brown’s reply. He told his audience 
at Newcastle that the charge almost took bis breath 
away, because he had a sort of dim lecollection of 
having made the very proposition in question. On 
November 29th, 1899, the whole of the afternoon 
was occupied by the members of the General Medical 
Council in discussing various motions standing in 
the name of Mr. George Brown, and amcmg these 
were two that certainly raised the very point in 
question, because their purport was to adjudge guilty 
of infamous conduct in a professional respect any 
registered practitioner who takes part in any exami¬ 
nation in the art of midwifery held by a Society that 
is not legally authorised to bold such examinations. 
Mr. Brown considers that Dr. Glover had forgotten 
this Wednesday afternoon. That may or may not 
be the case, but when Dr. Glover has recovered from 
bis indisposition it will be interesting to hear what 
he has to say on the matter. 

Lager Beer in Acute Vomitiog. 

VoMiTiNO and nausea are symptoms which are 
met with in association with a large number of con¬ 
ditions, especially in connection with pregnancy and 
in disease of the pelvic organs and of the nervous 
system. To be sure, there is no lack of remedies for 
this distressing state, but, as is well known, iced 
champagne, sipped at short intervals, is a trust¬ 
worthy and by no means repulsive remedy. But 
champagne, even of average quality, is not accessible 
to many persons, and, according to a correspondent, 
lager b^r, especially that which is dark in colour, 
has a very decided effect in arresting vomiting. The 
effect is most marked in those who are not accus¬ 
tomed to alcoholic beverages in any form, and the 
soporific action enhances the local sedative action- 
The dose must be proportioned to the severity of 
the case, but three bottles appear to be as much as 
most sufferers will require, as can well be imagined* 
for this quantity in a person unaccustomed to drink¬ 
ing beer is certain to determine marked physio- 
lopcal effects. 

Foreign Bodies in Food at Restaurants. 

That the law is a somewhat capricious arbiter of 
the fate of suitors is proverbial. Some two or 
three years ago a visitor at a well-known London 
restaurant swallowed a needle in some spinach served 
in the course of a public dinner. After much litiga* 
tion the case was decided in favoxu* of the defendants, 
a decision that was clearly not calculated to augment 
the confidence of customers in the management of 
hotel and restaurant cooks, inasmuch as they were 
thereby relieved of responsibility for the presence 
of foreign bodies in their cuisine. A recent 
case, however, seems to have more or lees 
traversed the former dedrion. A genUeman 




OoT. 80, 1901 


NOTES ON CURRENT TOPICS- Th. Mtoical Press. 475 


We regret that this dignified course of procedure by 
the Irish Colleges was not also followed bj other 
medical corporations, but all honour is due to the 
authorities of the Irish bodies for lending a helping 
hand towards the assistance of their follow-practi* 
tioners in Plymouth, and the sooner other bodies 
follow suit the sooner they will earn the gratitude of 
the medical profession. 


The Improvement in the General Medical 
Council. 

Speaking at Newcastle on Saturday last Mr. 
Horsley said that during the last four years the legal 
work of the Council had been completely reformed, 
and he was evidently in complete accord with bis 
audience when be said that it was a matter for con* 
gratulation that the General Medical Council now 
had for its solicitor a geotleman who was deeply in¬ 
terested in his work, and very keen to follow out 
every point so that the Council should never agun 
be committed to such an awful scandal as that con¬ 
nected with the late Mr. Hunter. Mr. Horsley’s 
remarks on the financial reform necessary in the 
Council had, somewhat justly, a triumphant note in 
them, and it was a pity that Dr. MacAlister, of Cam¬ 
bridge, was not present to bear Mr. Horsley’s com¬ 
ments on what he called the most extraordinary 
misunderstandings and misstatements made on be¬ 
half of the Coxmcil by their official spokesman, Dr. 
MacAlister. In the last four years it bad been 
driven home to the members of the Council that 
there must be an amendment of the Medical Acts. 
In spite of these lines of improvement Mr. Horsley’s 
opinion is that the only way to secure a new Medical 
Act is by first reforming the General Medical Coun¬ 
cil. If that could be effected by a reformed British 
Medical Association there would be the groundeork i 
of a real campaign against quackery. 

The Effect of Diet. 

The varying conditions induced in different 
species of animals by diet, especially in relation to 
susceptibility to tuberculosis, have been investigated ; 
by Woods Hutchinson, at the London Zoological 
Gardens. In the case of monkeys it was found that | 
there was a veiy marked divergence between those 
on a vegetarian diet and those on a meat diet. 
Seventeen out of the .thirty-five deaths among the 
vegetarian monkeys in the course of six months 
were from tuberculosis, but not a single death from 
this cause was noted in the ten deaths among the 
carnivorous monkeys. The trend of opinion and of 
clinical experience has been of lute towards empha¬ 
sising the importance of a highly nitrogenous diet 
in the treatment of tuberculosis at sanatoria, and 
curiously enough this is quite in agreement with the 
experience of the keepers at the Zoo, who have come 
to the conclusion that if the anthropoid apes 
are not put upon a diet of animal food it 
is only possible to keep them alive for a short 
time. This effect of food only partly explains 
the divergences noted in the susceptibility 


to tuberculosis of the several species of animals, for 
certain of the herbivora have almost as complete an 
immunity as the carnivora. It is considered, 
and in our opinion rightly so, that the method of 
life of the carnivora, involving as it does a higher 
degree of activity, had something to do with this 
relative immuaity. It was apparently a matter of 
vigour and endurance in the resistant powers rather 
than of race, diet, or exposure to infection, as these 
powers were usually higher in flesh eaters than in 
vegetable eaten. 

The Neanderthal SkulL 
One of the great landmarks in the study of 
primitive man has hitherto always been the extra¬ 
ordinary skull found in the Neanderthal cave. In 
spite of the attractiveness of the theories that have 
been founded upon the internal evidence of that 
famous relic there has always existed a lingering 
suspicion that the chain of scientific—that is, lopcal 
—proof was insecure. Skulls of somewhat similar 
construction are not infrequently found among 
existing individuals of low and presumably rever¬ 
sionary type. Who is to say that a prehistoric idiot 
has not slept bis last sleep in that ancient cave> 
where his skull has been preserved by the capricious 
band of Nature to puzzle far-off generations of 
scientists P If the skull came from a nation of 
similar type it would be reasonable to suppose that 
ere now companion skulls would have been unearthed. 
That has not happened, however, and the Neander¬ 
thal skull remains unique. Professor Yirchow has 
dealt with these points in an address at the recent 
Congress of Anthropologists in Berlin. He insisted 
that it is impossible to infer from a single individual 
what a whole race may have been, and furthermore, 
that the conclusions drawn from the examination of 
a few skulls are misleading. If this declaration de¬ 
prive popular lecturers of their Neanderthal skull it 
will have taken away one of their most valued 
possessions. However, they may take heart from 
the reflection that all we know of many extinct 
mammals is, say, an under-jaw or a thigh bone. 
The famous Archseopieryx skeleton, again, is a single 
representative of the transition form between 
reptile and birds. 

PERSONAL. 

Da. Mackenzie, of Linlithgow, was thrown from his 
horse on Thursday last, and sustained serious injury to 
his head. —- 

Da. Laxbe Atthill has been elected Presidant of the 
Eoyal Academy of Medicine for the ensuing session, the 
opening meeting of which will be held on Friday next. 

Da. J. Hallidat Crook, Physician to the Edinburgh 
Boyal Infirmary, ha* been elected to the Presidency of 
the Boyal College of Surgeons, Edinburgh, for the 
ensuing year. 

Ma. E. TanACHsa Collins, F.B.C.S., has been elected 
to the newly-oreated post of Ophthalmic Surgeon to 
Charing Cross Hospital and Lecturer on Ophthalmology 
in the Medical School. Dinm/ed b\ C 




476 The Medical Fsise. 


SCOTLAND. 


Oct. 80, 1901. 


Dr. Judson S. Bust, of Manohestor, will deliver the 
Bredehaw Leotare before the BoyalColl^ of PhyeidaDB 
of London on November 6th on “ PrognodB in Belation 
to Dieenee of the Nervons System.'’ 

Mr. a. Pxabcr Gould is to deliver the LettBomiaa 
Leotorea before the Medioal Society or London on Feb* 
mary l7th, March Srd and l7th next, on the subject of 
“ Certain Diseasee of the Blood VeeBelB.’' 

Sir Joseph Dimbdale, the Lord Mayor Elect, has pro* 
mised to preside at a meeting to be held at the Mansion 
Honse in January next in aid of the appeal on behalf of 
Gay's Hospital for further public support. 

Mb. Alban Doran, F.B.C.S., will be chief editor of 
the New International Journal of Obtfelriee and Oynm. 
eclogy, which is expected to appear in January. Messrs. 
Bailiiere, Tindall, and Co. will be the publiBhera. 

Tux marrii^^ of Surgeon Lieut.>Colonel Balph 
Gooding, M.D., took place last week during his 
mayoralty of Greenwich, to Misa Laura Frances Baillie- 
Hamilton, youngest daughter of the late Admiral and 
Lady Harriet Baillie-Hamilton. Dr. Gooding's term of 
ofBoe expires on November 9th. 


$C0tIanb. 

[from oub own correspondent.] 

General Council or the Univebsitt or Edin* 
BUBOH. —Though this is the only body through which 
the greater number of its graduates can m^e their 
voices heard in University management, the meetings 
are not, as a rule, attended by many medioal men. At 
the last statutory meeting, however, several topics of 
medical interest came up, and there was an unusually 
full attendanoe of medi<^ graduates. A motion was 
tabled by Dr. B. J. A. Berry requesting the University 
Court to inquire into the feasibility of reorganising the 
medioal curriculum on the lines suggested by the 
Pathological Club of Edinbn^h. A oeitain amount of 
attention has already been directed to Dr. Berry’s 
scheme an aooount of which has appeared in one of &e 
Edinburgh medical journals. The principal changes 
proposed are the division of the a<^emio jear into 
three sessions of three months each, a diminution in the 
amount of time devoted to preliminary scientific subjects, 
with a corresponding increase in the time available 
for practical work. The student would no longer be 
compelled to take surgery in his second year, and would 
not be allowed to work in the ho^ital until t^ter he had 
passed his second professional. He would no longer be 
permitted to take art classes in new subjects until he 
passed the previous professional examination. Into the 
details of the scheme it is impossible to enter here; 
suffice it to say that, while it reads well on paper, and 
would certainly be an enormous advance on we present 
arrangements, it is doubtful whether the University 
authorities wiU yield to such a sweeping scheme of 
reform. As it is the medical faculty has turned a rather 
unsympathetic ear to the report of the Medical Class 
Hours Commission—a body composed bcth of teachers 
and students, which went very fully into the question 
of conflicting class hours, and proposed certain altera* 
tions with a view to remedying these defects. Dr. 
Berry's motion was not oarriM in the exact form pro* 
posed, but a technical alteration was made so that it 
might be remitted to the business ooiumittee of the Coun* 
oil. The second motion of medical interest was one by Dr. 
E. Greville for returns of the number of hours spent by 
each professor in teaching his practical classes; the 
numbw of hours so spent by assistants; the amount of 
fees paid by the student for such practical classes. The 
mover of the motion has during the past summei issued 


several rather polemic tracts dealing with the appmnt* 
ment of professors' assistants, and by his speech in sup* 
port of the motion alienated many who would have voted 
with him. Many felt that the motion its^ was dejir- 
able, but abstained from voting rather seem to 
endorse the rather personal character of the q>eeoh 
introducing it. The motion was not carried. 

Tbe Cabnboie TausT.^The joint reprats of ihe 
Business and Finance Committees presented at this 
meeting of the General Council dealt with the Carnegie 
Trust and the decrease of students at Edinburgh. 
Speaking of the former, the reports discuss the 
of the various departments for fiiiMimaJ assistanoe ic 
teaching and equipment. It recommends the 

Council represent to the University Court tliat the 
following are the clamant needs of the University : (1) 
The development of the work of the University in con* 
nection with tbe teaching of modem languages. (2) 
The strengthening of the teaching staff in the medical 
faculty. (8) The provision of suitably equipped 
laboratories for the instruction of students in all gradua* 
tion subjects for which practical work is reauired. (4) 
The establishment of research laboratories. (6) The 
improvement of the library. Tbe second, ana leas 
important^ half of Mr. Carnegie's gift is devoted to 
the payment of fees. Contrary to tbe expec¬ 
tation of some who claimed to have an intanuite 
acquaintance with the working of tbe scheme the full 
amount of fees claimed has hSaa paid in almost every 
case, and this has often amounted to upwf^s of £20. 
Matriculatioo, hospital, and examination fees are not 
Twd. The number of applicants seems to have been a 
little over 8,000, and the Trust is now busy with late 
applications. It is generally supposed that tiie first 
ye^s work is to be held as of an experimental nature, 
and no doubt changes will be enforo^ as occasion may 
demand, but it is impossible to withold a tribute of ad¬ 
miration from all those concerned in the management of 
the Trust for the speedy way in which they have enabled 
the students of Scotland to participate in its ben^ts. 


THE GENERAL MEDICAL COUNCIL ELECTION, 
1901. 

Mr. Georoe Brown's Address to the Bboistered 
Practitioners of Enoland and Wales. 

Fellow Practitionebs,—As the term for which you 
elected Dr. Glover aod myself in 1896 to represent you 
in the General Medioal Council will expire on January 
let next, you will shortly be called upon to fill the seats 
which will thus become vacant. 

I beg to inform you that it ie my intention to offer 
myself for re-election, and I venture to hope that my 
efforts to serve your interests during the four and a half 
years I have had tbe honour to r^resent yon will en¬ 
sure me a renewal of your confidence. 

It will be in the recollection of many of you that at 
tbe last election I pledged myself, if sucoei^al, to do 
my utmost to carry out a definite line of action in 
regard to five questions of great importance as affecting 
the wellbeing of tbe profession. Beepecting theie, it 
may be convenient if 1 as briefly as possible report 
progress. 

1st.—Amendment of the Medical Acts with a view to 
the soppreesion of Unqualified Practice. 

As yet it has been impossible to persuade the Council 
to take action in favour thereof, but as some of the 
most powerful opponents of medical reform have, dor* 
ing the last year or two, ceased to be members cd tbe 
Council, and their seata are now occupied by others 
whose views are more in harmony with those held by 
the bulk of tbe profession, I am not without hope that 
medical reform will be regarded with more favour in 
the future, although some outside preesure may be 
necessary Imfore the Council takes any practical stei» 
to promote a Bill to amend the Medici Acts in the 
direction indicated. 

find.—To prevent sick clubs and dispensaries whose 
agents canvass for patients from obtaining the 
services of rostered practitioners. 

It is a great satisfaction to me to know that I have 


Oct. 80,1901. 


MEDICAL COUKCIL ELECTION. 


Thx Medical Pbees. 477 


assisted in pwsing a reBolntion ezpreBsiog the disapproval 
of the CooncU with those practitioners who associate 
themselveB with clubs whose agents BjBtematically 
canvass for patients. This resolntion is a step in the 
right direction, bat as the expression of a pions opinion 
it will, I fear, ^ of little nse. The degrading practice 
can only be snppressed by dealing with it in the same 
manner as offences which are regarded as infamous in a 
professional respect. I shall always insist, as I have in 
the pa«t, that the absence of a wage-limit is likely to 
lead to the abase of dabs and dispensaries, as well as to 
friction and contentions among neigL^uriog practi¬ 
tioners. 

Srd.—To oppose the Bill for the Kegistration of 
Midwives. 

Through the action initiated by me at the May res- 
lion, 1897, notwithstanding that the Connoil bad pre¬ 
viously in very decided langnage, to use the late Sir 
Richard Qnsin's own words, declined to interfere with 
the proposed legislation respecting the practice of mid¬ 
wives, the Council appointed a sprecial committee to 
consider the proj>osed measure. As a result the Lo^ 
President of tbe Privy Council was informed that the 
Council “ would earnestly deprecate its passing into law.” 
Happily, in consequence of the opposition thus raised, 
the mischievous Bill did not receive the sanction of 
Parliament, and I have no fear that it ever will become 
law if the profession as a whole oontinnes to exercise the 
vigilance and activity in opposing the measure it has 
hitherto done. Mach will depend upon the votes re¬ 
corded in this election, and yon may rely upon me that 
my opposition to legalising midwives as independent 
practitioners will be as keen as ever, and I should like 
both midwives and all unqualified practitioners 
legally responsible for any damage they may canse to 
mother or child or any other person. I am. however, in 
favonr of legislation to insure the better education and 
regiatration of obstetric and other noises to act nnder 
the direct snpervision of medical practitioners. 

4tb.—The raising of the standard of 
education. 

In accordance with mv pledges, 1 have worked in har¬ 
mony with those members of the ConncU who are in 
favonr of raising the standard of education, and it is satis¬ 
factory to report that daring the last year or two regnla- 
tions have been adopted lengthening the coarse of pro¬ 
fessional study and raising tbe standard of preliminary 
examinations. It is to be regretted t^t the Royal 
College of Physicians and the Itoyal College of Snrgeons 
of England appear disposed to dispute tbe authonty of 
the Council in regard to this matter. Although I am a 
member of the College of Snrgeons I feel that in all 
questions relating to medical education the fiat of the 
Medical Conned should be absolute, and as tong as I 
continue to be a member of that body my action will be 
folded by a sincere wish to support its authority. Un- 
leu the CouDcil’s authoritr to maintained, medical 
education will soon become chaotic. 

5.—-Increased Direct Representation. 

On two occasions I have proposed motions calling 
upon tbe Connell to make application to the Privy 
Connoil to obtain an additional Direct Representa¬ 
tive for England and Wales, as provided for in the 
Medical Act of 1886, bat I regret to say that on each 
occasion the proposition was rejected by a large 
majority. If I oontinue to represent yon on the 
Conncil I shall again press this question upon the 
members, but I fear nothing will to aocompliahed in 
that direction nnless a direct appeal to Parliament be 
made. I shall do my utmost, both inside and outside 
the Connoil, to ueist those who consider that their 
Representatives on it ehonld to elected by the graduates 
of Che nniversitiu and the members of the oorporations, 
and not solely by the Senatu and Councils respectively. 

It is a satisfaction to me to report that daring my 
term of office I have taken an active part in bringing 
about the promulgation of new regulations respecting 
the employment of ODqnalified assistants which have 
done more to protect the public against unqualified 
praotioe and to elevate tbe piofeesion t>»an any other 


measure adopted by the Council since the profession 
bu had the privilege of aending direct representatives 
to the Conn^. 

There are other points I would have desired to men¬ 
tion in this address, but must deal with them at the 
pnblic meetings. I would therefore conclude by thank¬ 
ing yon for the generous consideration ^shown towards 
me during my term of office, and by giving yon the 
assurance that should yon honour me by re-ele<^iag me 
as one of your represen'atives I shall, as in the past, 
do all in my power to serve your interests and to uphold 
the honour and dignity as well as the interests of our 
profeesiou. 

I remain. Fellow Praotitioners, 

Yonr obedient eervant^ 

Geobox Bbowk. 

6, Gibson Sqnare, I^ondon, N., October, 1901. 

Ma. Gxobox Jackson's Addbsss to thb Beoistibxd 
Pbactitionbbs or England and Walxs. 

Ladies and Gentlemen,—Having been invited by tbe 
Incorporated Medical Practitioners' Association, in oon- 
junction with Mr. George Brown, to become a candidate 
as a direct representative on the General Medical Coun¬ 
cil, I have aooeded to their request, and am enoonraged 
to do BO by the fact that I obtained 4,082 votes at the 
last election, although very late in the field. 

On the last occasion, omitting a bye-election caused 
by the resignation of Dr. Rentonl, the contest turned 
prinoipaUy on the question of the r^stration of mid- 
wives, the votes in favour of it being only 8,443 as 
against 26,040. 

I am now, as then, opposed to the registration of 
midwives, the creation of an inferior order of praoti¬ 
tioners. The only way to settle this vexed question is 
by the registration of all nurses, who will to obliged to 
act under tbe direct control of dnly-qualified m^cal 
praotitioners. 

The objects which should engage the attention of the 
Genertl Medical Council in tbe immediate future should 
to in my opinion :— 

1. The reform of the Medioal Acts, so as to provide 
for direct representation of tbe medical profession in 
every case except the Crown nominees. 

2. Raising the standard of the entranoe examinations, 
and limiting the age of entranoe so as not to to nnder 
seventeen years. 

8. The one-portal system of entrance to to secured by 
forming a Board of Examiners, composed of delegates 
from the present examining bodies. 

4. Snob an alteration of the Acts which will give the 
ConncU power to suppress quacks, &a, who practise 
medioine and surgery under various forma of colourable 
pretences. 

6. A more definite pronouncement against medical 
' men acting as medical advisers to clubs and insurance 
societies whose agents tout for members. 

For the information of those to whom I am unknown 
personally I may state that 1 have taken an active part 
in medical politics for more than twenty years. 

In conjonction with Mr. Reginald Harrison 1 set on 
foot some twenty years ago a movement which had for 
its object the voting by voting papers for tbe election of 
members of the Connoil of the Royal College of 
Surgeons, which was snocessful. 

About fifteen to sixteen yeaie ago I endeavoured to 
establish locally a medical sick assaranoe society, and 
thus helped to prepare the way for tbe Society which at 
present exists, and does such good work. 

In 18951 was President of the Incorporated Medical 
Practitioners’ Association, and founded the Devon and 
Cornwall local branch of the same, which has done good 
work in checking irregular practice and the like. 

Last year I was a delegate of the Plymouth Medical 
Society to the medical organisation meeting at Man¬ 
chester, and vas appointed a member of the committee 
which has had a great deal to do with the reform of the 
British Medioal Association. 

I have aasisted in the work of establishing the Three 
Towns (Plymouth, Devonport, and Stonehonse) Provi¬ 
dent Dispensary in conjunotion with the local branch of 
the Incorporated Medioal Praotitioners* Aaaooiation, 




478 Thb Mbdicai. Fbbbs. 


MEDICAL THKWri. 


Oct. 80. 1901. 


which works on the principle of a waf^Umit, the 
management being in the hands of the members of the 
staff. 

Asking the faronr of ^onr vote and interest, 

I remain. 

Your obedient eerrant, 
Gbobob Jacebok, 

F.S.C.S.Ens., Es-Prefident and^ice-PrMident of the Incorponted 
Medicel Pra^itionere’ AjsocUtion and of the Devon and Corn¬ 
wall Branch of the tame, and Ex-Freaident of the Plrmonth 
Medical Societj. 

10, Port'and Villas. Plymouth, October, 1901. 

Addbiss bt Chas. Hatwabd, M.D., D.P.H., C.D.9.D., 
Ac. (Barri8ter-At*Law). 

As one who believes it to be essentisJ that the General 
Medical Council should undergo some radical alterations 
and improvements, and who trusts that he is to a con¬ 
siderable extent qualified to anist in the proper carrying 
ont of these modifications, I am coming forward as a 
candidate at the approaching election. 

The foundation of my claims is, that I believe that 
the General Medical CcuncU should be essentially oon- 
oemed with the welfare and interests of the general 
medical profession and the safety of the public, and not, 
as at present, only with trying to reconcile the various 
selfish interests and jealousies of the different corpora¬ 
tions and licensing b^iea. 

The constitution, prooedure, and finances of the 
Council require thorough revision, and the members 
must directly represent the profession, not the restricted 
councils of each corporation. 

The present unfair treatment suffered by our direct 
rep rooo ntatives must be met by sending re»olnte men 
who will not flinoh from asserting the wishes and in¬ 
terests of the general profession, no matter how bitterly 
the vested interests oppose; and in some instances this 
opposition has overstepped the limits of mere bullying 
snd become absolutely illegal. 

It is especially in such circumstances, and also in the 
necessary amendments to the Medical Act and other 
legislation, that I hope my qualification of barrister-at- 
law may be of especial service to my fellow-practitioners; 
and as 1 n?w am, and have been for over fifteen years, 
engaged in general medical practice, I trust thi^ the 
profession will recognise that it would be to their in¬ 
terest to avail themselves of the servioes which I now 
place at their disposal. 

Grove Street. Liverpool, October 27th, 1901. 


Correfijjottliena. 


LW«do not hold oanelvesroaponsible for the opinions of onr 
coireepondente.] 


THE BACTERIOLOGICAL TEST. 

To the Editor of Thb Medical Fbess and Ciboulab. 

Sib, —Mr. Sere is disappointed that 1 did not respond 
to his last letter. His letter of October 2nd so wandered 
from the point at issue between you, Mr. Editor, and 
myself that I considered it necessary to restate my 
original argument, and this you very courteously per¬ 
mitted me to do in 5 onr issue of October 9th. I have 
not the slightest objection to reply to any arguments 
which Mr. Sere chooses to set forth on the whole ques¬ 
tion of vivisection, but I cannot waste my time nor 
trespass on your hospitality by dealing at length with 
all Mr. Sera’ rather involved sentences and his somowhst 
irrelevant arguments. I like to deal with one thing at 
a time, and I asked in my last letter how did the 
biological test help in the case of my relative whose 
story I told at &e beginning of ^is controversy. 
As Mr. Sers has not answered this reiterated ques¬ 
tion the matter goes by default as judgment for 
me. I say it did not help at all. I have no 
contempt, as your correspondent seems to impl^, 
for idle science of bacteriology; all I maintain 
is that if trufted implicitly as a means of diagnosing a 
difficult or obecure case it is exceedingly liable to lead 
us astray, and I think most bacteriologi^ would admit 
this. If bacteriology involved no cruelty to I 

should become an ardent student of the scienoe for its 


own sate, but I should be exceedingly oautioas how 1 let 
it inflnenoe my dealings with my patimita. Z am no 
fanatic, require no coaxing “ to tom from the error of 
my ways,” as your correspondent suggests that I should, 
and am quite opeu to conviction on any subject Mr. Sers 
may intzmnee, but I am not anxious to disouss the very 
teobnical and wide subject of vivisection in relation to 
medicine and surgery with a gentleman who boasts that 
he " knows little or nothing about it ” I have studied 
the question for twenty years very closely, and am well 
aware of the difficulties involved in its diMUssion, and I 
am sure your very courteous correspondent will pardon 
me for saying that the relation of animal experimenta¬ 
tion to medical science is not to be discussed like Mark 
Twain’s opinions on chemiosJ science, with an unbiassed 
mind becaose he knew nothing whatever about it.** 

I am, Sir, yoors truly, 

Edwabd Bbbdoe. 

London, October 26th, 1901. 

COUNTEBrPEESCBIBING BY CHEMISTS. 

7*0 the Editor of The Mbdical Pbbss and Cibculab. 

Sib,— My attention having been directed to an article 
in yonr valuable journal of October 23rd under the head¬ 
ing “ Casting out the Mote,” I think it but fair to myself 
both as president of the Pharmsoeutical Society and as a 
pharmacist, and also on behalf of my brother phsr- 
macists, to say that I have as strongly condemned th^ 
practice of counter prescribing by the pharmaoeutical 
chemist, as I have, and do, the compounding of prescrip¬ 
tions by unqnalifi^ and incompetent persons; both at 
our Council and other meetings. I have strongly de¬ 
precated this praotics (if it eiists). I consider the 
moment we pais the line of merely recommending a 
oertoin nostmm for some minor ^ment, such as a 
cough, Ac., and attempt to di^nose the case and pre¬ 
scribe for such case, then I most emphatically say we ai 
chemists ontstep the limits laid down by the law, and 
exceed onr duty and the privileges conferred on us by 
our diploma; but surely you do not infer that the 
chemist is not to recommend such nostrums, the ingre¬ 
dients of which be is quite familiar with and cognisant 
of their therapeutical effects. I think it is more the 
business of the pharmaoeotioal chemist who has served sn 
apprenticeship and passed his examination to put up these 
articles than the wholesale mao, who in some or most 
cases knows little, if anything, of the pr<^rtiea of the 
drugs he is handling, and I maintaia that the chemist 
thus acting differs very materially from eounUr prt- 
ieribinj. 

I am very pleased to say that in no city of the kingdom 
is the practice of counter prescribing by the ohraist 
praotis^ less than in Dublin; consequently, then, the 
pharmaoeutical chemist enjoys the confidence andesteem 
of tile medical profession, and it is my fervent wish that 
such relations may long continue. Trusting you will 
excuse my trespassing thus far on your valusble space, 

I am. Sir, yours truly. 

0. D. Beoob, Pres. Ph. Society, Ireland. 

Dalkey Medical Hall, Oct. 26tii, 1901. 


(JUcitcal 

The New War GonnelL 

Thb following statement has been issued by the War 
Office j— 

1. The Secretary of State has directed that in 
future the War Office Council shall be constituted as 
follows r— 

President— 

The Secretary of State for War. 

Members— 

The Commander-in-Chief. 

The Parliamentary TJnder-Secretaiy of State. 

The Permanent TJnder-Seoretary of State. 

The Financial Secretary. 

The Qnartermaster-GeneraL 

The Inspector-General of Portifloations. i 

Dinm OOQlC 


Oor. 80, 1901, 


MEDICAL NEWS 


Tbi Hkdioal Pbsbb. 479 


Tbe Direotot-General of Ordnance. 

The Adjntant-Oeneral. 

The Direotor-Oeneral of Mobilisation and Military 
Intelligence. 

The Director-General Army Medical Department (tot 
medical and sanitary questions). 

Tbe Secretary of the Conncil. 

And such other members of the Staff of the War Office 
as may he ipecially snmmoned from time to time. 

2. In the ab::pnce of the Secretary of State the Com- 
mander-in-Chief wUl act as President. 

8. Tbe Conncil will meet on Mondays, nnless other¬ 
wise ordered, at twelve o’clock in the Secretary of 
State’s room. 

4. Tbe Conncil will discuss snih matters as may be 
referred to it by the Secretary of State and any ques¬ 
tion brought before it by individual members. In order 
that a precit may be prepared notice of tbe matters for 
discussion, together with tbe office papers on tbe subject, 
should reach tbe secretary not later than the Wednes¬ 
day evening before each meeting. 

6. Eeoords of the proceedings will be kept and copies 
will be supplied to each mem^r. 

In addition to tbe foregoing there is to be a Perma¬ 
nent Executive Committee of the War Office, under the 
presidency of the Permanent Under-Secretary of State, 
or in bis absence of the Assistant Under-Secretary of 
State, with certain military and other officials, and the 
Deputy-Dirrctor-General, Army Medical Department, or 
an officer selected by the Director-General, as members; 
and the present Army Board, of which the Director- 
General of the Army Medical Service is constituted a 
member, will be con^ued. 

Contract Medical Attoidanee at Bnrton-on-Trent 

Ths club doctors of the Bnrton-on-Trent District ore 
agitating for a readjustment of their remuneration, 
more p^icnlarly in respect of tbe juvenile members, 
who, it is contended, sho^d pay four shillings per head 
per annum. The clubs are determined to resist this 
by no means exorbitant demand, and have decided, it is 
reported, to eetablisb a medical aid association, and to 
import four practitioners to take over all the club work. 
We fancy, however, that they will not find this " under¬ 
taking ” as easy as they imagine. If the practitioners 
will stick to their guns we do not doubt that ultimately 
the clubs will reof^nise the validity of the claims and 
acquiesce in the inevitable. 

A Medical Man Committed for TrlaL 

Astxb a hearing extending over four days. Dr. 
William Tyndale Watson, Medical Officer of Tottenham, 
who has resided there nearly forty years, was yesterday 
committed for trial on charges of improper iMhavionr 
to girls who were sent to his house for mMicine. 

Bt. Oeoxge's Hospital Medical School. 

Ths Lord Chief Justice (Lord Alverstone) presided 
at the annual distribution of prizes at this school on 
Monday last, when the following were presented:—Mr. 
W. Byam, the H. C. Johnson Prize in Anatomy, and 
Prize for Proficiency in Anatomy, Physiology, and Phy- 
siolc^cal Chemistry; Mr. S. H. Watson, Certificate of 
Honour in Anatomy; M. A. Manuel, the Pollock Prize 
in Physiology ; Mr. C. M. Henley, Sir Charles Clarke’s 
Prize; Mr. W. B. Swete-Evans, Sir B. Brodie’s Clinical 
Prize in Surgery ; Mr. A. Jex-Blake, B. A., Brackenbury 
Prize in MMicine, Treasurer's Prize, and Thompson 
Medal; Mr. T. C. English, the William Brown £100 
Exhibition, and the Webb Prize in Bacteriology; Mr. 

A. B. Coomber, an Entrance Scholarship in Arts of the 
value of £60; Mr. H. E. 8. Collier, an Entrance Scholar¬ 
ship in Arts of the value of £160; Mr. ,T. Drysdale, 

B. A., an Entrance Sidiolarship in Science of the value 
of £85. 

Royal Academy of Medicine in Ireland. 

At the annual general meeting held in the Boyal 
CoUem of Physicians on Friday .last, 26th inst., the re¬ 
port for last session was adopted and officers elected for 
the present session. It was announced that invitations 
had Deen received to the first Egyptian Medical Con- 
grons, to be held at Cairo in DecemW, 1002, and to the 
foorteenth International Medical Congress, to be held at 


Cairo in April, 1903. Fellows wishing to attend these 
Congresses are requested to communicate with the 
Secretary for Foreign Correspondence. The following 
officers were e'eoted for the ensuing session, 1901-2: 
—President, Lombe Atthill; General Secretary, John 

B. Story ; Secretary for Foreign Correspondence, Sir 
J. W. Moore. Medical Section: President, Sir C. 
Nixon ; H. T. Bewley, James Craig. H. C. Drury, E. A. 
Hayes, T. P. Kirkpatrick, ConoDy Norman, J. O'Carroll, 
O. Praoocke. E. Travers Smith, W. Langford Symes. 
Sui^cal Section : President, Thomas Mylos; Arthur 
Chance, Henry Croly, F. Conway Dwyer, T. £. Gordon, 
6. Jameson Johnston, John LeDtiigae,H. B. Swanzy, E 
H. Tailor, W. Taylor, B. II. Woods. Obstetrical Sac' 
tion: President, W. J. Smyly ; B. A. Flynn, J. H. 
Glenn, A. J. Home, 11. Jellett, F. W. Kidd 
J. L. Lane. A. Y. Macan, A. J. Smith, E. Hastings 
Tweedy, T. H. Wilson. Pathological Section.—Presi¬ 
dent, E. J. M'Weeney; A. H. Benson, J. B. Coleman, 
F. C. Crawley, W. B. Dawson, H. C. Earl, A. C. O’Snllivan. 
A. B. Parsons, D. Bambaut, J. A. Scott, A. H. White. 
Section of Anatomy and Physiology.—President, D. J. 
Cunningham; A. Birmingham, D. J. Coffey, A. Fraser. 
J. A. S^tt, 'W. Taylor, W. H. Thompson. Section of 
State Medicine.—President, Ninian MT. Falkiner; Sir 

C. Cameron, C.B., W. B. Dawson, F. C. Hartley. H. 
Onlton, D. Bambant, J. M. Bedmond. 




Edinburgh University, 

Thb following candidates have been successful iu 

K ing tbe professional examination for degrees in 

ioine and Surgery:—Old Begulktions: M.B.C.M.: 
Clarence Granville Hey, Arthur Hutton M’Shine, Albei t 
Cormac Poterson, Percy Wilfred Shepherd. New Begn- 
lations: M.B.C.M : Arthur John Brook, Alfred Brown, 
John Webster Duffns, John Mnnro Dnpont, Lncius 
Aosten Holcroft, John Jamieson, Ernest Winbolt Lewis, 
Harriet M’ologbry, John Bryce M'Cntcheon, Lionel 
Alexander HacMann, Kenneth Duncan Cameron Macrae, 
Antoine Felix Gaston Masson, Bobert Murray, Peters- 
wald Pattieon, George Archibald Park Boss, Bichard 
Butherford, Charles William Somerville, George William 
Smith, William Casswell Spooner, George Henry Steven, 
George Cecil Strathmm, James Paget Thome, Noel Na- 
tlumiel Wade, Douglas Larmer 'Wall, Harold Edger 
Wareham, Ph^p Weatherbe. 

Ths Royal University of Ireland. 

Thb Examiners have recommended that the following 
candidates be adjudged to have parsed the under¬ 
mentioned examinations respectively: M.B., B.Cb., 
B.A.O. Degrees Examination:— 

Upper Pass.—*Jobc H. Ferris, Bobert W. Fisher, 
*Jolm H. Oili, Patrick Hefferaan, B.A., *Miobael J. 
Laffan, B.A., Alexander McCloy, Hugh M. McCrea, 
*Jobn E. Haollwaine, *John S. F. Weir, and John A. 
Williams. 

Candidates marked with an asterisk may present 
themselves for the further Examination for Honours. 

Pass.—John M. Aheme, William J. Bannister, 
Frederick C. BuUen, Bobert H. Canghey, B.A., William 
J. B. Fergus, Frederick Garland, John Knox, Bichard 
MoCandless, Daniel 8. A. O'Keeffe, Hen^ E. S. Bichards, 
William Borers, M.A.,HenryBo8B,WilliamA. Sandys, 
and Bobert A. Stewart, 

M.D. Degree Examination.—William J. DargaD,M.6., 
B.Ch., B.A.O., John Beid, B.A., M.B., B.Ch., B.A.O. 
M.Ch. Degree Examination.—Charles Cooper, M.D. 
M.A.O. Degree Examination.—Charles Cooper, M.D. 

Conjoint Examinations in Irsland by the Royal College ox 
Physiclxuu and tbe Royal College of Surgeons. 

The following candidates have passed the Second Pro¬ 
fessional (Old Begulations) Examination as under- 
noted :—(a) In all subjects, H. W. Kelly; (6) completed 
the examination, T. M. iJlen, F. X. Costello, D. E. 
Crosbie, Miss S. F. Dickson, Jas. Nash, E. O’Gz^y, M. 
O’Keeffe, and C. B. Bicbardson. The names of the can 
didates who passed Part I. under the New Begulations 
are not publmedtill they complete Part 11. 




480 Thi Midioal Pbb88. NOnCBS TO CORRKSPONDBPfTS. 


Ocr. 30, 1901 


(llOtUCB to 

^rorrrto^ionbtnto, ^hort ’jCettero^ 

COBMsrovDBVTt raquiriiif a raply in thia oolnmn an par- 
tlaolarlf reqaeated to make om of a diitinetivt $ionatuT« or 
initioUo, and aroid the practice of eignln; themMlrea ** Beader,** 
” Sabaoriber,” **01d Sabecrlber,” &o. Mnoh eonfneion will he 
ap&nd bp attention to thia rale. 

OaiotKAL Aeticlbb or Lamns intended for pablieation ihonld 
be written on one aide of the paper onlp, and muatbe authenticated 
with the name and addresa of the writer, not neceaaarily for pabUoa- 
tion, but 08 eridence of identitr. 

Bapuara.—Beprinte of articlea appearinir in this Journal can be 
had at a reduced rate, proridin^ authora ^ire notice to the pub* 
liaher or printer before the type haa been distributed. Thia ahould 
be done when returning corrected proofs. 

Hr. H. E. (London).—The errors of which ^ou complain were 
referred to in our notice of the work aoon after ita appearance, and 
no u^ut purpose would be serred by diahing them up afreeh. 
They are only minor blemishes, and do not detract materiwy from 
the Talne of the treatise. 

Mb. W. S.—We prefer to let the matter drop. 

THE ANDEBSON FUND. 

The committee formed to appeal for aid for the widow and two 
sons of the late Mr. B. B. Anderson, F.R.C.S., to announce the 
following additional list of Bnbscriptions from July 26th to 
October 22nd. The total amount now anbecribed ia 73 guineas. 



£ 

B. 

d. 


£ 

a 

d. 

Edmund Owen. Esq. ... 

2 

2 

0 

K. W.M.. 

, 1 


0 

Reg. Gilbert Ksq. 

2 

0 

0 

G. B. Toye, Esq. 

. 1 

0 

0 

G. Durnford Inomas, 




A. H. Dodd, Esq. 

. 1 

1 

0 

Em. 

2 

2 

0 

Dr. Collier 

. 2 

2 

0 

Dr. F. de Havilland Hall 

2 

2 

0 

Dr. W. J. Branch 

. 1 

0 

0 

Dr. Connel . 


0 

0 

G. JaokMn, Esq. 

. 1 


0 

H. C. M. 

0 

5 

0 

B. J. Page Smith, Esq 

. 1 


0 

W. B. Burchell Esq- ... 

1 

1 

0 

Capb W. B. Battye 

. 1 


0 

Dr. Edmund Frost 

2 

2 

0 





Dr. B. Boldina. 

1 


0 



_ 


W, F. Brook, Esq. 

1 


0 


£24 

3 

0 

Donitiuns for “The late R. B. 

.Anderson Fond '' should be sent 


and made payable to the Manager, Union Bank of London, Chan* 
eery Laue, London. As it ia proposed to close the fund at an early 
date, intesding anbecribera are requested to send in their donations 
without del^. 

Thi Eibl op SraiiPOBD, Chairman. 

Tikotht Holhbb, Esq.,ff .B.C.8.. Hon. Treasurer. 

WaLTsa MoHKiaoTOv, Eeq., 7, Fig Tree Court, 
Temple, E.C., Hon. Sec. 

J. W. D.—(1) Tea. Fufe Culltn, on “Cancer of the Uterae,’’ 
p. 6S6. It $fg. (Kimpton, 1900). (2) We can find no reference of anch 
«rer haTing been done. It hae been snggeated to inoeulate the 
serum of animals which hare been previouily inoculated with 
cancer “ juice." VuU B. M. y. Epitome, Vol. i, 96, 51,and Yol. ii., 
95, 60. 

Da. O. H. Etskb (San Francisco).—Letter to hand will be con* 
aidered. 

Mr O. C B. 1b thanked for his MS, which is, bowerer, hardly 
snltable for cur columns. 

EaaaTnM.-In our review of Dr. Mocnaaghton .lones’s “P/ac* 
tical Poinis in GynRcology,” September IBrh, pege 322, the transla¬ 
tion of Schultze's “ Dis^acements of the Uterus,’’ it should have 
l-eea stated, was due to Dr. J |J. Macan and not to Dr. Hood, 


Meetings of the Societies. 

ENGLAND. 

Widhbsdat, Dct. 30tH. 

British Balriolooical ard Clihatoiawical Sociktt (20, 
Hanover Square, W.).-S.30 p.m. Addreea by the incoming Pre* 
eident. Dr. Douglaa Eerr. ur. Houchin en Aix Treatment of 
Syphilis la London. 

Thcrsdat. Oct. 318T. 

KEnBOLOoiCAi. SocirTT^OF Lordor (11, Cbandos Street,'Cavendish 
Square, W.}.—8.30 p.m. Cases will be shown by Drs. Ferrier, Hut¬ 
chison, Head, aud Maskens. 

Friday, Nov. Ist. 

Labtroolooical SoaETT or Lordor (20, Hanover Square.).— 
5 p.m. Cases will be shown by Mr. Spencer, Dr. Douelsn, Dr. 
Bt. Clair Thomson. Dr. Tilley, Mr. Weatmaoott, Dr. St. Oeoree 
Beid. Mr. Lake, and Mr. Waggett. 

West Kbrt Medico-Chibuboicai, Bocibtt (Boyal Eent Dispen¬ 
sary Greenwich Boad. 6.E.).—8.45 p.m. Mr. G- Chisholm Williams 
on High Freouency Electrical Currents in the TrMtment of Certain 
Diseaees. 

West Lordor Uedico-Cbibuboical Society (West London 
Hospital, Hammersmith Boad, W.) —8.30 p,m. 

Thcbsdat, Not, 7th. 

Haeveiar Society op Lordor.— 8.30 p.m. First Harveian Lec¬ 
ture. Mr. Buckston Brown’s Twenty-five Tears* Experience of 
Urinary Surgery in England. 

IBELAND. 

Wedresdat, Oct. SOth. 

Inaugural Address at Jervis Street HospltaL Opening ol Session. 


Supplementary Conjoint Preliminary Examination Boyal CoH^ei 
of Physicians and Surgeons. 4 30 p.m, 

Feidat, Not. Ist. 

Monthly Meeting Boyal College of Physicians. 

Boyal Academy of Medicine, Section of Pathology, Boyal College 
of Surgeons, 8 p.m. 

Mondat, Not. 4. 

Boyal College of Snrgeous Fellowship Etamlnattons and Exami¬ 
nation for L.B.C.S. (registered pTECttUonera) commence. 


BiED. Arthur Cteil, M.B.C.S. Eng., L.B.C.P.Lond., Surgeon to 
the Victoria Cottare Hospital, Sidmonth. Deron. 

Bhowrlbx, Alex., L.B.C.F. aud S E., L.D.S.EdiD., Senior Home 
Surgeon to the Ingham Infirmary, South Shields. 

Btoott, Albebt Hehrt, M.B.Lund., District Medical Officer for 
the Deritend and Bordesley Districts of the Aston Union. 

CtiTPiELD, A.. M.B.C.S., L.S.A., Medical Officer forthe Urban Dis¬ 
trict of Boss 

Foestth a. F.. M.B., C.M.Aberd., District Medical Offleerfor Kea 
and Welt Eenwyn by the Truro Board cf Guardians. 

Jackson, D., M.D..L.F.P.8.Glaag., Medical Officer for the Urben 
District of Hexham. 

Lamb, J. M. A., L.S.A., District Medical Officer of the Poole 
Union. 

ScTCLiPFR, W., M.R.C.8.. L.B.C.P.Lnnd., Medioal Officer of the 
West Bromwich Ns. 3 District. 

Steeb, Walter, L.B.C.F., L.B.C.S.Eng., L.F.P. and S.Glaat. 
Junior House Surgeon to the Birmingham an 1 Midland Eye 
Hospital. _ 

Willett, Geoeqe Gilmore Draer, M.BC.S., L.S.A., Uelica 
Officer for the Marksbury District of tbe Keynsham Union. 

9 axancu 0 . 

Bmcebridge Asylum, near Lincoln.—Junior Assistaut Medical 
Officer. Sala^ £125 per annum, with furnished apartments, 
board, attendance, Ac. Applications to W. T. Page, jon., 5 and 
6, Bank Street, Lincoln. 

Essex County Asylum, Brentwood — Fourth Assis tant Medical 
Officer. Age not otcf twenty-fire years. SUary £150 per 
annom. with board, Ac. Apply to the Medical Snperinteadeat. 

Glasgow Unirrrsity.-AdditioDal Exomlnenhips in He^cine and 
Science, with special reference to Chemistry, Materia Medioa, 
Zoology, Practice of Medicine and Surgery. Particulars as to 
dates, emolument, Ac., on reference toouradTertisingoolnmns. 

India.— Asslstantsbip on Tea PtantaUon. Hesltby climate. Salary 
commencing at £300, with free bnngalow. Must be English, 
Scotch, or Irish, and unmarried. Apply Ur. G. B. Stocker, 22, 
Craren Street, Strand, London, 

Enockalower Diapensary District.-Medical Officer. Sali^£l80 
per annum, mth £10 a year as Medical Officer of Health, 
to^herwith Vaccination and BegiitrationFeea. Appl io a tton s , 
accompanied by diplomas and testimonials, to be sent imme¬ 
diately to E. N. Flynn, Clerk of Union. (See adrt.) 

Leioeater Infirmary.—Aaoistant Houee Surgeon. Salary £80 per 
annum, irith board, apartmente, and was hing . Applications to 
tbe Secretary, 24, Friw Lane, Leicester 

Linooln (bounty BospitaL - Senior House Surgeon. Salaiy^OO per 
annum, with board, lodging, and washing. Further informa¬ 
tion of W. fi. Daaby, Secretary. 

Margate Boyal Sea Bathing Hospital—Beetdent Surgeon to act as 
Junior tor sis months and then as Senior for the like period. 
Salary of the two offices is at the late of £80 and £120 per aunum 
respectively, with board and residence. Applications to toe 
Swreta^, Offices, 30, Cbtriog Cross, London. 

Boyal South Hants and Southampton Hospital. Surgeon and sn 
Assistaut SuigeoD. Application to T. A. Fisher Hall, Secretary. 

Salisbury Inflrmarr.-House Burgeon Salarr £100 per annum, with 
board, loiiglng, and washing Apnlications to the Secretary. 

School Board for London — Medical Officer for the Highbury Grove 
School Salary £125 per annum. Further particolars may be 
obtained on application to C. P. Turner, School Board Offices 
Victoria Embankment. 




ArPLrTAED—W alter.— On Oct, 23rd, at Christ Chnreh, Wac- 
strad, Walter B. Appleyard, M.BC.S., L.8.A., of Ilford, to 
ZUlah Annie, third ^ughter of Geo. Walter, of Wonatead, 
Essex. 

Coombs-Jobrstore.— On Oct. 22od,at St, Barnabas, Beckenham, 
Bussell Coombe, M.A., M.D.Camb., F.B.C.8.Eng,, of Exeter, 
to Eve Harriet Cartlsd^. eldest daughter of Jolin Cartledge 
Hirst Johnst'ine, J.P., of Beckenham. 

Wilson -Hibbbbt.—O n Oct. 24tb, at St. Paul's Church. Enlghts- 
brldge, london, Walter Frank Wilson, only sou of the late 
Henry Swindon Wilson, of Begent's Park. London, to Ellen 
Ann (Nellie) Hibbert, second uughter of Chat, H. Hibbert, 
L.B.C.P.I L.B.C.8.Ed., of Marple, Cheshire, 




Aplir.—O n Oct. 21st, at Hill House, Notts County Asylum, Alfred 
Aplin, M.D., M.B.C.8., L.B.C.P., aged 47, Becident Medical 
Buperintendeotof Notts Connty Asylum. 

Bbrrbtt.-Ou Oct. 16th, at his residenae.SloaneStreet, London, 
Francis Graham Bennett, M.B.C.S., L.8.A, aged59. 

HoLDiRO.-On Oct. 17th, at East Henored Bsotory, the residence 
of his son-in-law, Charles Holding, F.B,C,S., late of Victoria 
Street. Weetmi uster. aged 93 years and 9 months. 
pKETB.— On Oct. aoth. at Great (^U^e Street, Brighton, Thomas 
Peete, M.D.6t. And.. H.B.C.S., L.B.A, aged76. 


Dinif 



ik Mdirat Wtm anl CiCtrnilat 


*'8ALt7S POPULI SUFBEUA LEX.” 


VoL. CXXIII. WEDNESDAY, 




LESSONS TO BE LEARNED 

FBOM 

VEGETABLE PATHOLOGY, (a) 

3y JONATHAN HUTCHINSON, F.B.C.8.,F R.8., 

Conraltii)^ Snrfeon to the London HoeplUL 
[BPKCIALLT BCPOBTKD fob this JOUBNAL.j 

6BNTLBAiBK,~>It is oor intention to-day to en- 
•deavonr to get some lessons as regards general 
pathology from the diseases of plants. The first 
-subject to which we will direct attention is the differ¬ 
ences between the causes of disease in trees and 
plants and in animals. Of course I need not say that 
.plants and trees hare no heart and no nervous 
eystem and no lunge, at least in the sense recognised 
in animals; and they cannot be killed either by being 
-choked from want of air, or by the strangulation of 
-any trachea. Nor have they any definite cesophagus. 
Still we find that the general laws of pathology in 
reference to trees and plants are the same, and 1 
think they are instructively similar to those which we 
recognise in animals. Of course we have in animals 
to think of the vital endowments of the solid tissues, 
-and also of the blood which circulates in the tissues. 
We know that in some cases there is an inherited 
tendency in the solid tissues to disease, and in some, 
in the blood and in others, various classes of influence 
are brought to bear. I would ask you, in looking at a 
-sickly tree or plant, to at once put to yourself the ques¬ 
tion, Why is it so P and then to investigate the sym- 
jitoms which the tree displays very care^ly, and you 
will find the same problems suggesting themselves to 
you as you have in tne examination of a patient. Is t here 
-anything in the tissues of the tree or its root struc¬ 
ture which makes it incapable of prolonging its life 
-l^yond a certain duration? Are its organs of 
-assimilation in a certain condition? You will find 
there is a whole series of facts to be con^rehended 
■and investigated in reference to disease anectingthe 
roots. The roots must not be thought of simply as 
ifixation organs, but in their far more impoHant 
'Sense as organs for absorption from the ground of the 
Auids and salts, and other ingredients, by which the 
lant will be fed and stimulated. If the roots are 
iseased it is easy to see that the plant or tree will 
probably be diseased. Next, are the leaves diseased ? 
These stand to the tree as the organs of respiration 
and the stomach do to the animal. If the leaves are 
■extensively diseased the ti ee is in the same 
condition as an animal suffering from disease 
of the stomach, and unable to thoroughly digest 
•and assimilate his food. It is by the leaves 
that the fluids are converted into nutriment, 

(«} Alwtnct of a lecture deUvered at the London HoepiUl on 
July 3rd, 1901. 


NOVEMBER 6, 1901. No. 19. 


and that the t arious ingredients are made into xylem 
or phloem, or other matter as the tree may need. If 
on should And that the whole tree is sickly—trunk, 
nincb, and leaf—you may take it for granted that 
either there has been some starvation process at 
work in the supply of nutriment or some general 
^eease of the roots; and if these be continued the 
tissues will die. You would not think of referring a 
disease of the whole tree to that which merely 
affected its trunk or leaves—at least, not in a generu 
way. To mention an instance in proof of the close 
connection between the general laws of vegetable 
and ^mal pathology, I turn to the subject of com¬ 
petitive nutrition. We have a larM cancerous 
growth in an animal, making neat ^mands upon 
the nutritive materials supplied by the blood, and, 
as everybody knows, cancer leads to emaciation and 
to want of nutrition in various organs. This over¬ 
growth,or inflammation, of one organ is caused by the 
excess of blood supply to it, and as the result of com¬ 
petitive nutrition the other parts of the body are im¬ 
properly nourished. We see thisgenerallawexempli- 
nedsometimesintbecase of congenitalhypertrophies. 
One part is endowed in some way with larger vessels 
than the rest We have many similar instances in the 
animal kingdom. 1 will mention in passing a verr 
interesting example of the suppression oi growtn 
under tbie competitive nutiition which occurs in the 
case of the walrus and the elephant’s tusk. Here 
is an illustration to show the overgrowth of one tusk 
and the suppression of the other. In the nharwal 
we also have the most interesting instance of this 
law in the whole range of zoology. It is a speoiee 
of whale and has nothing to do with fishes, it has 
incisor teeth; one tooth has grown to a length of 
about seven feet, an ivory tusk projecting in front of 
it; the other incisor is absolutely atrophied. In 
vegetables we sometimes see tbis Lw exemplified in 
the potato. Many of the plants do not produce 
flowers. Why is that? Every plant has a destiny 
to prolong its kind in some way by the production 
of seeds or tubers. The potato has taken to pro¬ 
ducing under the ground tubern which have “ eyes *’ 
—a sort of false stem—from which buds the potato 
can be propagated, so that the potato no longer 
needs its se^ at all for reproduction; the plant Is 
produced by the tubers or potato root. There is one 
other curious thing to be noticed about tbe potato 
plant. If you take tbe trouble to gather it you will 
find the flowers arranged in a bunch, and that the 
majority of them have dropped off. Take hold of 
one of the remaining flowers, give it a pull, and you 
will find it very easUy comee off; it is destined to 
come off, and is loose at a certain place. Thus, the 
underground tuber takes up tbe food which would 
be necessary for tbe production of seed, and the 
lant, realising in some obscure way that tbe pro- 
uction of se^ is not necessary, makes no attempt 
to produce seeds, and tbe potato bearing a seed is 



482 Th* M*mcAL Pbisb ORIGINAL COMMUNICATIONS. 


Nov. 6, 1901. 


now comparativelj infrequently found, because the 
plants have been carefully cultivated with a view of 
selecting tbctse which produce the tubers. If one 
part then has a tendency to grow it is at the expense 
of the growth of some other part, and of the proper 
nutrition of the whole. Another very interesting in> 
stance of the law of competitive nutrition is found 
in trees, which have a tendency to produce a large 
number of seeds. The nobilus is one such tree, pro¬ 
ducing innumerable cones. It flowers when young. The 
cones are very large. Theeffect of this great output 
of cones is tnat their production absorbs the sap 
which ought to go to the development of the shoots, 
and the central shoot, instead of going up s ix or 
eight or ten inches, is very much dwarfed by the 
overgrowth of its seeds. 

The diseases of roots are extremely common. 
Tarious forms of fungus growth attach the roots of 
plants just as they may attach the boughs and the 
leaves; some of the worst diseases of plants occur in 
cases in which the fungus is growing at the roots. 

To go back for a moment to competitive nutrition, 
I have a most curious poplar tree on my own farm 
at Haslemere. The roots are divided into two forces, 
the one going down deep in the earth and branching 
out, the other going up, not down at all. to the top 
soil with a view of getting the first supply of rain 
that there may be and the nutritive fluids, manure, 
Ac., which may exist in the upper layers of the soil. 
The poplar and some other trees have a tendency to 
tiie throwing out of roots from the parent root with 
the view of fetching for the latter’s use various 
superficial products; sometimes this branching 
covers an area of thirty to forty square feet. This 
tree stands near a bank, and therefore its spread is 
limited on one side. Now, at the end of each of these 
roots there has grown up a young poplar, which hua 
made its appearance above ground. The result is 
that the parent tree is killed. 

Fungi very often attack the stems of trees where 
some most interesting lessons may be learned in 
reference to animal pathology. Sometimes healthy 
trees will be attacked, sometimes diseased trees, and 
rerj often wounded trees. Just the same as you 
know occurs in connection with diseases in the 
human subject. We have certain specific animal 
oisons and fevers which may occur in a perfectly 
ealthy person, and from which good health is no 
security whatever. Small-pox affords a very good 
instanoe of this; it attacks healthy men, in whom 
there is the beat supply of blood; indeed, the latter 
suffer more severely than others, as if there was 
more favourable opportunity for the development of 
the parasitic poison introduced into healthy people. 
So it is in reference to the attacks of fungi in plants. 
The fungus exists in immense variety; each species 
is different and has a different t^mdency. Some 
will flourish in perfectly healthy plants, no predis¬ 
posing influence whatever being necessary to their 
growth, while others wait till the plant is injured or 
is sickly, or just dead or nearly dead, before they 
can att^k it. The antiseptic t^tment of wounds 
in plant and vegetable life is of extreme importance 
as in animals. A wound on the bark of a plant 
will allow a fungus to settle there and grow into it 
and the stem, causing disease and gradually con¬ 
verting the woody tissues of the stem into a soft 
structure, which destroys them. So that funp;! act 
as agents for the absorption of and obstruction of 
the passage of fluids, which are necessi^ to tbe 
nutrition of the plant On looking at this piece of 
wood 1 have here you will see certain blue fines in 
tbe structure of the wood, and a transverse section 
will show a sort of circle of blue lines. Each blue 
line is the growth of the fungus. Most frequently 
they are found alon^ tbe whole length of the stem, 
branching but little if at all. In this way the stem 


of tbe tree will be very extensively affected and 
converted into a structure no longer capable 
of carrying up tbe sap. This is not at all uncommon. 
In that big tree, the Weymouth pine, you will notice 
—in a great many of them—that a single bough is 
completely brown. Tbe rest of the tiee is quite 
healthy; some of tbe boughs stand at a considerable 
height. Examine ibis brown bough, and you will 
likely find on it a scar where some little injury baj^ 
occurred. It may have been caused by a bird, or a 
hailstone, or a blow. Anything breaking off the 
bark will permit tbe entrance of tbe fungus, which 
once implanted in the injured spot, will pass into tbe 
stem. These fungi differ in their growing tendencies; 
they will grow far into tbe bough, and sometime 
not. In the instance I am now mentioning there is 
a local death from local implantation of the fungus. 

A very curious fact was observed at Haslemere. 
which is of interest to those who are engaged in the 
life-history of tbe fungi. We found on a Weymouth 
pine a very common fungus called the peridermia 
stromi. This fungus has been known on tbe Con¬ 
tinent for a long time to be liable itself to be attacked 
by fungus. We found, for tbe first time I believe in 
England, this second fungus. It is very difficult to 
account for its origin. Tbe authorities at Eew 
Gardens told us that it had not to their knowledge 
been previously observed in England There is evi¬ 
dently some law of association between these two 
fun^ 

I have previously hinted that the protection of a 
wound from infection is just as necessary in the case 
of a plant as in an animal, but, of course, in the 
great majority of instances it is not a practicable 
measure in the plant. If the tree is a valnabl-* one, 
sometimes the Mugh is cut off if it is not possible to 
protect the wound from infection. Or the wound 
may be smeared with some antiseptic tar to prevent 
tbe entrance of fungus. Fungus is apt to destroy 
fir trees on a large scale by inducing decay of aU 
the midd'e wood, and it creeps up the whole of the 
stem of the tree. All rot is toe fungus growth; all 
decomposirion is due to fungus. Tbe source of in¬ 
fection in these firs is believed to be by tbe roots 
and through the agency of rabbits and rats. The 
rabbit burrows under the fir tree and eats the bark- 
root, thus causing injury. The rabbits then run nbout 
under other trees and gather the spores of the 
fungus, and in running i^mn under its burrow where 
it has already broken the bark-root, tbe spore is 
deposited. In this way tbe fungus gmns access tO' 
the tree. 

Another point of great interest in fungus life in 
trees and plants is the fact that the fungus in some 
of its varieties would appear to be capable of pro¬ 
longed periods of latency .ceasing growth andTemM.in- 
ing inactive. Here we have another important lesson 
corroborating what I said the other day in regard 
to tubercle bacillus, i.e., that it could remain along 
time in the tissues of the human body without pro¬ 
ducing any morbid influence whatever. There are- 
hundreds of instances in vegetable pathology in 
illustration of this fact. Tbe fungus is present is 
one case, and yet there is no active disease; in another 
case there is no fungus visible, and yet a good deaf 
of disease. 

As regards idiosyncrasy in trees. In animals 
we make great allowance, hut not too much, for 
original differences, of which we can detect no evi¬ 
dence until disease attacks tbe individual, and then 
we find that no two individuals are affected in the 
same way by tbe same disease. To this great fact 
we give the name idiosyncrasy, and by this word we 
recognise that each individual is differently endowed, 
and reacts in apecuiiarway totbe influence of apoison. 
It is frequently coincident with a condition which 
does not reve^ itself. Idiosyncrasy is a personal 

05 It 


Not. 6. 1901. _ ORIGINAL COMMUNICATIONS. Tm Midical Pmbb. 483 


peculiarity which is just as real in the regetuble 
world as in the animal. I haye another idiosyncrasy 
to give you. In the illustrations I haye passed 
round there is one of two oaks standing near to¬ 
gether in the same field. They are of the same age 
and in equal good health ; as far as I can tell they 
haye been reared under exactly the same inflnence; 
they are of the same species of oak. Now, you will 
see one tree has kept its leayes on throughout the 
winter though they are brown and dead; it ought 
to hare shed its leaves last autumn. The photo¬ 
graph was taken in April this spring. The other 
t^ree has, in the usual way, no leaves of last year on 
it. The former oak is endowed, in other words, with 
a personal property by which it keeps on its autumn 
leaves. The retention of summer foliage in the 
winter, especially in small beecn trees which grow 
in hedges, is often seen. Tet by their side stand 
other laches in the hedge exactly similar, but they 
shed their leaves. We can give no explanation of 
this, but 1 would suggest, in the case of the oak tree, 
that the retention of the foliage is an attempt on its 
part to become an evergreen. This is in accordance 
with the laws of variation. These laws, as explained 
by Darwin, lead to the development of species. So 
our oak may be in a transition stage, for it does not 
keep its leaves green, but keeps them on. 

Another lesson which we may get from the pre¬ 
sence of fungi relates to the laws of diffusion, I 
quite expect that you are taught in the medical and 
surgical theatres that the disease known as tetanns 
is doe to a specific form of microbe, and is due to 
inoculation. I am not going to dispute that state¬ 
ment, but there are certain facts which render it 
difficult of explanation. Enlightenment may be 
thrown on the subject by the examination of what 
occurs in vegetable life. Is it not very curious 
indeed that the germ which produces tetanus 
should be so widely diffused and yet so seldom 
produces itself? If it is a specific germ one 
would expect to get a whole lot of tetanus cases, 
but as it is we get a case here and there, 
and there is never an epidemic. I am referring to 
England only, for we know tetanusia much commoner 
in tropical climates. We have some similar facts in 
reference to vegetable disease. In the Weymouth 
pine the fungus is extremely common, and exists 
almost solely on that tree. There are many questions 
in reference to ths laws of diffusion of these germs of 
fungi which form interesting food for study. To a 
certain extent—to a very great extent—science has 
enlightened us as to bow these germs are to be 
sought, and has enabled us to destroy them. Here 1 
would allude to another branch of the subject which 
is of great interest, and extends a little caution to ns 
in being too quick to draw inference from rather in¬ 
complete examination of the facts in reference to the 
different species of fungi. I would suggest that we 
be a little cautious in inferring that, bewuse the ex¬ 
ternal appearance produced by the disease which we 
know as tinea versicolor and that which we know 
as ringworm are very different; therefore it is 
certain they are not transmutablc. I believe 
one cause produces pityriasis, tinea versicolor, 
tinea favus, ringworm. My belief is that you can 
from the fungus of the common ringworm found on 
a collection of children produce any one of these or 
spots on the skin of the cbest of an adult. I have 
seen many instances in which young nurses carrying 
children with ringworm have not developed ring¬ 
worm, with the appearance of which everyone is 
familiar, hut tinea versicolor, with the appearance 
of which one is equally familiar. The fungus may 
modify its form of growth, or the same fungus may 
produce the two diseases 1 believe that the same 
fungus produces the two diseases. A great lesson has 


been given to us with regard to the disease which pro^ 
duced rust in the wheat—that disease in which the leaf 
of the wheat becomes brown all over and dies pre^ 
maturely. The crop is injured by the destruction of 
the leafage. This ‘^rust” also occurs in some 
grasses. On account of the importance and value of 
the wheat, the word “rust” is more particularly 
associated with that cereal. The prevention of tbs 
disease was an urgent question to the farmers and 
botanists. The former observed that where a com¬ 
mon barbary grew in the hedges of a wheat field 
there was likely to be rust in the wheat. Tbs 
botanists said there could be no coonection between 
the two plants, as there was one fungus which grew 
on the barbary, and the fongus producing the mst 
was quite different. The species were different. The 
farmers held to th-ir origmal belief and acted on it, 
in spite of scientific teaching. They got rid of the 
barbary trees, and in so doing got rid of the rust. 
A law was passed in Massachusetts that all barbary 
trees should be exterminated to prevent wheat 
rust. Strict measures were taken to put this law 
into effect. The great discovery was then made that 
the barbary tree was one whose leaves bad two 
hosts, and it was actually the same fangus which 
produced wheat rust as was found on the barbary. 
It was a case of transmutation due to two different 
stages of development of the fungus. The wind 
scattered the fungus seeds over the fields of 
wheat. Here was an instance where science lagged 
behind the observations of practical men. We 
must no*' urge a statement too strongly until 
we are quite sure of its truth, as approved by the 
general verdict of experience. Learn when and 
where yon can; listen to everybody: bnt do not forget 
to take into account errors to which all are liable, and 
listen to those who have bad opportunies of making 
practical observations, even though their remarks 
may not appear to conform to the scientific truth. 
Even so with regard to the study of forms of disease. 
We shall very probably with further study simplify 
remarkably our opinion regarding variety of form of 
diseases, Many of the present distinctions are no& 
really true. 

I turn now to quite a different subject, and that is 
the effect of introducing disease and living parasites- 
upon plants. One is the formation of galls, of which 
you see a specimen before you. It is developed at 
the root of certain stems and looks uke a 
cone; it is sometimes called a pineapple cone. 
But it is not a seed cone though it looks exceedingly' 
like it This specimen is from a Norwegian spruce. 
It is caused by the presence of an insect, but not- 
made by the insect, which is a member of the ubi¬ 
quitous aphides. The mother aphis deposits her 
eggs at some point of the tree where a stem Is about 
to bud. The plant mistakes the irritation produced 
by the eggs for the irritation produced by its own 
living seeds. It is obvious that the local irritation 
cannot be exactly appreciated by the tree. Tbo 
result is the production by the plant of something 
very like a cone. Remember the insect takes no- 
share in building up the gall, which serves as a nest 
for its larvse. In some firs the gall is produced at 
the very top of the boughs. Of course, the kind of 
gall depends upon the tree and its tendencies. It i» 
interesting to know that some trees of the Bamo 
family are so much alike that the easie-^t means of 
distinguishing them is bv the diseases of the cones. 
The character of the gall also depends a great deal 
on the precise part of the tree which is attacked. 
There aro an immense variety of galls. In the oak 
you m^ have several kinds of gall on the same 
tree. The time of the year and the condition of the 
circulating sap are important factors in their forma¬ 
tion. Such are the general laws. 



484 Thx Msdioal Pbkbs. 

CAESAREAN SECTION: 

WITH NOTES OF THREE SUCCESSFUL 
CASES, (a) 

By JOHN M. MUNEO KERR, M.B., O.M., 
F.r.P.S.G., 

Obetotric PhjtieUn to the OlaeMir Ueternitjr Hoipita]; As- 
0 detent to the Professor of Sudwlfeiy, Glasgow unireni^i 

Dispenserr PhTsioien for Dia«eses of Women, Western in- 

flrmeiy. 

Among the cases of extreme pelvic deformity 
which have been under my care in the Glasgow 
Maternity Hospital during the present year, and 
since my appointment as oostetric physician to that 
institution, there have been three iu which I deemed 
it advisable to perform Csesarean section. These 
oases 1 venture to bring under your notice to>day. 

Before giving a brief summary of the individual 
cases, let me shortly refer to a few details connected 
with the operation as it was performed. 

In the Glasgow Maternity Hospital, since April, 
1888, when Professor Murdoch Cameron performed 
the first successful Ceesarean section, the operation 
has been performed somewhere between sixty and 
seventy times. Of the cases that have proved fatal, 
with only two or three exceptions, the cause of death 
has been septicmmia, and, further, the infection in the 
majority of cases, as far as could be judged, has been 
from the vagina and cervix, and not through the ab< 
duminal opening. This, I think, is a most important 
point, and one that has not been sufficiently empha¬ 
sised. The reason for it is evident. On the one 
hand, the skin is sufficiently cleansed with compara¬ 
tive ease, and that as a matter of routine nowadays; 
while, on the other hand, the vagina and cervix, if 
septic, are difficult to disinfect, especially the latter, 
and attempts at doing it are, as a rule, carried out in 
a more pennnctory manner. 

To get the best results I am quite convinced we 
must suspect the vagina in aU cases of containing 
pyogenic organisms, and adopt means to remove 
them. This is esnecially true of cases that have been 
bandied before admission to hospital, but is also true 
of some few cases which have never been examined. 
The investigations by Doderlein, Menge. and others 
have demonstrated the occasional presence of pyo* 
genic organisms in the healthy vagina and cervix, 
and all of us have bad experience of cases of septic 
infection in the puerperium where there has never 
been any examination made either before or during 
labour. Now, simple douching, the usual routine, 1 
do not believe is sufficient; the vagina, especially ^e 
vault and the cervix, must be carefully swabbed with 
some antiseptic solution. In the cases to be related, 
15 to 20 ozs. of a 1 per cent, solution of lysol was used. 
I would have preferred to use perchloride of mer¬ 
cury, but it constricts the canal to such an extent 
that it is extremely difficult to swab it out. The 
skin was cleansed by scrubbing with soap and water, 
turpentine, alcohol, and carbolic solution, as is so 
generally done. 

No sponges were used—only sterilised absorbent 
swabs. A^ut thirty are required for each operation, 
as no one is used twice. One nurse wrings them out 
of hot sterilised water, another collects and counts 
those that are soiled. 

After opening the abdomen, swabs were placed 
round the uterus, but the latter was not pulled out 
through the abdominal opening untii after it bad 
been emptied of its contents The opening into the 
uterus was always longitudinal and in the middle 
line, the bleeding in cutting through the wall being 
controlled l^ the vulcanite ring recommended by 
Cameron. It always acted veir satisfactorily, and 
allowed me to out down on to the membranes witb- 

(a) Rest the Annual Meeting of the British Medical Associa¬ 
tion held at Cheltenham, ISOi. 


Nov. 6, 1901. 

out having the wound flooded with blood. Aftertbe 
child Wats extracted, my assistant g^^ped the ntems 
firmly with fresh swabs, and controlled the bleeding. 
I never used elastic tubing to control the bleeding. 
In each case the placenta separated immediately 
after the child was extracted, and it and the mem¬ 
branes were readily removed. 

In two cases the uterus was sntnred with Hart¬ 
mann’s cat^t boiled for half an hour in a Jellett’s 
steriliser. In the other case sterilised silk was ns^. 

Each of the patients was sterilised by tying the 
Fdllopian tabes in two places, and dividing them 
between the ligatures. 

In each of the cases labour was in progress, and in 
two had advanced considerably, before the operation 
was commenced. 

Case I.—Mrs. L., 33, iii-para, was admitted to the 
Maternity Hospital under my care on March ]5tb, 
1901. In each of her two previous lalMura cranio¬ 
tomy had to he performed before the child could be 
extracted. 

Ou examination, the 03 was fully dilated, and the 
membranes were ruptured. The oblique conjugate 
was found to be 3} inches, and the transverse dia¬ 
meters were slightly under the normal. The pre¬ 
senting head was freely movable above the brim, 
although labour bad been in progress for twenty- 
four hours. The fmtal heart-sounds were strong, 
regular, and numbered 140 per minute. 

The operation was carried out by making the uetial 
longitudinal incision through the abdominal wall and 
anterior uterine wall. The child was easily extracted 
by the head, but in doing this the lower end of the 
wound was increased by slight tearing of the lower 
uterine segment. The child, a female, cried lustily 
soon after its birth. It weighed 7 lb., and measured 
19 inches. The placenta, which was situated on the 
posterior wall of the uterus, became immediately 
separated, and was easily removed along with the 
membranes. The woman was sterilised by tjingand 
cutting the tubes as described. 

The uterine wound was closed with silk. The 
abdominal wound was closed in one layer with silk- 
worro-gut. 

The puerperium was very satisfactory, and the 
woman's pi'ogress to I'ecovery rapid after the first 
few days. The temperature never i*ose above the 
normal, except the morning after the operation, 
when it registered 100°. The pnlse, however, for the 
first few uays was very rapid, and gave cause for 
considerable anxiety. On the evening of the second 
day it registered as much as 160, but fell on the 
third day to 108. This rapid rate was attributed to 
a very bad bronchitis which developed immediately 
after the operation, and was caused, 1 feel sure, by the 
irritating fumes of chloroform and ^s. The 
stitches were removed on the fourteenth day, at the 
first dressing, when the wound was found quite dry 
and healed. 

The woman was dismissed on the thirty-fourth 
day, both she and the child being perfectly well. 
She began to nurse the child on the tenth day after 
she had recovered from the bronchitis, and continned 
doing so until she left the hospital. 

Note to Cate I .—The most striking feature in this 
case was the alarming bronchitis which developed 
after the operation, and which, I think was correctly 
attributed to the irritating fumes of the chlorine set 
free by the coal gas, the only illuminant we have in 
the hospital. I have seen the same complication 
occur once or twice before in cases operated on 
during the night, but never in such a severe form. 
The woman was really exti'emely ill. 

Case II.—S. 0., primipara, 23 (?), was admitted 
to the Maternity Hospital under my care on April 
l9th. On examination, the os was foimd fairly well 


ORIGINAL COMMUNICATIONS. 


It 


Nov. 6. IflOl. 


ORIGINAL COMMUNICATIONS. 


Thc Medical Press. 485 


dilated, and tbe membranes unrnptured. Tbe C.I). 
measured 31 incbes, and the C.V. I estimated at 2| 
inches. As the (cetal heart* 80 und 8 were strong and 
regular, it was decided to do Csesarean section. 
There was, unfortunatelj, some delay in getting tbe 
patient ready, so that the operation was not com* 
menced until three hours after the patient's admis¬ 
sion. The operation was performed in the ucual 
waj, and the child extracted without the least diffi¬ 
culty. Tbe placenta, which was situated on the 
postero'lateral wall, immediately separated, and 
was removed along with the membranes. Unfortu¬ 
nately, the child, a female, was dead, no trace of a 
heart beat being appreciable. It weighed 7t lbs., 
and measured 2l incbes. Tbe uterine wound was 
closed with catgut, and the abdominal in one layer 
with silkworm-Kut. Tbe woman was sterilised by 
tying and cutting tbe tubes as described. 

Tbe i-ecovery of the patient was moat satisfactory. 
Tbe only feature of special interest about tbe puer- 
perinm was the scantiness of the lochial discharge. 
At first this rather alarmed me, especially as during 
tbe first four days tbe temperature was never much 
below the 100^. and on tbe evening of the fifth day 
registered and the pulse was often running as 
high as 120. However, these alight disturbances in 
pulse and temperature disappeared by tbe sixth day. 
The lochia all through was very scanty. 

Tbe stitches were removed on the fourteenth day, 
at tbe time of the first dressing. Tbe wound was 

? uite dry and healed. Tbe patient was dismissed 
rom hospital on the thirty-second day, quite 
recove*ed. 

Note io Cate II.—li is extremely unfortunate that 
tbe child was dead in this case, as it was chiefly on 
its account that Cssarean section was performed. 
My colleague, Dr Jardine, very kindly saw the case 
along with me. and we both considered it one of those 
cases where, as regards tbe mother, the risks from 
craniotomy and Cwsarean section were about equal 
—if anything, a little in favour of the latter. The 
child being alive, however, we decided on Csesarean 
section. Unfortunately, 1 did not listen for tbe 
foetil heart immediately befoi'e commencing tbe 
operation, as three hours before, at the time of the 
patient's admission, I heard it quite strong and 
regular. The child must have died in the interval, 
and not. I think, daring tbe early stages of the 
operation. 

Case III.—Mrs. B., set. 26, ii-para, was admitted 
to the Maternity Hospital under my care on April 
loth, 1901, for the purpose of being delivered by 
Cmsarean section. Her pelvis was very markedly 
deformed in tbe conjugate diameter, but little i 
affected in the tranverse. The C.D. was 2^- inches, 
and the C.V. was eetimated to be 2 inches. Her pre¬ 
vious pregnancy terminated at full time, the child 
being delivered with difficulty after craniotcmy bad 
been performed. 

La^nr in this second pregnancy began on tbe 
t25tb. Dilatation of cervix was rapid, so that before 
tbe patient was ready for operation the os was fully 
dilated and the membranes had ruptured. The fcetal 
lieart was heard beating strongly immediately before 
operation. 

Tbe operation was performed in the nsnal way. 
There was great difficulty, however, in extracting 
tbe child us the uterus grasped it so firmly. It was 
delivered alive, but in doing this tbe uterine wound 
was enlarged by slight tearing of tbe lower seg* 
ment. 

The child, a female, cried immediately after it 
was born. It weighed 6^ lbs., and measured 21 
inches. Tbe placenta was situated on the posterior 
wall, and separated immediately after extraction of 
the child The utems was closed with catgut 
sutures, and the tubes were tied and divided as 


described. Tbe abdominal wound was closed in two 
layers with catgut and silkworm gut. 

Tbe patient's convalescence was very satisfactory 
until the fourth d^, when in tbe morning the tempera¬ 
ture rose to 103'2° and the poise to 162, tbe lochia 
became foetid, and there was diarrhcea. I at once 
douched out the vagina and then tbe uterus with a 
solution of 1 in 2,000 percbloride of mercury. This 
bad the desired effect, for tbe same evening tbe tem¬ 
perature was i00'6°. On the eighteenth day there 
was again a slight rise of temperature. The stitches 
were removed on the seventeenth day, when tbe 
wound was found quite healed and diy. She was 
dismissed from hospital on the twenty-eighth day. 
The only thing that was not just satisfactory was 
that she seemed unable to completely empty her 
bladder, as each time it was catbeterised, and this was 
done several times after she had micturated, there 
were several ounces withdrawn. 

Note to Cate III .—The difficulties in extracting 
the child were very considerable. This was not due 
to the small size of tbe wound, but to tbe strong 
uterine contractions. Consider'<ble advance had 
been made before it was discovered that the patient 
was in labour. As has been stated, the os was fully 
dilated, and the membranes were ruptured before 
tbe operation was commenced. 

In this case a slight septic infection occurred, and 
it was from tbe vagina or cervix almost certainly. 

The cases just described, along with those pub¬ 
lished this year by Oamercn (a) and Sinclair (6), in¬ 
dicate the comparative safety of tbe operation of 
Csesarean section performed under favourable condi¬ 
tions. Such a state of matters is cause for great 
satisfaction; it permits obstetricians to recommend 
the operation wab great confidence, and under less 
restricted conditions than formerly prevailed. In 
cases of pelvic deformity we are now hardly ever 
justified in destroying a living child by craniotomy 
or any other d«8tructive operation. The only cir¬ 
cumstances, indeed, under which such operative 
measures are permissible, are where fruitless 
attempts bare been made to extract tbe child with 
forceps or version from ignorance of or miscalcula* 
tion of the extent of the pelvic deformity, 
where the mother's condition is such as to 
preclude abdominal section, and where tbe child is 
the subject of hydrocephalus or some other extreme 
malformation, or is on the point of dying. 

As far as I can see there is no other position 
tenable now by those who practise obstetrics as a 
specialty. That the pregnancy is illegitimate can¬ 
not be considered as some would have us do. With 
such a circumstance we dare not concern ourselves. 

I Nor is the fact that a pregnancy is a first any argu- 
' ment against Cssarean section if tbe conditions 
clearly indicate tbe imposeibili^ of delivering the 
child alive per rias naturalee. The line of practice 
indicated is very cleai* and distinct, and by fculowing 
it we are faced by no subtle ethical problems. Tbe 
following of it is occasionally prevented, however, by 
one circumstance—the refusal of tbe patient to con¬ 
sent to the operation. It rarely happens. If it does, 
and ihe woman is in labour, there is no alternative 
but to do craniotomy, unless that is impossible 
owing to the extreme degree of pelvic deformity. 

If the woman is not in labour one can only refuse to 
1 ave anything to do with the case. Some little time 
ago a woman came to me far advanced In her fourth 
pregnancy. In all her three previous labours the 
child had to he destroyed by craniotomy, and she 
wished to arrange for the same operation l^ing done 
for a fourth time As she refused to submit to 
Csesarean section, there was nothing for it bnt to 


(fi) “ Glugow Hospitnl Eaport*,” vol. Ui., 1901. 

(b) [.anirt, Juyatry I9th, iwL MCi 





Not. 6. 1901. 


486 Th» Midmal PaiBS. OBIGINAIi COMMUNICATIONS. 


doclice to treat her, wticb I did. No self^reepecting | 
man can go on destroying children indefinitely. 

But the good results now following the Cccraiean 
section cauee another and ver;? important question t.) 
he asked, viz., should we sterilise the woman after 
performing the operation P Cameron, in his most 
recent paper on Cffisarean section, says—" A very 
important point in favour of Csesai-ean section is that 
the Fallopian tubes can be tied and divided so as to 
prevent subsequent conception.’’ It has been the 
custom in Glasgow, following Cameron's teaching, to 
do this, and in the cases related I have done so also. 
Such a position now is hardly tenable, however, for 
the two great arguments in favour of sterilising do not 
hold good any longer. They are—(1) That the opera¬ 
tion of Cffisarean section being so dangerous, 
and so frequently fatal, it is not desirable to submit. 
a woman to the risks of it a second time; (2) that 
there is great danger of the sutured uterus ruptui ing 
should the woman again become pregnant. I say, 
with our pi-esent-day experience, neither of these 
arguments bold, and sterilisation should not be the 
routine practice. 

In all these cases the operation was performed 
after labour was in progress for some time. In the 
first two that was unavoidable, for the women were 
in labour when admitted, but in the third case it was 
done intentionally because it has been the custom in 
the hospital. To judge by reported cases, however, 
it is not necessary, and it is undoubtedly much more 
convenient to fix ^forehand the time of operation. 
One can choose the day time when there is good 
light, and one can have all preparations for the 
operation more leisurely and thoroughly carried out. 
But, to my mind, much more important than either 
of these advantages is that the lower uterine segment 
has not developed, and the actively contractile por¬ 
tion of the uterus has not retracted, consequently 
one can open into the uterus through the latter part 
more easily and with a lower incision. In two of the 
cases just detailed there was some teping of the 
lower uterine segment. It is most desirable not to 
wound that part, and it is not easy to prevent it with 
the ordinary incision and if the segment is well 
developed, because the tear is difficult to control, and 
because the wound is brought down near the cervix 
and vagina, where any pyogenic organisms, if pre¬ 
sent, are most likely to be found. 

In all the three cases the incision was longitu¬ 
dinal, and only in Case III. was there the least diffi 
culty in extracting the child. The only advantage 
of the fundal incision, “nach Fritsch,” as far as I 
can see, is that the wound is removed away from the 
most probable source of infection There are 
weightier objections to it, I fear, on which, however, 
as I have no experience of the incision, I will not 
speculate. 

In all three cases the placenta was situated on the ' 
posterior wall of the uterus. A very striking feature 
was that the placenta became separated immediately 
after the birth of the child. Might not the much- 
discussed cause of the separation of the placenta be 
answered by olwerving the separation after Csesarean 
section P 

I also observed that in all three cases there was 
only about a third of the circumference of the uterus 
between the tubes in front, and so confirmed Leopold’s 
statement that, with the placenta on the posterior 
wall, the tubes are closely approximated m front. 
That the contrary is also true 1 have not been able to 
confirm. 

In two cases I confirmed Cameron’s contention 
that the back of the child is always towards the 
opposite wall to which the placenta is attached 

In a small portion of the Fallopian tube excised 
in one case, I did not find deciduail changes in the 
cells of the mucous membrane. 


AVKNUES FOR MEDICAL 
PRACTICE: 


THE ARMY MEDICAL SERVICE.(a) 

By THOMAS MTLES, M.D., B.Cb., F.R.C.S., 

PresideDt of tbe Bojal CoHeire of Snr^«oo». Ireland; Surgeon to 
tbe Bicbmond Uospital. 


Afteb some iotroduclory remarks, Mr. Myles re¬ 
ferred to the openings which the medical profession 
presented to the newly-qualified medical man. He 
said:—Now, speaki* g broadly, the average young 
qualified medical man has three courses open to him. 
First, he may e'ect to settle in private practice at 
home. Secondly, he may elect to seek an appoint¬ 
ment under the Crown as Colonial surgeon. Thirdly, 
he may elect to enter the Medical Service of tbe 
Navy or Army. At the present moment, as most of 
you are aware, our professional world is agitated by 
the report of the Commission appointed by Mr. 
Brodrick, Secretary of State for War, to draw up a 
scheme of Army medical reform. Now, before I pro¬ 
ceed to discuss this scheme in any detail 1 want not 
only to make my own position as official bead of this 
College, but that of others who may be similarly 
situated to myself, perfectly clear. It has been 
alleged that the Medical Schools have boycotted the 
Army Medical Service, and in corsequece of this boy¬ 
cotting there has been a dearth of suitable candidates 
for tbe vacancies occurring in recent years. My an¬ 
swer to that statement is a very simple one, and I 
think you will agree with me in saying that ic is 
strictly in accordance with tbe truth and tbe facta of 
tbe case. Itsimply is that if the Army Medical Ser¬ 
vice is really made attractive, not all the blandish¬ 
ments or persuasive eloquence of presidents or 
professors can keep men from offering them¬ 
selves for vacancies therein. The stiws^ and 
struggle of competition in our profession is so 
great that I am convinced that a large proportion 
of highly qualified youn^ men would embrace, even 
at a considerable pecuniary sacrifice, the assurance 
of a certain income under the Crown, if such assur¬ 
ance were not accompanied by very grave disadvant¬ 
ages. Again, let me add to this preamble by stating 
that in my opinion the profession as a whole owes a 
debt of gratitude to Mr. Brodrick for the work he 
has done in this connection. Now, what are the 
improvements in tbe proposed scheme as compared 
with the terms at present in force? First and fore¬ 
most is the improvement in the examination for 
admission to the service. The diminished import¬ 
ance that will io future be attached to _tLe elemen¬ 
tary scientific portion of the examination, and the 
increased importance that will be attached to the 
vitally important subjects of medicine, surgery, &c._,is 
undoubtedly a step in theiightdirection. Anotherpoint 
which undoubtedly will conduce to the well-being of the 

service is the establishment of an Advisory B^rd. On 
this Advisory Board will be four civil medical men, 
two surgeons, and two physicians. The presence of 
the civil element on the Board should be of gi'cat 
benefit to the entire service. As the civil representa¬ 
tives will be changed at frequent interv^s. there is 
little likelihood of tbe Royal Army Medical Depart¬ 
ment lagging behind the times, and it will at the 
same time a guarantee to the officers serving fhat 
efficient work in any department will not fail to have 
due recognition. A gain, tbe scheme provides for the 
formation of a sub-committee, ou_ which_ the cml 
element will be represeuled for tbe inspection pf the 
military hospitals at interval?, and for reportmgM 
to their relative efficiency, Ac. Moreover, in the all* 


(«) AbstTMt of the iMuanisI Addres* 
of tbe Winter See»ion, Bojel College 
1001 1902. 


delivered at tbe OperiV 
of Surgeone of Irelaad, 





Nrv. 6, 1901. OBIGINAL COMMUNICATIONS. Th* Mkdicai. Pr>bs. 487 


important matter of pay,the proposed scheme in many 
points compares favourably witn that now in force. 
Beyond question, when one considers the certainty 
of t'le income and the comparatively easy life of the 
Army surgeon, the terms I nave detailed to you com¬ 
pare favourably indeed with that of the average civil 
practitioner. The blemishes on the scheme so far as 
jou are concerned, to my mind, are three. The first 
of these is the uncertainty which exists at present as 
to the terms under which an officer may retire, who, 
having served six years in the rank of captain, has 
failed to pass the subsequent examination. Doubt¬ 
less through an oversight, it appears from the scheme 
that, while an officer before the examination may retire 
with a gratuity of £1,000,yet, shouldhe elect to pi esent 
himself at the examination and fail, he is compul¬ 
sorily retired without any compensation. In other 
words, he apparently must risk £1,000 on the chance 
of passing an examination. I cannot bring myself to 
believe that this was the in'ention of the Commttee, 
it is so manifestly unjust and unfair, and I have 
every hope that on revision uncertainty on this point, 
will disappear. The second blemish in the terms 
appears under the head of parasraph 43 and those 
following. These paragraphs state that an officer 
after serving eighteen years is liable to be compul¬ 
sorily retired with a gratuity of £2,500 in the event 
of bis failing to pas'* a certain examination. This 
seems hardly fair. Under the proposed scheme a 
man is liable after eighteen years' service to be com¬ 
pulsorily retired on a pension which cannot be more 
than £150 ayear, and may be very much less. Doubt¬ 
less the object of this proposal is to weed out from the 
service incompetent men, and equally, without doubt, 
to do so is not only right, but absolu ely necessary. 
Surely some method other than that of examination 
could be adopted for determining the efficiency or in¬ 
efficiency of officers of mature age. Now let roe say 
a word about the Advisory Board. Sir William 
Thomson, who had a place on the Consultative Com¬ 
mittee, has very rightly drawn attention to the com¬ 
position of this Board. This little country of ours 
supplies a very large number, I might almost say 
a aisproportionate number, of the officers serving in 
all branches of his Majesty’s army, and I think, 
therefore, we are fairly entitled to some representa¬ 
tion on that Board. Under the terms of the present 
scheme such representation is absolutely impossible. 
The honorarium assigned to each member of the 
Board is £200 per annum, and as the Board meets 
fortnightly, or twenty-six times a year, it would mean 
that any Iinshman appointed would have to be at 
least three days in every fortnight away from his 
home and business. This, of course, practiclly ex¬ 
cludes this country from representation on the Board. 
There can be no doubt that young Irishmen 
would be more attracted to the service if they felt 
that in the event of any unjust treatment being 
meted out to them they bad a fellow-countrvman at 
headijuarters, to whom they might confidently apply 
for redress. The leading daily papers and distin¬ 
guished military officers speak of tbe details of the 
scheme as “ concessions " to the medical officers, who 
ought now to be thoroughly satisfied at last. There 
can be no ‘‘ concession ’’ to you who are not yet in 
the service; improvement in the conditions of ser¬ 
vice may be perhaps regarded as concessions to the 
men already in it, but to you who are not iu it tbe 
term “concessions’’ is utterly inapplicable. Tbe 
Secretary of State for War is not making any con¬ 
cessions to anyone. He is coming into tbe open 
market, which is regulated by the laws of supply and 
demand, and ht has simply offered better terms in 
the hope of getting more men of a better class than 
hitherto. If tbe terms are good enough le will get 
plenty of good men; if they are not the service will 
remain undermanned as at present. 


NOTES ON THE LATEST RESEARCHES 


THE 

ORTGry AND PROPAGATION OF 
MALARIA. 


[fBOH a CORBEBPONDINT.] 

The October number of the Itdian ^fediel^ Gazette 
coiitains several itemsof interestilluBtrative of the very 
important—and. just uow, very promineut—subject of 
ms^ria. Tbe first of these is a ante on “ The Occur- 
rence of Anophtles Punestite and Aitophelet Contalie in 
India.” This appears under the triple responsibility of 
J. W. W. Stephens, U D.(Cantab.) ; 8. K. Christophers. 
M B (Viot.) ; and S. P. James, M.B.(Lond.), Captain. 
I.M.S. The commnnication reveals the very lignificant 
fact that the two species of Anopheles nam^ in tbe 
title, although not previously dencribed as occarriog in 
India, have been fonndby the antbors to be p-evatent 
in the planting district of tbe Dusrs. As they truly 
observe, “ the interest of the discovery lies in the fact 
that they are the two s ;>eoieB of Anopheles which carry 
malarial infection in tropical Africa. It is worthy of 
note that A. Functue and A. Cottalu should occur com¬ 
monly in the district of India where blackwater fever 
is most frequent. 

At the present period, when so many keen observers 
and accomplished naturalists are engaged in concentra¬ 
ting all their rays into a single focua for tbe illumina¬ 
tion of the dark places of malaria, let us venture to 
express tbe hope that this significant discovery will 
soon prove pregnant with means for the future diminu¬ 
tion of the baneful effect) of that terrible scourge of the 
human race. 

Encouraging it is in this direction to find in the same 
issue of our contemporary a first instalment of a very 
oarefnlly prepared communication by Wm Glen Liston, 
M.B., Captain I.M.S, from tbe BMearch Laboratory, 
Bombay. The title is “A Year's Experience of the 
Habits of Anopheles in Elliohpar.” This very able 
article has reference onlvto the northern part of tbe 
Deccan; in particular the Ellichpur District, which is 
situated about the 2 lBt parallel of northern latitude 
and YTth meridian of eastern longitude. It is necessary 
to bear this geographical fact in mind, seeing 
that, as tbe writer himself poicts out, tbe habits 
of anopheles differ m different countries and in 
different parts of the same country where that country 
is a large one such as India. The region regarding 
which the investigations of the writer have been carried 
out extends southward from tbe Satpura range of Cen¬ 
tral India hills with lateral expansions to east and west 
as a vast black cotton plain. The annual rainfall is 
about thirly-five inches, and the year may conveniently 
be divided into two seasons or periods: (1) June to 
October, “the rains"; at this time all rivers and 
streamlets are fab, and many ditches and drains conlain 
water; (2) the rest of the year “ tbe dry eeason," when 
the rivers are small, a mere trickle, with here and there 
a pool of water in their beds; even these in tbe latter 
part of the season dry up, and it is then difficult to find 
any piece of open water. The soil of this district is that 
known in Indians “black cotton soil"; it lies on the 
surface of decaying rooks, having at a depth of 
ah nt ten feet the stratum of hard “ murrhsm," which 
develops from tbe weathering of rocks, especially those 
which contain lime. Attbeoommenoementof the rain the 
breeding places of tbe anopheles larvs are few; they 
increase during tbe rain; period,and are mostnumeroue 
at the beginning of the dry season. The collections of 
water in which anopheles are found at this time are 
generally shallow collections of water, seldom more than 
two feet deep; they are of small size, not more than ten 
yards, and more frequently only a few feet in longest 
diameter. In this important district malarial fever 
“ has a very definite seasonal variation. The number of 
cases teaches its maximum just at the close of the 
rains, and it f/ills to a minimum at the commencement 
of tbe hot weitber." Most careful observations of the 
h\bitB, life-history, and reprodaction of the anopheles 
have ^en collected by this observer. i 

o. gl« 



488 Th* Medical Paisa. 


Ci^fNICAL RKC0BD8. 


Nov. 6. 1901. 


^ The reaalt will andonhtedly be an important addi¬ 
tional lif^bt on the oonnection between it and the 
regional plagne of malaria. We shall »itbhold farther 
obeervationa till this farther commanication has been 
completed. 

Then Dr. Leonard Bogere, Officiating Professor of 
Pa'hology, Medical College, Calcat*’a, famishes bis con¬ 
tribution to the malarial discussion ander the title of 
“ The Effect of the Silting np of a Lower Bengal River 
on the Prevalence of Malaria; with Some Remarks on 
the Spleen Test, and the Reduction of Malaria by 
Filtered Water.” The author’s investigations were 
made in connection with an inquiry into the sffect of 
the silting-ap of the Eara'oya R'ver on the health of 
the Bopa district. The inquiry arose from a petition 
which the native inhabitants of the district bad sub¬ 
mitted, stating that ever since the diversion of the main 
current fnm the Karatoya River into the Bei^ali about 
balf a century ago the former had gradually silted np 
” and has slrmdy become a source of givat nnhealtbi- 
ne^s to extensive tract) on either side.’' The author’s 
inqu r es have showo that "the mojt silted-up part of 
the river is the moit healthy one, and vice versa/' But 
be admits that this observation applies to the present 
period only; it may not have been so in the earlier 
years of the physical charge. He attaches great import¬ 
ance to the value of the '* spleen (es( ”—which some recent 
authorities have treated with diminishing respect - as a 
test of the regional infectivenessof a district. Bis exami¬ 
nation of ohlldren'b blood for the malaria parasite was 
found t) be very tedious, and, in the end, entirely uncon¬ 
vincing. He admits, however, that if such investiga¬ 
tion could be carried out io the fever season, which his 
was not, the results might have been more de^ite. 
The writer also dwells on the curious points of striking 
contrast presented byihe features of malarial fever in 
India and in West Africa. The ]< as common infection 
of young children in India is very striking, and the 
difference of frequency of enlargement of the spleen in 
the malarial fever of the Dsrk Continent is certainly a 
very striking phenomenon. Total absence of splenic 
enlargement in the malarial fever of Central Africa is 
noted, while 70 per cent, of cases in tbe neighbour¬ 
hood of Calcutta were found by the writer last year to 
present tbe well-known ague-cake. 

The number of skilled and enthusiastic investigators 
who are at present simultaneously engaged in en¬ 
deavouring to unravel the phenomena of malaria 
cannot fail to give confidence to the scientific world 
that tbe heart of its mystery must soon be plucked out. 


Clinical ^ccorbs. 


ADELAIDE HOSPITAL, DUBLIN. 

A Case of Otitis Media Aeu*a, with Jmplicaiion of the 

Lalrral finua Operation-Liuature of tie Internal 
Jupvlar Vein — Se'Ovrry. 

Under tbe Care of 8 . Horace Law, M D., F.B.C 8.I., 

Tbruat Surgeon to the Adelaide Hospital, and Surgeon to 
the Dublin Throat and Ear Hospital, 

Thx interest of this case centres mainly round tbe 
short history and rapid onset of dangerous symptoms, 
with the complete relief afforded by tbe operation and 
the subsequent uninterrupted recovery. 

B T., male. cct. 19, was admitted to Adelaide Hospital, 
Dublin, on Febr< ary 26tb, under the care of Dr. Beatty, 
complaining of having felt unwell and having had some 
slight pain but no discharge from his right ear for some 
days previously. His symptoms before admisBiou con¬ 
sisted principally of beaidacbe, vomiting after food, con¬ 
stipation, and pain in front of left shoulder, as well as the 
pain in his right ear mentioned above. On admission, 
temperataro was 102'6^, pulse 136; there was also 
some cough with slight expectoration and some albu¬ 
men in tbe urine. The temperature rapidly fell and 
remained normal till March 7tb, when it again rose, and 
be complained of soreness in his neck and some head¬ 
ache. I first saw him on March 11th, and diagnosed 
acute otitis media, and saw some granu'ations in the 
external auditory meatus of the right side; there w3re 


DO mastoid symptoou, but there was swelling and ten¬ 
derness in tbe course of the internal jugular vein, and 
patient seemed very ill indeed. Up to this time be bad 
not complained of much paia, and had had no rigors, 
except for one said to have occurred before admie-ion. 

March 13th.—A little cough aad some frothy sputum, 
his couditioD otherwise remaining much the same. 

14th.—Condition more serious, some cough wi'b a 
little msty spotam; a whitlow was noticed on index 
fioger: and at 10 a.m. he had a severe rigor, tempera¬ 
ture 105*8", all pointing to a spreading septic iofectior. 
As he was getting rapidly worseaadbecoming comab'S-', 
a consultation was held and operation decided upon, 
the diagnosis being acute otitis media with partial or 
complete thrombosis of the lateral sinus. 

Operat'on performed on March 14’h.—Patient having 
been anaostbetised and tbe side of head and neck 
cleansed as far as possible, I made tbe first incision 
opposite the cricoid cartilage and tied the internal 
jugular vein with two ligatures one inch apart. I then 
proceeded to the operation behind the ear, and mad-* the 
usual iactsion. from which there was free haemorrhage 
(probably due to the ligature of the vein), and opened 
the mastoid antrum in the ordinary way after the mt-thod 
of Schwartze. A small amount of pus was found in the 
cells and antrum, and the bone in tbe antral region 
felt soft. I next proceeded to work down on tbe lateral 
sinus, using a full-sized gouge to enlarge backwards my 
opening for the antral operation. The moment the bony 
wall of the sinus groove was opened pus flowed out, 
in quantity about half a drachm. I then laid bare the 
wall of the sinus for about an inch of its length, 
and found it covered with granulations and a dark 
slough on the upper part of the exposed pottion. 
The sinus pulsated freely, and did not seem to com¬ 
pletely thrombosed, so I omitted to open it, and 
decided to do nothing more. Tbe ends of tbe upper 
incision were brought together with a few stitches, and 
the cavity in the bone plugged, the jugular vein was 
cut across between the ligatures and the lower wound 
sewn up. The condition of the patient under tbe anaas- 
thj tic was not all that could be desired as he required 
oxygen nearly the whole time. After the operation, the 
temperature varied up and down for teo days and then 
finally came down, bis condition improving meanwhile. 
He was allowed up one month after the operation, the 
upper wound having nearly granulated up, and the 
lower one having long since completely closed. 

Bacteriological examination of the pus gave dtplo- 
cocci as its principal contents. 

As will be seen by tbe above, the diagnosis was sub¬ 
stantially correct, the sinus was inflamed and covered 
with granulations, so that one may safely say that the 
internal coat could not have remained normal, and 
therefore a partial septic thrombosis was certain, 
whicb is entirely borne out by the presence of the rusty 
sputum and cough, and by the occurreno of an abiOess 
which afterwards formed on one of bis toes. 

The paib of infection seems to have extended back¬ 
wards through the antrum, though there were no antral 
symptoms at all to help the diagnosis. 

April 26th.—There is now no discharge from the 
ear, and the drum has nearly regained its normal 
appearance. He hears whispering voice a^ about two 
yaids on tbe side affected. 


CYSTIC SARCOMA OF BREAST. 

Under the care of Dr. Herbert Snow. 

A LABox breast, which had been removed owing to the 
presence of an intra-cystic sarcoma. The specimen ( •) 
weighed, even after the escape of a considerable amount 
of fluid, 6 Ibe. 12 ozs., being heavier than any the author 
had ever had occasion to excise. For comparison he 
shewed the photograph of another such growth in situ, 
which bad been subsequently removed and found t> 
weigh 4 lb). 4 ozs. The patient was an eccentric maiden 
lady. set. 62, whose breast had been tbe site of a tumour 
for at least twenty y^ars, the late Sir James Paget 

(<>) Shown before the Dritisb Gjna’cological Society, October lOtU, 
191)1. 

Coi.gli 



Nov. 6, 1901. 


TRANSACTIONS OF SOCIETIES. 


ThS UeDICAI, I'BKS. 489 


haviog tbeo advised its removal Tbe mass was mobile. 
Large vessels covered the surface of tbe skio, wbiob, 
however, was not ulcerated. There were no enlarged 
glands. Operation was resorted to only when tbe pain 
from distension became agonising. The growth, a con¬ 
geries of cysts filled with pnlpy tissue, cn microscopical 
examination, showed the nsnal characters of a rapidly 
growing spindle-celted «arcoma. The patient made a 
favourable recovery. It was remarkable that no rise of 
temperature bad taken place during conviUescenoe ; tbe 
chart, which was also before tbe Society, showed that it 
had been subnormal throughout. 


transactions of gocirttes. 


SOCIETY FOR THE STUDY OF DISEASE IN 
CHILDREN. 

Mkitino hkld at tbs Cbildren'b Hospital, Great 
O suoKn Stbebt, London, October 18th, 1901. 


Dr. D. B. Lees in tbe Chair. 


Cerebroi DxpUgia. —Dr. Fennell showed for Dr. 
Garrod a care of cerebral diplegia in a child, set. 5^, 
wfau'b presented some pointe of interest. A^xy was 
associated with spasticity and retinitis pigmentosa was 
present. Tbe retinitis was notewoitby when viewed in 
the light of the suggestion that cerebral diplegia was 
syphilitic in origin. Dr. Potntom mentioned a case of 
cerebral diplegia in tbe out-patient department which 
was getting progressively worse. Dr. Hawthorne 
asked for details as to the family history, and 
Mr. Carbb-Shith as to tbe nature of tbe labour at tiie 
time of the birth of tbe child. Mr. Lucas asked for 
information about the retinitis pigmentosa, and Mr. 
Fernet remarked that De Amicis, of Rio Janeiro, had 
placed on record several cases of retinitis pigmentosa 
in which syphilis was present in one or both parents. 
Dr. Fennell, in reply, said that the child did not begin 
to walk until three years of age. The family history 
was unimportant. No history of syphilitic taint could 
be obtained, and there was no history of nervons or 
mental disease. The labour had been a natural one. 

Mr. H. 8 . Collier showed a baby the subject of 
a deformity of the shoulder gi'die. It came to hU 
out-patient room on tbe previons day. Tbe deformity was 
similar to that shown in cases published by Mr. Willett. 
Mr. Collier also exhibited a process of bone whicfa bad 
been removed by him three years before from a similar 
case. 

A paper was then read by Dr. Watland Chaffbt. 
upon a 

CASE OF DIFFUSE LYMPUOUA 
terminating in pernicious aneemia, cccurring in an 
infant, set. 11 months. Wbon first seen the spleen 
and liver were enlarged. Examination of the blood 
showed no increase of leucocytes, tbe ery tbrot^tes were 
2,530,000, and the hemoglobin 44 per cent. The child 
died after being in hospital twelve days. After 
death the liver, spleen, and kidneys showed tbe 
Prussian bine leaction with hydrochloric acid and ferro 
cyanide of potassium. Mioro-copic sections of the 
organs showed small-celled infiltration along the capil¬ 
lary blood-vessels, especially around the lobulee of the 
liver. The Cbairhan remarked that tbe case was an 
example of a gronp of cases npon which much more light 
was needed. 

Dr. Lees showed a case of a iheumatio enlarge¬ 
ment of the heart in which brachial thrombosis 
had been present. Dr. Sansou remaiked npon tbe 
prognosis cf such cases and npon the causation of 
thrombosis in rheumatism. Dr. Theodore Fisher also 
commented upon tbe thrombosis, and Dr. Fotnton, at 
the request of Dr. Lees, made some remarks. He said 
that thrombosis, associated with rheumatism, had 
attracted more attention in France than in England. It 
was much more common in children than in adults. In 
the fatal cases be had met with cultures from the clot 
hsH proved sterile. 

Louhlt Facial Paralysis, —Dr. Hutchison showed a 


Mse of doable facial paralysis due to middle ear disease. 
When first seen tbe child had doable facial paralysis of 
a few weeks duration associated with discharge from 
both e^. Mr. Baliance cleared ont tbe cells of both 
mastoid bones and recovery ensued immediately. The 
Chaibkan and Dr. Sansom commented upon the 
and Dr. Hutchison replied. Dr. Hutchison showed 
also two cases with congenital deformities. A boy, aged 
4 weeks, with sapemnmerary digits, sbnormaliries of 
the feet, and congenital heart disease; snd alto a child, 
aged 16 months, showing a diffuse lipomatous nevus, a 
papilloma of the tongue, and congenital ostaract. Dr 
Sutherland remarked that he had a case under his 
care similar to the first case of Dr. Hutchison, and 
thought it possibly a case of achondroplasia. Dr. 
Hutchison did not consider his case one of achondro¬ 
plasia, but was open to conviction npon the point. 

Congenital Distas*. of the Heart.—Or. THeodob* 
Fisher showed two specimens of congenital diseaee of 
the left side of the heart. A case of mitral stenosis 
from a child, aged 16 months, and a case of aortin 
stenosis from a child, aged 4 months. The Chairman, 
until he had seen the first specimen, always felt con¬ 
vinced that congenital mitral stenosis did not exist, and 
ftated that snob cases must be szcessiveJy rare. Dr. 
Sansou considered that congenital defect of the mitrai 
orifice was a myth, but thought that mitral stenosis 
occasionally was present, as in this case, as the result of 
intra-nterine endocarditis. Dr. Nash remarked that be 
bad made an autopsy upon a case of congenital heart 
disease in an infant, ^ed 6 months, in which mitral 
steuMis was present. He proposed to exhibit the 
specimen,^ Dr. Sutherland remarked that he had 
heard a mitral presystolio murmur in an infant, aged 18 
months. Dr. Theodore Fisher agr^ that in 
previoosly recorded cases the stenosis appeared to 
have been tbe leiulb of endocarditis. In his spect. 
men, however, be could not understand how endocar¬ 
ditis could produce the fenestrated membrane which was 
present. 

Other cases were shown by Mr. Collibe and the 
Chaibuan. Mr. Collier sbow^ a child with deformity 
of the hip-joints superficially resembling congenital 
dislocation. At three weeks of age the baby bad 
suffered from abscesses in tbe neigbbonrbood of tbe 
bips. Skiagrams now showed separation of tbe femoral 
bead epiphyses Tbe Chairman showed a girl who had 
suffered from arsenical neoritis, due to the taking of 
15 m. of liquor arsenicalis three times a day for five 
weeks during treatment for chorea. Dr. Sutherland, 
Dr. Hawthorne, and Dr. Chaffbt remarked npon tbe 
ca<e Tbe Chairman also showed the oast of a skull of 
a boy, ia which very large nodules were present. Dr, 
Hawthorne remarked t^t nodules were now known 
not to occur only in acute rheumatism, but in rheuma¬ 
toid arthritis also. 

The meeting terminated with a vo!e of thanks to Dr. 
Leea for presiding. 


LIVERPOOL MEDICAL INSTITUTION. 

The Opening Meeting of the Session was held on 
Tho'sday, October 10th, when the Prtsident, Mr. Edgar 
A. Browne, delivered the Opening Address on 
intellectual PBOeSESS AND GENIUS 
After some prefatory remarks beating on the work of 
the Institation, tbe President saidTo those who live 
in tbe midst of the most remarkable achievements of 
tbe intellect, the conditions of mental progress must be 
a fascinating enbject, from whatever ske approached. 
Wtetber we give ourselves up to mere wonderment, or 
to a pictnreEque enumi ration of recent trinmphs, or 
whether we endeavonr to analyse the causes, the evolu¬ 
tion and development of modem ideas, whether we take 
a historical view of the pasc.or endeavonr to casta horo¬ 
scope of the future, whether regarded merely as an in¬ 
tellectual amusement, or as a practical guide for the 
organisation of onr medical schools, or even as a 
help for tbe improvement of our minds, the interest 
of a general view of progress ia likely to appeal to 
everybody. All travellers like occasionally to pause 
and view the road they have traversed, and examine 



490 Tan Msdical Pbmb. TRANSACTIONS OF SOCIETIES. 


Nov. 6. 1901. 


the map of where they are going. It would be 
wrong to take a sorvey vf medical progress in a mere 
parochial spirit; oar surrey moat be wide ; we do not 
Btand alone. There is no medical science properly eo 
called: we are tied and bound by the condition of the 
ooliateral sciences on which we depend. We are 
opportunists, in the midst of our more precise brethren, 
taking from them what will serve our turn. But 
though we have no science we may claim a scientific 
method, which In its way is exact and productive of 
good results. I he ait of the practitioner must be dia> 
tinguisbed from bis scisncs, his knowledge of the 
details of other sciences, from his appreciation, of what 
his own science requires. If we could carry out to its 
logdoal conclosioQ the scheme of a modem preliminary 
examination, f.g., the matriculation of London, we 
should be not physicians, but sc'entists. The more 
exact a science, the lees room for the exercise of art. 
and it is a union of the methods of scholarship and 
science with the personal ski’l in dealing with the half- 
seen and the obscure in clinical work that makes the prac¬ 
tice of medicine so fascinating. Bat arts tend to he 
lost, and though science is more stable, not only sciences 
but oiviiisatijns themselves have disappeared. The 
Egyptians have gone; tbeir learning was snfficieotly 
profound to command the respect of the Oreeke, but it 
has vanished. The modern Greeks are a brave and in¬ 
telligent people, but they have not a tincture of the 
old civilisation; theirs is French. The possibility that 
modem science may be destroyed must be admitted, 
therefore the mode in which the torch of learning is 
kept burning or becomes extinguished is full of in¬ 
terest. There is nothing to show that in historical 
times the individual brain power has increased. The 
power of using it has; the increased power due to co¬ 
operation is enormous. We can only judge of the past 
by the remains of literature and architecture, and by 
tho^e tests the ancient civilisations were raised by men 
fully our equals. The mental endowments of men have 
always been in three classes: men of genius, of talent, and 
the mediocrities. There is no sharp line of demaroa’ion, as 
the characterisitios may even be shown in the same indi- 
vidnal under different circumstances. Genius can scarcely 
be defined, as it is manifested in many various ways. 
In relation to science it means the possession of faculties 
especially adapted for the work to be done. A man of 
genius may ^ supposed to faave a fvline quality of 
vision, able to pierce the surrounding gloom of ignorance 
earlier than others; hence have sprang the ideas which 
lie at the foundation of progress. Genius, however, ia 
sdways of it<elf efficient., and tbe gieat value of the men 
ef talent is as interpreters. They are capable of appre¬ 
ciating genius, of seizing tbe gist of new ideas, and 
bringing them into touc^ with tie knowledge of tbe 
times. Tbe mediocrities, of themselves, do not appre¬ 
ciate genius ; they like it diluted; they herd tugether, 
they have their shibboleths, they distrust oriyinality, 
singularity, or independence of thought. Thus they 
maintain the atmosphere of any ait or science they may 
be connected with. They profit most by education, and 
they serve tbe practical purpose of diffusing and apply¬ 
ing the knowledge afforded them by the men of talent. 
Now, if we fail in educating tbe mediocrities suffi¬ 
ciently for them to appreciate tbe teaching of tbe 
more active minds, tbe progress cf knowledge is 
arrested, and science fails for want of diffusion. 
If genius fails, on tbe other band, there is little use for 
tbe man of talent, and under such conditions science 
may dwindle, and even become lost. Tbe inventive and 
research capacity of the Chinese must at one time have 
b^n considerable, bat knowledge baa not moved with 
them for 2,000 years ; they have settled down to a vast 
population of mediocrities, occupied inoissaotly in 
passing examinations or examining others more mediocre 
than themselves. Appalling aa the thought may eeem, 
the poss'bility of the same thing occurring to ourselves 
if our educational machinery b^omes perfected is not 
wholly chimerical. Moreover, a great discovery may be 
made and become public, but from a want of sufficient 
collateral knowledge maynot only fall flat and be useless, 
but may even become positively detrimental; take, for 
example, the familiar discovery of the circulation of the 


blood. There are various interesting points connected 
with the state of knowledge at the time it was made. 
Why was it not made before? First, it needed the 
establishment by Bacon, the protagonist of scientific 
thought in this country, of the inductive philosophy 
on tho ruins of the ancient authority, eepeoially 
that of Aristotle. Bacon found the phvaicuns 
great offenders ; he had a poor opinion of them, be said 
they reasoned in a circle, and doobtlesa be was right. 
But he gave them a serviceable map of the country; he 
said “ Look the facts in tbe face, form your own opinions, 
never mind tbe ancienta." Until that method was 
accepted as the working method, tbe passage of the 
blood through tbe arteries was not likely to I)e investi¬ 
gated because they were supposed to m air-passsges. 
A few advanced thinkers knew that some blood was 
mingled with the vital spirits, bat no connection with 
tbe veins was generally accepted. The liver, not tbe 
heart, was tbe prime motor, and when a thing was 
believed, and was obvions on superficial examination 
ittook an original mind to look below the surface. Then 
it was a very unmecbanical age, people did not concern 
themselves with the body as a machine—it was a vital 
organism, and a marvel, and not to be too rudely exa¬ 
mined either. Th>n the collateral sciences were not 
ready. Oxygen was not discovered for more than 150 
years. Before oxygen was disc ivered the knowledge 
of tbe mere paths of tbe circulation was no good; so 
instead of seeing that the central fact about the circa- 
lation was its connection with respiration, and acooont- 
ing tentatively for the existenoeof the pnlmonary tract, 
attention was merely confined tn the movement of the 
blood—tbe movement, and not the reason for tbe move¬ 
ment—and therefore they bled. Thus tbe valae of a 
great discovery was not only negstived but perverted. 

The address, which was listened to with great atten¬ 
tion and delivered without the assistance of any notes, 
<nded somewhat abruptly owing to want of time. 


NOETH OP ENGLAND OBSTETRICAL AND 
GYNiECOLOQlCAL SOCIETY. 

Mcxtikq hcld at Livibpool on Octobek 18th, 1901. 


Dr. T. B. Gbimsdale, President, in the Chair. 


Da. W, jApp-SiNCtAiB (Mancheeter) exhibited an im¬ 
proved portable apparatus for continual irrigation with 
fluid at a constant temperature, and ezplaii.^ its use. 

Dr. T. B. Gbimsdale (Liverpool) showed a specimen 
of cancer of the cervix in a utema with three and a- 
half months' pregnancy. The symptoms bad first de¬ 
clared themselves with the commencement of pr^nsney. 

I Tbe utems was removed successfully by vaginal hyster¬ 
ectomy. 

Case of Cakcbb of the Cebvix.—Opbbation and 
Eicuvbrt. —Dr. J. £. Gikmell (Liverpool) showed 
a uterus with four and a-balf months' preg¬ 
nancy and extensive cancer of tbe cervix, which 
he bad removed by vaginal hysterectomy. Owing to 
the size of the nterua it had been found necesavry after 
separating the bladder, to slit up the anterior wall of 
the cervix and uterus as far as the peritoneal fold, and 
through this of ening to empty the cavity. The sabse- 
quent steps of the operation were easy, and the patient 
recovered and was reported well twelve menths after¬ 
wards. 

Dr. Llotd Roberts (Mavchester) showed a pair of 
largo ovarian cysts with papillomatous degeneration 
removed by abdominal section. Nine of tbe cist* bad 
bnist, and the i eritonenm had not become infected wi'h 
the vi*cwtb8. There was no asoites, ita absence being 
p'obably asscc'ated with the fact of non-infection of tbe 
peritonenm. The patient made a good recovery. 

Case of Ca:sakean Section Twice Pehfobmed.— 
Dr. W. Japp Sinclair (Manchester) related a case of 
Cs-anan section perforiiiid fur tbe second time in the 
fame patient. 1 he uterine wonnd was eo intimately 
adherent to the abdominal wonnd that the new incision 
was carried directly into tbe uterus without opening 
the peiitoneal cavity. Tho child was delivered through 
this opening. The patient waa not sterilised by liga- 

O^lt 


GERMANY. 


Tbs Medical Fbxss. 491 


Not. 6. 19J1. 

tore of tlie tabes or otberwise, 
recoTored. 

A disoassion followed on tbe dangers of sabseqaent 
pregnancy after CsAarean section been petfotmed, 
and on the qaeetion of sterilising operations under sach 
f-ipi>nmariLni>Aa. Dr. Grimsdale (President), Drs. Lloyd 
Koberts, Davies, Croft, Briggs, Gamer, and lica took 
part. 

Scrmanp. 

[from our owk correspondent.] 

Beblis, NoTember2nl, 1001. 

The Mvnch, ifed. Iforh., 30/1601, contains sn article 
hj Dr. Liitbje on 

Bsnal Diabetes. 

Klemperer was the first who pointed oat the poraibility 
of arena! diabetes. A discoseion took place as to whether 
in that condition the passige of tbe sugar through the 
renal epithelinm was passive, or whether the kidney 
actively sought out the sugar contained in the blood 
and excreted it. Such a question must be difficult to 
answer, and tbe fuLdauental question really is. Is there 
a diabetes in the human subject the cause of which lies 
in some disturbance of the partncbyma of the kidney ? 
If an answer to this could be found our present know, 
ledge of tbe pMthogenesUof diabetes would be advanced 
a step. The positive material at hand from publications 
is very scanty, but theories are to be met with in abun. 
■dance. The author relates a case which appears to be 
free from objection, and which answers all the require* 
menta necessary for the postulate " renal diabetes." 

The Okse pioved tbe following: (1) absence of sugar 
before the appearance of tbe kidney affection; (2) 
appearance of sugar shortly after the commencement of 
the renal disease; (3) independence of tbe excretion of 
sugar on the amount of caibohydrates taken as food; 
G) diminution of tbe quantity of sugar in the blood. 

Intermittent Htdbops Aeticdli. 

A. Linberger has an aiticle on this subject in the 
Beitrage Z. Kfii. Chir. The material employed in the 
cempiiation was met with in the Tubingen surgical 
klinik. Ibe etiological factor was in twenty-five cases 
rheumatism, iu eight cases injury, then infection during 
tbe puerperiuDi, ^onorilcBS, malaria, tubetcnloeis, ai d 
intoxication, making agrauitotal of forty-nine cases. 
On tbe appearance of hydrops pain is never Absent; 
when the cause is rheumatic there is usually pain, 
fever, some general disturbance, and of function, 
especially at the commencement. A chronic 
hydrops sometimes became an intermitting ore, 
or tbe svelliDg continuud a long time even in the 
periods between tbe attacks. Stiffening sometimes 
took place, with grating on pressure. Internal lemedies 
weie rarely of use, but the usual surgical treatment was 
generally sucjsssful. There was no constant relation l 
betwein menstruation and hydrops, nor bad the ner* 
vous affection any influence. Age and occupation had 
an influence in the origination of the disease. In most 
of tbe cases tbe author could determine that inter- 
mittent hydrops was a sequel of iLflammation of tbe 
joint. Tbe affection was not an independent one, but 
only a symptom of the most varied diseases. 

At tbe Medical Society fir. Tb. Meyer showed a case 
of 

Iodine Dermatitis. 

The patient, a woman, bad taken 22 grus. of potassic 


iodide in ten days. Tbe exantbem had spread very 
rapidly over a great part of the body in a very short 
time, especially tbe lower part of the face, tbe backa of 
tbe bands and thumbs, and both legs from tbe kneee 
downwards Tbeamalleetpapuleewereadeepred with, 
in the middle, a small depression snrronnded by a gray> 
coloured area. On the hands were vesicles, that later on 
became purulent, seated cn a firm infiltrated red base. 
In one place was seen a blister tbe size of a two-shilling 
piece, which later on became puiulent. Tbe feet were 
similarly sffeoled. Later on scabs formed. Syphilis was 
out of the question. The speaker drew attention to the 
observation of some French writers, who stated that 
under certain circumstances iodide cansed exantbem of 
an erythematous or eczematous type, and also some of 
papulous form. The urine contained no iodine. Casts 
of the condition were shown, as well as photographs on 
tbe screen. 

Hr. Stein, from Prof. v. Bergmann's Klinik, showed 
a lautidrymaid with a 

Saddle Nose 

That had been snccessfully treated by injection of 
fluid paraffin. The patitnt, set. 14, had suppurating 
glands in the neck, which had been removed. In 1889 
she feU down some steps, striking her no^e and fore* 
head, from which accident the saddle nose resulted. On 
admission into von Bergmann's klinik the condition was 
typicaL There was no bridge to the nose, and the nos* 
tnis looked upwards. Tbe patient naturally had a 
repulsiveBipearance. The results of the injection were 
excellent. Tbe speaker related tbe history of this 
method of procedure fiom practice by Geisung, of 
Vienna, who first employed it cn a man whose testicles 
bad been removed for tuberculous disease, and who was 
refused admission to military service on account of the 
objectionable defect. Tbe result in that case was satis* 
factory. Gereung than made use of tbe procedure in the 
case of awoman, set 29, who suffered from incontinence 
of urine. He injected a ring of paraffin around the 
dilated urethra, whereby the urethra was narrowed and 
the incontinence cured. Pfannensteil then tried to cure a 
case of incontinence in tbe same way, but failed, and 
a small embolism in the lung was caused. The case 
being published was ibe reason why tbe method was 
abandoned. Stem observed that the evil result was a 
consequence of the injection being improperly made, 
and that embolism may be avoided with certainty. 

By permission of v. Bergmann tbe speaker bad tested 
the method as to its safety in numerous instances on 
mice, rabbits, and cogs. The paraffiin was not poisonous 
as he had injected one-third the body weight into an 
animal and it remained lively, but care must be taken to 
have the paraffin peifectly pure. If neither %eiu nor 
muscle was punctured the operation was perfectly safe. 
The paraffin should be passed into the subcutaneons or 
submucous tissue so that the overlying structures should 
be thrown into ridges. Tbe paraffin in time got absorbed, 
but not before a growth of connective tissue bad formed 
around and through it, which remained and made the 
result permanent. It bad been found that bard paraffin 
softened in the connective tisane, whilst soft paraffin of 
the consistence of oiotme-t at tbe end of a month had 
become as hard as cartilage. In the neighbourhood of 
muscles the paraffin was absorbed more quickly. His 
experiments had extended over a period of three months, 
and the parts then injected were still as hard as car* 

Digiiized ^ 


Both mother and child 



492 Thc Mbdicai. Fsxm. 


THE OPERATING THEATRES. 


Kot. 6. IDOl. 


especially those noder the scalp; whilst another 
deposit, below the shoalder blade, had been partly mas¬ 
saged aaay by the action of the mnsolee. 

Jluetrm. 

[raotf ODB OWN OOBBK8PONDBNT.] 

Vleuns, November tnd, 1901. 

PSOBOSFXBUOSIB CuTlS. 

At the Gesellschaft der ^rzte Ehrmann presented a 
case of psorospermosis cutis in the second generation. 
The father of the patient entered the Prague “ Klinik ’* 
in 1892, under Janowsky, with a similar disease. The 
patient now exhibited entered hospital in 1896, with 
earth-coloured swellings on the skin of the gro'n, vary¬ 
ing from a millet seed to the sire of a poppy seed. 
These tubercles had a homy surfaoe that oould be easily 
tom off, leaving the horny epithelium in the folds of 
the skin. Under these tubercles were found finer 
granulated matter, with and without sheaths, which 
had formerly been the psorospermin, which now re¬ 
mained as a degenerative product of the epithe¬ 
lium. These tubercles have now become oonfinent, 
and formed a scurfy raw surface which has extended to 
the infra and supra-clavicnlar spaces, as well as patches 
on the scalp. 

After the homy mass had entirely desquamated, the 
disease assumed the form of exudative eczema with 
ephelide pigmentation. In the inguinal region, probably 
owing to the maceration, the diiease assumed the 
appearance of pemphigus foliaoens vegetans with a foul 
secretion and peculiar horny snrronnding. 

The disease may appear at a very early age, from 
three to five years and upwards, associated with scrofula. 
The ioteraal use of cod-liver oil gives favourable 
results. 

Neumann said the case was a very uncommon one, as 
hilberto no such case bad been observed in Vienna. The 
diagnosis of the disease is the result of exclusion, as 
three other diseases closely resemble it, viz., lichen 
scrofulosum, which also has other local sites, as in 
psorospermosis, but has smaller tubercles with a central 
depression and a lasting pigmentation. The small 
papnloEEB of the syphilides arrange themselves also in 
groups arising from the hair sics in the form of tubercles. 
There is also another form of difease, such as the com¬ 
mon favus, that has a large number of reddish-blue 
tubercles, forming a scntnlnm. 

Ehrmann related a similar case that had come under 
his notice a year ago, where a combination of Inpns vnl- 
garis and psorospermosis were fonnd closely nnited in 
the same individual. 

Edptubi op the Utxbus. 

Merzfeld next showed a preparation of the uterus which 
had ruptured before parturition. The patient was 38 
years of age and had had seven children. In the tenth 
month of pregnancy severe pains commenced which 
were accompanied with vomiting. The bowels were 
cosfined, with a good deal of meteorism. The child's 
head was distinctly felt in the left side. After exclnding 
all other complications, the diagnosis was arrived at that 
the nterns had been ruptured. Shortly after this peri¬ 
toneal phenomena demanded operative relief- Under 
chloroform for the fi’st time a large quantity of blood 
came away, which on clos'-t examination was discharging 


from a tear, tiro inches long, inside the neck of the 
nterns. Laparotomy oonflrmed the earlier oonclnsions; 
the child was removed through the rent, and the utema 
and peritoneum carefully brongbt together. The woman 
died, notwitlutanding every attention, through loss of 
blood. 

Merzfeld preenmed that the mptnre had arisen in the 
first place from an old cicatrix in the uterus, probably 
from the cnrettement which had been performed after a 
former confinement. He warned the members against 
tbie operation, or any other instrumental interference 
in the uterus during the puerperal stage. 

Thx Provincial Diet of Upper Hungary has passed a 
resolution in favour of granting the status of medical 
prantitioners to three peasants residing in a country vil¬ 
lage in virtue of the alleged possession by them of 
•< miraculous powers in the treatment of injariee io 
bones and joints. None of the three can either read or 
write; in fact they are nothing more nor less than 
popular bonesetters. Naturally enough the decision has 
excited the resentment of the medical men as a class, 
and a movement is on foot to obtain the rescinding of 
the objectionable and nnprecedented anthorUatioa. 

^hc (Dperating theatres. 

MIDDLESEX HOSPITAL. 

Abdominal Htstbbxctomt. —Mr. Andbew Clark 
operated on a woman, set. abont 45, who was suffering 
from fibroids of the uteins, and whose life was rendered 
miseiable by a constant desire night and day to 
mictnrate, the act being attended with ccnsiderable 
pain. After the patient had been aniestbetised. tbe 
usual incision was made from the nmbilicns nearly to 
the pubes. It was fonnd that the bladder projected 
considerably above the pubes, notwithstanding it being 
empty. The left band was introdnced into tbe abdo¬ 
men, and no adhesions were fonnd except in tbe 
neighbonrbood of the left ovary ; but there were suffi¬ 
cient to prevent tbe tnmonr being extracted frcmthe 
abdomen until tbe incision bad been extruded upwatds 
sonre three inches to tbe left of tbe umbilicus. Tbe 
bulk of tbe uterus was then drawn cnt, and it was 
fonnd that there were several subpetitoneal fibroids as 
cell as a general enlargement of tbe uterus, there 
were drawn well over tc tbe right side and without 
much difficulty the adhesions were separated and two 
or three bleeding points secured with ligatures. The 
ovary and Fallopian tube were then freely exposed and 
removed after a double ligature bad been applied to 
prevent bleeding at either end. The tumour was next 
drawn over to tbe other side, and tbe ovary and Fal'o- 
pian tube freed in tbe same manner; this enabled the 
whole uterus to be pulled out well on tbe abdomen, and 
a flap of peritoneum marked out and disiected 
up from tbe front t the uterine arteries were 
then seized with prevsure forceps and divided and the 
whole of tbe uterus removed with scissors at its neck; 
silk ligatures were applied to the uterine arteries, and 
the flap of peritoneum sewn over the uterine stump 
with a continuous suture, the parts having been first 
thoroughly treated with a perchloride of mercury scln- 
ion (1-4000). The pelvis was mopped out, and the 
abdominal wall brought together layer by layer with a 
continuous suture. The wound was dressed and th» 


Diyiiized by 


Google 



Nov. 6, l901. 


LEADING ARTICLES 


patient removed to the ward. Mr. Clark remarked that 
there were oertain conditions under which hysterectomy 
wai not only desirable bnt necessary; namely: 

1, when a tnmoar had attained snch a size 
as to produce serions inconvenience on that score; 

2. wh'n it was rapidly (^wing; or 3, when 
from its presecce by pressure or otherwise, it produced 
troublesome symptoms, and although there were some of 
three cases in which cophorectomy might be practised 
with a view of arresting the growth or diminishing the 
size of the tumour, snch was not likely to be of service 
in a woman about the time of (he natural menopause; 
moreover, hysterectomy was a more certain cure, and 
now that it bad become such a safe operation it 
was generally preferred. The reason for submitting 
this patient to the operation was the trouble produced 
by pressure on the bladder, and here the dilated bladder 
rather interfered with the incision, which would have 
more conveniently been extended downwards instead of 
upwards. Be further remarked that this was a good 
specimen of the three varieties of uterine fibroids: 
(1) the Bubperitoneal, (2) the intra-uterine (for on 
opening it two polypoid fibroids werefonnd in the uterine 
canal), and (3), perhaps the commonest condition of all, 
the general enlargement of the ntems itself. The 
second of these three was not expected, as intra*ateriae 
fibroids are usually attended with menorrhagia, and 
this woman bad never suffered from this; indeed, she 
stated that from the age of 14 she had been absolutely 
regular in her monthly periods, even to the day. Mr. 
Clark pointed out that he had used the continuous 
suture throughout in this operation, and be did eo 
because of the rapidity with which it could be applied, 
and although speed was not of supreme importance in 
operations nowadays there are caaea, and particularly 
abdominal sections, in which the patient becomes con- 
aiderably collapsed after a time. 

Ten dajrs after the operation the patient had pro¬ 
gressed without any unfavourable symptoms, except that 
she bad been, and was still, unable to pass her uri ne. 
and had to be relieved by a catheter. 

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(^cbical jprtBB anb (Circular. 

'* SALTIS POPDLI 8CPRBMA LBX.” 


WEDNESDAY, NOVEMBER 6, 1901. 


A NATIONAL CONCERN. 

The theory of air-boroe typhoid as contrasted 


Thx Mxdical Pbebs. 493 

with watei’-bome typhoid in armies, to which 
Dr. Leigh Canney recently directed public atten¬ 
tion, involves questions of extreme importance. 
The author bases bis deductions mainly on the- 
reports of the Army Medical Department. In the- 
case of India and South Africa he has eel< cted those 
of the years 1897 to 1899, and for Egypt those of 
1884-1887 and 1898-99; be also brings forward facts he 
has himself observed while in private practice in Upper 
Egypt during the past ten years. That Dr. Canney 
is not an advocate of the air-borne theory is seen 
from his experience at Assouan. He notes that wbile- 
8,000 English and American visitors spent a great 
part of the winter at that place, and swallowed quan¬ 
tities of dust, only four developed enteric last winter, 
and that this is the usual proportion for previoua 
winters. He does not, however, make any statement 
for the summer months, which necessarily must be 
more important, as it is at this time the British 
troops stationed at that place suffered most. 
Dr. Canney, however, states that “wherever the 
British Army or other Army has gone it has 
either taken enteric germs with it (with tare 
exceptions), or it has managed to fix on some- 
of the worst camp sites, with no suitable pro¬ 
tective methods. When the disease appeared army 
methods were rarely timely, adequate, or compre¬ 
hensive enough to command success.” The protec¬ 
tive methods of the Army against enteric are, in the 
main, the points to which Dr. Canney desires to draw 
attention, and be suggests the formation of a Royal 
Water Corps. lu a previous issue, we have discussed 
this proposal and the objection to the use of petro¬ 
leum and steviliy.er8. We po'nted out the grave 
risks of the vicinity of such a volatile explosive when 
accompanying ammunition, more especially in a 
country like South Africa where grass fires are of 
daily occurrence. We also alluded to the fact that 
exception would be taken by military authorities to- 
tbe transport of such fuel, of the sterilising 
apparatus, andof its accompany log refrigerators, as it 
would necessitate more mule transport in a regiment 
than is at the present allowed for ammunition. 
With regard to the formation of a Royal Water 
Corps on the lines suggested by Dr. Canney, the 
idea is not new. It was adopted in the 
Natal Army by General Buller’s principal 
medical officer, Sir Thomas Gallwey, and has 
probably been adopted in other parts of South 
Africa. In our issue of August 28th last we 
published an article on this subject by Lieutenant E. 
Blake Knox, M.D., H.A.M.C. In it, the aetiology and 
prophylaxis of water-borne diseases, more especially 
enteric, are discussed. Had Dr. Canney referred 
to this officer's statements of the prophylaxis 
followed, at any rate by the Natal Army if not 
also by other columns, it is very doubtful if be would 
have made the following assertion. He says, “ Pure 
water—the one important thing in war—is practi¬ 
cally no man’s business in the Army; water polluted 
with enteric, dysentery, and diarrhoea organisms is 
still drunk every day in South Africa.’’ We all fully 

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LEADING ARTICLES. 


Nov. 6. 1901. 


recognise that sanitary reform is open to improve¬ 
ments in the Army. The recent warrant proposed 
by the Army MedicalService Committee hasaiso recog¬ 
nised this in its recommeadations. We should 
regard as a practical scheme in this respect 
the appointment of a special sanitary officer, 
with a few men, to erery division in the field, 
or home district, whose sole duty and responsibility 
-would be the selection of camps and their daily 
sanitary inspection, the selection and allotment of 
available water supplies—marking one for human 
oonsumntionione for washing, and oae for animals— 
and the supervision of the disposal of refuse and dis¬ 
infection of excreta. Further, in order to assist 
end co-operate in sanicary matters with this officer, 
e special committee should be formed in each 
district or camp, including the Provost-Marshal and 
en officer of the Royal Engineers. The combined 
men serving under this committee would famish 
police and fatigue parties sufficient to enforce strict 
attention to all matters connected with the sanitation 
of the camp. Any breach of discipline pertain¬ 
ing to sanitary matters would be reported by 
the police to the committee and dealt with by 
the latter. We are of opinion that the 
problem raised by Dr. Ganney is a serious one, and | 
that it can only be faced with a hope of success when 
the Army shall be educated to its vital importance. 
Medical men and water corps such as Dr. Canney 
suggests are next to useless unless all officers, non- . 
■commissioned officers, and men, are taught the ele- I 
ments of sanitation. In this lies the keynote of 
success. 

THE NOTIFICATION OF PHTHISIS. 

Will tuberculosis ever be stamped out of our 
midst? The answer to that question would pro¬ 
bably be in the affirmative from all who are 
acquainted with the history and the methods of , 
pi*eventive medicine, which in its way may be re-' 
garded as the most progressive of all branches of 
medicine. Of recent years the mind of the nations 
all the world over has been exercised upon the great 
problem of the preveution of phthisis. The great 
impetus to the melern study of the disease was un¬ 
doubtedly due to the discovery of the specific bacillus 
of the malady by Professor Koch, in the year 
1882. The subject has now become part of the 
atock-in-trade of the popular journalist, and 
it is almost impossible to find an ordinary 
newspaper of any importance that does not 
■contain a reference to tbe matter. The cura¬ 
bility of consumption, indeed, is now everywhere 
recognised as an established fact in scientific medi- 
•cine. Further, it is recognised that there may be 
various methods of cure, while no specific has 
hitherto been discovered. At the same time, it is 
impossible to admit the claims of tbe thousand and 
one so-called “cures” that are placed daily on tbe 
market by persons who seek either advertisement 
by notoriety, or mere sordid pelf through the agency 
of advertisement. There are not a few Gordian knots 


in the causation and the prevention of tuberculosis 
that have still to be unravelled or out before success 
can be attainei. A crucial problem, for instance, 
was raised by the theory advanced by Koch at the 
recent London International Congress, namely, that 
tubarculosis was not communicable from the lower 
animals to man. In the answer to that objection lies 
the key to tbe effective organisation of oar public 
sanitary service as regards phthisis. If tu^iercle 
cannot be conveyed by infected flesh and milk then it 
will be useless to control batchers and dairymen, so 
far as the spread of tuberculosis is concerned. If, 
on the other hand, the specific bacillus tuberculoiit 
of the lower animals he communicable to man, then 
the greatest hope for future generations almost cer¬ 
tainly lies in the rigorous supervision of food sup¬ 
plies. lathe Uuited Kingdom the trend of general 
scientific opinion has of late years been strongly in 
favour of the identity of human and comparative 
tuberculosis. Some years ago Klein found that 
guinea-pigs kept in the ventilating shaft of Bromp- 
ton Hospital became tuberculous. Some quite recent 
experiments by Professor DeWpineiu this country 
point to the infection of lower animals by human 
tuberculous sputum. Ths latter observatirtn, 
howeTer, cannot be accepted as absolutely con¬ 
clusive, owing to the fact that the tnberenlin 
test for existing tuberculosis was not previously 
applied to the animals experimented upon. 
Bub whatever the upshot of tbe investigation 
of this point that is now being carried on vigorously 
on both sides of the Atlantic, the infectivenesa of the 
[ phthisical human subject has not been called in 
i question. All measures, therefore, which are directed 
towards the limitation of the disease in man, apply 
with equal, or rather with much greater force, even 
were the truth of Professor Koch’s paradoxical 
theory demonstrated. Prom this point of view we 
are brought back face to face with the practical 
sanitarians, the medical officer of health, his 
inspectors, and his disinfectors. Needless to 
remark, ons of the great weapons wherewith 
communicable diseases h »ve been brought under 
the control of sanitary authorities is that of 
compulsory notification. The first step in the 
scotching of infection is to be able to locate and 
attac'x the centres of infection as they arise. Can 
this be done in ths case of tuberculosis ? Tbe recent 
Congress in Loudon recorded tfieir approval of 
voluntary notification, and it is not surprising that 
a great representative body of that kind should adopt 
a somewhat cautious attitude in approaohmg a 
matter that affects tie material and social interests 
of tbe community to no small degree. A-' th • same 
time it may be urged that the law has I’ecognised 
the right of local aut,horlties ti control the in¬ 
dividual in the case of other communicable diseases. 
Moreover, that supervisioo has been exercised with¬ 
out friction with the medical profession and with 
vast benefit to the community. To be content with 
the notification of deaths from phthisis to the 


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Nov. 6, 1901. NOTES ON CURRENT TOPICS. Thk Medical Pbess. 495 


medical officer of health is to deal with the effect 
and to paaa on the other side of the road so far as 
the essential cause is concerned. The rooting out of 
tnberculosis appears to demand some form of notifi* 
cation of the disease npon grounds that have ali'eadj 
been recognised by the Legislature. The exact form 
of the notification will have to be carefully con¬ 
sidered and determined upon before many years have 
passed, otherwise the discoveries of science and the 
efforts of preventive medicine may be stultified, and 
the attainment of the ultimate goal of eradication 
may be indefinitely postponed. 

DEGREES FOB LONDON STUDENTS. 

Diplohates of the Conjoint Board of the Royal 
Colleges of Physicians and Surgeons have recently 
been circularised with the object of formi'-g an 
association to be termed the London Licentiates’and 
Members' Society. The aims and objects of this 
embryo association are set forth as follows:—1. To 
petition the RoyaljOolleges. (a) To obtain powers to 
grant degrees; (b) or in the alternative to join with 
the University for the same object. 2. To request 
the Royal Corege of Physicians to rescind their 
by-law prohibiting their Fellows, Membe's, and 
Licentiates from using the popular title of “ Dr.” 
For some years past scarcely an opening add ess 
has been delivered at the medical schools without 
the solemn assurance being given by the orator 
that the question of degrees for London students 
was occupying seriously the consideration of the 
"authorities,” and that " something was sure to be 
done during the ensuing year.” This farce has con¬ 
tinued for so long that it was becoming almost a 
time-honoured joke, and was beginning to be warmly 
welcomed as an old friend by October audiences 
Now, howevor, it seems to have fallen, as have many 
of the introductory addressee themselves, into disuse. 
The proposed society, however, shows us that, 
in a certain section at any rate, tbe question 
has not been allowed to drop. While admit¬ 
ting the justice of the grievance which the London 
diplomates put forward, we gravely doubt whether, 
the objects given as forming tbe plan of campaign 
of the society are likely to obtain their wish, or, 
indeed, to do more than again bring attention to the 
fact that there is a grievance. To commence with, 
the first suggestion is to petition the Royal Colleges 
to obtain powers to grant degrees. It is stated that 
in 1887 the Royal Colleges of Physicians and Sur¬ 
geons determined to endeavour to obtain powers to 
grant a degree on the same standard as tbe then 
granted diplomas. We do not recall what steps 
these bodies took, but that their endeavoure failed is 
evident, since nothing has been done in tbe matter 
during the fourteen years that have elapsed since 
that determination was decided npon. Moreover, 
we do not see how corporate bodies which are not 
universities can, however powerful they may he, 
obtain such powers in the face of the strong opposi¬ 
tion which tbe established universities would raise 
to combat what could only be considered as an in¬ 
fringement of their particular rights. The alterna¬ 


tive is that the Colleges should join with tbe Univer¬ 
sity (we presume that of London) for tbesame object. 
Here again we do not see, when tbe regulations of 
the Colleges and those of the London University are 
compared, bow this is to be accomplished. It would 
mean great changes on the side of one or both, 
changes of a radical nature. Existing graduates of 
London University could not but object to any 
change that would make the degrees they bold easier 
to obtain, whilstintendingdiplomates might grumblo 
at having to face a more stringent examination than 
their predecessors. The suggestion that the Royal 
College of Physicians should be requested to rescind 
its by-law regarding tbe title of "Dr.'’ appears to us 
to be equally impracticable, for the use of such a 
title without the holding of a degree giving the right 
thereto is not merely a question for the College. 
Lastly, some provision would, were the objects of the 
suggested society attained, have to be made in the 
case of Fellows of the Royal College of Sut^ ons and 
Members and Fellows of the Royal College of Physi¬ 
cians. Granting, for the sake of argument, that 
diplomates of the Conjoint Board were to 
become entitled to some degree, say an M.B.» 
B.S, then tbe F B.C.S. and M R.C.P. or 
F.R.C.P. would have to carry with them a 
higher rank, say an M.S. or M.D. respectively. 
Therefore, whilst we are fully in sympathy with the 
London diplomates in their grievance as to the hard¬ 
ships and disabilities under which they suffer in this 
question of degrees, we cannot but think that tbe 
proposed line ol work suggested by tbe London 
Licentiates and Members’ Society is impracticable 
and not calculated to arrive at any satisfactory sola- 
tiou of tbe problem. To our minds the only possible 
way out of the difficulty is tbe formation of a teaching 
University for London, in the accomplishment of 
which, judging by Ihe want of progress daring the 
years which have elapsed since the subject was first 
taken up, there are numerous obstacles to be sur¬ 
mounted. 


on (Eur«nt ^opicB. 


The Health of the King. 

OuE article on this subject in last week’s issue haa 
had tbe desired effect, which was to obtain an 
authoritative contradiction of rumours which have- 
of late been persistently current on the Continent 
and in certain circles in this country. It is with 
unalloyed pleasure that we receive the assurance of 
tbe baselessness of tbe statements put forward with 
such circumstantial plausibility. The publicity 
given to this authoritative contradiction will dissi¬ 
pate a feeling of grave anxiety which was gradually 
gaining ground in the absence of an official state¬ 
ment. One reason why such rumours obtain more 
or less ready credence is no doubt because past ex¬ 
perience has led the public to suspect that it is often 
left in ignorance of events of the highest import¬ 
ance until secrecy is no longer possible. We con¬ 
gratulate ourselves on having been the means of 

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NOTES ON CURRENT TOPICS. 


496 Ths Mkdioal Pfiicsii. 


Not. 6, 1901. 


removing tbig goarce of anxiety by eliciting a eatig- 
factory asgurance of the excellent state of bis 
Majesty's health. 

The Negro Queetion in America. 

The negro question in America has been again 
brought prominently to the front by the action of 
President Roosevelt in accepting a distinguished 
member of the coloured community as his guest. 
This step on the part ’ of the bead of the United 
States’ Government has, we understand, caused a 
perfect storm of indignation and disapproval, an 
outburst which we in England have a difficulty in 
understanding, for with us the prejudice against the 
coloured races, although scarcely non-existent, is 
faint. The question with which our cousins across 
the Atlantic will soon be confronted is one of im* 
mense importance to them, and is, again, one which 
it is impossible for an Englishman to realise. The 
unquestionable superior fecundity of the negro is 
resulting in a great numerical increase in the 
coloured population of the States, especially in those 
of the southern portion of the continent, where 
climate and other circumstances are markedly 
advantageous to the black race. This fact, together 
with the probability of a limit belog put to 
the influx of alien whites, a point which is 
seriously engaging the United States' Government 
at the present moment, threatens the white popula* 
tion with the possibility of a future superiority of the 
black population, a possibility which may, perhaps at 
no very distant date, require all their energies to 
meet it. We cannot, botvever, imagine that such a 
contingency would ever become of a more serious 
nature than frequent negro revolts, with occasional 
massacres of whites, for, despite the hysterical 
drivellings of a certain class of people, the black m.n 
never was and never will be the white man’s equal. 
" Am I not a man and a brother ? ’’ was a frequent 
and favourite question in the time when the question 
of slavery caused so much bloodshed between men 
who should have been united, and were that question 
asked of us now we should return an emphatic nega¬ 
tive. Taking the white man to be the—at present— 
highest development of the species, the African 
negro is intellectually far behind him. Speaking 
from the point of view of the development of races, 
the negro is still in his infancy, and he must pass 
through many generations before he can have 
sufficiently corrected his facial angle and in¬ 
creased his cranial capacity to enable him to 
compete with the superior white. That certain 
members of the negro population have attained to 
some degree of eminence in the various vocations 
and professions of civilised life is true, but they are 
but the exceptions—the isolated instances; we doubt 
if they could be considered us the “ vortrekkers " of 
a coming race. It is this inferiority which lends an 
element of security for the white in the future rela¬ 
tions of the two races in America. That an over¬ 
whelming superiority of numbers would in the end 
lead to trouble cannot for one moment be doubted. 


but, until that event were accompanied by equality 
or superiority of intellect, it could never lead to the 
negro becoming the predominant race. 

The Bacelli Treatment of Foot and Mouth 
Disease. 

It ip not often that a Minister of Agricnltnre poees 
as the discoverer of novel methods of treating the 
diseases of animals, but Signor Baoelii's name is 
well known in connection with the carbolic treatment 
of tetanus—a method which is still upon its trial. 
Proceeding on very similar lines he now advocates 
intravenous injections of percbloride of mercury as 
a cure for foot and month disease. If the statistics 
are to be believed, the results are little short of mar¬ 
vellous, but we feel bound to maintun an attitude of 
reserve in respect of experiments made at the in¬ 
stance of a Minister, himself the inventor thereof. 
Foot and month disease is sufficiently prevalent for 
confirmatory experiments to be made forthwith in 
abundance, and we shall await the results of the treat¬ 
ment in independent hands before formulating a 
deflnite opinion ns to its value. 

The Medical Offleership of the Liondon 
School Board. 

The circumstances attending the resignation of 
Dr. "William B. Smith, who for upwards of ten years 
has filled the post of Medical Officer to the London 
School Board, are sufficiently instructive to deserve 
some consideratiou. When the post was created can¬ 
didates were invited to compete under certain condi¬ 
tions, one of them being that he should devote the 
whole of his time to the duties of bis office, and that 
be shonld not hold any other paid appointment. Dr. 
Smith was selected from among a large number of 
candidates, and the first thing the Board did was 
to abrogate this condition in his favour, he receiving 
permission to remain in poBsession of certain other 
posts then held by him. We protested against this 
course at the time, on the ground that it was unfair 
to exclude possible candidates by insisting on a very 
onerous condition, only to waive it in favour of apar- 
ticular candidate. Since that time Dr. Smith has 
discharged the responsible duties of bis position with 
assiduity and, as far as we are aware, to the satisfac¬ 
tion of the Board. The remuneration attached 
to the post is £600 per annnm, obviously 
a wholly inadequate salary for a man of 
the standing and experience required for the 
duties and responsibilities imposed upon him. Some 
time eince Dr. Smith applied for an increase of salary, 
and after several discussions the Board rescinded a 
resolution increasing the salary by £200 per annum, 
and required Dr. Smith to accept the £800 forayear, 
be continuing to hold his professorship at King’s 
College, and failing his acquiescence, to receive six 
months’ notice. As Dr. Smith did not see his way to 
complying'with the Board’s conditions he sent in bis 
resignation. Now we cordially concur in the view 
that the Medical Officer to the London School 
Board ought not to hvld any other paid appoiat- 


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Nov. 6, 1901. 


NOTES ON CURRENT TOPfOS. 


Thb Ukdical Pbxsb. 497 


ment, the datieB of the office offering ample 
scope for the most indefatigable workers; but 
it is unjust to impose this condition unless the 
salary be made commensurate with the dignity and 
responsibility of the appointment, which obviously 
six, or even eight, hundred a year is not. The Board 
will have no difficulty in finding candidates for the 
vacancy created by Dr. Smith’s retirement; but if they 
succeed in obtaining the services of a really capable 
man they will have to raise the rate of remxmeration, 
or he will, after a time, follow Dr. Smith’s example. 
In the interest of the community ruled by the Board 
we trust this view will receive due consideration. A 
capable man can render inestimable service, but he 
is not likely to throw his whole soul into his work 
unless he can rely upon receiving more generous and 
considerate treatment than has been meted out to 
the present bolder of the post. 

Domeetio Filters. 

Dr. Joseph Priestley, in a letter to The Times 
of October 26lb, draws attention to the need for a 
standard for domestic filters. He remarks “that a 
need exists for domestic filters as a thorough protec¬ 
tion against water-borne disease must be admitted 
when we tracea water supply from its source, through 
its storage and distribution, and see the many 
different points at which infection may take place.” 
Sand filtration, which is generally used at water¬ 
works, although theoretically correct, was found 
wanting in the cholera outbreak at Altona. 
Infection may occur in the mains, ei her from 
hydrants and fittings, or leaking from defective joints. 
Analyses of the same water made at different 
points seldom agree. As regards filters, experiments 
made at the laboratories of the College of Physi¬ 
cians showed that filters depending on charcoal, 
asbestos films, spongy iron, magnetic oxide, &c., were 
all more or less inefficient, using the term “efficient” 
as meaning the power of arresting disease germs. 
Some filteia were even found to add germs to the 
water. Only two filters were shown to arrest germs, 
the “ porcelain ” and “ infusorial earth ” filleia. The 
former, known as thePasteur-Cbamberland, is made 
from a specially prepared porcelain. It was used in 
the French Army when enteric fever was prevalent, 
and is said to have caused immunity against the 
disease whenever used, Since the Pasteur-Chamber- 
land filter the Berkfeld has been introduced, depend¬ 
ing on infusonal earth. This has also proved efficient. 
There is, however, a difference between the two filters, 
as shown by experiments at the Netley Laboratory. 
Typhoid bacilli wei*e found lo penetrate the in¬ 
fusorial earth in a few days, but failed to penetrate 
the Pasteur-' hamberland. These experiments were 
exhaustive, and conducted with polluted and un¬ 
polluted waters, to which typhoid bacilli were added, 
and waters with or without the addition of nutrient 
broth, ensuring all possible conditions. These con¬ 
ditions were necessary, as it is known that bacilli do 
not g^ow equally in all waters, and not necessarily in 
the most polluted waters. Dr. Priestley concludes 
with pointing out the necessity for increasing the 


standard of efficiency for domestic filters, and to 
make them able, not only to filter germs, but to per¬ 
manently avert them. He, therefore, recommends 
the Pasteur-Chamberland filter as the only one 
which fulfils this high standard. The Berkfeld 
filter was used in the South African war, and did not 
prevent enteric fever. However, Tommy Atkins 
when thirsty, does not wait for his water to 1^ filtered. 

The Q-eneraJ Medical Council Election. 

The date is approaching (November 2lBt) ere which 
the Domination of candidates for seats on the Council 
must have been filed. There are in the field five can¬ 
didates for the two seats left vacant by the retiring 
members, Dr. Glover and Mr. George Brown. These 
two gentlemen offer themselves for re-election. The 
other candidat( 8 are Dr. S. Woodcock, a prominent 
member of the British Medical Association in the 
north, Mr. George Jackson, of Plymouth, and Dr. C 
Hayward, who appears to be attached to the Hahne¬ 
mann Hospital at Liverpool, and may be assumed to 
come forward as a representative of the homceo- 
pathic practitioners. We have from time to time 
published the addresses of the various candidates 
from which our readers will have been enabled to 
form <ipinion8 as to their respective suitability. 
It is imperative that in selecting their represen¬ 
tatives, practitioners should take care to choose men 
with definite views on the questions which press for 
solution, men, moreover, who will be able to urge 
these views on the Council in a manner calculated to 
commend them for adoption. In view of the wide¬ 
spread interest which is taken in matters bearing on 
medical reform, we may hope tbat a larger propor¬ 
tion of medical men will take the tixtuble to register 
their votes than has been the case at previous 
elections. In Scotland, Dr. Bruce, the retiring 
member, presents himself for re-election, but be will 
be opposed by Dr. Charles Robertson, of Glasgow, 
and Dr. Norman Walker, of Edinburgh. In Ireland, 
Sir Wm. Thomson will, so far as we are at present 
aware, offer himself for re-election. We have not 
heard of any opposing candidates. 

A Pertinent Question. 

“ Truth” calls attention boa curious concatenation 
of circumstances which certainly appears to call for 
some explanation:—“ In the correspondencd columns 
of a weekly paper a few weeks back some one signing 
himself ‘L. P.’ inquired after a cure for bronchitis. 
In the following week another correspondent signing 
himself ‘ W. P.,’ of 256,Peckham Rye, answers that 
be has been cured and w 11 be glad to forward the 
name of the doctor who cured him and a pamphlet 
written by tbat individual. A sufferer from asthma 
writes to ‘ W. P.' and receives from him a pamphlet 
written by G. A. Macnutt, M.D., M.R.C.SEng., 
L.R.C.P. and L.M.Edin., and inscribed with the 
anthor's address, 21, Leinster Square, London, W. 
In a covering letter * W. P.’ assures bis correspondent 
tbat he knew nothing whatever of the correspondence 
in the paper until it was sent to him, testifies to his joy 
and gratitude at his delivery from lifelong 
DiniP'^ed b\ 


suffering, 

■og 


498 Th* Mbdical Pkbbs. NOTES ON CXJRRB^iT TOPICS. 


Nov. 6. 1901 


and conclndestbuB:—If Mr. B. will send Dr. M. a full 
statement of bis case, Dr. M. will tell bim whether be 
can treat bim at a distance; or, still better, perhaps 
Mr. B. will come for a personal interview.” It would 
be interesting to know bow ” W. F.’’ came to be pos¬ 
sessed of Dr. Macnutt’s pamphlet for distribution; 
indeed, in the absence of explanation, the case savours 
strongly of an occult method of advertising which is 
very much to be deprecated. We may assure our 
contemporary that such a method is not “recognised 
as legitimate,” though it may for obvious reasons be 
very difficult to suppress. 

The Advertisement Crase in High Places. 

The craze for notoriety, which, in the following 
connection, is merely another name for advertise¬ 
ment, among Continental professors and leaders of 
medicine has developed a fine art of its own. Not 
only the medical profession in the United Kingdom, 
but the general public also are continuously exploited 
in favour of this new cure, of that synthetic drag of 
great price and indescribable virtues, or of some¬ 
thing or other curative that is calculated to bring 
custom to chemists and patients to consulting rooms. 
Not infrequently the news of the great discovery 
flashed roiand in the world in pithy telegrams con¬ 
veys some fallacious and exploded theory, or some 
silly paradoxical or quack speculation—in other 
words, a lie. It is said that a Vienna professor, 
more candid than his fellows, when asked recently 
how they were getting on in that part of 
the world, repled, *' Oh! we are getting on 
excellently well, as Bismarck used to say, by pub¬ 
lishing lies.” The evil is not altogether unknown 
within the sea-girt shores of our own tight little island, 
especially now that some of the leaders of the pro¬ 
fession carry on discussions in the newspapers about 
drugs of which they confess they know nothing. 
The Americans have cut the Gordian knot by 
allowing everyone to advertise all round, a latitude 
of which the restless Yankee medico avails himself 
to the full. Their method has, at any rate, the advan¬ 
tage of complete candour, for the stringent unwritten 
rules of the medical profession in the United King¬ 
dom are over-ridden roughshod by those wbo sit in 
high places. They have not yet, however, sank to 
the level of the systematic advertisers among the 
Continental professors 

The Plague at Liverpool and Glasgow. 

One of the indirect risks from the South African 
War is the great amount of infection, chiefly enteric, 
that is being brought home by the shipload. Now 
tbat-tbe plague has been added to the other dangers 
of the situation, the chances of infection of our home 
porte hks been greatly enhanced. It behoves the 
port sanitary authorities, therefore, to keep their 
watch upon ships coming from the Cape with un¬ 
wearied vigilance. The plague has recently obtained 
a footing in Liverpool, as officially testified by the 
Local Government Board. It appears that some half- 
dozen cases of illness occurred in that town 
about the end of September, and they were sup¬ 


posed to have been doe to influenza. Later,, 
some doubts having arisen as to the real nature 
of the malady, baoteriologioal teste were applied, and 
it was found that two of the patients bad died of 
bubonic plague,while three other cases were doubtful 
The mother of two ^rls engaged in a Liverpool 
drapery shop returned from Glasgow, and shortly 
afterwards sickened and died. Her daughters were 
taken ill, and one died. The woman who attended 
to the bodies became ill and died, as well as three 
of her children, while a fourth is still in hoe* 
pital. Other cases of infection are suspected. 
Immediately on the heels of this intelligence comes 
the news of an outbreak of plagne in Glasgow. 
Several patients have been removed to hospital from 
a leading hotel in the city. It is snpposed that the 
infection was conveyed by rats. The attacks are said 
to be in no way connected with the cases reported 
about a fortnight ago to have been brought into the 
port in the Anchor liner Batavia. In that case it 
points to a recrudescence of a former attack, and 
points to a widespread distribution of the baclUus 
It is not stated whether the Liverpool sufferers 
visited tie infected hotel at Glasgow, or whether they 
contracted the disease elsewhere in the latter town. 
In spite of the fact that recent experiences seem to 
show that plague cannot become established in the 
United Kingdom under modem sanitary conditions, 
the invasion of a great centre of population mast, 
nevertheless, be always regarded with a good deal of 
anxiety. —■ 

Anglophobia in Continental Health Resorts. 

Thebe can be no donbt that ons of the unpleasant 
results of the present war at the Cape bas been a 
widespread awakening abroad of the fierce unreason¬ 
ing bate of u'.l things British. So blind to their own 
interests are the residents of some of the Continental 
health resorts that a correspondent to a London 
newspaper has solemnly warned both doctors and 
their patients as to the reception awaiting them 
abroad. As regards Davos, he writes that “ the anti* 
English campaign bas been carried on with a coarse 
savagery that renders the place nnfit for invalids.” 
Really it is time that the medical profession of the 
United Kingdom took to ordering their patients to 
the excellent spas and seaside watering places in 
! oar own islands. Springs like those of Bath, 
Harrogate and Droitwicb are unsurpassed by any 
Continental spas. All that is wanted is for them to 
be made fashionable by the combined patronage of 
Royalty and of the consultant physicians. It is 
matter of common knowledge that the Germans re¬ 
gard with unmixed astonishment and contempt the 
custom of English medical men in sending off their 
patients, cnrable or incurable, to places away from 
their own country. As to consumption cures, there 
is no need nowadays to go to Davos or any other 
foreign resort. In the United Kingdom there is 
abundant choice of the purest air and the finest 
scenery of its kind in the whole world, and the con¬ 
sumptive is more likely to recover amidst native 
surroundings than in the midst of strangers, whose 


oy 


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Nov. 6. 1901. 


NOTES ON CURRENT TOPICS. Thi Medical P»»88. 499 


odIj inierest in him is a pecuniary cne. Beeides. 
many of the high-altitude resorts are saturated with 
tubercle bacilli in dwellings, hotels, laundries, and 
every other point of domestic euvironment. 


An Action Against a Medical Man. 

A cusious case of alleged malpraxis came before 
the Recorder of Dublin the other day. It is one 
which well illustrates the difficulties attendiog the 
diagnosis of certain forms of injury to the shoulder, 
and also the degree of gratitude which a medical man 
may expect to receive from a certain class of patient, 
A Mrs. O'Reilly, the wife of a teacher and librarian 
at the Mountjoy Prison, on February 22nd last, 
received a serious injury to her shoulder as the result 
of a fall downstairs. On the following morning she 
consulted Dr. Dowdall, the Medical Officer of Mount- 
joy Prison. Heraim was then considerably swollen 
and after careful examination he recommended her 
to go to the Mater Hospital. However, as the 
patient said that she would prefer to be attended in 
her own house, he recommended her to foment 
the arm and shoulder with hot water and poultices. 
On April Ist she went to the Mater Hospital, where 
she was attended by the Assistant Surgeon, who told 
her that her shoulder was dislocated. She remained 
in the hospital about a fortnight, and came back on 
June Ist. By the use of the Bontgen rays it was 
found that beside dislocation there was an impacted 
fracture of the shoulder. The plaintiff complained 
that if this injury had been discovered and treated at 
an earlier period she would have been spared much 
pain and suffering, and the evil effects of the acci¬ 
dent. The medical evidence of Mr. Blaney, the 
Hoepital Assistant Surgeon, and of Dr. Myles, 
President of the Royal College of Surgeons, who was 
called on behalf of Dr. Dowdall, was to the effect that, 
even if the diagnosis of a dislocation had been made 
in the first instance, it would not have been advisable 
to attempt the reduction of it on accoimt of the com* 
plicating impacted fracture. The resultof the action 
was, as might be expected, to completely vindicate the 
defendant. The following words of the Recorder are 
clear, and very much to the point; we commend 
them strongly to the attention of the general public, 
who consider that not only is a medical man to 
do everything for nothing, but that he is to be 
punished for every error of judgment made whilst 
doing so. He said: “ Doctors can only be held liable 
for mistakes caused by negligence, and net for errors 
of judgment. In my opinion the poorer classes are 
BO absolutely pampered with medical assistance that 
anything like grace or gratitude to the medical pro¬ 
fession had absolutely gone from them. In this case 
the patient was attended free by a skilful medical 
man in her own home, because she was the wife of a 
prison official, and would not go to hospital, as she 
was recommended to do. Was it fair for her now to 
bring this gentleman into publi ccourt, and arraign 
him as if he had done something wrung P Dr. Dow. 
dall leaves the court without the slightest imputation 
on his medical escutcheon.” 


The Mosquito Campaign in West Afi'ica. 

Major Donald Ross delivered an interesting 
lecture at Liverpool on October 2l8t to the West 
African Trade Sections of the Liverpool Chamber of 
Commerce, in which he recounted the various steps 
which are being taken in different portions of the 
West Coast to bring about the discomfort of the 
mosquito. It is pleasant to learn that he has 
returned from a tour round the most important 
settlement satisfied that reform in sanitary 
matters was taking place, and that the Governors 
of the coast were doing all in their power 
to farther it. Major Ross is a strong advocate 
of radical measures of reform. He approves of the 
adoption of such precautions as the general use of 
quinine, the segregation of Europeans, and wire-gauze 
protective screens for the entrances and windows of 
houses ; but be considers that the really im 'ortant 
step is the drainage of swamps and the breeding 
pools of mosquitoes. In answer to the criticism that 
it is impossible to entirely eradicate mosquitoes. 
Major Ross says that such a proceeding is not pro¬ 
posed. An attempt is being made not to destroy 
every mosquito in Africa, but to reduce their num¬ 
bers in towns by doing away with their uuumerable 
breeding places. The speaker also called atteution 
to the effect which greater comfort had in nuuntain- 
ing health, and contrasted the condition of Europeans 
in Calcutta with their condition on the West Coast. 
He believed that if private subscriptions were forth* 
coming to pay the initial expense of “settlement 
forme” and other improvements, the Govemm*nt 
would help. The two great watchwords for the im* 
provementof health on the West C*>a8t were—“No 
stagnant water, and greater comforts for Euro* 
peans.” 

Proposed Coronatioii Gift to the Hospitals. 

As Prince of Wales, King Edward showed bis 
deep interest in the London hospitals by the inaugu¬ 
ration of the hospital fund which bears his name. It 
is evident that in his elevation to the Throne our 
Sovereign has not forgotten his charitable schemes, 
and, just as be endeavoured to free the hospitals 
from emharrassmeut to celebrate the Diamond 
Jubilee of his illustrious mother’s glorious reign, so 
he is now hoping to similarly mark his own acoes- 
sion. The Committee of the Prince of Wales’s Hos¬ 
pital Fund have issued an appeal to the charitable 
public to provide a sufficient sum, by way of a Coro¬ 
nation gift, to free the London hospitals from finan¬ 
cial embarrassment There can be no doubt that 
such an appeal, if successful, would result in much 
help to the suffering poor for whom the hospitals are 
really intended, but we should like to see some more 
stringent means taken than heretofore to prevent the 
gross abuse which exists of this form of charity. 
There is ample necessity for increased hospital ac¬ 
commodation among the really poor, and the raising 
of money by such an appeal as we have mentioned 
would enable some 450 hospital beds, now closed for 
want of funds, to be reopened. To our minds, however, 

.oog e 


Dinii'- 



500 Th* M*dioal n«8s. NOTES ON CURRENT TOPICS. 


Nov. 6, 1901. 


tbe unportant question to be asked is: — Would these 
beds be occupied bj the patients who are in most 
urgent need of them P Or would thej be filled by 
those who are perfectly able to afford to pay fees for 
proper medical attendance? This a matter for tbe 
Fimd officials to carefully and seriously discuss, for 
much might be done to regulate hospital abuse were 
these authorities to formulate a series of rules which 
would settle the question as to what is and what is 
not abuse, and to refuse aid to all institutions which 
did not agree to stand by such rules. In formulating 
any series of rules of this nature it must be remem¬ 
bered that abuse of general and special hospitals is so 
widely different that they must be considered separ¬ 
ately. The person who can well afford a half-crown 
fee, but seeks aid at a general hospital for a trivial 
ailment, abuses that charity; but the same person 
who seeks the aid of some special hospital, we will 
say for an affection of the eye, does so with perfect 
right. Such institutions are provided for the relief 
of those who cannot pay the high consultation fees 
charged by specialists, and, therefore, a totally 
different class of patients resorts thereto. 

Quacks and their Fees. 

A CASK which presents certain points of interest 
was tried the other day at the Rirkby Lonsdale 
County Court. Dr. Wearing, of Clapham, Yorks, 
sued a railway guard named Nash for £2 12s. for 
attendance on the defendant’s son. It appeared 
from the evidence that Dr. Wearing first saw the 
case in February, 1900. The child had then been 
limping for three months. There was marked 
eversion, external rotation, and flexia of the right 
hip-joinh The doctor at once diagnosed hip-disease. 
By rest in bed and extension the limb was got into 
good position and the pain ceased. A hip 
Thomas was then applied and the patient allowed to 
go about on crutches. In January, 1901, a fluctuat¬ 
ing swelling appeared over the front of tbe hip joints, 
and Dr. Wearing advised the parents to let the child 
go to a hospital. Instead of doing this, however, 
they took him to a man in Lancaster, who described 
himsel ‘as a herbalist. This worthy told.them that the 
joint was “ out,” and that there had never been any 
disease. He gave them something to rub it with, and 
then, having taken a fee of £2. sent them to a bone- 
setter. He concurred in the diagnosis of his friend 
the herbalist, manipulated the hip, and was paid ten 
guineas. Tbe father subsequently refused to pay 
Dr. Wearing’s account, alleging that he had treated 
tbe child for hip disease, whilst all the time it had 
been suffering from a dislocation. Dr. Mackenzie, 
of Ingleton, saw the child once, just before it was 
taken to tbe herbalist, and confirmed Dr. Wearing’s 
opinion. Mr. A. S. Barling, Sirrgeon to the Royal 
Lancaster Infirmary, was also put in the box. He said 
that he had heard the evidence, and there could be no 
doubt that the case was an ordinary one of hip 
disease. Being asked by tbe Judge to explain how it 
was that the child seemed to have been l^nefited by 


Mr. Barling said that in these cases there was always 
some stiffness of the joint due to adhesions, and bone- 
setters always said they were dislocations took 
credit for reducing them. The boy was in court 
walking with difficulty with the ud of a stick. The 
parents refused to accede to the Judse’e suggestion 
that Mr. Barling should examine the child. In ^ving 
judgment for the plaintiff, with costs, tbe Judge said 
that tbe case was undoubtedly one of hip 

The Ventilation of Tubular Bailwaya. 

A FEW weeks since we criticised the ventilation 
of the Central London Electric Railway, and pointed 
out that it would be in the future interests of the 
large towns of the United Kingdom to detect and 
remedy defects in that direction. It appears that 
for some time past Professor Wynter Blyth has been 
making experiments on tbe air of the tunnels in 
question, and he states that be found the amount of 
carbonic acid gas at some stations reached 10'3 parts 
per 10,000, while in the tunnels it rose to 11*9, that 
is, from four to seven parts beyond the permissible 
limit. Dr. Blyth points out that owing to struc¬ 
tural arrangements ventilation depends entirely on 
the passage of the trains, and the tunnel air is 
dilated, but never thoroughly swept out. We cannot 
help thinking that the crux of the matter has not 
been grasped by any of these critics. That there is 
a fine upcast draught in tbe approaches must be evi¬ 
dent to all who have gone down the lifts or stair¬ 
cases just before the advent of a train. In our 
humble opinion, what is wanted is a downcast to 
supply fresh air, to be artificially propelled if need 
be. Further, a proper direction must be given to the 
air propelled before the trains. Under the present 
arrangement tbe air driven into one half of a 
station is simply transferred to the other side by a 
fatuous system of open doorways. A more in¬ 
geniously absurd plan of thwarting natural veniila- 
ation could hardly have been devised. 

The Hygiene of Bestanrant Kitchene. 

The sanitation of public kitchens, meaning thereby 
the cooking quaiters attached to hotels and re¬ 
staurants, has been recently going the round of the 
newspapers. Some years ago tbe matter was in¬ 
vestigated by a well-known medical officer of health, 
who laid some remarkable facts before tbe attention 
of customers of the useful institutious in question. 
But his voice was that of a man crying in the wilder¬ 
ness, for qotbing has been done to amend the evil, 
although considerable advances have been made to¬ 
wards improving tbe condition of bakeries, whiob 
about the same time received his unremitting atten¬ 
tion. To begin with, one fatal flaw is extremely 
common both in bakehouses and kitchens, namely, 
they are underground. No satisfactory cleanliness 
and whulesomeness can be hoped for in either case if 
the operations are conducted on premises below the 
general level of the surrounding surface. The next 
great requirement is registration and licensing, 


thebone-setter 8 treatment if there was no dislocation, i accompanied by systematic inspection and control by 


Dit-iiiizeti ijy 


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Nov. 6,1901. 


NOTES ON CTJBRBNT TOPICS. 


Thi Mkbical Pbms. 501 


a central authority, such as the district county coun¬ 
cil* Nothing short of central administration will 
ever secure sound sanitation in hakehouses and 
kitchens, for here, as in other branches of public 
-sanitary administration, efficiency only be 
obtained by a system that is prompt, thorough, inde¬ 
pendent, and impartial. With a fair amount of 
experience in the matter of hotel and restaurant 
kitchens we have little hesitation in saying that an 
enthoritative inspection, conducted upon a fairly 
wide scale, would secure a plentiful crop of '• revela¬ 
tions ” of a loathsome and revolting character. 

The German Bmperor and the Study of 
Cancer. 

The Emperor William, with his usual directness 
of aim, has taken steps to place the study of cancer 
under the most favourable conditions possible to 
modem scientific research. It has been announced 
that be has requested Professor Ehrlich to devote 
his whole time and energies to the study of the dis- 
-ease in question. At the same time the Professor 
will have the advantage of a magnificently appointed 
ohemical and bacteriological institute, while an 
Austrian specialist has been appointed as his 
assistant and coadjutor. This step is in accordance 
witii modem views of the right and proper environ¬ 
ment required for advanced scientific researches. 
With some reserve it may be said broadly that n-) 
returns can be looked for from a great deal of such 
work unless a corresponding amount of money is 
expended. That does not mean that scientific inves¬ 
tigators are a whit less single-minded and enthu- 
aiastic in their labours, but simply that methods of 
«xact investigation nowadays demand the use of 
costly methods and infinitely varied and elaborate 
apparatus. The secret of the causation of cancer is 
eo elusive that if mankind can ever hope to wrest it 
from the band of Nature, it is only by means of a 
concentrated, sustained, and well-equipped attack. ; 
The pathetic family experience of the Kaiser's family 
has no doubt impressed them deeply with the desir¬ 
ability of some practical step of the kind. Here in 
the United Kingdom the matter has been mooted in 
some of the public newspapers, but nothing has been 
done by way of establishing a systematic school of 
epecialstudy of cancer. State-supported science does 
not flourish on British soil. 


An Important Vaccination Appeal. 

The vaccination officer at Leicester recently 
instituted proceedings against the father of an un vac¬ 
cinated infant for non-compliance with the law, and 
the case excited considerable interest because it was 
regarded as a test case, some 60,000 defaulters await¬ 
ing the decision in Leicester alone. The defence was 
based on the assumption that the vaccination officer 
had no legal right to initiate proceedings in opposi¬ 
tion to the formally expressed views of the guardians. 
The case was argued at great length, and resulted 
in the defendant being fined. An appeal has been 
lodged against this decision, the outcome of which 


will be eagerly awaited on every hand. The only 
serious contingency is the possibility of the decision 
being reversed on some technical point, leaving the 
question at issue undecided, but in view of the very 
careful consideration given to the arguments by the 
magistimtes we hope such may not be the case. 

A Royal Example. 

It is announced that, by order of the King, all the 
servants at Marlborough House have been vaccinated 
by his Majesty's physician. Sir Francis Laking. 

In answer to a correspondent, the Minister of War 
states formally that there is no present intention of 
removing the Army Medical School from Netley to 
London, and that no change will take place “ unless 
by the strongest advice of medical authorities.” This 
assurance does not take us very far since, as the sub¬ 
ject is actually under cemsideration, it only affirms 
ths fact that no alteration of the kind will take 
place unless it be decided otherwise. 

The Opening Meeting of the Dublin University 
Biological Association will he held on Thursday, 
November 14tb, at 8.15 p.m. An Inaugural Address 
will be delivered by the President, Dr. R. Travers- 
Smith, on An Apology for Bacteria.” Among the 
speakers will be Professor J. M. Purser, D So., the 
President of the College of Physicians, and H. H 
Dixon, D.So. 

The Inaugural Address at the opening of the 
Medical Session at Jervis Street Hospital will be 
delivered to-day, at 430 p.m., by Dr. Austin 
Meldon, D.L. 

The Autumn Session of the General Medical Coun¬ 
cil will commence on Tuesday, November 26th. 

PERSONAL. 

Dr. Donald MacAlistsb resigns the Professorship 
of Medicine at the University of Cnmbridge, which will 
become vacant at Christmas. 

Db. John Macinttbx, of Glasgow, baa been re-elected 
President of the British Laryngological Association, and 
will deliver the Opening Address on Friday next. 

Db. J. Mitchell Wilson has been elected County 
Medical Officer for the East Biding of Yorkshire, having 
previously occupied the post of Health Officer for 
Doncaster. 

Subobon-Oenebal a. F. Preston, M.B., Director 
General, Army Medical Ser?ioe (temporarily), has been 
appointed an Honorary Physician to the King, vice 
Sorgeon-Major-General W. A. Thomson, M.B., deceased. 

At the conferring of Degrees at the Boyal University 
of Ireland last week. Lord Dnfferin announced the award 
of a gold medal with dUtinotion to Mr. Wm. J. Dar- 
gan, M.B.,B.Ch., B.A.O., of the Catholic University 
School. 

Mb. Thohas Evans, M.B., M.S„ has been presented 
with a handsome silver spirit tantalos by the officers 

Diyiuzed by GooqIc 



^2 Th> Msdical Pbbbb. 


CORRESPONDENCE. 


Nov. 6. 1901. 


and nnnmg staff of the Holborn Infirmary, on his ap* 
pointment as Medical Saperintendent of the City of 
London Workhouse. 

Pbofbbsob Hugh L. CiiLLSKDiB, has been 

appointed to the Professorship of Phyeics in the 
Boyal Collie of Boienoe, rendered vacant by the resig¬ 
nation of Professor Sucker, who has become Principal 
of the University of London. 

Db. W. S. Sxith has resigned bis appointment of 
Medical Officer to the School Board of London, in con¬ 
sequence of the refusal of the Board to allow him to 
hold certain other paid appointments which prevented 
him devoting his whole time to the duties of his office 

gcotlanb, 

[fboh oub own cobbbspondsnt.] 

UsCBXABB OF StODKNTS AT EdINBUBOH UNIVBBSITT.— 
In an interim report dealing with this matter the Finance 
Committee of the General Council point out that there 
was a steady diminution from 8,600 in 1889*90 to 2,800 
in 1895-96, since which date the numbers have fiuotnated 
near the latter figure. It cannot be said that the report 
she^ much fresh light on the causes which have led to 
this state of affairs, so far, at least, as the medical faculty 
is concerned, since the reasons have been fairly obvious 
to amvone considering the matter. The Committee state 
that for a generation prior to 1869 Edinburgh held a 
foremost place among the medical schools of the world; 
it attract^ not only an abnormal number of students, 
but also an unusuid number of men destined to teach 
elrawhere. The school has, in short, for years been 
shedding many of its best medical teachers ovmr the globe. 
The competition thus brought about affects Edinburgh 
in sevmrafways. The mere increase of teaching centres 
would reduce the number of students coming from a 
distance, and these must specially be taken into account; 
the great strides of medicu education in the midlands 
of England, in Wales, in America and in Germany. 
Another c^nge is the growing importance of prac¬ 
tical, as compared with systematic instruction. 
Newer institutions, often with younger teachers, are 
more ready to adapt themselves in this respect, while 
the Sootti^ schools of medicine are clinging and striv¬ 
ing to keep to both methods of instruction. This entails 
increased work on the student, and a longer drain on the 
purses of their parents. In addition to ^e above causes, 
which speoially affect the medical faculty, the improved 
social status of commerce as a oaUing, the establish¬ 
ment of journalism as a profession, the advance in the 
standard of instruction of secondary schools, the im¬ 
proved status of tea<diing as a profession, the reduction 
of the stipends of the Established clergy, nay, even the 
substitution for patron^^ of a preaching competition 
for electi'>n to charges, with its deterrent effect upon 
sensitive natures," have contributed to diminish the 
number of students as a whole. Financially, the de¬ 
crease is of serious importance. Prior to the Act of 
1889 the Professor drew the whole class fees. The pro¬ 
fessorial incomes regulated by that Act was thus bued 
on incomes which were at their height when the Act 
came into operation, and which were, as events have 
proved, temporarily infiated. With a falling revenue 
tiie same salves have still to be paid, and the 
competition of other schools has necessitated addi¬ 
tional expenditure on teaching laboratories, Ac. 
For remedies for this state of matters the Committee 
look to improvement in ^e teaching, increased fiexibility 
and a^ptability in the staff and arrangementd, and a 
greater vigilance on the part of the authorities to prevent 
grievances; secondly, to the development of some means 
(postgraduate scholimhipsorthe Uke)of inducing the best 
men to stay in Edinburgh; and then, relief to the over¬ 
crowded cnrticulnm by the transference of preliminary 
subjects, botany, soolc^, physics, and chemistry, to 
the secondary schools. 


Gbnibal Ubdical Council ELscmoN. — It is 
announced that Dr. Norman Walker has consented to 
stand for election as direct representative for Scotland. 
Though he cannot now claim to stand in the ranks of the 
great body of general practitioners. Dr. Walker wm for 
a number of years in general practice, and has always 
continued to interest himself in the needs of those who, 
after all, form the backbone of the profession. 

Plaovb in Glasgow.— Glasgow has been visited by 
plague for the second time within over a year. 
Bnmonrs to this effect have been current for some days 
but were not officially confirmed until November 
All the cases have occurred among the employes of one 
of the larmt hotels in the city, and on Friday the 
directors of the Caledonian Railway Company, to whom 
the hotel belongs, took measures to close the establish¬ 
ment It appears that the outbreak was first brought 
under notice of the sanitary authorities early last week, 
and on Wednesday two patients, and on Thursday 
another, were removed to the fever Hospital. One of 
them has died, and the pathological and bacteriological 
examinations prove conclusively that the disease is 
plague. Since then two more suspected cases have been 
foun<L The Medical Officer of Health states that 
although the source of the outbreak baa not been fully 
traced, it has been definitely ascertained that it has no 
connection with the cases recently reported among the 
crew of the Anchor Liner Bavaria, which came into port 
abont a fortnight ago. These cases were treated in the 
. Glovan Hospital. Glasgow has, and deservedly has, the re- 
I pntation of being a model municipality, and its public 
health departmentin no way l^s ^hiod its fellows. The 
success with which the previous outbreak was met leads us 
to hope that this one may be equally satisfactorily dealt 
with : active steps are iMing ^en te exterminate the 
rats with which that part of the city is infested. The 
municipality has been engaged during the past year iu 
a vigorons crusade against these vermin, and within 
the past two or three months some five hundred have 
been killed and examined. So far the outbreak has 
remained limited to the Central Hotel—an extremely 
restricted area as compared with the previous one—and 
this has been convert^ into a reception house for the 
servants, nnmtering about three hundred who are 
employed in it. They are thus under complete medical 
supervision, and in addition they have been inoculated 
with anti-pli^pie serum, A clean bill of health can no 
longer ^ given to ships leaving Glasgow, but as yet 
there has not been time for the outbreak to disorganise 
the shipping trade to any extent. 


CIorrtBpoTibmcf. 


(We do not hold ooxaelTestesponsible for the opinions of onr 
oorrespondenta] 


THE CURE OP CONSUMPTION. 

7*0 tAe Editor of Thi Mxoical Pbbss and Cibcul a b 
Sib, —The correspondence under the above heading 
begun in August last in The Time$, still drags its slow 
length along, and continues to be at once equally amus¬ 
ing. inetmctive, and deplorable. Colonel Le Peer 
Trench, like a ^lant soldier, etill sticks to bis guns 
and reiterates hie belief that Alabone's great discoveiy 
has been deliberately “enppressed " by the profession, 
so that thousands of cases *' pronounced inonrable by 
ordinary treatment" have been wilfully allowed to 
perish miserably whilst within reach of the salvation 
afforded by Alabone’s miracnlous method. For purely 
sordid or eelfish reasons or in obedience to trades union 
commands, the whole profession have—it is thus allied 
—conspired to make a martyr of a great diecoverer, and 
have murderously withheld from snffering hnmanity 
the benefit of his treatment. The conspiracy has been 
joined in by the large number of pure scientists who do 
not practice medicine bnt devote ^emselves entirely to 
research, and has been participated in by the same class 
as well as the entire profession of medunne thronghoat 
the civilised world, the whole of whom have hitherto 
ehamefolly bnt consistently ignored and despised Ala- 
bone and all his works. CoL Trench is qnito intelligent 

Co.gl( 



OORRBSPONDBNCB. Th* M*dical Patsa. 503 


Nov. 6, 1901. 

dnoQ^h to tmderatand that this is the extended logical 
etatement of hie argomente, and he reiterates bis charge 
notwithstanding. If Col. Le Poer Trench stood alone 
or in a Tery small minority of the pablic capable of 
serioosly holding and pabliclyasserting such a monstrous 
belief the fact would not be remarkable; but it wrtaWy 
is a remarkable fact, and one well worthy full discussion 
that a la^e proportion of the public in every rank of 
life have equally little respect for the profession ; have 
as little confidence in medical science, and are as ready 
to reject its authoritative opinion in favour of that of 
any pretender loud voiced and persistent enough in his 
alaims to attention. 

Colonel Treocb’s letter is next followed by one from 
Sir W. Broeidbent, pithy, smart, and ending with an 
apropos Latin quotation, but qnite insufficient to be in 
any way adequately explanatory to the averse reader 
of The Timt* who needs enlightenment and guidance not 
to be found in a few epigrammatical statements. Having 
ontered into the controversy, it seems a pity Sir William 
has not written at sufficient length to make the matter 
fnlly and clearly comprehensible, at least to the intelli* 
gent lay reader. 

Dr. Pollock next writes and adds the important in¬ 
formation that he has retired from practioe. If he had 
made this known in his first letter he would have avoided 
giving a point to bis adversaries, who were able to reply 
with a vulgar tu quoqnt to his charge of obtaining a gra> 
'toitons advertisement from the correspondence. Or. 
Pollock's independent position being known he might, 
with great advantage to the pablic and the profeesion, 
have discussed the whole question at sufficient length. 
Dr. Pollock is of course followed by the martyr Alahone. 
He scorns to reply to the libellous imputations of bis 
•enemiee. It is enough for him that he has had 
« quarter of a oentnry’s experience of the wonder¬ 
working powers of the laohnanthes treatment, and 
only prays for the day when generally adopted 
and need in the hospitals it may increase 
-the tale of oases cured to a figure beyond the present 
■deplorable average. One cannot foretell what may 
happen at the hospitals, but it is satisfactory to know 
at any rate that patients in great nnmbers are deserting 
their old-fashioned, stnpid, and prrjndioed regnlar 
medical attendants, and are rushing to the consulting 
rooms of Alahone and his difoiples, there to be cared 
by the simple method now so folly and scientifically 
explained. If no other good than this had come out of 
the correspondence in The Ttmu, if it had not at the 
same time exposed the trne character of the medical 
profession ana enabled the world to estimate them at 
their proper value an immense service to mankind 
would at least have been performed. Not often does a 
oorreepondence in The Timet so speedily achieve snch a 
glorions result. 

1 am, Sir, years truly, 

October 30tb, 1901. UBiquc. 


THE ELECTION OF DIBECT EEPBESENTATIVES. 
To the Editor of Thi Mxdical Pbiss and Oxboulab. 

Sib,—I think all will ^ree with Hr. Victor Horsley 
that we most look to the British Medical Association for 
reform of the General Coxmcil of Medical Education und 
Begistration—indeed, for the many changes so nrgently 
ne^ed in the affairs of the profession. This being his 
view it is singular that he should suggest as the best 
means of bringing about reform—the return of Dr. 
Woodcock as a “ Direct Bepresentative" on the General 
Medical ConneiL Dr. Wot^oook has been for years on 
-tiio Council of the Association—he was sent there 
by the Lancashire and Cheshire Branch entirely on 
acconnt of his avowed opposition to the registra¬ 
tion of midwivee. He has kicked away the ladder 
be climbed np to his present exalted position, and 
declares himself a registntionist. The electors have no 
idioice but to vote for Dr. Glover, who is a consistent 
registrationist, and Dr. Woodcock on the one hand, and 
Hr. George Brown and Mr. Jackson on the other, both 
of whom emphatically decline to tamper with the 
** Unity of M^oine." The election will be fought as 
before, on the vexed midwives' question, and very 


properly so. Legalise the aspirants to a position withont 
qualification, and no alteration of the Medical Acta will 
ever retrieve the damage. These women will be duly 
qualified medical practitioners as far as obstetrics is 
concerned, and will demand and have a right to expect 
our services in consultation with them. 

The feeling is very strong here upon this question, 
and this probably is the reason of the very delicate and 
modest naaimer in which Dr. Woodcock referred to the 
“Guild scheme" at his Liverpool and Manchester 
meeting, a scheme he before characterised as qnite im¬ 
practicable. 

I think it reasonable to expect a candidate who has 
had so many years’ experience and official responsi¬ 
bility to give a liberal account of bis work, successes 
and failures, when addressing the electorate.—I am. Sir, 
yours truly. Jab. Bbassbt Bbibblxt. 

OldTrafford, Manchester, Nov. 2,1901. 

P.S.—Mr. Horsley asks us to refuse Dr. Woodcock and 
Mr. Jackson. This, of course, carries with it a farther 
act—we must turn out the sitting members. Dr. Glover 
and Mr. George Brown I imagiue Mr Horsley’s iftt 
dxzit will be resented by many electors. District 
representation is doubtless the id^—but the first con* 
dition is a snitable candidate, no matter where he 
resides. We want men, like Hr. Horsley himself, inde¬ 
pendent of the petty “ ^tteries or threats of humanity," 
fearless of opposition and with courage to lead minori* 
ties. 


THE MISUSE OF THE BBONCHITI8 KETTLE. 
To the Editor of Tax Mkdical Pbbss and Cibculab, 

Sib,— Now that the winter is on ns, witii its moist, 
foggy atmosphere, medical men will be called on to 
treat great numbers of oases of bronchitis in young 
children and elderly people. May I veutare to protest 
against the routine use of the bronchitis kettle. It is 
not denied that in certain dry, hard N.E. winds the 
bronchitis kettle may soften the air in a room, and may 
ease the breathing of a sufferer, but I refer to its routine 
and oontinnal use in cases of bronohitis. I have entered 
a bedroom of a lady at 11 p.m. on a foggy November 
night, and found abronobitis kettle ponring ont its steam, 
whilst the gas fireplace had no effertive connection with 
the chimney; the ratient, ased 74, was sitting up in bed 
gasping for breath and life. I removed the kettle, 
effected a connection between the gas fire and the 
ohimney; in a few honrs the patient was lying hack in 
bed in ease and comfort. I had removed the oppressive 
moisture of the room, also I had retained the gas fire 
to promote dryness of the air of the room, whilst the 
irritating fnmes of the gas fire had been con¬ 
ducted into the chimney. 

This is not by any means a solitary instance. The 
bronchitis kettle seems to be a fashion or fad; its occa¬ 
sional value is not denied, but its rontine use is often a 
cruel punishment and injury to the patient. 

1 could alwa3rB breathe gloriously on an Australian 
lain, with a difference of 16'=’ F. between the wet and 
ry bulbs; but breathing was often oppressed in Bengal 
in the south-west monsoon, with the atmosphere laden 
with moisture. 

I would refer your readers to a grand disoonrse by the 
late Sir B. W. Biohardson on this subject in your issue 
of January 25th. 1888 (‘‘Clinical Beadings and Prac¬ 
tices—Hydrops Bronohialis ’’) ; those who may read that 
essay will receive much light and knowledge. 

I am. Sir, yours truly, 

William H. Psabsb, M.D. 

Plymouth, October 23rd, 1901. 


A Midwife Committed for Manslaughter. 

A xiDwiPi at Mile End has been committed for trial 
on a charge of manslaughter on the coroner’s wanant. 
Judging from the evidence, she most be a descendant of 
Mrs. Gamp, only worse, but we doubt very much whether 
any useful pnrpoee will be served by her committal, the 
throwing ont of the bill by the grand jnry being almost 
a foregone conclusion. 



504 Thi Mbdical Pbbss. 


MEDICAL NEWS. 


Nov. 0, 1901. 


NEW BOOKS AND NEW EDITIONS. 

The following have been received for review oinoe the 
publication of oar last montUy list 
Loadon: Bailmebr, Tihdill abd Cox. 

The Pocket Or»; or, Anatomieta’ Veda Ueeam. Fifth EdiUoa, 
Bevieedand iMit^hy 0. Herbert PagEO, M.B-Load., F.B.C.S. 
Price 3fl. 6d, aet. 

Lessona on Maaaage. By Mre. Margaret D. Palmm-, Maaseuae 
and Manager of the Massage Department at the London 
Hospital. Price 3s. 6d. net. ^ 

London: J. ABD A Cbtibchill. 

Ontlinea of Gynecological Patbo1(«y and Morbid Anatomy. By 
C. Hub^ HobeM, M.D., F.B.C.S. l&O iUuatraiione. Pp. 33^. 
Price 21 b. 

A Short Practice of Midwifery. By Henry Jellett, M.D, 
P.B.O.P.I. Third Edition. PriceSe.ed. 

An Introduction to the Bacteriological Examination of Water. 

By W. H. Hoirocks, M.D., B.Sc. Pp. 300. Price lOs.Sd. 

A Manual of Practical Anatomy. By the late Professor Alfred 
W. Hughes. U.B.. M.C., F.B.C.S.Ed.- Edited and completed by 
Arthnr Keith, H.D.Aberd., FB.C.8. Part I. ; Upper and 
Lower Extremities Pp. 274. Price 10s. 6d. 

Pharmacopeia of the Hospital for Diseases of the Throat (Golden 
Sqpare). Edited by H. Lambert Laok, M.D., and C. A. Parker, 
F.B.C.S.Ed. Sixth Edition. Pp. 75. Price 28. 6d 
London: Hebrt Eimptob. 

The Principles and Practice of Medicine. By Wm. Osier, M.D., 
F.B.S., Prof, of Medicine in the Johne Hopkins University, 
Baltimore. Fourth Edition. Pp. 1,182. Pnce 18e. net. 
Manchester: Betwood abd Sob. 

Blsckpool as a Health Besort.l By Thomas Carr, M.D.Durh., 
M.HC.S. 

London: J. B. Kibo abd Sob. 

Pnhlio Health and Housing. By John F. J. Sykos, M.D. (Milroy 
Lecturer). Pp. 216. 

London: H.E. Lewis. 

TrsDsactlons of the Dermatologioil Society of Great Britain and 
Ireland. Edited by C. H. Thompson, M.D., and £. G. Little, 
M.D. 1900-1901. Pp. 59. Price 58. 

Edinburgh; E. abd S. Livibostobe. 

Handbook of the Public Health.'Ey John Orr, M.D.,F.B C.P.Ed. 
Pp 236. Price 4e. net. 

Newcsstle-on-Tyne: Lobohdest. 

Blanipulation or Massage By John A. Peters. 

London: Lobohabb, Gbexb abd Co. 

Diseases and Injuries of the Teeth. By Morton Smale, M.B.C.S., 
L.D.S., and J. F. Collyer, L.B.C.P., M.B C.S., L.D S. Second 
Editiou. Pp. 685. Price 2Ie. 

Elementary Practical Hygiene (Section J), By Wm. 8. Fumeanx. 
Pp. 239. Price 28 6d: 

London: Machillab and Co.. Limited. 

Practical Histology. By J. M. Langler, M.A., Sc.D., F.BS. 
Pp. SiO. Price 6 b. 

New York and London; Pvtbam's Sobs. 

The Care of the Consumptive. By C. F. Gardiner, M.D. Pp. 
182. 

Edinburgh and London; YouBO J. Pebtlabd. 

Text-honk of Pharmacology and Tberapentica Edited by w. 
Hole White, M.D.. F.E.C.P. Pp. 1,0*0. 

London i Hebrt Bebshaw. 

Dictionary of Treatment. By W. Whitla, M A., M.D. Fourth 
Edition. Pp 1,055. Price 16s, 

London: Swab, Sobbebscheib and Co. 

ATreatiaconPlague. By Major G. 8. Thomaon, M.B., M.Ch., 
and John Thomson, M.B.C.S., L.B.C.P.L Pp. 299. 


©bitunrs. 


MR. HY. SPENCER SMITH, F.R.C.8. 

This gentleman, whose death we have now to record 
at the ripe age of 89, at one time occupied a prominent 
position among the sni^eons of his day, be having re* 
tir^ from practice about fifteen years since. He was 
admitted a member of the Royal College of Surgeons, 
England, in 1837, of which he was elects an Honorary 
Fellow in 1843, and occupied for some time a seat on 
the Court of Examiners and of Council. Mr. Spencer 
Smith was for many years on the active staff of St. 
Mary's Hospital, and was subsequently elected consult¬ 
ing surgeon to the hospital He was also a Fellow and 
a Vice-President of the Royal Medical and Chimrgical 
Society. His contributions to medical and scientific 
literate were numerous and highly appreciated; 
among others he translated for the New Sydenham 


Society “Schwann’s Miorosoepio Researches into th» 
Accordance in the Structure and Growth of Animals 
and Plants," and of a Memoir by Professor Bisehoff, 
and had contributed various clinical lectures to the- 
pages of this and other medioal journals. 


JCabopaturo ^ot£6. 


DAD’S QUININE PILLS. 

Ws have reoeived from Messrs. Battle, of St. Lonia 
and Paris, samples of Dad’s Quinine Pills. The quinine- 
contained therein—each pill being equal to two graine 
of the salt—is claimed to be produced by a new process,, 
and to be more active than the ordinary drug. In ad¬ 
dition to this, it appears to be comparatively free from- 
the unpleasant secondary effects which in some 
subjects follow the ingestion of quinine. These pilla 
are sugar-coated and irreproachably made, and we 
have asoeitained that they contain pure quinine, re¬ 
sponding to the standard t^ts in regard to solubility in 
the variooB media. The form is a convenient one in 
which to administer the drug, and accuracy of dosage- 
is ensured, moreover, the price at which they ue sold 
makes them also one of the cheapest. 

PHENALGIN CAPSULES (PINK TOP). 

Wb have received from the Etna Chemical Company^ 
U.S.A., via Mr. E. J. Reid, of Basinghall Avenue, 
London, E.C., a sample phial of their specially- 
prepared Pink Top Capsules of Fbenalgin. Each oap- 
snle ooDtaiuB five grains of this well-known analgesic 
and anti-nenralgio remedy, and they appear to consti¬ 
tute a oouvenient and exact way in which to preacribe- 
this substance, especially as the cost is stst^ not to 
exceed that of the drug in ordinary form. We may 
remind our readers that phenalgin is a coal-tar de¬ 
rivative containing ammonia, which is liberated in tbe 
stomach in a nascent state, and exerts its oanal toni& 
and stimulating action, thus effectually combating the 
tendency to depression which characterises the analgesic 
effects of this group of medicinal compounds. They- 
readily dissolve when left in contact with moist heat. 
They ate uniformly sold in one-ounce bottles. 


CRE080TED EMULSION OP COD-LIVER OIL. 

WITH HTPOPH08PHITES. 

Mxssbs. Pabks, Davis and Co. prepare an Emulsion, 
of Cod-Liver Oil with Creosote and the Hypophosphites 
of Calcium and Sodium, a sample whereof has been, 
submitted to us. The emulsion is remarkably com¬ 
plete and stable, and the taste of the oil is completely 
masked by the creosote, which, moreover, possesses 
valuable therapeutical properties of its own in the vety. 
oasea in which the oil is likely to be prescribed. The- 
presence of the hypophosphites confers a tonic and 
reoonstituent medication also of value in pnlmonary 
disease, debility, Ac. Taken with food, the emulsion 
does not repeat, and it appears to undergo prompt 
assimilation, judging from the absence of traces of the- 
oil in the stools. 


^tbiral ^ctD0. 

Medical SickaesB and Aocidsnt Soclsty. 

Teb usual monthly meeting of the Executive Com¬ 
mittee of the Medioal Sickness, Annuity, and Life 
Assurance Society was held at 429, Strand, London, 
W.C., on the 25th nit. There were present Dr. de Havil- 
land Hall (in the chair). Dr. J. B. Ball, Dr. Frederick S. 
Palmer, Dr. M. Greenwood, Dr. St. Clair B. Shadwell, 
Dr. W. Knowsley Sibley, Mr. J. Brindley James, Dr. J. 
W. Hunt, and Dr. Alfred S. Gubb. The favourable sick¬ 
ness experience of the early part of the year has been 
well maintained. The claims have been under the ex¬ 
pectation both in number and in average duration, and, 
BO far, the year's working shows a oonsiderable margin in- 
favour of the Society. The number of new entrants is also 
rather greater than in 19(X), but the Committee, feeliog- 
Bure that ^e membership of the Society would be greatly 


ypT. 6, 1901. 


MEDICAL NEWS Thb Mmioal Pbjsb. 505 


inoreaMMl if tbe beaefite it offers were more follj known, 
app^ to tbe members to brin^ tbe business nnder the 
notice of their medical friends. In this way they can 
greatly aid the management in extending the nsefnl 
work of the Society, and in keeping down tbe expendi¬ 
ture rate to the present low level, viz., less thw 6 per 
oent. npon the premiom income. Frospectnses and all 
particnlars on application to Mr. F. Addiscott, Sec- 
Medical, Sickness and Accident Society, 83, Chancery 
Lane, London, W.C. 


Death Under Ether. 

A DKATH under ether occurred last week at the Great 
Northern Central Hospital, the victim being a young 
mao, 8Dt. 17, who was undergoing an operation for 
strangulated hernia. He suocumbed when we operation 
was approaching completion. Tbe coroner commented 
on the fact that death from ether was of exceedingly 
rare occurrence, and the nrnal verdict was returned. 

Death from Half a Grain of Morphia. 

An inquest was held a few days ago at Worthing on 
the l^y of John Franks, a retired surgeon, who had 
been in the habit of inhaling chloroform for the relief 
of pain. Having run outlof chloroform he injected half a 
grain of morphia which proved fatal in spite of the 
efforts of Dr. Hinds, who had been called in when the 
symptoms of poisoning declared themselves. Dr. Hinds 
attributed death to the action of what he described as a 
dose of the alkaloid, *' well within the margin of safety," 
on a constitution enfeebled by the habitual use of chloro¬ 
form. ^ We may point out, however, that half a grain of 
morphia is by no means a safe dose, death having on 
nnmorous occasions followed the ingestion of this 
quantity. A verdict of death by misadventure was r^ 
turned. 

Lady Medical Candidates. 

Ths managing b^y of the Lincoln County Asylum 
have decided to adhere to the practice of allowing 
qualified women to enter as candidates for posts on the 
junior staff of that institution. 

Acquittal of a False Doctor. 

Absolom WiaaiAJi Exad, described as a medical 
assistant, was tried on a charge of manslaughter last 
week at the Central Criminal Court, he having falsely 
represented himself to be a medical practitioner to a 
patient who subsequently died from undiagnosed abscess 
of the liver. The jury acquitted him, adding a rider to 
the effect that no effort should be spaced to make it im¬ 
possible for unqualified persons to jeopar^se the health 
of the public by indiscriminate treatment. The judge 
pointed out that the accused had laid himself open to 
a penalty for acting as a medical man; but, as Mr. Head 
will probably select some other sphere for his labours 
in future, the risk of prosecution is not very great. 

Death In a Workhouse. 

A ONB-Tius medical practitioner of Bridgend, Mr. 
George Joseph Llewellyn, has wound up a downward 
career by dying at tbe workhouse, whither be had been 
removed from a model lodging-house on being taken ill 
last week. 

Dublin Sanitary Assodatlott. 

At a meeting of the council of this Association held 
on the 29th nit, the following resolution was adopted 
The attention of tbe council having been drawn to 
the fact that it appears from the weekly returns of the 
Eegistrar.General that in several instwoes each week 
the cause of death has been uncertified, there having 
been no medical attendant during the last illness, the 
neat majority of such cases having been those of chil¬ 
dren under one year of age, they are of opinion 
such a state of things calls for serious attention with a 
view to insuring that no death should be registered 
without proper certificate, and that where no medical 
certificate of the cause of death o^n be obtained the 
catise should be ascertained by an inquest.” Copies of 
this resolution were ordered to be forwarded to the Local 
Government Board, Public Health Committee, and to 
the coroners for tiie City and County of Dublin. We 
have on so many occasions called attention to this 
serious condition of affairs that it is satisfactory to see 
that the Sanitary Association have also undertaken the 
task of directing public attention to it. 


Royal College of Surgeons, un gi«Tni 
Thb annual meeting of fellows and members will 
held at the college in Lincoln’s Inn Fields on Thuie- 
day, the 21st inst., at 8 o’clock p.m., when a report 
from the council will be laid before the meeting. Fel- 
lo*^s^ and members can obtain copies of the report on 
application to the secretary, and can, if they so desire, 
raster their immes as wishing to receive the report 
Mnnally. Motions to be brought forward at the meet¬ 
ing mwt be signed by the mover, or by the mover 
other fellows and members, and must be received by 
the secretary not later than November 11th. 

The British Laryngologlcal Association. 

Db. John Macinttbe, of Glasgow, has been re-elected 
President for a seoond term of the British Laryngo- 
logioal, Ehinological and Otologioal Association. He 
will deliver the Preeidential address at the next meeting 
of the Association, which takes place at 11, Chandos 
Street, on Friday next, November 8th, at 6 p.m. The 
title of the address will be ” The Application of Physical 
Science to the Surgery of the Nose and Throat.” It will 
be illustrated by photographs and cases demonstrating 
in a remarkable manner his treatment with electrical 
discharges, which differ materially, both in character 
and application, from those in present nee. 

Surgical Instruments at Uie Naval and Military Exhibition- 
Mbssbb. Abnold and Sons, the well-known surgical 
instrument manufacturers, ask us to announce that ther 
have received the highest award for excellence in work¬ 
manship at the Naval and Military Exhibition, Crystal 
Palace, and also the highest award at the Military Ex¬ 
hibition, Earl’s Court. 

Jaes Jjfitfi. 


Conjoint Examinations in Ireland tty the Royal OoUese of 
Physloiaas and Royal College of Snrgeons. 
Second Professional and Third Professional Eiamina- 
tion.—Candidates have passed these examinations as 
undemotedSeoond Professional—Part II.—Honoors: 
Jas. Parker. All Snbjeots-Pass: B. G, Allen. Completed 
Examination; B. C. Byrne, M. A. Denuy, P. Maher, T- 
S. Beeves, J. W. Butherford. Third Professional Exami¬ 
nation.—All Subjects: W. J. Greeny,J. B. Logan, Miss H. 
E. M. L<^an, J. J. Moore, M. J. Pie^ (fonr years). Com¬ 
pleted the Examination: C. H. Browne, H. M. Clarke S. 
H. Carry, W. F. Delany, G. H. Enright, D. Jones (four 
years), A. T. Mnlhall, J. Mtmhy, M. A. A. O’Brien, Qeo. 
C. Boblnson, J. P. Byan, J. H. White. 


Royal Colleges of FbyilcianB and Snrgeons 
and the Pacnlw of Physicians and 
Glasgow. 


of Bdlabnrgh. 
Snrgeons or 


Ths quarterly examinations of the above board, held 
in Edinburgh, were concluded on 26th ulh. with the 
followinK resolts:— 

First Examination, Four Tears’ Coarse.—Of five can¬ 
didates entered, the following four passed the examina¬ 
tion: James Sydney Cooper, William Patrick Timmon, 
Joseph Edmnnd Malian, and Joseph John Bell. 

First Examination, Five Tears' Course.—Of ninot-ee n 
candidates entered, the following seven passed the 
examination: Terence Owens, Alexander Brown, Tom 
Newman Darling, Bobert Percy Hosford, Wilfrid Me^ 
oalfe Chambers, Leo Patobett, and Victor Brown; and 
one passed in physios, two in elementary biology, and 
three in obemistiy. 

Second Examination, Four Tears’ Course.—Of ten 
candidates entered, the following five pass^ the exami¬ 
nation : Norman Pigott Fairfax, Jesndason Joseph 
Anthony Pillay, John GUmonr, Charles Vanghan, and. 
Edward Bobeit Harriott; and one passed in physiology, 
and one in materia medica. 

Second Examination, Five Tears’ Coarse.—Of twenty- 
six candidates entered the following thirteen passed toe 
examination: William Lang Hodge (with distinction), 
Alexander Blaxell Hugh Pearse, Ian Campbell, Donald 
Cameron (with distinction), Gwige Morley Arundel 
Thomis, William Fleming, Denis Christopher Callaghan 
(with distinction), Harry Armstrong, Jolm David Jones, 
Charles Bichard Whittaker, Jamee Joseph Egan, John 
Watson, and Bndolf Baranov; and three pas^ in 
anatomy and two in physiology. 


t 


506 Th« MvDtoiLL Pbkob. 


NOriOBS TO OOBBE58PONDBNT8. 


Not. 6. 1901 


fioiitts to 

(ttorreapoitbcittje, Short Ac. 

Co»UBPO»D*»Tt reqniriof » reply In tWi oolnmn »re p»r. 
Uanlarly reqvMted to nuke om of a dittinctivt lignatwre or 
And BTOid the pnotioe of ngning themaelTea “ Beoder," 
'‘Snhecriber,” “Old Sabeoriber,*’ io. Kuoh oonfoBios will be 
spared by attention to this mle. 

;THE NOTOBIOD8 EAK-DEUM BPITCIALIST—NICHOLSON. 

It affords os much pleasure to place on record the fact that that 
arch-quack, “ Dr. *' Nicholson, whose a-farious praotioea we ex¬ 
posed in these columns some timea^. and who has since adopted 
▼arioas aliasee and cono.>oted nnmerons irands, the “ Nicholson 
Aural Institute," the '• Holbetke Institute,” to wit. was last week 
sentenced at the old Bailey Sessions to eighteen m-mths hard 
laboor. Will his imrenult* be equal to defrauding the labour- 
master In o^nm-pioldng and the treadmill f 

Db. Boebbt.—T he pnblicatlon ceased to exist some years ago. 
De. H. B. SkiTH.—W e do not oonaider that the enterprise, 
haring regard lo m^ical ethioa, would be a legitimate one for a 
medical to embark upon- 

THE BACTEBIOLOGICAL TEST. 

To 1M EdUi>r of The Hboicxi. Fexbs abo Ciecitlab. 

SiE,- I hare no wish to encroach on M-. Berdoe'e time, but I may 
mrthat the idea, he entertains with regard to Titisection being of 
” Tslue ” is not tenable in a sdentifio pnffeBUon. On 

the other hand, if his feelincs are to overcome that he disoovera 
cnielty in the inoculation ofmlce lengge-t that if a mouse were 
in the condition to offer an opinion of Its own, it would protebly 
prefer Inoonlation to being mauled to death by a oat, nature a form 
of Tiviseolion. . , 

I am. Sir, yours t nly, 

Ci-xiiBBT H. Serb. 

Qaeen'B Boad, S.E., Oot. Slst, 1901. 

Thin correspondence mnitnowcloee.—E d.] 

JElcftinfis of the goneties. 

LONDON. 

Wedbbbdat, Not. 6th. 

Obstetrical Societt or Lobdob (20, Hanover Sqa^, W.)-— 
8 p.m. Specimens will be shown by the President, Blr. Bland- 
Sutton. Dr. Handley. Dr. Lewers, Mr. Doran, and Dr ^labln. 
Paper: Mr. A. Dorii and Dr. C. L'vckyer: Sloughing Fibroid of 
the Left Uterine Coma, Abnormal Belationa. 

Tbuesdat, Nov. 7tb. 

Habviiab Societt or Lobdob (Stafford Booms, Titchborne 
Street,Edgware Bead, W.).-aS0 p.m. Mr. B. Brown: I^ty^ve 
Tear^ Experience of Urinary Surgery in E n g land . (Harveian 

Societt (28, Hanover Square, W.).—8.30 p.m. Mr. H. 
Jackson: Presidential Address. ^ .. 

Childhood Societt (Library of the Sanitary iMtitu^ Margaret 
Street. W.) —8 p.m. Discussion on the Subiect of the P*w usan. 

Noeth-Eabt Lobdob Clibical Societt (TotUnham H^tal). 
.-4p.m. Clinical cases will be shown by Dr. TresiUan, Dr. WU- 
lou^by, Dr. Whiting, and others. 

FaiDAT, Nov. 8th. 

(TLmcAL Societt of Lobdob (20. Hanover Square, Wy.-8.30 
p.m. Papera: Mr. B. G. Moynihan : The Operative Treatment of 
t^oerof the Pyloric Portion of the Stomach. Mr. T H. Mor»e: 

of Intracranial Section of the Second and Third DivUions of 
the Trigeminal Nerve for Severe Neuralgia. Mr. W. Hayward : 
A Case of FragUItas Oesium. 

OpHTHALMOLOOICAL 60 CIETT of the Ubited KIHODOM (11, cnan- 

doe Street. Cavendish Square, W...-Dr. A. H. Thompeon: Section 
of Orbiul Tumour (PEndotbelloma P Adeno-earcoma). Mr. i. 
Nettleshlp: Chronic Serpiginous Ulcerof Cornea^Mooren sUleer). 
Dr W E Thomson: Three Cases of Keratitis la the New-born 
occumngafterlmtrumental Delive^.and resultogin each case 
in sn slmost I-1 entlcal Bare Form of (Jpacity. Dr. C. 0. HairthorM : 
Ou Intia-cnmlal lirombosia as the cause of Double Optic Neuritis 
in Casesof Chlo'oais. _ . _ 

BaiTisu Laetboolooical, Beibolooical, akd Otolooical abbo- 
CIATIOB (11. Cbendos Street, Cavendish Square, W.). 4 p.m. AMual 
General Meeting. Ck>mmumcations will be read and Cases shown 
by the President, Mr L. Browne, Dr. Abercrombie, andMr. Nouiae. 
6pm Address: The President-Elect (Dr. J. Macintyre, Glasgow): 
Tne Application of PhyBi«jal Science to the Surgery of Diseases of 
the Throat and Nose. 

DUBLIN. 

Wedkebpat, Nov. 6te. 

Opening Meeting of Session, Jervis St^t Hospital, 4.30 p.m. 
Meeting of Council Pharmsceutical Society, 3 p.m. 

Thpesdat, Nov. 7th. 

Council Meeting Boyal College of Surgeons, 4.30 p.m. 
Examination for L.M. Boyal College of Physicians. 

City Hoapltalfor Diseases of the Skin, Annual Meeting, Mansion 
House, ASOp.m. 

Feidat, Nov. 8tb. 

Boyal Academy of Medicine in Ireland, Section of Surgery, Boyal 
College of Surgeons, 8.30 p.m. 

Stated Meetmg Boyal CoU^ of Fhysiciana, A30 p.m. 

MOBDAT, Nov. llTE. 

Prevlovs Medical Examination DubUn University eommsaoes. 
Examination for Licence in DentistiT, Boyal College of Sorgeona. 
Meeting of Pharmimentical Society, KlOp.tn. 


Falcobeb, Dobald Oobdos. M.B.. M, S.Aberd.. Certifying Surgeon 
under the Factory Acts for the Foyers District of Invemesi- 
shire. 

FAEquEAESOB, A C-, M.B.. M.S.Qlasg., Medical Offloer of Health 
for the Auckland Baral District. 

Gaedibeb, Peter, ILD.C.M Glaag.,D.Ph.Lead., Honorary Medical 
Officer te the Csmbome Dispensary. 

Gbet, T Campbell, F B.C.S.£Dg.. L.B.C.PXond.. Honorary 
Medical Officer to the Camborne Dispeniary. 

HtWTHOBBB. C 0-. M.D., U.B.C.P., Assistant Physician to the 
North West iKindon Homi^al. 

Labcashibe Georob H., M.B.C.S.EDg., L.R.C.P., AHistBut Phy¬ 
sician to the Manchester and Salford Hospital for Skin Diseases. 

Mobris, T. H. P , M.B.C.8., L.B.C.P., fortifying Snrveon unier 
the Factory Acts for the Hale worth Die rict of Suffolk. 

Sladsb, ReqibaldJ. Lakbabt. M.B.C.S., L.B.C.P., Senior Besi- 
dent Surgeon to the Boyal Sea Rathing Hoenital, Marsate. 

Spebce, Johb W. L , L.B.C.P., L.B.C S Eld., Clinioal A*sstant to 
the Elect ioal l>cq>artmentof the Boya* Infirmary, Edinbiugh. 

Thomas, J. Telfbb, L.B.C.P.Lond.. MB.C.S., Hononry Mescal 
Officer to the Cambo ne (Cornwall) Diepen>ary. 


lacattcus. 

Bracebridge Asylum, near Linoola.—Junior Assistant Medical 
Officer. Sal^ £126 per annnm, with tnroished apartments, 
boaM, attendance, Ac. Applications to W. T. Page, Jan., 6, 
Bank Street, Lincoln. 

Brentford Union.—Assi'taiit Medical Superintendent. Salary £100 
per annum, with board, washing, Ac. Forms of application 
of W. Stephens, Union Offices, Isleworth. W. 

Connty Asylum, Lancaster, Assistant Medical Officer. Salary 
commencing at £160, with board, washing, Ac. AppUcatioiu 
to the Medical Snpointendent. 

County Asylum, Hickleover, Derby —Senior Assistant Medical 
Officer. Salarycommencingat £130, with beard, washing, Ac. 
Applioationa to the Medical Superintendent 

County asylum, Preetwich.—Junior Assistant Medioal Offloer. 
Suary commencing at £150, with board, Ac. Applications to 
the Medlesl Superintendent. 

Dover Hoepltsl. House Surgeon. Salary £100 s yMr, with board, 
lodging, and weehing. Particulars to be obtained of E. Elwin, 
Esq., 2, Castle Street, Dover. 

Essex County Asylnm, Brentwood -Fonrth Assistant MediasI 
Officer. Salary £160 per annum, with board, Ac. Apply to the 
Medioal Snpenstende'it. 

Olasrow University. Additional Exsminerships in Medicine and 
Science, with special reference to Chemistry, Materia Medics, 
Zoolo^, Practfoe of Medicine and Surgery. Partionlers as to 
dates, emolument, Ao., on reference to our advotiaing columns. 

(jreat Northern Cent^ Hospital.—Surgeon on the Staff Co attend 
to Out-Patients. Applioationa to L. H, Gleetcn-Eerr, 
SeoretAry, 

Lincoln County HnspitsL - Senior House Surgeon. Salary £I00 per 
annum, with board, lodging, and wasbiog. Farther informa¬ 
tion of W. B. Danby, Seoretexy. 


Belfbaob.— On Oct. 30th. at 2, Montagu Plaoe, London, W., the 
wife of S. Henning Belfrage M.D., of a son. 

BiDWELL.— On Oct. SOtfa, at 69, Wimpole Street, Cavendiah Sqntra, 
London W., the wifeof Leooara A. Bidwell F.B.<.'.8., of a son. 

ELKiBa.—On Oct. 30th, at Leavesden, Herts, the s^e ot Frank 
Ashby Elkins. M D., of a daughter (Mary). 

WiLLUMS. On 0':t. 29th, at Botorua, Harrow.on-the-HiU, tho wife 
of Dr. A. H. Williams, of a son. 

WooDHEAD. On Oct. 27th, at Chisholme. Sale, Cheshire, the wife 
of Dr. H. Miall Woodhead, of a daughter. 


^arrisgeB. 

Bbtabt—Watts.— On Oct. Slst. at St. Paul's Church, Cambridge, 
Charles Hilary, M.D., F.B.C.S., third son of E. Boss Bryants of 
NewcasUe-on-Tyne, to Theodora Harvard Watts, fifth daughter 
of the late Thomas F. Watts, of Brscondale, Cambridge. 
Caessebo Fastnbdoe.— On Oct. Slst, at St. George's Church, 
Stamford, Alfred Emeat Careberg, M.A., M.B.(^Ub., 

S onngeetton of George N. Carsberg, Esq., of Hornsey Lane, 
’., to Uatbelle Bath, youngest daughter of Biohard B. Fast- 
ne^e. Esq. 

Dburt Bichabds.— On Oct. Slst, st St. James’s CAiureb, Pictit- 
duly, London, h^urice O'Connor Drury, Surgeon-Major, 
retiMd, B.A.M C.^f Salmok, Conn-<mara, to Martha Louisa, 
widow of the late Henry Brinl^ Bichards, and daughter of the 
late Henry Wm, NeviU, of 16 Clranley (Gardena. South Eansiiig- 
ton 

PooLBt -Dddlet.—O n Oct. SOth, at St. Andrew's Church, Walcot, 
Bath, Charles Archibald Pooley, C.E. eldest son of Walter M. 
Pooley, of The Ceders, Bath, to Evelyn Maigaret, eldeet 
daughter o' Brigade-Sargeon-Lieut.-Colonel W. Edmonson 
Du^ey, B.A.M.C., of Bath and lemplemore, Tipperary, 


LLLABD.— On Nov. 2n(L at Tewkeebnry, Joseph H. Allard, 
M.B.C.S., L.B.G.P.Ed., aged 46 years. 
lEHBETt.—Os Nov. 1st, at hu resideno& 47, Clanrioards Qardsns, 
Bayswater. W. A. Hughes Bennett, M.D.^, P.B.C.F.lx>nd.,CqB 
salting Physician to the Hoepitsl for EpUepsy, late Physioiaa 
to the Weetininster Hoepital. 

IMITH.— On Oot. 29t:^ at 92, Oxford Terrace, London, W., Henry 
Spencer Smith, F3.C.8., in hisSOth year, i 











xm and Cmlat 


*‘SALUS POPUU SX7PBEMA LEX.’* 


VoL. CXXIII. WEDNBSDAT, NOVBMBEE 13, 1901. 


Ko. 20. 


fans Clinical %ttivixts. 

THE 

SYMPTOMS AND COMPLICATIONS 

OP 

GASTRIC ULCER. 

By Prof. ROBIN, 

Profeneor Agr*iri of tbe Vtooltj of MediolM of Parln. 

The predominating symptoms of gastric nicer 
are pain and vomiting, with constipation or diarrhoea. 
Simple gastric nicer is an essentially painful affec¬ 
tion, and the pains m^ in some cases become so 
severe as to urgently call for special treatment. The 
samo, indeed, m^ be said of the other phenomena. 

Treatment of Pain .—The painful manifestations 
are of two kinds. Either the pain is continuous or 
it comes on in acute attacks during digestion, under 
the influence of the secretion of hydrochloric acid. 
You will notice different forma, such as pyrosis, 
cramps or distressing sensations in the epigastrium. 
Now. of all the causes which excite the pain, the 
first in line is the ingestion of food. That is why I 
always insist on the necessity of absolute rest for 
the stomach. But, as I have pointed out on previous 
occasions, the diet cure cannot be continued indefi¬ 
nitely ; and when the patient commences to eat he 
begins to suffer. 

What, then, are the means at our disposal to give 
him relief ? The first and the simplest is for the 
patient to take, five minutes before each meal, four 
drops of 

Picrotozine, 1 

Hydrocblorateof morphia/ 3 » 

Sulphate of atropine, gr. |: 

Ergotine, n\_ xx; 

Cherry laurel water, 5 iij. 

(A little spirit should be employed to dissolve the 
picrotozine, which is not very soluble.) 

The dose may be increase, but should not exceed 
twenty drops in any one day. 

This mixture dulls the sensitiveness of the stomach 
towards the irritating contact of the milk or solid 
food. It will, however, sometimes happen that the 
pain is not relieved in spite of this prophylactic 
treatment; in such cases the best plan is to admin¬ 
ister a powder which will neutralise the excess of 
acid which, as you know, is the immediate cause of 
the pain. The following is the formula which I 
employ 

Lactose, grs. xx; 

Calcined magnesia, grs. xxz; 

Sub-nitrate of bismuth. 

Prepared chalk, a a grs. x; 

Codeine, gr. ; 

Bicarbonate of soda, grains xx. 

For one powder. To be taken by the patient in a little 


water when in pain. If this does not prove snccess- 
fnl I have recourse to preparations of belladonna or 
cocaine, as follows 

Belladonna powder, j 
Ext. of belldaonna, * ^ 

For one pill, one to three in the twenty-four hours; 
or, 

Cocaine, __ • 

Codeine, 

Spirit of chloroform, 5ij ; 

Lime water, 3vij. 

To be taken in tablespoonful doses. 

External applications are by no means without 
effect; the following liniment may be employed for 
example:— 

Liniment of belladonna, ^us ; 

Ext. opium, y 
„ belladonna, V 3ss; 

„ hyosc^amus, ) 

Chloroform, ^ij. 

This liniment applied to the pit of the stomach 
often gives excellent results where other treatments 
fail. 

Treatment of Vomiting. —When patients suffer 
from obstinate vomiting the first thing to try is the 
picrotozine mixture indicated above, as it wm often 
afford relief; if not, apply a small blister to tbe 
epigaslriumandpow^rwith two grains of opium, or 
order inhalations of oxygen gas. One or other of 
these means usually succeeds. In tbe contrary event 
I know of only one meuiB of arresting the vomiting, 
and that is a return to the rest cure. 

Treatment of Constipation. —When there is consti¬ 
pation, a very frequent complication with those 
patients, we must, of course, give laxatives and 
enevata of warm water. The laxatives I employ are 
castoroil,oalomel (calomel, grs. vi; jalapm, grs.vi; cal¬ 
cined maunesia, grs. xv) in cachet form, or the fol¬ 
lowing pills:— 

Cape aloes, ^ss; 

Scammony 'i 

Jalap > XV grs.; 

Vegetable turpelh ) 

Ext. of hyoscyamus-) ..- . 

„ beiadonna ) 3 o”* > 

Castille soap, q.a 

Divide into fifty pills. 

Ton will take care in writing the prescription to 
underline turpeth to avoid confusion with 

mineral tnrpetb which, as yon know, is a preparation 
of mercury (sulphate). The vegetable turpeth is 
derived from a plant in Japan, and resembles jalap 
in its action. 

One or two of these pills are to be taken at bed 
time. 

Treatment of Diarrhcea. —This condition is rare, 
for out of fifty-two cases of my personal statistics I 
have observed but two in which it called for active 
treatment. I employ with constant success for this 




^06 Thk Midical pBiBS. OBJQHT^AIj GOMMUmCATIONS. 


Nov. 18, 1901. 


oomplication a plant, to-day forj^tten but nnjastly 
so, for it possesses a real value not only in tbe 
diarrhoea of gastric ulcer but in a number of simitar 
oases. I speak of the root of the wild etratoherry 
{Ev.onyiMU\. It is a therapeutic agent long ^one out 
of fahhion, and might be ranked among the “ simples,” 
but nevertheless I strongly recommend it The 
powdered root is given in doses of thirty grains, 
infused in a little water, and taken after meals. Not 
being toxic, the dose can be safely repeated several 
timen a day. 

Treatment of Hemorrhage. —We now come to the 
treatment of a patient seised with h»morrhage. 
Place him on his back, recommend absolute immo¬ 
bility, and apply ice over the stomach. The next 
step is to injrot subcutaneously a solution of ergo- 
line into one loin, and a gelatine solution into the 
other, according to this formula:— 

Gelatine, pure, ; 

Chloride of sodium. 3ij ; 

Distilled water, ^xxv. 

Six drachms of this solution is to be injected under 
the skin. You will prescribe, also, the following 
mixture which should be taken in doses of a tea¬ 
spoonful every hour^ 

Ergotine, 53: 

Gallic acid, gr. x; 

Syrup of turpentine, 33 ; 

Dill water, Jiv; 

and between each hour a tablespoonful of 
Chloride of calcium, 53 > 

Extract of opium, gr.j ; 

Syrup, 5i; 

Water, 5iv. 

The chloride of calcium, as you know, has the 
property of incieasing the coagulability of the blood. 
A copious enema will complete the treatment of this 
urgent stage. , 

On the other hand, should the hsemorrhage recur, 
however slightly, the patient must 1 ^ placed on the 
absolute rest cure for a period of nine days at least 
and a fortnight at most. 

The hsemorrhage is generally arrested by the above 
means, and this is an important point to note at the 
time when so much is spoken of surgical treatment 
as a substitute for the medical treatment of gastric 
ulcer. We will refer to this subject again by-and- 
bye. , 

It happens sometimes that the pati^t, through 
loss of mood, is seized with syncope, and in such a case 
you must give injections of ether or normal saline 
solution. If fever be present jrou may be ce^in that 
some of the blood has passed into the intestine. This 
constitutes a grave complication, as intoxication may 
be the result. Should this be the case, give a pur- 
gative at once, and the best of them is certaiuly 
calomelaccording to the formula already given. When 
the hsemorrhage is exceedingly abundant, and tte life 
of the patient is in imminent danger, you will not 
hesitate to perform tranefueion, for it has pven more 
than once unhoped for results. 

When all complications have disappeared, Md the 
patient is slowly returning to health, prescribe pei^ 
chloride of iron internally, not only as a brnmostatic 
agent, but in order to overcome the ansemia from 
which these patients so frequently suffer. 

In concluding my remarks on this interesting sub¬ 
ject of gastric ulcer and its treatment, I will give 
you in a few words my opinion as to the value of 
the radical cure advocated by our surgical colleagues. 
In the immense majority of cases the medical treat¬ 
ment succeeds, and if we compare the mortality of 
cases of gastric ulcer treated medically with that of 
the cases treated by surgical operations, we shall 
find that the former is markedly lower to the latter. 
The mortality of medical cases is 9 per cent., while 


that of oMratod cases is 20 per cent. Gon^uently, 
the so-called radical cure should not be advised. 

On the other hand there are complications which 
require surgical treatment, such as intestinal perfo¬ 
ration, subpbrenic abscess, cicatricial stenosis of the 
pylorus,perigastritis in patients obliged to work bard 
and who cannot obtain the special food necessitated 
by their condition, and finally in slight, but oft- 
repeated heemorrhagea which cannot be controlled 
by medical treatment. 


PYLORIC STENOSIS 

CAUSED BT 

HYDROCHLORIC ACID. 

By Prop. NOTHNAGEL, M.D., 

Professor of Medlolne in the University of Vienna. 

I WISH to direct your attention to a peculiar case of 
poisoning with hydrochloric acid. According to the 
history m the patient he is 36 years of age, and a 
labourer. Three months ago he was brought into 
hospital after having swallowed two mouthfuls of 
pure hydrochloric acid while in an attack of mama. 

Daring the subsequent fortnight he was fed per 
rectum. On the day following admission he vomited 
a large quantity of black clotted matter and re¬ 
mained unconscious for some time after. He 
suffered great pain during the next fortnight, and 
had to be nourished per rectum until he was able to 
swallow milk. 

A bougie was passed into the csstmhagus to pre¬ 
vent stenosis which never occurred. Later, however, 
pain in the stomach with vomiting after takii^ food 
set in, but subsequently vomiting occurred even when 
the stomach was empty. Bapid emaciation followed. 

On being readmitted the thoracic organs were 
found to be heathy, and the abdomen was much con¬ 
tracted. In the left hypochondrium there was a 
distinct tumour of kidney shape, convex below and 
concave above. It was hard and firm, moving with 
every respiration. On lifting it forward and bolding 
it in this position it gave the patient p^, but after 
a time it became softer, though no peristaltic action 
was to be observed. 

The day after admission he vomited about a quart 
of food containing large quantities of 8 arcin®,long 
bacilli, and yeast cells. There were also free hydro¬ 
chloric and lactic acids present. 

The stomach was careiully washed out, and tested 
shoi-tly after, when hydrochloric and lactic acids were 
found, giving an acidity of 30° when titrated. The 
stomach was greatly dilated, and by its tonic contrac¬ 
tions gave the appearance of a phantom tumour under 
prolonged observation. The large amount of lactic 
acid present combined with the emaciated cachectic 
appearance led us to suspect pyloric carcinoma. 
This was farther confirmed by the hydrochloric 
accident, yet the oesophagus was apparently healthy. 

He was afterwards transferred to the surgical 
wards, where Albert examined him and found the 
stomach enlarged, the walls thick^ed, and the 
lumen of the pylorus closed as if with a ligature. 
Gastro-anastomosis was performed and the patient 
made a perfect recovery. . « x- > 

Pyloric stricture after acidbum without affection ol 
the oesophagus is a rare occurrence. Riegel relatesone 
case of this kind in hie " Hand-book of Surgery of 
the Stomach,” where a labourer swallowed aquantity 
of sulphuric acid without doing any injury to the 
oesophagus, but set up narrowing of the pyloras with 
ectasia and reduction of free hydrochloric acid m the 
stomach. On opening the stomach in this case there 
was a larM ulcerating cicatrix extending from the 
I cardiac end along the great curvature to the pylorus. 


oogl< 


D.:’ed I 



Nov. 13, 1901. 


ORIGINAL COMMTJNIOATTON8. 


Thi Mzdical Psns. 509 


He explained the absence of fa jdroshlorio acid bj the 
existence of gastritis toxica, 

BeyUnd describes another case which developed 
about a month after swaUowing a quantity of hydro* 
chloric acid. There was shrinking of the pjforus, 
with hour-glass contraction of the stomach, and ad¬ 
hesions between stomach and parietal peritoneum, as 
seen when the operation was performed. 

It is difficult to explain how the oesophagus and 
stomach escape injuiy while the pjloros is dMtrojed 

by fhe escharotic, unless it be due to a large amount 

of secretion and a thicker layer of epithelium in the 
higher portion of the alimentary tract, doe probably 
to smoking, drinking. &c.; hence, when the eecba- 
rotic is swallowed rapidly, enough of the epithelium 
is shed with a flow of secretion to nen tnlise the 
adhering acid. 

Hadenfeldt’s theory of the stomach escaping inj ury 
by reason of the acid being thrown across the smaller 
curvature, which is usually inflated with gas, is more 
fanciful than real. It appears from Biegel’s case, 
quoted above, that the acid passes from the cardiac 
to the pyloric opening along the greater curvature of 
the stomach. The most probable exp'anation is 
that the fundus carries all fluids rapidly across the 
cavi^ towards the pylorus, where it is caught in its 
rapid flight, to linger and eat into the tissues, while 
the mucus and secretions of the^ stomach proper 
neutralise the acid in the same way that it did in the 
cssophagas. 

Hammerschlag drew attention to the occurrence of 
lactic acid, fermentation in bis ca< e, which he pointed 
out in a previous lecture was due to the reduction 
of the natural acids of the stomach, owing to insuf¬ 
ficient mobility andstagnation of the contents, similar 
to that which occurs in carcinoma of the stomach. 
In his case there was a gastritis toxica, associated 
with altercdsecretion, which produced a similar 
effect. 

In lethal cases all the glands are fotmd full of 
leucocytes, with dilated vessels which produced 
atrophy of the mucous membrane and destniction of 
the secretory apparatus. Although atrophy is present 
in the gland, the walls of the stomach become hyper¬ 
trophic by the muscular efforts. 


JrcBibcntial 

ON THE 

ROLE OF PROTOZOA IN THE 
CAUSATION OF DISEASE, (a) 

By ED. J. McWEKNET, M.A., M.D.. D.P.H., 

Examiner in Pathologr, Boyal CoHem of Sorgcoos, and Prcfesior 
of Patholoinr in the Cath. Unir„ l^blin. 

Aiteb some introductory remarks, in which he set forth 
the reasoDS which had induced him to select the para¬ 
sitic protozoa as the subject of hia address, the sp^er 
briefly explained the characters of the Protozoal 
Organism. The single cell of which it is composed 
most exercise the several functions which among the 
Metoza are carried ont by the groups of differentiated 
cells termed organs. It must move, feed, and mul¬ 
tiply. The manner in which the Protoioal cell dis¬ 
charges there functions is taken aa the basis of olassifl- 
cation. There aro font great classes of Protozoa—the 
Bbiiopoda, Sporozoa, Flagellata,and Infnsoria. The Rbi- 
zopoda comprise the lowliest of living beings, amcebae, 
formless lumps of protoplasm, moving by means of 
temporarily emitted pseudopodia, and differing from 
a human leucocyte only in their capacity for leading an 
independent existence. Amoebs are normal inhabit^ts 
of the human intestine where they seem to have been 
first seen by Lambl in 1870. Losen, in 1876, ascribed 
dysentery to their parasitism. Since then an extensive 

(a) Delivered at the openiu? meetias of the Section of Patbo- 
logy, November let, ISOl. 


literature ba8'''aooamalated with reference to the 
causal relation in which amesbse are supposed to stand 
to a certain form of dysentery termed “tropical** by 
Councilman and Lafleur in 1891. The speaker sketched 
the development of this doctrine, pointed out the sources 
of error that nnderlie not only some of the reputed 
findings of atneebes in the faeces aud ia the pus of liver 
absceMee, but also invalidated some of the reputed posi¬ 
tive results of animal experiment, and oonolnded this 
part of the subject by saying that, in view of the positive 
reeults recorded by Quincke ani Boos, Eartnlis, Kruse 
and Pssquale, and Zancarol, from the inje<^ion of 
baoterially sterile liver-pus into the rectum of cate, it 
was hardly possible to escape from the conclusion that 
the amceba coU is, by itMlf or in conjunction with 
Bacteria, responsible for the causation of “tropical** 
dysentery. He did not know whether any case of this 
disease had as yet been recorded in Ireland. He 
demonstrated a coloured screen picture of Amoeba Colt. 
He then proceeded to describe the Sporozoa, animals 
which in their adult stage appear as amcebse or else 
as more or less definitely-shaped protoplasmic masses, 
but which mnltiply by division into a greater or 
lesser number of encapsulated germs, which from their 
resemblance to the reprodootive b^ies of the fnngi 
were often spoken of as spores. They had recently 
been shown to possess a highly.remarkable sexual 
method of reproduction. Passing over the Or^arinidffi, 
as not fonnd in the higher animals, be desired 
to lay epecial stress on the next order, the 
Coooididia. Species of ooccidium, prodnoed peendo 
adenomata in the bile ducts of the rabbit aud plaqua- 
like thiokeninn of the inteetinal wall. Severely 
affected animus die of cachexia and ansemia. The 
parasite had two developmental cycles, both passed 
within the same host-animal. The mature animal con¬ 
sists of a ronnded coarsely granular mass of proto¬ 
plasm (echizoBt) lying within an epithelial cell of 
the rabbit’s intestine or bile duct. It splits np 
into nnmerous sickle-shaped segments (merozoites) 
which became amceboid and infect neighbouring cells. 
At a certain period schizogony came to an end, and two 
varieties of mature parasite Moome differentiated, one 
larger, more evenly grannlar, the macrogamete or 
female; the other smaller, more hyaline, the micro- 
gametooyte. Bi-flagellate bodies, the macrogametes or 
spermatozoa, are emitted from the latter, each carry¬ 
ing with it part of the nucleus. They penetrate into 
and fertilise the macrogamete, which increases greatly 
in size, assumes an oval shape and a doubly-contoured 
oapenle, and, becoming detuhed from the epithelium, 
emerges with the fssoes into the outer world, as a 
I “uporont"—theooccidinmof the older writers. Soon its 
contents become divided into four sporoblasts, each of 
which assumes a tough membranous investment, aud 
being set free by the decomposition of the outer cyst- 
' wall, is called a spore. Its destiny is to gain access 
' to the alimentary canal of a fresh animal with the 
food, and there to liberate the two sickle germs 
(sporozoites) which had been meanwhile formed 
in its interior. He alluded to the reduction of 
the chromosomes and the Best-kOrper or eo'ps 
de reliquat. This interesting life history had 
been revealed through the labours of L. and B. 

I Pfeiffer, LabM, L4ger, Sohandinn, Siedlecki, and Simond. 
What made it the more intereeting was that it ran 
strictly parallel to the life-bistory of the malarial 
parasites, which had been recently so admirably 
cleared up through the work of Uanson, Boss, 
Bignami, Grassi, and MaoCallnm. These parasites con¬ 
stitute the next order of Sporozoa, the beomo- 
sporidia. The speaker then proceeded to trace ont the 
developmental cycle of the parasites of human malaria, 
and to show that the phenomena were by no means 
isolated, bnt were stnoUy parallel to what had been 
shown to hold good for the Cocoididia. The repix^ 
dnetion of the malarial parasite by spomlation in the 
oircnlation of the warm-blooded host was homologons 
with the schizogony of the oocoidinm in the rabbit's in¬ 
testine. The sexual process of the malarial parasite 
differed from that of the coccidinm in one feature only 
— the complication of a change of host, from the warm- 





510 Ths IfsDicAL PB>8a ORIGINAL COmiUNICATIONS. 


Not. 18, 1901. 


blooded vertebrate to the cold-blooded invertebrate 
aoimaL TbU change vras, of coarse, effected by the 
agen<^ of the mosquito. He insisted upon this homolog'y 
as bringing the malarial parasite into line with other 
forms of psrasitio protozoa. Taming next to the third 
class of Protosoa, the Flagellata, the speaker detailed 
the main facts known reg^ing this parasitism in the 
lower animal>>. The best known of these parasites 
was the Herpetomonas, or Trypanosoma Lewisii, often 
foand in the blood of the common wild rat. Through 
the coortesy of Professor Canningham he had that 
morning examined the blood of fifteen rats at the Zoo¬ 
logical Gardena, and found the parasite in seven He 
b^ brought down one of the animals, and now showed 
its blood, containing numerous actively motile fish-like 
parasites, each as long as three or four red discs, and pro¬ 
vided with a long fi^ellom and an undulating mem¬ 
brane. He demonstrated a film stained by Bomanow- 
sky’s method, showing the macro- and mioro-nuclens 
stoned red, and also the flagellum, an interestingfaotfor 
which he could not at the moment satisfactorily account. 
Although this parasite seemed harmless to the rat, a 
clorely allied form. Trypanosoma Bmcil, had been shown 
to be concerned in the causation of surra, a diseate of 
teansport animals in India, and of the famous nagaoa 
or tsetse fly disease in the warmer parts of Africa. He 
demonstrated a stained blood film from an experimental 
gninea-p^, which he owed to the kindness of the late 
Prof. Eantback. As compared with those in the rat, 
some were blunter at the non-flagellate end. This did 
not hold good in all cases, and he could see no other 
difference. In conclusion, the speaker referred to 
parasitic protozoa of uncertain biological position. Piro- 
plasma bigeminum was a minute pear-shaped or oval 
speck of protoplasm, often occurring two together in the 
red corpuscles of the ox iffected with parasitic bsmo- 
globinnria or Texas fever. The parasite was discovered 
a few years ago by Theobald Smith and Eilbome in the 
United States. They found that its propi^pttion from 
one ox to another was effected by ticks. A 
unique feature of this transference was that it was 
carried not by the female tick that had actually sucked 
np the infected blood, but by her progeny. Owing to 
thecourtesy of Professor Mettam, Irincipad ofthelteyal 
Veterinary College for Ireland, he was in a position to 
show specimens of the parasite found for the first time 
in Iremnd by that gentleman in the blood of catUe 
suffering from red-water. Of still more uncertain posi¬ 
tion was the supposed parasite of vaccinia disooverM by 
Guamieri in the epithelium of the inoculated rabbit^ 
cornea. Through the kindness of Dr. Gustave Mann, 
of Oxford, he demonstrated a preparation showing these 
bodies in almost every epithelial cell. The subject was 
one of some complexity, and opinions were much divided 
OB to the interpretation of the " bodies" in question. 
He preferred to reserve this part of the subject for a 
further communication later on in the session. Lastly, 
the supposed protozoal etiology for carcinoma was a still 
more doubtful topic even thsm vaccinia. The tendency 
among recent Italian workers was to ascribe the dis¬ 
ease to a blastomyoete or yeast-form, which would, of 
coune, be reckoned among the vegetable parasites. 
Sanfelioe, of Naples, claimed to have obtained from 
fruit-juice an organism of this kind whii h had yielded 
positive results on inoculation. In England Plimmer 
bad obtained from a rapidly-growing cancer a growth 
of an organism the biological question of which ap¬ 
peared doubtful. The results of the inoculation- 
experiments seemed to the speaker far from convincing. 
The several varieties of cell-inclusions that had been so 
indnstrionsly worked np and identified at first with 
cocoidia, then with blastomyoetes, seemed to him to be 
susceptible of other explanations. He now demon¬ 
strate some of these inclusions. In this connection it 
was interesting to note that ulcerated swoUings ex¬ 
ceedingly like tumours were developed on the roots of 
the oablmge and turnip as the result of the intra-cellnlar 
pawitismof Plasmodiophora Braasicse (Wor), an amos- 
Doid organism reckoned by some with the Myxomj- 
cetes, by others with the Protozoa. Cachexia and 
death of the host-plant was caused by this intra¬ 


cellular parasite, which thus formed an interesting 
analogy to what was sought to be established in the 
case of human cancer. He demonstrated sections of 
the affected roots showing the cells filled with the 
parasitic protoplasm and subsequently with the small 
spores, into which it divided. 


THE STUDY OF CANCER, {a) 

By AUSTIN MELD ON, J.P., D.L., 

Ez-Preaident, Bojsl College of Sorgeoas, Ireland; Senior Sur¬ 
geon, Jervie Street Hoeritsli Conenlting Savgeon to National 

Maternity Uoapltel; Ei-f resident, Irish Medici Aasodatiob, 

Aetxb some introductory remarks, the speaker said 
When casting abont for a fitting subject for my ad- 
drest my m<nd came to dwell upon the fact that the 
vast and rapid stridee made in aocumulating informa¬ 
tion on a diseaee which in recent years hts apparently 
been on the rapid increase in Ireland might intereet 
thnee whom I have the honour to address. I allude to 
that most terrible and fatal malady which afiiicte the 
human race, Cancer." 

The first point which must be settled is whether 
cancer is a parasitic disease. Pathologists all over the 
world have agreed that there are appearanoee among 
cancer-cells which do not belong to the cells and are 
foreign to their stmotnre and development. Some call 
them protozoa, others fonp, and some assert they are 
but degenerate cells. The latter contention may at 
once be dismissed, as these appearances are not found 
in the part of canoer undergoing degeneration but are 
abundwt in the growing portion. Mr. Plimmer, the 
well-known patholc^t, of St. Mary's Hospital, London, 
has recently, ont of 1,^6 cases, found perasitee, which 
he believea to be tiie cause of the disease in 1,130. 
These be has been able to cultivate outside the body 
and when injected into other animals they produce 
tumours and death. In those in which they were not 
found the growths were either locally cured—sarcoma 
has been known to undez^ spontaneous zetrc^ression— 
or so d^enerated that no stain could affect the cells. 
There hu not been yet time enough however to prove 
beyond doubt whether these parasites are the cause or the 
result of the disease; bntoertain it is that they only exist 
in canoer and are not foand in any other disease ; that 
they exist only in the growing portion and not in the 
degeuerate part, and the greatw the number the more 
rapidly the cancer grows. 

Adsjni and Bjux have recently discovered micro- 
oimnisms so small that they pass through the fine por- 
ceuun, which till now was supposed to filter all germs, 
and are too small to be seen singly with the most 
powerful lenres, beiog only reoc^ised when growing in 
colonies. These belong to other diseasee, but may 
account for many hidden causes which, with new lenses 
and new stains will become clear and recognisable. As 
yet we most look on the parasitic origin of canoer as 
more than probable. Beyond this we canoot go at pr^ 
sent. 

There has been a large accomnlatioa of facts which 
snggest that canoer is infectious, and. if it be due to 
parasites it most be oommonioable by oontagiou. On 
this point, daring the past oentnry, mescal opiniou was 
so uncertain that at cue time cancerous patieute were 
refused admission into some of the Continent «1 hospitals, 
and special caocer ho*pitals were provided. Cancer un- 
donb^ly haunts pls^, and has a great analogy to 
malaria, and, like ihe latter, shows a preferenee for 
marshy soil. 

Mr. Power’s view is that the germ of the diseaee, a 
(>oafa< 7 ium uivvm, lives in some intermediate host belong¬ 
ing to the aoitral or vegetable kingdom, from which, 
or in which it somehow finds its way into a suitable 
place in the body of its human victim. Is it not pos¬ 
sible that some kind of gnat or fiy may prove to be an 
effitient host for the parasite, and, consequently, dan- 
gerons to man. Many flies, like mosquitoM, whi^ are 

(a) Abstract of Address delivered at the Opeolnr of the Sessxen 
1901-2., in Jervis Street Hospital, Dablin. 



Nov. 13, 1901. 


OBIOIK.AL COMHUNIGATIOKS. Tei Mssioal Fbssb. 511 


Tecoffoised as oonveying the malarial serms, ding to 
paddle and swamp, where they are hat(med, and where 
they in torn depot it their eggs. Cancer is most common 
in damp and marshy plaws. It is, moreover, well 
known in other diseasee acknowledged to be oontagi 
ons that the micro*oigani8m enters bat leaves no trace 
whereby to track it, antil it reaches the tusne suitable 
for its growth. 

Much interest can be gleaned from the researches of 
Noel, which show a oertdn relation between arboreal 
and human cancer. Not only are malignant tomonrs 
more frequent in habitations on the borders of woods, 
but labonrers and others who live among trees are very 
prone to them. Cancer bearing trees are exceedingly 
common in orchards. Insects, as Moran has experi¬ 
mentally shown, have a decided predilection for arboreal 
cancer, and carrying infection from one tree to 
another, may also infect fruit or other food. 
On these insets, protosoa and fungi have been found. 
Moran placed white mice over pans of turpentine and 
camphor so as to keep them free from insects, and they 
remained healthy, whereas white mice with whom bed¬ 
bugs, taken from cages of cancerous mice, were put, one 
and all developed the disease in a few months. Professor 
Loffler, of Q-relfwald, and many others have shown that 
in oountries where malaria is prevalent cancer seldom 
ever appears. In Borneo, Dr. Pagel in ten years never 
met a case of cancer. It is quite true that I he two 
diseasee rarely exist in the same district. In Jamaica, 
Mauritius, the East Coast of Africa, and the Guinea 
Coast cancer is rare, but in Holland nudaria and cancer 
are both common. In the Argentine Bepnblio, Hr. Bath 
informs me, cancer is frequent, whereas malaria is almost 
unknown. In some localities it is more prevalent than 
in others. 

In Ireland Armagh has the Isugest mortality from 
this disease, then follow Carlow, Dublin, and Athlone, 
whereas Kerry has the least. Dr. Seymour, medical 
officer of Bath, states that his district haa 50 per cent, 
mote cases of cancer than the adjoining neighbourhood. 

Occupation seems to have some influence on the disease. 
From 1681 to 1890 47 per 1,000 of those registered were 
from cancer, the distribution being: Occupied males,44; 
unoccupied males, 96; clergymen, 35 ; lawyers, 60 ; 
medimu men, 43; commerciu travellere, 63; steble men, 
58; seamen, 60; porters, 48; farmers, 86; fishermen, 46: 
brewers, 70; hotel servants, 65; chimney sweepe, 156. 
The theory that excessive nervous strain and anxious 
work cause the disease could be contradicted by these 
figures, as medical men and clergymen are among those 
most free. It has been stated by at least one patholo¬ 
gist that is peculiar to the human subject, and in 

days gone by many medical men believed this theory, but 
such is not the fact. Al^ough the disease is not fre¬ 
quent among the lower animus, yet every veterinary 
pathologist knows that it is at times met with in almost 
every species of them. It is, however, a curious fact 
that the animal which seems most free from it is the pig. 
The study of this disease in the lower animals almost 
proves that it is not, at least, caused by irritation,a3 the 
parts most subject te this in animtis are those almost 
exempt from the disease. 

The question whether cancer is increasing in Itelsnd 
must be answered in the affirmative. In 18M the total 
deaths from this disease were 2,145, and every year, from 
that time, there was a gradual increase, unt^ in 1900 
the deaths numbered 2,717. In 1889 Iroland bad regis* 
tered per 10,000 of population 4*5, whereas in 1898*1900 
the figures were 61. In England, in the same period, 
the figures rose from 6'6 to 8 0, and in Scotland from 6'7 
to 8*2. Some may say that this increase is but apparent,and 
is really due to the fact that our diagnosis is nov more 
accurate, hence many deaths are now registered from 
this disease which were formerly doubtful, and, secondly, 
that cancer, being a disease of degeneracy, increases as 
age progresses, and there are greater numbers of sur¬ 
vivors to the “ cancer age,'* which is between thirty-five 
and seventy-five. Thii explanation cannot aooount for 
the gradu^ but startling increase in tbe mortality. It 
is, moreover, the only disease which is steadily on the 
increase all over the world. 

We should have in our midst a Central Laboratory, pre¬ 


sided over by a ti ostwortby chief, in whom tbe inofeesion 
and the publio should have the fuHest oonfi^noa, and 
this institution should be in touch, not only with every 
hospital in Ireland, but also with aU similar institutions 
abroad. All the great soientiflo oentree, of which 
Austria, Italy, America, and Germany are the principal, 
where the Governments do so much to foster original 
researob, should work together, and should frequently 
interchange their views and let every advance be at once 
known all over tbe world, lo that all might follow up the 
latest discovery. Such a work cannot be done through 
private philanthropy. In this country the Government 
or Corporation should undertake to found and mainta'n 
a properly equipped institution replete with everything 
necessary for unportant research, and, if necessary, a 
rate should be levied, as it is at present, for school 
attendance, toobnical instruction, rmding rooms, and 
other things essential to tbe common weaL When this 
is done rapid progress will be made, especially when we 
obtain more powerful lenses, new stains and more media, 
all of which are now so urgently required. Tbe matter 
is so important, and comes home to so many, that I feel 
certain the ratepayers would not object to tbe small 
amount which would be necessary to carry out this 
proposal, and the State has already shown that it feels 
its responsibility in this direction. 

Our beloved King said, a short time ago, when ad¬ 
dressing the delegatee of the Congress on Tubercu¬ 
losis :—God grant that before long you may be able to 
find a cure for cancer, or check its course, and I think 
that to him who sh^l make the discovery a statue 
should be erected in all the capitals of the world." I 
venture to predict that within tbe next few years Heaven 
will hear this earnest prayer, and cancer will be numbered 
with the curable diseases. 


SAFETY EYE IRRIGATOR. 

By JOHN WARD COUSINS, 

Senior Surgeon to tbe Boyel Portemouth Hospital, end tbe Ports 
month and South EUnts Eye and Ear Infirmary. 

Thi treatment of contc^ons disorders of the eye has 
often proved disastrous to both su^^ns and nurses, 
and many instances have occurred of serious injury 

and loss of sight. 
Now this little con¬ 
trivance has been 
designed to give 
protection to ^e 
operator, and also 
to secure rapid and 
thorough irrigation 
of the ooujunotival 
sao. It disohaiges 
a doable current of 
lotion with suffici¬ 
ent force to com¬ 
pletely cleanse the 
eye without any 
risk of splashing 
and Boattoring the 
dangerous secre¬ 
tions. The instru¬ 
ment consists of 
two metal tubes 
which are at 



Fio. 1. 


extremity bent, but at an acute angle, and united by a 
short tube which is perforated with several holes on the 
convex edge; at the other extremity they are joined 
together and form a short tube to which the india- 
rubber tube of the glass receiver is attaoheA (See 
Fig. 1.) 

DiaacTiOKB fob Usi.—The irrigator must first be 
carefully introduced under the tmper lid, and then held 
betireen the thumb and finger oAhe left hand, and the 
lid gently elevated, at the same time tbe right hand 
raises the glass receiver containing the lotiou. The 
full stream caused by the double current quickly 
waabes out the upper palpebral sinns. The irrigate 
should then be removed and introduced under 


C 



512 Thi 1£si>i<ui. Pbxbb. 


TRANSACTIONS OF SOCIETIES. 


Nov. 13. 1001. 



the lower 
can 


In oaseB of 
contagiooB 
ophthalmia 
the sound eye 
must be pro¬ 
tected by an 
.bseptio pad 
'luring the 
i)peration. 

The instm- 
inent has been 
neatly made 
for me by 
Messrs. Allen 
and Hanbory. 
and with it 
compressed 
discs of snl- 
Fio. 2. phate of zinc, 

nitrate of silver, perohloride of mercury, boracio acid, 
and sulphate of aluminiom can be obtained ready for im- 
me^te use. 


A MODIFIED OBMSBY’S ETHER INHALER. 

This well-known inhaler has been modified by Mr. 
TjtTiA Joynt, of the Meath Hospital, and, while preserving 
the principle of the orieinal Ormsby's Inhaler, has 

been made capable of 
thorough ste^isation 
as far as is possible for 
any such contrivance. 
The face-piece is iden¬ 
tical with Baith’s pat¬ 
tern used on gas appar¬ 
atus, Clover’s inb^er, 
Ac., and is attached to 
the body of the inhaler 
by a slip joint, so ena¬ 
bling the anaesthetist 
to use larger or smaller 
sizes for adults or chil¬ 
dren as required, (v, fig. 1) 
The cage for holmng 
Fiq. 1 , the sponges also fits into 

the body by a slip joint, 
so that the sponges can readily be removed for cleaning. 
The body is made of gun metal and plated, and the 
air valve and ether tube so rarely of use in the older form 
has been done away witb. Ether can be poured either 
directly through the face piece or on to the sponges by 
removing the body. In the latter is a cnp, on the prin¬ 
ciple of the unspillable inkpot, to prevent any surplus 
ether running on to the patient's face. Every 




part of the inhaler can be reached by the finger for 
cleaning. This is a matter of the greatest importance, 
as will readily be seen when it is borne in mind that 
the instrument is used for varied oases, and may be 
rendered septic by the breath and expectoration of the 
patient. Many operators, including Frofeesor Eooher, 
of Berne, to prevent the possibility of a dirty inhaler 
infecting the wound, hang a towel on a frame between 
the head and bmnk. 


The inhaler is mannfaotnied, on 'modem aeeptie lines, 
by Messrs. Smith and Sheppherd, "Stephen’s Green, 
Dublin. 


Cllinkal 


CANCEE HOSPITAL, BROMPTON. 

Case of Cyitic Sarcomn of the Right Ovary Removal 
— itecovery. (o) 

Under the care of F. A. Pttbccli., H.D., M-Ch., 
Bnrseon to the Hospital. 

Thb specimen shown weighed, twenty-fonr hours after 
removal, 7 lbs. 15 ozs. Its circumference, measured at 
its greatest diameter, was 26} ins., and its least, 18 ins. 

Eliza C., est. 62, single, a prison official, was admitted 
to the Cancer Hospital, Sept. 24th, 1901. She stated 
that since the menopause, which occurred six years pre¬ 
viously, she had lost nothing ; that prior to this she had 
slways suffered from dysmenorrhcea, and that during 
the ten years immediately preceding the menopanse 
the menstrual discharge hM been more copious than in 
earlier life. For five or six years she had been |frowing 
stouter. She had suffered from abdominal pain, how¬ 
ever, for a considerable time before anyswelling b^me 
evident. The tumour, when first detected, was about 
the size of a hen’s egg. She had also experienced a feel¬ 
ing of weight in the abdomen, and this had become 
more noticeable daring the last two years. The bowels 
and bladder had been normaL 

The patient was observed to be well nourished, and to 
be unable to lie flat on account of the dyspnoea pro¬ 
duced. The abdomen was much distended, the super¬ 
ficial veins enlarged, and the umbilicus flattened. A 
movable tumour, about the size of a football, was 
situated in the right hypoohondrinm,extending,bowever, 
across the middle line and three inches above the um¬ 
bilicus. It was hard generally, but cystic in puts. A 
good deal of ascitic fluid, the presence of which denoted 
malignant nature of the growth, masked its extent 
laterally. The uterus was felt, per vsginam, to be 
drawn up, but to be separate from the tumour. The 
sound passed 2} inches. The heart, kidneys, and liver 
were normal. 

On October 2ad, the patient being under ether, the 
ablomen was opened in the middle line. The omentum, 
adherent in many places to the tumour, was peeled off 
and ligatored. The pedicle, four to six inches in 
breadth, was secured in sections, divided, and the stump 
covered by peritoneum. Seve^ openings which had 
been made in the omentum were closed with catgut, any 
tags preient were cut away, and all bleeding points 
secured. The ascitic fluid was cleaned out, the left 
ovuy examined and found nomud, and, finally, tbe 
abdominal waU was closed in tbe usual way. The 
patient made an uneventful recovery, the temperature 
never rising above normal. 


^rattBactixntB nf §ocictte6. 

CLINICAL SOCIETY OF LONDON. 
Mkitinq hxld F&idat, Novxhbib 8th, 1901. 

Mb. Howard Marsh, F.B.C.S., President, in the 
Chair. 


Dr. Motnihan on 

THX OPKRATIVS TRXATXXNT OF CANCKB OF THX PTIiOBIC 
PORTION OF THX STOMACH. 

An examination into the records of cases of recurrence 
of malignant disease of the stomach after operation shows 
that the return of tbe growth is almost always local, ia 
tbe stomach wall at or near the line of aeotton, or in the 
glan^ or lymphatic vessels which drain the affected area. 
It has been estimated by Hemmeter that recurrence 
occurs in 99per cenhof cassB submitted to operation. In 
order to perform an operation which shall prevent recur- 
zenoe we must base such operation upon a knowledge 


(a) British OTnaeolofiesI Soeietj, October lOth, 1901. 

Difiiiized by Gooole 


Nov. 13, 1901. 


TBANSACTT0N8 OF SOCIETIES. Thi Mxdioal Fbub. 613 


(a) of the mode of mvarion of the stomaoh b 7 the pri> 
marjr growth, and (b) of the lyniphatio distribn. 
tion in the stomaoh and of the position of the glands 
into which tiie veee^ di^n. The researohee of Borr- 
mann and Coneo have shown that the most oommon 
point of origin of caroinoma in the stomach is 2-4 cm. 
from the pyloms, on or near the lesser onrvatnre. From 
this point the disease spreads gradnallj, bnt more 
rapidly and to greater extent towards the body of the 
stomal than towards the dnodenam. On the stomaoh 
side the growth is not equal in all directions; there is 
a prononnced tendency for the induration to spread 
towards the curvatures. Towards the duodenum the 
smeading is slower and invariably less extensive. 
If sections are made at the edge of a malig¬ 
nant neoplasm and the slides examined, the 
following condition will be found: The edge of indura¬ 
tion corresponds to the limit of growth in the mucosa. 
In the snbmuoofa the growth extends much further in 
a solid unbroken mass, beyond the edge of this mass 
isolated nodular deposits of growth extend, becoming 
smaller as their distance from the tumour increases. 
The subserous and serous coats are implicated approxi¬ 
mately to the same extent as the mucosa. The lym- 
pbatio glands of the stomach are situated chiefly along 
the vessels. 1. The coronary group lies along the 
lesser curvature. The glands are continuous at the 
origin of the coronary artery with those along 
the upper border of tbe pancreas. 2. The hepatic group 
lies along the hepatic artery, and some of ite members 
lie along the pyloric artery. The glands of the greater 
curvature lie along the right gastro-epiploic artery. At 
the pylorus they are numerous and close together, and 
pass behind the stomach to the head of the pancreas. 
The lymphatic vessels draining into these elands pass very 
obliquely in the walls of the ^maoh. Three chief lym¬ 
phatic areas of the stomach may be described. An ares 
along the lesser curvature: an area along the greater 
curvature; an area comprising the greater tuberosity of 
the stomach extending up to the oesophagns and on the 
greater curvature as far as the limit of supply of the left 
gastro epiploic artery (as far as the gastr^splenic omen¬ 
tum). In oases of malignant disease of the pyloric por¬ 
tion of the stomach, the growth extends in the direction 
of the curvatures, and the glands of the first two 
groups are affected, and the glands of the third group 
and the area which they drain escape. This latter area 
may be looked upon as an area ap^, as one into which 
extension very rarely occurs, and as one therefore 
whose lymphatic vessels and glands remain healthy. 
The term ** isolated area" may well be employed to 
describe it. Upon the following facts an operation 
should be based: 1. Malignant disease of the stomach 
commences most often near the pylorus, just below the 
lesser onrvatnre. 2. From its point of origin it spreads 
most widely in the snbmucosa, and chiefly towards the 
cardiac end of the stomach. 3. On the duodenal side it 
spreads tardily and never extensively. 4. The drift of 
the growth is towards the curvatures. 5. The lympha¬ 
tics draining the affected area pass to glands lying 
along the coronary and pyloric arteries al»ve, and the 
right gastro-epiploic and gastro-duodenal arteries below. 
6. The greater tuberosity of the stomach (the “ isolated 
area ’’) is very rarely involved. In order to ensure com¬ 
plete removad of the primary growth of the infiltrated 
lymphatic vessels, and of the glands into which those 
veesels drain, it will be necessary to remove the stomach 
as far up on the lesser onrvatnre as the point of abut¬ 
ment of the coronary artery, and on the greater curva¬ 
ture as far as the gastro-iplenio omentum, and to remove 
the first portion of the duodenum. In order to make the 
operation simpler and quicker, a preliminary ligature of 
the coronary, the pyloric, the gaistro-duodenal, and the 
left gastro-epiploic is performs. After removal of the 
portion of the stomaoh, the anastomosis between the 
** isolated area," and the small intestine may be made by 
end-to-end approximation. Kocher’s method, or suture 
of the out ends, and the performance of a separate 
gastro-enterostomy. The corona^ artery is ligatured 
first, and is found as it lies in the "ligament of 
Huschke,” the falx ooronaiia, whose folds enclose it. 
The position of the artery can be defined by lifting up 


the liver and pulling the stomach downwards and out- 
wards until a ridge is raised up in the peritoneum by 
the underlying vessel. The pyloric and gastro-duodenal 
are beet ligatured as they leave the hepatic artery. The 
hepatic can be found just above thej^loms, and u made 
clearer by draggi ng the pylorus downwards and to the 
right. 

Dr. Pn-SwiTH, discussing the comparative frequenov 
with which different parts of the stomach were att^ked, 
observ^ that the smaller curvature was much more 
frequently the seat of cancer than the greater curve. 
Incidentally he remarked that it was a very rare thing 
for caroinoma of the pylorus to spread into the duode¬ 
num though it often spread in the opposite direction. 
He admitt^ that the surgeon was, as a rule, called in far 
too late, and be insisted on the importance of physicians 
having earlier recourse to their assistance. Tue next 
best thing to nylorectemy, he said, was simple short cir¬ 
cuiting whi<m relieved the most urgent ^mptoms, 
especi^y in the cases in which these were due not so 
much to the cancerous growth as to the mechanical ob¬ 
struction which it caused. Moreover, this operation im¬ 
proved the patient’s condition, so that the giaver opera¬ 
tion might, if thought well, ^ proceeded with later on, 
with much greater c^noeof success. 

Dr. Nouman Moobk pointed out that la^ secondary 
growths were unknown in connection with cancer of the 
stomach, and this constituted a point in favour of opera¬ 
tion. He had not seen a single case of cancer of the 
pylorus extending into the duodenum in the course of 
nine years’ post-mortem work at St. Bartholomew’s, 
though he hM met with one or two since. Out of thirty 
cases there were eleven in which the whole wall of the 
stomach was involv^, so that no particular area could be 
regarded as exempt. He clamfied cancer of the 
stomaoh in three groups (1) those in which there 
was a marked tumour; (2) those in which 
ths walls were more or less infiltrated, even 
involving the terminal part of the stomach, and (3) 
oases in which the cardiac end and greater curvature 
were involved. He mentioned also oases in which can¬ 
cer developed on the site of an old ulcer. In fourteen of 
the ^irty cases there were growths in the liver, often 
very sm^ and not perceptible during life. In some the 
secondary growths were on the under side of the 
diaphragm, and in about a third the lumbar glands 
were enlarged. The average duration of life in cancer of 
the Btoma<^ was about eighteen months. 

Mr. Chabtebs Sthondb said his experience in opera¬ 
tions on the stomach had been somewhat disappointing 
so far as effecting a cure was concerned. Out of about 
twenty cases of cancer of the pylorus there was only one 
in which he had felt justified in attempting pylorectomy, 
and even then he found it impossible to remove all the 
disease. In many of these no tumour was perceived 
clinically. In his cases it was quite impossible to make 
an end-to-end junction, and the disease must be very 
limited for this to be possible. In none of his oases was 
there any secondary growth in the liver. What sur¬ 
geons wanted was earUer diagnosis. 

Mr. A. Babkbb questioned whether it would ever be 
possible to arrive at an earlier diagnosis, and in any 
case they had no guarantee against recurrence. He did 
not believe that tee duration of life was materially in¬ 
creased by pylorectomy, and even when it aiqwar^ to 
prolong life they had to allow for the fact that the 
malignancy of these growths varied within very wide 
limits so they could not be sure that the pyloreo- 
tomy was to be credited with the result. 

Dr. Habbbbhon divided these cases into two groups, 
viz., those which produced obstruction with the classic 
symptoms, and the oases which simulated gastric ulcer, 
due to malignant disease in the neighbourhood of the 
pylorus, not causing obstruction, yet giving rise to 
extreme dilatation of the stomach by setting up spasm. 

Mr. Ballakcb compared the excellent rs^ts he had 
seen in Germany from these operations with the results 
obtained in this country, and asked why it was teat the 
latter were inferior. In England it vras but too often 
impossible to attempt a radical operation on account of 
the extent of the disease. It was impossible for them 
to rest satisfied with the results of the pr e s e nt meth o ds 




514 Tn Hsdxoal I^biss. TRANSACTIONS OF SOCIRTIFS. Not. 18, 1901. 


of tre atu ieot of oaroinoma of the itomaoh. There was 
a lack of knowledge which prerented their making a 
diagnoeia early enoogh to admit of soooeseful intei^en* 
tion. He roggectea that physicians, instead of waiting 
for the prodncoon of a definite tnmour, should get the 
surgeon to mike an exploratory incision which would 
show what was wrong. 

Mr. Mazinb obsei^ed that the feeling of late was 
against the removal of pyloric growths. He referred 
to the case of a young woman with a limited growth of 
the pyloros wUch ho removed with about a third of 
the stomach. She did splendidly for three months when 
dilatation recurred, and she died seven months later. He 
regretted that in this case he had not done gastro* 
jejnnostomy. He questioned the desirability of re* 
moving many intestinal growths which it was at present 
the practice to remove, and he doubted if these 
patients lived longer thw if they had been merely 
short-circuited. 

Mr. Moynihan, in r^ly, pointed out that in 70 per 
cent, of the oases the growth was in a part of the 
stomach, which admitted of its removal. With respect 
to dij^pnoeis, he said that with a patient under me4xical 
treatment for gastric trouble at an ^fe when one might 
expect to meet with cancer of the stomach, and when there 
was an absence of hydrochloric acid—a very imrarcant 
point in their estimation—then, whatever the physicid 
signs and clinical condition might be, it was their prac¬ 
tice to advise an exploratory incision. This had per- 
mitted them to obtain oases at an earlier date than else¬ 
where. Even in the early stage, however, the radical 
operation might not be permissible, because the disease 
might already have got beyond the limits of snooessful 
removal. He join^ issue with Mr. Barker in respect of 
bis view that life after gastro-enterostomy was at all 
comparable with life after partial gastrotomy or pylo- 
reotomy. Statistics showed at least one year clear 
gain in favour of ^e latter. The improvement after 
gastro-enterostomy was great and immediate, but was 
quite ephemercJ. He suggested that the attitude of 
surgeons towai^these operations was their attitude of 
some years since toward operation for cancer of the 
breast. Gradually they had extended the limits of that 
OMration, and no doubt, as their knowledge increased, 
they would do the same in regard to operations for can- 
oer of the stomach. He believed that, if attacked early 
by an operation on the lines he had described, they 
might hope in the future to obtain far better results 
thw had been the case hi^erto. 

OBSTETEICAL SOCIETY OF LONDON. 

MBniNO HSLD WxDmSDAT, NOVIMBXB 6 th, 1901. 

Dr. Fktbe Hobboces, President, in the chair. 


OONOBBHCBAL PBLVIO raSITOMITlB. 

Mb. J. Bland-Scttom made a short communication 
on this subject. The patient, et. 22, presented a history 
of appendicitis. On opening the abdomen on the right 
side the appendix was found adherent to the right ovary, 
which was cystic and contained pu.^. The tube of the 
same side also contained pus. These were removed 
after the separation of many adhesions. The appen- 
da^s of the other side were healthy and were left. 
Suspecting ihat the condition was due to gonorrhcea, 
the vulva was examined, and found to be the seat of 
yellow mnco-pns. The specimen was at once wrapped in 
warm sterilis^ Gamgee tissue, and within forty mmutes 
was in the hands of Mr. A. G. £. Fonlerton, who reported 
that the micrococcus gonorrhces was demonstrated 
both by microscopical examination and by baoterio- 
l(^oal culture. 

Dr. Dbummobd Eobinbov made some observations on 
the paper. 

TUBAL XOLX WITH (?) IWCTSTID E^MATOOXLB. 

Dr. W. 8 . Handlbt showed this specimen, and read 
notes of the pathologicaloonditionsfound. The clinical 
features of |the case (had already been reported by Mr. 
Alban Doran, who had operated on the patient. One 
feature of special interest was that the |^vid tube lay 
n front of the ntems, in the uterovesical pouch, the 


uterus itself being retroverted. The specimen ocnsisted 
of two clot-containing sacs, one of which was clearly 
the dilated tube, communicating by a narrow apertore, 
which appeared to be the abaominal ostiam of the 
tube. Dr. Handley described the microscopic appear¬ 
ances of the wall of the distal sac, whii^ presented 
the characters of an encyst^ hamatooele; and pro¬ 
ceeded to discuss the probable mode of its formation. He 
considered it probable that a layer of viscid blood 
situated at the ostium tubs had b ec om e expanded by 
pressure and by fresh blood within the tube, so that in 
its production the hematocele might be omnpated to a 
fain aneurysm, or to a glass bulb blown with a blov- 

S ipe. He therefore suggested for it the tenn^hsmo- 
ynamocele.” 

Mr. Alban Doban remarked that the gravid left tube 
in this case was not only in front of the uterus, but 
actually lying in front of the right appendages, and had 
contracted an attachment to the vermiform appendix. 

Dr. Hxbbsbt Spbncbb suggested that the posi¬ 
tion of the tube might be congenital. He once founa the 
Fallopian tube of one side lying in front of the ueems 
in a new-born child. The mode of origin of the hsma- 
tuoele suggested by Dr. Handley was interesting, and 
received some support from a case he had seen in which, 
during an operaHon for an ovarian dermoid, the tube, 
which was tuberoulous, had a small blob of reddish 
mucus projecting from its open end. This condition 
might constitute a stage in the formation of a tnbo- 
ovarian cyst. 

Dr, W. S, A. GairriTH observed that if the uterus 
was retroverted, it was not necessary to invoke any 
special explanation of the position of the tnito, which 
would naturally enlace in the direction where there 
was the most room. A similar position was not very 
uncommon in the case of ovarian tumours. 

Mr. Bland-Sutton said that the presence of any 
tumour in front of the ntems introduced a puEzling 
feature into the diagnosis. He had bimaolf seen two or 
three oas es in which a gravid tu^ lay in front of the 
uterus. 

Borne remarks were also made by Dr. Lbwbbs end Dr 
Locktxb, and Dr. Handlbt replied. 

fibbo-htoua of thx bboad lioahxmt. 

Mr. Alban Doban showed a flbro-myoma of the broad 
ligament associated with an ovarian cyst. The patient, 
let. 44, was found to have an ovarian tumour, and a 
second tumour was discovered low in the pelvis. Aiterth) 
removal of the ovarian cyst, which contained over ten 
pints of chooolat^oolonred fiuid, the second tumour was 
found to be a fibro-myoma arising within the layers of 
the mesometrinm, quite distinct from the uteiiu. It 
was enucleated, and weighed 2i Ibe. It was a true retro¬ 
peritoneal fibro-myoma. Mr. Doran demonstrated on 
the black-board that tumours arising in the mesosalpinx, 
although anatomically retroperitoneal, were not so clini¬ 
cally or surgically; whilst tumours in the meeometrium 
were anatomically, clinically and surgically retro-perito¬ 
neal. A parallel was to be found in the esse of mesen¬ 
teric oyst^ which, like those of the mesosalpinx, were only 
anatomically retro-peritoneal, whilst the cysts which 
corresponded to mesometrio tumours lay quite poste¬ 
riorly where the layers of the mesentery diverged from 
one another. 

Dr. Hbbbbbt Spxncsb asked whether fibromyomata 
of the broad ligament were as liable to degeneration as 
those of the uterus ? 

Dr. W. S. A. Gbiffith said that Pick, of Berlin, con¬ 
tended that in broad ligameot myomata adenomatous 
stmcturescould generally be found, derived fromWolffian 
duct remains; and he asked whether any such structure 
had been found in this instance P 
Mr. Bland-Sutton said that the pathology of retro¬ 
peritoneal fibromyomata in the meeometrium must be the 
same as that of such tumours in other retro-peritoneal 
situations, for instance, behind the kidney; and it did not 
seem to him that there was any evidence that they were 
derived from glandular vestiges. Von Beckliaguusen 
attributed the origin of myomata in the uterine cornua 
to Wolffian remains; but his theory did not extend to 
broad ligament myomata. 

Cov.gl 


Not. 18. 1901. 


TRANBACTIONS of societies. Tn« M«dical F»88. 515 


Mr. Albak Doban, in reply, said that broad ligament 
myomata appeared to be subject to much the same de* 
generations as those in the nterua. The microscope 
showed no trace of g’andnlsur stmatnres in the present 
tumour, which showed the features of a pure fibre* 
mjoma. 

^e following specimens were also shown:— 

By Dr. A. H. N. Lswbbs. —A uterus remored six years 
ago on account of ^na»*on8 epithelioma of the cerrix, 
the patient being still alive and well. 

By Dr. A. L. Galabin.— A papillary ovarian cyst, 
associated with an accessory ovary on the same side. 

By Dr. T. W. Edxh.—A f<etal monstrcMity of the 
variety known as oyclops. 

Mr. Alban Doban and Dr. Cuthbxbt Locetxb read a 
paper on 

fcLOUOHlNO FIBBOID OF THB LBFT VTBBINX COBNU : 

ABNOBXAL BBLATIONB. 

The specimen was from a single woman, set. 30, sub* 
ject for a month to symptoms of pelvic in^mmation 
with fever. There wassm irre^lar movable mass in the 
leftfmmix, rising into the left iliac fossa, and connected 
witbasm^ anteflexed utems. Mr. Doran performed 
snpra-Ti^final hysterectomy, removing the uterus and 
tumour with the left appendages; the right tube and 
ovary were spued. The patientrecovered. The tumour, 
five inches in its long diameter, was much lugerthanthe 
uterus, projecting outwards raUier than npwu^ from 
that organ. It wm a true flbro-myoma in a necrotic 
condition, and adhered to intestine and omentum at its 
blunt-pointed outer extremity. This degenerative change 
apparently accounted for the febrile symptoms. At 
first sight the tumour simulated a fibroid in an 
undeveloped uterine oomu, but the Fallopian tube and 
ovarian ligament rose posteriorly, and not externally, 
and were attached to a d^p groove between the uterus 
and the tumour. The left round ligament arose from 
the under surface of the tumour somewhat posteriorly, 
passing under it and forwards to tiie ingubosJ canal. A 
tumour with somewhat similar relations to a utems 
much smaller than itself had recently bMii flared with¬ 
out any clinical history by Doederlein in Kustner's 
“ KutzesLdirbuch der GynUologie” (fig. 146). This out¬ 
ward growth of a fibroid of the oomu without outward dis¬ 
placement of the corresponding tube and ovary was very 
unusnaL The sloughy state of the tumour demanded its 
removal, and the utems could not possibly be separated 
from a growth of this kind, so that it was also removed. 

The paper was briefiy discussed by the President, Dr 
Lewers, and Dr. Lookyer; and Mr. Alban Doran replied. 

BEITI8H LAEYNGOLOGICAL, BHINOLOQICAL, 
AUD OTOLOGICAL ASSOCIATION. 
Annual Gbnkbal Mxxtiko hild on Novxmbbb 8th. 


The President, Mb. Mato Collibb, F.B.C.S., in the 
Chair. 

Mb. Lxnnox Bbownb showed the Nerast electric 
lamp as one giving a far whiter light than any in pre¬ 
sent nee. 

Mr. Mato Collibb showed (1) a case of malignant 
disease of the pharyngeal wall, which was inoperable, 
and it was proposed to submit the patient to electrical 
treatment by Dr. Maointyre, of Glasgow; (2) a case of 
abscess of the maxillary antmm, assooiatod with facial 
paralysis, which had subsided promptly after surgical 
treatment; (3) a case, in the person of an Army surgeon, 
who was present and spoke on his own case, in which 
asthma 1^ been relieved after the lemov^ of nasal 
polypi. 

Mr. Chichblb Noubse showed a case in which a 
laryngeal growth had disappeared after the removal of 
nasal polypi. 

Mr. Lbnnox Bbownb remarked on these last two 
cases and said that although they were by no means 
uniqne, it was neefnl to reoom them, and he trusted that 
snob cases would be always brought forward in view of 
the fimt that quite recently donbts had been thrown on 
the importance and freqnen <7 of asthma and other 
disesues suising as nasal refiexes, notwithstanding that 


they had been accepted by observers of repute all over 
the world. 

_Dr. Babe, while accepting these cases as reported, re¬ 
minded the Fellows that not all were cured. 

Dr. P. H. Abbbcboubib showed a case of black tongue, 
from which Dr. Wyatt Wingrave had prepared micro¬ 
scopic slides and fnmiahed a oaoteriologicaf report. 

Mr. Lbnnox Bbownb made a short oommnnication 
on the preliminary and after treatment of operations on 
the month and fauces, insisting on (1) preliminary anti¬ 
septic washes, (2) sterile instraments, (8) complete rest 
of the parte and of the body generally ^ter operation, 
(4) the nse of month washes, by means of the throat 
spinge, iostead of gargles, and (6) the non-administra¬ 
tion of internal drugs, snoh as the bromides, which 
might cause skin eroptions liable to be mistaken for 
symptoms of septic infection. 

Bemarks were made by Dr. Hablah, Dr. Wtatt Win- 
OBAVB, and the Prbsidxnt. 

Dx. Macinttbb then delivered bis Presidential 
Address on “ The Application of Physical Science to the 
Surgery of Diseases of the Throat and Nose.” This was 
illnstirated by the exhibition of many instruments, and by 
lantern photographs. 

The foUowins ofiBce-bearere were elected at this 
meeting:—President: Dr. John Madntyre, of Glasgow. 
Vioe-^Bsidents; Dr. Greville Maodonald, Londmi; Dr. 
Walton Biowne, Belfast; Dr. Hillis, Dublin. Council: 
Mr. Mayo Collier, Dr. Culver James, Mr. Claud Wcakes, 
Mr. Atwood Thome, Dr. Woods, Dublin; 1^. Kelson. 
TreasareT: Mr. Lennox Browns. Secretaries: Mr. 
Chichele Nourse and Dr. P. H. Abercrombie. 


SHEFFIELD MEDICO-CHIB17BGICAL SOCIETY 

Thb First Meeting of the Semion was held Octobxb 
IOtb, when the President, Dr. C. H. Willxt, delivered 
an address on the ** £tiology of Some Forms of Gastric 
Dilatation.’* 

The Second Meeting held Octobbb 24th. Dr. C. H. 
WiLLBT, the President, in the chair. 

Mr. l^B-SxiTH brought up the case of unilateral 
congenital displacement of hip which he had shown 
last February. The displaoement had been reduoed by 
Lorenz’s me&od of manipnlation under an anssstbetio, 
and the hip bad been kept for nearly four mon^ in a 
plaster of Paris case. The deformity and limp had now 
disappeared, smd a second skiagraph showed practical 
symmetry. 

Mr. Edwabd Seinnbb showed specimens from a case 
of oanoer of the lung. 

Mr. ScoBAH exhibited specimens from a oswe of 
lymphadenoma, shown last session. 

Dr. SiNCLAiB White ahow^ (1) a postirectal dermoid 
containing bone; (3) an nnmptiired tubal gestation; 
(3) a dilated vermiform appen<Bx removed from the sac 
of an inguinal hernia. 

Dr. Stanlit Bisblbt showed a case of dislocation of 
the lens in both eyes. 

Dr. Abthub Hall showed the following cases :—(l) 
Primary spMtio paraplegia, in a man, set. 39. Five 
years' dnration. No history of previous disease. Had 
been in the army. Gradual loes of power of walking, 
with slight pains in back and lege. Extreme myotatio 
irritability. No tensory symptoms. No atrophy. No 
ocular affection. Some difficulty in oontroUing urine 
and fiBOes. Marked spastic gait. (2) Two cases of 
trade eczema. Both patients, middle-aged women, who 
work as scratch bmeheis. One ca«e, although working 
under the same conditions for twenty years, only com¬ 
menced to suffer a few months ago. The other 
commenced within a few weeks of beginning her present 
work eight months ago. The irritsmt appears to be the 
“sonr beer” witb which they brush the silver goods. 
(3) Acase of lupus vulgaris and lupus erythematosus in 
the same individual. Lupus began at tbe side of the 
note eight years ago, and shortiy after she had been 
nursing a womanjwho died of conaumpntion. At the 
present time the lupoa is quiescent, but there is some 
destruction of both aiss nasi, and tbe upper gum is 
affected. Much later than the lupus she badsn outbreak 
of lupus erythematosus over both cheeks and nose. 


SPECIAL ARTICLES. 


516 Th» Hbdioal PBias, 

This has twice disai^>eared completely and recorred. At 
the present time the Inpus erythematosus >>»« an exten* 
siTe “butterfly" distribution. The patient is about 
twenty years of age. 

Mr. Snill inti^uoed a young woman, set. 19, with 
what appeared to be a Tasonlar growth in the lower 
and inner wall of the orbit. There was marked pro- 
tosis, and the surface of the sclerotic bebw was covered 
y a nsDvoid condition of vessels. The history only ex¬ 
tended back a few months, and ^e condition was 
progressing. There was no history of injury. 

Mr.^ Ptb Smith read a paper entitled " Four oases of 
Gastric Ulcer, in which operation was performed, 
together with one case not operated on, two oases 
operated on by others, and three oases of exploration 
for suspected perforation.” 

MIDLAND MEDICAL UNION. 

Annual Hsxtino held at Nottingham, Oct. 23bd. 

The President, J. 6 . Shba, F.R.C.S.I., J.P., in the Chair. 


Aftbb a short address by tbe Pbbsidxnt, 

The Hon. Secretary, Dr. HourroN, of Shirebrook, 
dealt with the work done during the past year. 

THB qUBSTION Or MBJDICAL FBB8. 

He described the origin and constitution of the Associa¬ 
tion, their first efforts being to try and establish a minimum 
fee for midwifery cases of one guinea, and to establish I 
a minimum rate for friendly societies of five shillings ! 
per member per annum, adults and juveniles. In rega^ 
to the midwifery question, they had met with con¬ 
spicuous sncoesa, for, with the exception of a district in 
and about EastwooA Notts, and a few oases involving 
contract midwifery, the guinea fee is now universal 
throughout the two counties, and the only reason the 
particular district mentioned is exempt is that one of 
the practitioners, whilst not attending cases for less 
than this fee himself, allows his assistants to do so. In 
regard to ^e contract midwifery question the Union 
agreed to support any member who cared to apply for 
the increased rate of payment for these particular oasea 
Dr. Bainsbury, of Skegby, who held a colliery appoint¬ 
ment to the Teversal Colliery Club, commenced to charge 
the increased midwifery fee, and, in consequence, was 
threatened by dismissal from his appointment. A depu¬ 
tation waited upon the club committee to point out the 
reasonableness of tbe fee, and asking them to give the 
matter their careful consideration. However, they sent 
Dr. Eainebnry an f^’reement to sign in which he should 
bind himself to charge a sum of lOs. 6d. for members' 
wives attended by him in their confinements. This be 
refused to do and, in consequence, was served with three 
months’ notice. The Colliery Club then advertised for 
a surgeon, the Union advertised warning men from 
accepting tbe poet, and through the courtesy of the 
editors of the medical papers no more advertisements 
were inserted from the Colliery Club. The club, how¬ 
ever, managed to secure a medical man who i^r^ to 
accept the appointment, but he never went to 
take up his appointment. The result was that after 
Dr. Bainsbury’s notice expired, on June 25tfa, 1901, the 
club was without a memoal officer. This state of 
affairs has continued up to tbe present. Dr. Bainebnry 
has been attending the club members, their wives, and 
children at private rates. We have b^n inform^ that 
the club has secured another medical practitioner, 
who insisted upon being given the appointment of a 
neighbouring practitioner as well under the same club 
committee, vis., that of a practitioner who had been 
asked to accept Dr. Bainsbury’s appointment and had 
refused. This practitioner hsm received three 
months' notice from the club, but up to date no 
medical man had arrived to take up his duties. 
In regard to the friendly society question no very great 
result can be recorded up to date. The resolution sug¬ 
gesting a minimum of 58. per member per annum has 
been rescinded, except in r^ard to new clubs or clubs 
changing medical officers, and a sum of 4s. substituted. 
But before enforcingthis the Chesterfield branch chose 
delegates to meet delegates from tbe Chesterfield and 


Nov. 18, 1901. 

District General Friendly Booieties’ Council to see if 
affmrs could be arranged amicably. Up to date the 
Friendly Societies' Council have offered a sum of 4 s. for 
adult members and 2b. 6d. for juveniles, but tbia baa not 
been accepted by the Union, and the matter is still under 
discussion. Several cases of difficulty between clubs 
and their surgeons have also been settled satis¬ 
factorily, and the founders of the Union might feel them¬ 
selves amply repaid for their trouble and work in the 
fact that they have raised the feeling of eiprtf de corpt 
of the profession in this district. 

On the proposition of Dr. Mutch, seconded by Dr. W. 
£. M. Weight, the following resolution was carried as 
an alteration of the rules:—(a) Members are asked to 
guarantee a sum of five guineas, or multiple of five 
guineas, so that in the event of indemnity being required, 
the money may be called up in tbe proportion promised; 
(6) Subscription to this fund is not compulsory; (r) In 
case any member shouldapply to be indemnified from this 
fond, who is not a subscriber to it, the granting of relief 
to such member shall be left with the President and Vice- 
President to decide whether there are special circum¬ 
stances entitling the member to such relief, (d) Tbe 
control of this fund shall be left with the Council of the 
Union. 


Special 


CAPITAL PUNISHMENT. 

Thb death of the assassin of President McKinley on the 
29th nit. has so far satisfied the acknowledged demands 
of civilised government, one of the principal functions of 
which is the protection of life. Whether the widely- 
recognised power of the law to deprive every mur¬ 
derer of life has ever acted as a deterrent of sufficient 
efficacy to justify the dreadfid responsibility of the 
infliction of capital punishment, is a question which we 
expect soon to hear sharoly discussed in our various civi¬ 
lian democracies. We have passed by degrees from the 
horrors of the stake, the tortere-chamber, of braying in 
a mortar, of flogging to death, of crucifixion, of impale¬ 
ment, of tearing to pieces by wild horses, of tbe lethal 
embraces of the “Jungfrau” of Nuremberg, through 
dticapitation and banging, and many other modes of 
deprivation of life, down to the practically scientifio and 
decently humanitarian “ electrocution " of the present 
day. That this latter is a distinct tide-mark in the n* 
vanoing onrrent of civilisation cannot, we think, be ques¬ 
tioned. Still tbe shrinking feeling which the idea of ex- 
posnre to a sharp electric shook elicits in most persons 
makes it very doubtful whether the approach of death by 
this method is not mote dreaded tha n that by deci^iti^ 
tion or hanging. There can be no question regarding tiie 
(quam proxiwe) iostantaneons ocoorrenoe of death in 
execution by the guillotine. The severance of head and 
trank, tbe cleavage of the oerebro-spinal axis close to 
the medulla oblongata is absolutely efficient. And tbe 
accompanying hemorrhage, so entirely onoontroUed, 
wonld by itself be as effective, although not- quite so 
rapid, a factor in the prodnotion of tbe fatal result. Bat 
in death by hanging the conditions are more compli¬ 
cated. It is not, we believe, very generally known that 
in the good old days of unlimited monsirohical power 
when execntions—especially political cnee—were carried 
out on so large a scale, when a rebel was drawn on a 
hnrdle, hang^, disembowelled, beheaded and quartered 
—hanging was used as an ameithetic. From time im¬ 
memorial in some of the Eastern nations, partial stran¬ 
gulation was so employed before important sn^oal 
operatioDS. And in the extwation of an English rebel 
the hanging was by “short-drop," and the onlprit was 
out down while still alive. He was then rippM open, 
the heart and bowels were torn out and burned “ before 
hie face" in a fire made ready for the purpose. In 
Ireland, where the executions were sometimes oondnoted 
on an epidemic scale, the “ long drop ” was very gene¬ 
rally used: it saved time and trouble. The present 
hnmanitarian age reqnires that the legal death of a 
murderer be attended with a minimum of physical suf¬ 
fering. And if the drop be duly regulated, death must 



SPECIAL ARTICLES. 


Tb> Medical Pbess. 517 


Nov. 18, 1901, 

be practically inatanlaneous. The first important step 
in the amelioration of this form of capital punishment 
was made in Ireland. A scientific philanthropist of that 
country, whowai also both a medical man and a mathe¬ 
matician, conducted a series of experiments on dead 
bodies with the object of calculating the length of drop 
requisite in each indiridual case to effect laceration of 
the upper part of the spinal cord, by procuring disloca¬ 
tion or fracture of one or more of the vertebras close to 
the base of the skull. The net result of those experi¬ 
ments and the calculations based thereon, was that a 
certain number was fixed on, which, when divided by the 
number of pounds of the 1»>dy-weight of the person to 
be executed, gave the number in feet of the length of 
drop required. Soon after the publication of this mathe¬ 
matical method of execution a case came on in a prison 
in Dublin, the visiting surgeon to which was a friend 
and admirer of its author. Accordingly, the culprit 
was weighed, the requisite sum in division was 
performed,—the quotient was fourteen. Result: 
The victim when dropped was decapitated by 
the rope. The author of the improved method of 
jugular suspension had overlooked the fact that while 
sritbmeticid numbers are fixed qnantities, the resist¬ 
ance of animal tissue varies with the individual; 
and that, accordingly, two persons of the same weight 
may be formed of tissues of vastly different strength. He 
afterwards, however, made another fertile suggestion— 
of placing the knot of the rope under the chin of the 
culprit, instead of under the left ear as was the old tradi¬ 
tional “ Jack Ketch " custom. With a moderate drop 
this arrangement utilised the lower jaw as a lever whose 
agency fractured or dislocated the upper cervical verte¬ 
bra. The comment on the gha»tly accident to which we 
have above referred, was, happily, a strong factor in the 
abolition of the brutalising spectacle of publicexecntions. 

The horrors of the execution of the weak-armed and 
weak-minded Damiens for his "pen-knife scratch ” of 
the sldn of the worthless sensualist, Louis XY. of France, 
must elicit a sigh of relief when we contrast that event 
with the details of the execution of the successful assas¬ 
sin of the late President of the United States. There 
can be no doubt that while the law continues to wield 
the power of depriving a murderer of life, the exercise 
of this gloomy function can hardly be carried out with 
greater regara to decency and philanthropy than 
it was in the case of Czolgosz. Damiens had 
his right hand and forearm roasted in a slow 
fire on the scaffold; portions of his fiesh—in the 
most sensitive parts—were nipped off with red-hot 
pincers, boiling oil, boiling pitch, melted mstn, melted 
wax, <kc., were poured into the wounds; and, when life 
had ebbed so low that the perception of pain was 
obviously evanesoiDg, hie limbs were lashed to four wild 
horses who were then whipped in different directions. 
It is noteworthy that this well-arranged attempt to have 
hiTM tom in pieces completely failed, so that the dismem¬ 
berment was completed with knives. The wretched man 
was carved on the scaffold! 

The "Jungfrau" of Nuremberg was another monu¬ 
ment of the abused application of legal revenge. A 
gigantic female doll—massively constmoted of wood 
and iron—opened vertically along one side, and presented 
a cavity adapted to the stwding posture for a full-sized 
TTinn When riie person destined by law to submit to 
the embraces of this " maiden" was placed standing 
therein, the door was firmly closed, and he was pierced 
by some half-dozen iron spikes projecting from the 
metallic lining of the latter, each of about six 
or seven inches long. Two of these were arranged 
for the orbits, one for the heart, and the ethers for 
various parte of the trunk. Beflections on the existence 
of such horrors, and on the frequency of their applica¬ 
tion to wretch^ humanity, must at least leave us with 
the assurance that, even with all its hurry and worry, 
the age we live in permits an existence at least more 
endurable than did the " good old times " which we have 
so fortunately escaped. 

So far as we can inform ourselves regarding sensation 
of suffering, there can be no opportunity for its appre¬ 
ciation in electrocution. The discharge being sufficiently 
strong, all vital functions must instantaneously cease. 


We remember a great deal of sensational newspaper 
comment on the first eleotrocction. Death was said not 
to have been instantaneous; a small out on the finger 
yielded some blood. This result will always follow— 
for a couple of minutes, as the blood does not in 
any case coagulate intfanily after death; and in all 
deaths by electricity coagulation is notably imperfect. 
Then, the repeated application of the current was 
followed by the smell of burning hsir, of roasting flesh, 
&c. This must have been pure invention; good con¬ 
ductors, such as must hare bmn used, do not so rapidly 
become heated. The only thing that could bum in such 
circumstances would be a spark, which could not form 
when the contacts were complete. L-t ns conclude, 
while expressing the opinion that physical suffering is 
practically annihilated by the employment of electrocu¬ 
tion, by hoping that the necessity for the employment of 
even this hnmane agent in depriving a murderer of the 
first gift of his Creator, will steadily diminiab as the 
years of our twentieth century roll on. 


ANNUAL REPORT OF THE ROYAL COLLEGE OF 
SURGEONS OP ENGLAND. 

Wb have received the Annual Report of the Royal 
College of Surgeons of England for 1901, containing also 
the notice that the aunnal meeting of Fellows and 
Members will take place on Novemlar 2l8t, at 3 p.m., 
when the report of the Council will he presented. The 
Report is a record of work done in the various depart¬ 
ments from August Ist, 1900, to August Ist, 1901. The 
earlier pages are occupied with disciplinary matters, 
relating chiefly to the prosecution More the General 
Medical Council of a dentist at Bury St. Edmunds for 
using misleading titles when unqualified, although 
registered. This matter was investigated by ^e General 
Medical Council during their June Session, and its 
further consideration adjourned for the attendance of 
the offending dentist. One member was rightly remov^ 
from the College List in January for disgracefifi conduct. 
This individual was a Mr. J. T. H. West, who associated 
himself with the Drouet Institute, an establUbment 
which has been fully and completely exposed in our 
columns, in Truth, and other journals. 

Working in conjunction with’the College of Physi¬ 
cians, the College has been seriously considering whether 
any action is desirable to remedy the effect of the pre¬ 
sent regulations relating to the recognition of prelimin¬ 
ary examinations on the entries of students to the 
examinations for the Conjoint diplomas. It appears 
from a memorandum prepared by the CommittM of 
Management that in 1899,1,973 students were registered 
and in 19J0 only 1,712. The net decrease at the exam¬ 
inations is 261 on the year. Such a serious decrease 
naturally calls for the consideration of the CoUege. 

An alteration has been made in the regulations for 
the Diploma of Public Health, in order to prevent the 
six months' laboratory course from overlapping by more 
than three months the period of study to m spent under 
a mescal officer of health. These alterations are given 
inerletwo. Certain alterations have idso been made in 
the regulations for the Diploma in Dental Surgery. 

Of the College prizes, two, the Collie Triennial Prize 
and the Walker !I^ze, have not been awarded. The 
Jacksonian Prize has been won by Mr. McAdam Eccles 
for his essay on "The Pathology, Di^nosis, and Treat¬ 
ment of the Diseases caused by and connected with 
Imperfect Descent of Testicle." We note with satis¬ 
faction that in the regulations for the Cartwright Prize, 
now under the control of the College, and awarded to 
dental surgeons, it is stated that a Diploma or Licence 
in Dental Snrgery without a medical or surgical 
diploma or degree will not be a sufficient qualification. 
Such a proviso cannot but be beneficial to the advance¬ 
ment of the dental profession. 

Among the gifts which have been bestowed upon the 
College during the year are included a bust of the 
late Mr. Henry Lee, and a portrait of the late Dr. 
Richard Neale, the well-known compiler of the " Medical 
Digest." 

In the report of the Laboratories of the two Colleges 
' it is highly satisfactory to note the large amount of re- 

C 


518 The Medical Pbess. 


G E it M A N Y. 


Nov. 18, 1001 


eearoh work th«t bail been aooompUshod dnriDg the past 
year. A luge amount of antitoxic serom for the troat- 
ment of diphtheria has been prepared, no less 
thirty'Seren doeee of 4,000 units each, and 26 928 doses 
oontaining 3,000 unite each having been supplied. The 
work in other antitoxins has been equally great. 

Turning now to the report of finance, we find that the 
gr^ income of the College for the past year is £26,10i, 
being ^698 greater than the previous year. This is oUefiy 
doe to the advance in the amount of fees paid by oandi* 
dates for the Dental diplomas The bcdance of income 
over expenditure amounts to i£2,llG. from this, however, 
must be deducted ^490 for one half-year’s rstes, which 
has not yet been paid. On the other hand it must be 
borne in mind that the extraordinary expenditure for 
the year has amounted to £1,800. 

The reports for the Mnsenm and Library are in every 
way satietectory, both departments shoeing improve¬ 
ment. 

In March the College lost the services of a most 
devoted servant by the retirement of Mr. Trimmer from 
the office of secretary, after no less than forty-two years’ 
service. In consideration of his long and valuable con¬ 
nection with the College Mr, Trimmer has b^n granted 
a pension. 

The report closes with the usual balance-sheet and 
statistics of the examinations, and an obituary list, 
which shows ^at the College faas been deprived by death 
of thirty-three Fellows and 450 members. 


ftemump. 


[from odb owh corbsspondent.] 

Beeiis, November 9tb, 190L 

Ar the meeting of the Medical Society, Hr. Oluck 
showed three oases of 

Bbcovxrt from Tubbbculous Peritonitis. 

The three were just typical of the various forma of the 
disease. All were subjects of suppurative peritonitis in 
which recovery could not be brought about until huge 
incisionB had been made and even eventration performed, 
the exudation cleared out, and diseased portions re¬ 
sected. Hr. Gluck’s investigations dated from the year 
1861. They showed that animals could very well live 
twenty-four to forty-eight hours with an open abdo¬ 
minal cavity with eventration of its contents. Beposi- 
tion was effected after two or three days, the animals 
remaining alive, whilst the control animals, for whom 
his special apparatus was cot used, died with the 
symptoms of loss of beat, sepsis, &o. The method of pro¬ 
cedure had been adopted by surgeons of keeping the 
abdomen open, wiih free drainage of eecretioos. 

Hr. J. Israel held that the method followed by 
sn^eons generally was different from that of Gluck. 
Most surgeons did not treat the inteetinei whilst even¬ 
trated, they generally made an incision with a view of re* 
lieving tension and of fnrnishicg a serviceable method 
of draining. The procedure of draining the abdomen 
was much older than Gluck’s. He himself considered 
Gluck's apparatus to be unnecessary. He had practised 
long-continued drainage both in children and adults in 
the most severe cases, and eventration had never been 
found necessary. Most patients recovered with complete 
closure of the abdomen with the exception of a few cases 
with carious patches, which naturally must be treated 
by tamponnade, wherein he saw no new principle. 
Gluck's procedure, moreover, resulted in large abdominal 
hernia. 

Hr. Gluck maintained that his oases were so bad that 
they would have died if his particular method of treat¬ 
ment had not been put into practice. 


The Diet Tbxatmsmt op Epilepst. 

Dr. B. Balnit, in the Ungar. Mtd. gives an 

account of the great success he has himself obtained 
with the dietetic treatment of epilepsy. When it can 
be said that in an institution in which about thirty 
attAoks per day occurred among the inmates, and that 
by diet treatment alone this total of attacks was reduced 
to two to three in the day, it may fairly be claimed that 
the method is deserving of some consideration. The 
method described is simplicity itself, but unfortunately 
there will be difficulty in carrying out the treatment in 
a trustworthy manner except in institutions where all 
is under control. 

The first proposition is that a diet poor in chlorine 
can and shonld bs Ctfried out in all cases of epilepsy. 

2. That it can best be carried out in a sanatorium. 

8. That it should be strictly carried out in all cases 
until the disease has become thoroughly understood. 

4. Along with the diet poor in chlorine a sm^U 
quantity of bromine should be given. 

6. That the bromine is beet iutroduoed in the food. It 
is recommended that two to three grammee of bromine 
made up in the bread in which the bromide is made to 
replace tbe usual sod. obloridebe given daily. 

6. The favourable effects of the treatment lie meetly 
in the inoreave of action of the bromide. Cases to 
which the bromine was given without deprivation of 
salt did not improve mneb, and deprivation of salt 
withent tbe substitution of the bromide bad little effect 
compared with that produced by the combined depriva¬ 
tion of sodium chloride and snbetitation of potaasic 
bromide. 

The Treatment of Eclampsia. 

From October Ist, 1896, to October 1st, 1900,143 esses 
of eclampsia came under observation in the Letpeio 
University Frauenklinik. In tbe same period there 
were 1,902 labours, so that the oomplioationa occurred 
in about 2 per cent of the oases. In Olshausen’s 
Klinik in Berlin there was a case in even 216 labours, 
equal to 4-6 per cent. 

Tbe treatment oonsistod in quick but gently empty¬ 
ing of Ibe ntoms under an ansesthetia For eclampsia 
in the after-birth period the expectant principle was 
carried out Manual removal of the placenta was only 
practiced in a single case. Dilatation <A. the cervix was 
effected either by gradual dilatation by means of elastic 
bags or by incision, or by both methods combined. The 
incisions were made by grasping tbe cervix or edge of 
the OB by two Billroth’s pressure forceps and cutting 
through between them. In this way the onttiog is 
easier to do, and by leaving the foroeps on for some 
little time the bleeding is nsually slight. The incisions 
are not generally sewn up after delivery has taken 
place. With the fcetal head high up and freely movable 
turning was generally preferred. When it was found 
that the child was dead either before or during de¬ 
livery perforation was always effected. If the attacks 
followed one another very rapidly and no great amount 
of blood htd been lost, venesection was performed, slong 
with tbe venesection saline infusions were made. 
Morphia and warm baths were given in a few cases. No 
fiuids were given to the patient to swallow whilst uooon- 
scions, but the fauces were frequently washed out Tbe 
treatment described was carried out in all the writer’s 
cases, and it did not fail in any instance. In a latge 



AUSTRIA. 


Tbi Medical Pbxsb. 519 


Not. 18, 16J1. 

onmber of them the whole prooees of deliTery was com. 
pleted within the hoar. The anthor acknowledges that 
the method has risks of its own, but that snch 

a serions condition as eclampsia jnstifies a certain 
amount of risk. The prc^osis is much more fovonrable 
than in Cesarean section. As regards maternal mor> 
tality he claims that it will compare fayourably with that 
attending any other mode of treatment. 


JluBtrta. 

[TBOJt OVB OWN CO&BKBFOHDBNT.J 

ViEKVA, NoTember 9tb, 1901. 

TbB BlLiTION BITWIIN THE ClBCOLATION AND 
Toilirs OF THE Bowel. 

At the Oesellschaft der Aerzte Pal drew attention to 
the altered condition of the bowel when the oironlation 
of the blood is interfered with. In connection with this 
he related his experiments on animals with snprarenal 
extract which when injected into the eeins determines a 
marked relaxation in the bowel. 

In endeaTonring to carry ont these experiments with 
greater precision he found that compression of the 
aorta was not adapted for laboratory work owing to its 
mobility. Therefore, when one desires to demonstrate 
the behaTionr of the bloodTessels in the small intestine 
in relaxation of the bowel it is necessary to cniarise the 
animal. The suprarenal extract was afterwards in¬ 
jected, and the morements of the bowel carefully ob- 
serred by the aid of an instrument which 
roistered the varying curves of mnscnlar movement. 
It was found that the drcnlar and longitudinal mnsdes 
were enfeebled, and the peristaltio movement of the 
bowel abolished as if its nervous system bad been de¬ 
stroyed. Morphia and suprarenal extract, however, 
have antagonistic effects on the bowel, probably owing 
to the special vascular action of the extract. If a seg. 
ment of small intestine of a curarised animal be detached 
from the mesentery along with its nerve supply, splanch* 
nic irritation will produce relaxation of the bowel 
with a cessation of peristalsis. From this it would ap¬ 
pear that a contraction of the vessels of the bowel widl 
produces relaxation of the bowel itself, a fact which is 
not easy to explain. It has been suggested that 
this anomaly is due to some interference with the 
ganglionic apparatus. The bowel in this relaxed 
condition is not distended, but remains passive in 
medium contraction. Its peristaltic movement stands 
in direct relation to the blood circulation. If the 
vessels of the bowel contract so that stasis takes place in 
the veins the bowel beoomes relaxed: if the contractions 
are feeble owing to the lowered stimulus of the 
splanchnic, the peristalticwavedoes cot cease altogether, 
although it may be modified, but if the extract be in¬ 
jected the result is reversed, both stimuli bringing the 
pressure of the blood to the highest point of pressure. 
There is no doubt about the vasomotor system exciting 
an inhibitory effect on peristalsis, bat the phenomenon 
is not confined to this system of nerve supply. It most 
be remembered that the peristaltio movement is deter¬ 
mined by the contents of the bowel itself, operating 
from within outwards, a fact which supports the hypo¬ 
thesis that atony of the bowel depends largely upon 
disturbed nutrition. 


Biedl a«ked whether it was a fact that suprarenal 
extract acted directly on the intestinal ganglia. 

New Tbeatkbnt of CABCiiroxA. 

Loeffler has recently surprised the profession by anew 
treatment of carcinoma by injections of malarial blo^, 
or by exposing the carcinomatoaB patient to the infected 
anopheles. His treatment is founded on the observation 
that in Centml Enr<^ carcinoma is increasing, while in 
the Tropics and in malarial districts generally carcinoma 
is on the wane. This is not anew idea, as a case of car¬ 
cinoma recorded by Tmka in 1776 shows. 

Ltsol Poisoning. 

Bnrgl records two cases of lysol poisoning. One of 
the victims was only st. 5 days, the other 8 years. 
These were given one teaspoonfnl of the undilnted fluid. 
Severe symptoms have been observed following the 
external use of lysol, the symptoms resembling those of 
carbolic poisoning. Bnrgl recommends thorough washing 
out of the stomach and bowels, followed by plenty of 
fluids to hasten the elimination of the poison from the 
blood. 

DiPLOCoccns Sehilunabxs. 

Elebs believes that the diplococcus semiluraris plays an 
importantpart in the organism affected witii tuberonlosis. 
It is constantly to be found on the tonsils of tuberculous 
patients, and must greatly impair the results of treat¬ 
ment, as it markedly rednoes the resistance of the tissues. 
He relates many oases in which the diplococcus has 
effected more widespread destruction than the specific 
microbe tuberculosis. 

derating theatres. 

ST. THOMAS'S HOSPITAL. 

Gabtbo Entebostomt —Mr. Battle operated on a 
female patient, et. 60, but looking ocmaiderably older, who 
had been sent to him by Dr. Waters, of Sbeemess. The 
woman was pale, very thin and feeble, and her skin was 
wrinkled and parchment like. She stated she had been 
suffering from pain in the upper part of the stomach for 
three months, and the doctor in the note that he sent 
stated that he con'd feel a small tumour in the epigas¬ 
trium, and that in addition to the pain, she had vomit¬ 
ing after food and constipation. After admission, she 
was kept in bed for a time, and bismuth and morphia 
were given internally. This relieved the pain and 
checked the vomiting, so that she gained strength and 
appeared much better; but at the end of a week she 
sgain had a return of the sickness, so it was deciied 
to operate at once. Through a median incision above 
the umbilicus, the stomach was explored, and the tumour 
discovered in the position of the pylorus. This was bard, 
firmly attached to the 8tomach,and surrounded the orifice 
like a ring. The glands were also enlarged, and it was 
quite evident that the patient could not undergo the 
necessary manipulations involved in the removal of the 
tumour bad its general condition permittedof an attempt 
to remove it. It was decided, therefore, to do gastro¬ 
enterostomy, and attach the upper part of the jejunum 
to the anterior wall of the stomach. This was done by 
means of sutures only in the following manner: The 
small intestine was taken at tiie part where it comes 
round from the side of the spine and is attached. A 
sufficient length was taken from this spot, and a loop 
brought forwards and held in the wound with the por- 
Digiiized : 


520 Thi Medical Fbeas. 


THE OPERATING THEATRES. 


Nov. 18. 1301- 


tioQ of stomach to which it was to be sutarad. Con* 
tmooos silk sotare (No. 1) was passed after Lem> 
berfs method for about two inches, uniting the 
walls of the opposed stmoturea in a somewhat 
onrved manner. Precautions were taken to shut off the 
peritoneal cavity from the site of operation, and both 
stomach and small intestine were incised at an equal dis¬ 
tance over about an inch and a half. A. oontinnons 
stitch was then inserted so as to completely surround 
the two apposed openings. Very little escape of fluid 
took place. After the openings had been closed a second 
continuous stitch was inserted, which surrounded the 
inner line of euture at a short distance, and one or two 
reinforcing sutures were placed advantageously. The 
parts were washed with warm saline solution and the 
abdominal wound closed. Mr. Battle remarked that the 
advantages of this operation were obvious, and the 
relief which it afforded was very great. While the 
essential things required in any operation performed on 
patients suffering from this form of disease were that 
that they should be capable of being quickly per¬ 
formed, and not of themselves to be particularly risky. 
He was glad to And that opinion was coming round to 
the advantage, gainst other forms of operation, of the 
anterior method of gaetro*enteroBtomy, and of the 
method of suture over that of special apparatus. He 
had always been in favour of this method of operating, 
and invariably used suturing as above described. The 
methods of uniting intestine to intestine, he said, were 
very numerous and could be counted by the score, but 
the true solution of the successful operation consisted in 
careful preparation of the patient, asepsis and rapidity 
of operation, combined, of course, with accuracy of 
apposition of the parts. 

Six days after operation the patient was doing ex¬ 
tremely well. When she recovered from the anssathetic 
she was permitted to drink water at intervals, and on 
the following day careful feeding was commenoed. 

WEST LONDON HOSPITAL. 

Aupi'tatxon at Hip-Joint fob SaaooHA of Fauna. 
—Mr. SwiRFOBD Edwards operated on a girl, eet. 14, 
with the following history Two years previously she 
had had some slight pain in the left thigh, which was 
thought to be rheumatic, and which passed away after 
a short time. She enjoyed good health till nine months 
ago, when a doctor was called in on account of pain 
in the left thigh, which prevented her walking with 
comfort; the pain got worse, and the thigh began to 
swell. Her temperature at this time did not ex¬ 
ceed 100. The case was looked upon as being 
possibly one of periosteitis. On admission to the 
hospital the child was completely bedridden ; she 
was a weakly, sickly • looking girl, evidently 
suffering considerable pain, and she could not 
bear the limb touched. She lay on her back, 
with the left thigh externally rotated, abducted, and 
slightly flexed. The thigh itself was generally swollen, 
and appeared about four times the size of the opposite 
thigh. The skin over it was tense, and dilated veins 
running over the limb were a well-marked feature. The 
dii^nosis of the case evidently rested between a new 
growth and a periosteitis; this was easily settled when 
an incision under ether was made into the swel¬ 
ling two days before, as there was no escape 
of pus, but a laige quantity of blood, granulation 


material, and broken down d«bri$ the Anger; was passed 
into the medullary cavity about the level of the trochan¬ 
ters where the bone had nndei^ne spontaneous fraotora 
The relieving of the tension by giving exit to so large 
a quantity of blood gave the child considerable ease 
from her pain. It being decided that the only chance 
of saving her life was to remove the limb, Mr. Edwards 
amputated by Fnmeanz-Jordan’s method. As it ap¬ 
peared probable that the amputation would take un¬ 
usually long because careful dissection had to be made to 
avoid cutting in to the new growth, and as the evidence 
had showed the patient to be highly vascular, the child’s 
median basilic vein was exposed and the transfusion 
apparatus kept all ready to hand in case of emergencies. 
An Esmarch’s tourniquet was entrusted to an assistant; 
it was placed below the crutch and made fast over the 
iliac crest of the corresponding side; its front portion 
passing across a rolled bands^ acting as a pad for 
compression of the external iliac vessels. On severing 
the superficial and deep femorals it was found that 
heemostasis was not complete; in spite of this but little 
blood was loet, thanks to the rapid and effective way 
in which the vessels were seized by Mr. Bidwell, who 
was assisting the operator. In spite of the fact that 
there was a spontaneous fracture, no difficult was ex¬ 
perienced in exarticnlating, the head of the bone being 
levered out by the manipulations of the limb just as if 
there had been no fracture. The disease did not appear 
to have extended to the oe innominatnm. The patient 
having become pulseless, three pints of normal saline 
solution were injected into the already prepared veim 
with such marked effect that the girl when taken from 
the operating table had a better pulse than when she had 
been placed on it. Although the tonmiqnetdidnotappear 
to answer for the vessels in front of the limb, there was 
but slight bleeding from those in the posterior flap, so 
that but a few ounces of blood were lost daring the 
operation. As it was feared that the effects of the 
saline solution might soon wear off, the transfusion 
apparatns was kept in its place in the vein when the 
patient was taken back to the ward, so as to be ready 
at a moment's notice. Mr. Edwards said that in a case 
of this kind amputation could not be so quickly 
performed as when it was done for tuberoolous 
disease ; he pointed out that he had to steer 
clear of the tumour, which was evidently a 
rapidly growing central sarcoma. A curious point, he 
remarked, was the ease with which exarticulation was 
performed in spite of the fact that there was a complete 
loss of continuity between the head and shaft of the 
femnr. He had expected to have met here with a little 
trouble, and he had quite anticipated having to use the 
Lion forceps in order to remove the head from the 
acetabulum. He was afraid that the prognosis was bad, 
although it was quite possible that the child might live 
for a full year, and this with comparative freedom from 
pain. No further collapse having set in after operation, 
the transfnsion apparatus was removed on the following 
morning, and then it was noticed the patient was 
Buffloiently well to amuse herself by reading a book. A 
week after operation she was doing welL 

Tax only title bestowed on the medical profession 
on the King's birthday last Saturday was a knighthood 
to Mr. George Anderson Critohett, F.B.C.S., Oculist to 
his Majesty. T 

Digitized bvCjOOglC 


Not. 13, i901. LEADING ARTICLES. Th* Medical Pbxss. S21 

BkOISTIBEO fob r&AliSXlSSIOS Abboad. 


^h£ jprMB anb (ttirntlar. 

PcbUthed «T6ry Wedaeadaj norniag, Pnoe Sd. Pest free, S)d. 

ABVESTISSIIBRTB. 

POB On IvsBBTiOTWbole Psgs, Os. Od.; Hslf Pscs, 
£S lOs. Od.; Quarter Paxe, PI 6s.; One-eiEbth, 12e. 6d. 

Fob a Sbbus or Ibsutiobb Whole Page, thirteen insertiona 
(weeklj, fortnightly, or monthly), at £8 lOa. Od.; twenty-six 
insertiona (weekly or fortnightly) at £S Sa. Od.; flf^-two 
insertiona (weekly) at £8 each. Half Page, thirteen insertions 
at 35s.: twenty-six at SSs.: fifty-two insertions at 80s. each s 
Quarter-page, thirteen inaertiona at 18 b. twenty-aix insertions 
at 16a. s fifty-two inaertiona at 16a each. 

Small annonneements of Pnctices, AsBistancies,VacanoieB, Books, 
dto.—Seren lines or under, 4a. per insertion; 6d. per line 
beyond. 


(lEtbicftl fttzB anb Clrcnlot. 


“ 8ALU8 POPULI BUPBIHA LBX.” 


WEDNESDAY, NOVEMBER 13, 1901. 


THE LESSON OF LONDON AND ITS 
WATER SUPPLY. 

It is needless to point ont that the welfare of any 
community is inseparably connected with the purity 
and the sufficiency of its supply of water. In,many 
different parts of the United Kingdom the right of 
providing particular districts with that prime neces¬ 
sity of life has been granted by Parliament to private 
trading corporations, who are thus obviously placed 
in possession of a valuable monopoly. With the 
growth of the critical municipal spirit, however, the 
modem citizen has come to recognise that the profit 
made out of the sale of water and of certun other 
monopolies, such as artificial lighting and transit 
might with advantage to himself he diverted from 
the pockets of private individuals and applied to the 
relief of local taxation. In other words, that he 
should own the monopolies himself. In some of the 
more advanced provincial towns of the United King¬ 
dom the question has long been solved so far as water 
is concerned, by the construction of water systems on a 
scale that for size and completeness might compare 
with the famous aqueducts of ancient Rome. In 
London, however, the capital of the kingdom, the 
water monopoly remains in the hands of eight water 
companies, who possess therein a property of enor¬ 
mous value. These corporations have received 
their powers on certain conditions, as to 
pressure, purity, and supply, which have been 
time after time grossly violated. The recurrences of 
prolonged droughts year after year in the East End 
of London furnish an object-lesson as to the way in 
which a company can play fast and loose with its 
obligations and yet escape with impunity. Inquiries 
have been appointed time after time by Parliament, 
and their reports have demonstrated the defects of 
the present system and the inadequacy of the supply 
for the wants of a future generation, while at the 
same time they have approved tne principle of pur¬ 
chase by the municipal authorities. These points have 


been vigorously adopted in the policy of the London 
County Coxmcil, which was created in 1888, a body 
that represents the leaven 'of municipal enterprise 
and progressive prudence that has at length begun 
to permeate the population of the greatest and 
richest city in the world. So far their attempts to 
deal with the water problem have not been att^ded 
with conspicuous success. Indeed, it is not too 
much to say that the policy of the County Council 
has been met with determined hostility by the 
political party that is at present in power. The 
results of the conflict so far have been disastrous to 
the long-suffering Londoners, whose experience, it 
is to be hoped, will act as a warning to all 
municipal communities throughout the kingdom who 
have not been wise enough to secure the control of 
their water supply. During the last three months 
the addition to the Stock Exchange value of the 
Metropolitan Water Companies’ ordinary stocks 
amounted to £1,800,000, in spite of the fact that 
nothing whatever has occurred to enhauce their in- 
trinsic value. A similar advance took p'ace in 1879- 
18S0, after the announcement by Mr. Secretary Cross 
of the intention of the Government to deal with 
the subject. Six years ago, so it is stated by 
the County Council, the whole matter of pur¬ 
chase could have been carried through for 
£6,000,000 less than would have to he paid to¬ 
day. That unearned increment has been due 
munlyto the obstacles placed by the Government in 
the path of those who at the last Council Election 
received an overwhelming mandate from the electors 
in favour ofmnnicipalisation. The County Council* 
however, have now shown their determination to 
bring matters to a crisis. At a recent meeting, by a 
large majority, they decided to reintroduce their 
own Purchase Bill in the course of the next Parlia¬ 
mentary Session. In the event of their proposals 
being either rejected or lendered impracticable by 
the party in power, the Council wUl be thrown back 
upon their own resources. It is, of course, impossible 
to predict at this stage of the weary controversy what 
action will in that event be taken by the municipal 
authorities. At the same time it will not be for¬ 
gotten that strong reasons exist in favour of obtmning 
an alternative supply from the Welsh hills, which 
still hold a few watersheds available for the purpose 
that have not been already appropriated by other 
towns. The Thames water, from which London is 
mainly supplied, is extremely hard, and is contami¬ 
nated by an enormous amount of sewage. Moreover, 
its resources are already overtaxed, and in the coarse 
of another generation the increased population of the 
metropolis will render the acquisition of large in¬ 
dependent sources of supply imperative. Meanwhile 
the unearned millions multiply in the coffers of the 
water companies at the cost of the ratepayers of the 
metropolis. 

IS CANCER INCREASING IN FREQUENCY? 

Ik the Inaugural Address at the opening of the 

182nd session of Jervis Street Hospital, Mr. Austin 

Uiyiiized t 


&92 Ths Hxdical Fbkss. 


LEADING ARTICLES. 


Not. 13, 1901. 


Meldon, F.R.O.8.I., dealing with the question of 
cancer, brought under the notice of the profesMon 
some very striking statistics of the prevalence of 
this disease in these countries. The figures were 
derived mainly from the returns of the Registrar- 
General for Ireland, and are based on investigations 
which have been carried on in his office for some. 
years past. An examination of these figures shows 
that not only has the rate increased, but that in the 
actual number of deaths recorded there is a cones- 
pondingincrease. When,however, we come toexamine 
the different age periods, we find that the increase 
is much more marked for the common cancer age— 
that is, between 35 and 75—than for the other periods. 
The question whether these figures indicate that 
cancer is becoming more prevalent or not in Ireland 
is answered by Mr. Meldon in the affu’mative, chiefly 
on the grounds of the inadequacy of any other ex¬ 
planation, and, also, because it appears that cancer 
is the only disease which is causing a gradually 
increasing mortality all the world over. It has been 
urged that, of late years, as a result ci better sanita¬ 
tion and other causes, the mortality from diseases 
other than cancer has decreased, and that many of 
those who now die of cancer would formerly have 
died of other diseases before they reached the age 
at which they were likely to develop cancer. It is 
also urged that, as our methods of diagnosis are 
gradually becoming more and more accurate, so 
deaths are more and more frequently registered 
under their true causes, it must, however, be remem¬ 
bered that accuracy of diagnosis is more likely to 
diminish the number of cases registered as cancer 
than to increase them. We must also bear in mind 
the increased number of cures which the more radical 
methods of modem suigery have undoubtedly pro¬ 
duced. If, however, the prevalence of the disease is 
actually on the increase, we should expect that this 
increase would not only be noticed in the typical age 
period, but also in the other age periods in which 
cancer is not so common. The question whether cancer 
is increasing is intimately associated with another— 
Is the disease infectious or not P In spite, however, of 
the vast amount of work done on the subject, and of 
the very positive and dogmatic assertions made by 
some pathologists,the verdict still is that the parasitic 
origin of cancer is not proven. It will be remem¬ 
bered that, many years before the ccmtagium vivum 
of tuberculosis was identified, its infections nature 
was asserted, and we might almost say demonstrated, 
so that even had the tubercle bacillus not been 
discovered prophylactic measures against the 
disease might have been adopted. So also 
in the case of cancer; if it can be shown to 
be infections, much may be done to stay its ravages, 
even though its true cause remains a mystery. The 
map presented by the Registrar - General in bis 
i*eport shows in a graphic way the striking partiality 
of the disease for certain counties in Ireland. Thus, 
in Kerry, the death-rate is only 2’76 per 10,000, while 
in Armagh it reaches 10 09, and, generally, the rate 
is higher in the Eastern than in the Western 


counties. It would be interesting to compare the 
zymotic death-rate of these districts, for were it the 
reverse of the cancer rate it would go far to support 
the objection advanced above. It should be remem¬ 
bered that, at present, the two great varieties of 
malignant tumours, sarcoma and carcinoma, are to a 
great extent confused together, and, indeed, are often 
quite indistinguishable, save by careful histological 
investigation, consequently it is impossible to say 
definitely to which of the two the increased death- 
rate is doe. Whether, then, this increased death-rate 
from cancer is merely an apparent one, or due to 
an actual increase in the prevalence of the dioaaAA, 
must, we fear, for the present, like the question of 
of its parasitic origin, be regarded as undecided. 

THE PLAGUE. 

Once again the plague is with us, coming, as of 
old, by trade routes. It formerly entered Europe by 
Byzantium and Venice, and for the short time that 
Spain encouraged commerce found an entrance 
through Cadiz. To-day the infected cities are 
Naples, Marseilles; and Glasgow. It is an occasion 
for thankfulness that of British cities the one in which 
the plague makes its entrance is the one best adapted 
for Bocoeesfully dealing with it—a city in which 
sanitation is studied as a science and its laws adminis¬ 
tered with impartiality. As a disease the plague is 
very famUiar to us; for ages we have known its 
natural history, and from time to time the 
British Isles have been decimated by epidemics of 
the '* black death,” as it was called in the past. 
All ovm knowledge of the disease way be summed up 
in the statement: it is a dirt disease, begotten of 
dirt, fostered by dirt, conveyed by dirt, and destroyed 
by cleanliness. As a rule it takes its rise in some 
overcrowded Chinese city, and is conveyed to Europe 
either by the overland route through Russia, the 
absence of personal cleanliness of the Russian peasant 
favouring its propagation; or by sea, where the un¬ 
sanitary housing of the crews furnishes a suitable 
soil for its propagation. In the Middle Ages its 
march was slow, and during the winter months it 
seemed to halt at the frontiers of the different 
Western kingdoms and during its rest to acquire inten¬ 
sified virulence; and with the coming spring it entered 
new territories, and its course was ever marked by 
multitudes of victims. Winter had stayed commercial 
intercourse between the Orient and the Occident 
and the disease was not carried on until commerce 
once mora brought Eastern spiceries to Europe. 
To-day steam has enabled business to continue un¬ 
interruptedly throughout the four seasons, and 
brought the Far East within a few weeks' journey. 
With this quickened transit the plague travels all 
the faster, hence we find that almost simultaneously 
Naples, Marseilles, and Glasgow notify the presence 
of the plague. The progress of medicine has latterly 
been so much belauded that the lay public have 
come to expect of the science miraculous gifts. They 
I quite ignore the fact that as science progresses mlra- 
I oulons gifts fall more and more into disrepute. Medi- 

D.:zed t 



Not. 18, 1901. 


NOTES ON CURRENT TOPICS. 


Thk Mbdical Pbbbb. 323 


cine is expected to meet the pMseesed man at the gate 
and by an exorcism drive the evil spirit out. But 
medicine plays no such ro/e ; she instructs the people 
in the prophylaxis and treatment of the disease, and if 
the teaching is unheeded the foolish ones sulEer un¬ 
pitied. It is now nearly three hundred and 
fifty years Wsince George Baker taught, as 
Senor Rubio teaches to-day, that soap and water are 
the best prophylactics, that they are to be freely 
used on the house, the dress, and the person. In case 
of infection wash the patient and bum the infected 
garments; keep the surroundings scrupulously clean 
and give nourishment. To this the most recent and 
the most authoritative writer, Montenego, adds 
nothing. For the public the great truth is that 
cleanliness is a perfect protection against plague. 
As shown in the outbreak in Bombay, dirty sur¬ 
roundings will generate it and perpetuate it. As a 
prophylactic of disease we may accept John Wesley's 
dictum^" Cleanliness is next to godliness.” 


JlotM on Current 


Mumps in Dogs. 

Man is not the only animal that is liable to that 
very painful disease, mumps. It also attacks, 
though rarely, the canine race. The literature of 
tbe subject is scanty, and until quite leceotly was 
confined to the cases observed by Schussele in 1842 
and by Hertwig. In these cases the origin of the 
malady was unknown, but in 1896, and again in 
1897, Whittaker and Busquet showed two cases 
before tbe Paris Academy of Medicine, in which tbe 
disease appeared to have been transmitted to the 
dogs by human beings. On the second occasion evi¬ 
dence which tends to demonstrate the rarity of the 
affection in dogs was adduced by MM. Leblanc 
Nocard, and Megnin, all eminent Perisian veterinary 
stugeons, and none of whom have ever seen similar 
cases. More recently, in La. Presse Medu 
cole, MM. Busquet and Boudeaud stated that 
they have satisfied themselves that the dog is capable 
of catching mumps, that the disease is transmissible 
from one dog to another, and that there is to be 
found in the salivary secretions of dogs suffering 
from mumps a special micrococcus. These observa¬ 
tions of MM. Busquet and Boudeaud are interesting, 
for there remains much to be studied in tbe connec¬ 
tion between the diseases of animals and those of 
man. Their first case^occurring in a dog coincided 
with cases of mumps in human beings in the more 
or less immediate neighbourhood. The second was 
in a young animal, and the disease was manifestly 
due to contagion from tbe first case, for it was by 
playing with the plugs of cotton wool used 
to swab the buccal mucous membrane of the 
first animal that the second caught the disease. 
Three days after being thus exposed to tbe infection 
it began to sneeze frequently and developed 
a hoarse cough. The following day a swelling ap¬ 
peared in the right parotid region about the size of an 
orange. In both dogs tbe clinical evolutions of tbe 


disease were similar. In the early days there was 
dnlness and fatigue, with loss of appetite, frequent 
shivering, nasal obstruction, and continual sneez ing. 
A cough was speedily developed, and at the same time 
the parotid swelling made its appearance. Tbe skin 
over the gland became cedematous and slightly ten¬ 
der, and there was evident pain on mastication. 

Comparative Medicine. 

WE have long held tbe opinion that there is a great 
future before the comparative study of the diseases 
of animals and man. At present the veterinary 
department is kept too much apart from the 
study of human disease. It is true that the 
class of men who enter for the two professions 
are widely different, and as a rule the intellectual 
development of the average veterinary surgeon is not 
as high as that of tbe aven^i^e doctor. The veterinary 
surgeon is not usually endowed with a scientific trend 
of thought: there are, of course, exceptions, but they 
are few and far between. The majority do not take 
that interest in tbeir profession that one might 
expect, a fact that is probably lately due to the 
debasing influence of the persons with whom they 
are brought daily into contact, for it is well known 
that the respectability of the people who have much 
to do with horses is in inverse proportion to the 
nobility of the animal with which they have to deal. 
We believe, however, that there is a better future for 
the veterinary profession, a future which will largely 
owe its improvement to tbe comparative study of the 
diseases of man and animals. This is a study which 
has been too long neglected, but is becoming an 
absolute necessity in the face of modem sanitary 
science. — 

The Xaght Treatment of Lupus. 

The light treatment of lupus, introduced by Pro¬ 
fessor Finsen, of Copenhagen, has, so far, been 
attended by satisfactory results. Several installa. 
tions have been fitted up in London and through 
England, and the accounts which we hear are such 
as to justify further installations. It is yet too soon 
to express a final opinion as to the actual value of 
this mode of treatment, but it may safely be said 
that it has proved its right to a full trial. In Ire¬ 
land, so far, no installation has been started, and 
consequently we are glad to learn tl at in the near 
future this will not be so. At the annual meeting of 
the friends and supporters of tbe City Hospital for 
Diseases of the Skin, which was held last week. Dr. 
C. M. O’Brien, honorary physician to the hospital, 
announced that it had been determined to 
start a “ lupus lamp.” Unfortunately, as the 
funds of this hospital are not in quite the 
condition that its friends and supporters would 
wish them to be, the will cannot be imme¬ 
diately equivalent to the deed. However, the delay 
will not be long. To provide the necessary money to 
purchase what is always an expensive installation, it 
has been decided to start a special fund. We trust 
that the request of tbe hospital authorities for con¬ 
tributions will be speedily answered. The City Skin 
Hospital is not, however, to be allowed to have a 
Digitized t 


S24 Thx Mbdioal Psxm. 


NOTES ON CURRENT TOPICS. 


Not. 13, 1901. 


monopoly of '‘Inpns lamps.” The Royal City of 
Dublin Hospital is, thanks to the generosity of Mr. 
Marcus Moses, one of its goTemors, also to be 
equipped with one. Mr. Moses has expressed his in* 
tention of presenting the hospital with the latest 
modification of the Finsen lamp, a modification 
which is said to render it possible to obtain in fifteen 
minutes the same result which the original Finsen 
lamp required an boor to effect. 

The General Medical Council Election. 

We have received the text of Dr. Charles W. Hay¬ 
ward’s address as candidate for the Council, for which 
we are unfortunately unable to find space. His views 
appear to be generally in accord with those of Mr, 
Victor Horsley and Mr. George Brown; that is to 
say, he condemns the election of corporate repre¬ 
sentatives by the governing “ ring,” in lieu of by the 
general body of licentiates and diplomates, and he 
is strongly in favour of financial reform, though, as 
he does not go into details, this may mean anything 
or nothing. We agree with him that it is absurd 
that the Cotmcil should be put to the expense of a 
separate election when Mr. Horsley’s period expires,, 
especially when we find that the single elec¬ 
tion costs as much as the general election. 
The fault, however, does not lie with the 
Council, but with the faulty wording of the 
Medical Act. Dr. Hayward is apparently in favour of 
the registration of midwives *' when they have had 
whatever training is deemed sufficient to entitle them 
to registration,’’ another delightfully vague pro¬ 
nouncement which does not commit the candidate to 
very much. He is an advocate of the ” one portal ’’ 
system, though this is hardly within the sphere of 
practical politics at present. Incidentally he is in 
favour of the reform of the government of the Royal 
Colleges, but this is hardly a Council question. With 
regard to the Medical Aid system he would welcome 
what he calls “ comfortable protection,’’ but he does 
not indicate how be hopes this may be obtained. 
Until we know for certain what is the candidate’s 
attitude towards homoeopathy we deem it our duty 
to regard him with suspicion, moreover, the unneces¬ 
sarily energetic language in which he couches his ad¬ 
dress leaves the impression that his presence on the 
Council would not have for effect to expedite the 
I'ealisation of the reforms which be is williog to 
advocate. 

The Working of the Inebriates Act. 

The report recently issued to the Home Office by 
Dr. Walsh Braithwaites leaves no room for doubt as 
to the BUccepB of the Inebriates Act of 1898. Two 
facts are rendered clear—that the accommodation 
at present available is far less than is required, and 
that there is still much reluctance on the part of the 
ma^strates to put the measure into full force, 
partly from its novelty, partly from mistaken kind¬ 
ness. Both these ressons only require time for their 
remedy, and we are, therefore, justified in believing 
that so salutary an Act as this will soon be applied 
to the full extent of the powers it confers, and in 


hoping thatjParliament will one day go much further. 
We are just beginning to realise that wbat we now 
consider as vices are in reality more of the nature 
of.disease, and with that realisation comes the dawn 
of better things in the treatment of crime and its 
cousins—the various vicious habits. The craving 
for alcohol is as well defined a disease as scarlet fever 
or small-pox. Treated early, and with;firmne8B and 
wisdom, there is every hope that the victim of such 
craving may be restored to normality with every 
trace of bis depraved appetite gone. At present the 
alcoholic is treated with too much mistaken kind¬ 
ness, he is allowed to pursue his own course, to ruin 
his own ’career and that of his family until it is too 
late for him to be reclaimed. Some magistrates 
appear to be possessed by the mistaken apprehension 
that when the Act is invoked the applicants may have 
sinister motives, but, as an able writer on the 
subject has pointed out, the times when the exercise 
of such powers as the Act gives would be used 
to further evil ends are passed, and in these days of 
aggravated publicity the probability of abuses is 
smalt. At present, judging from the report alluded 
to, we are dealing merely with the fringe of a large 
evil. There are now existing only twenty-two insti¬ 
tutions for dealing with inebriates, and there is 
room for several times as many. There is plenty of 
scope for well-conducted private homes, and for 
charitable institutions for the poor, a class in which 
the working of the Act is potent for incalculable 
good. So far the results of the measureare very encour¬ 
aging, and it is to be earnestly hoped that, baring 
once started in such a work, the legislature will go 
still further, and help to so stay the liberty of the 
habitual drunkard that the bestial exhibitions of 
chronic alcoholics may become more and more rare. 

Vaccination and Small-poz. 

At a meeting of the Executive Committee of the 
Jenner Society, recently held at Gloucester, it was 
resolved unanimously, that it is desirable in the 
interests of the public health as well as for the fuller 
appreciation of the truth concerning vaccination, that 
in every outbreak of small-pox the authority respon¬ 
sible for the isolation of infected persons should, at 
as early a date as possible, and from time to time 
during the outbreak, issue, for the information and 
assurance of the public, returns of all cases of small¬ 
pox under their observation, in a form showing the 
vaccinal condition of all persons attacked who are 
alleged to have been vaccinated, in regard to (1) their 
ages: (2) the time when vaccination was done; (3) 
the evidence, so far as may be discoverable, from 
scars or other sources, of the character of their vao- 
oination; (4) the type of the attack; and (5) its 
result (so soon as this can be done). We cordially 
concur in this expression of opinion. It is highly 
desirable that such returns should be laid before the 
public promptly, frankly, and completely. The pre¬ 
sent tactics of the anti-vaocinationistsare to oonfose 
the public by adducing apparent contradictions in 
the statistics, a trick which is easily performed by 




Nov. 18,1901. NOTES ON CTJfiBENT TOPICS. The Uidical Psesb. 625 


taking apeoial groups of figures and according to 
them the value of the ^gregates from which they 
are drawn. 


The State Supply of Vaccioe. 

It is oeitainly a remarkable and not altogether 
creditable cironmstance that private practitioners 
should he unable to secure a supply of lymph from 
Government laboratories. As matters stand private 
practitioners are dependent for their supply almost 
exclusively on foreign sources, French, German, and 
Swiss. Under the old system of arm-to-arm vaccina¬ 
tion the practitioner might be expected to maintain 
his own supply, but this is obviously not possible in 
respect of calf lympb, and one would have thought 
that the first duty of the Government was to under¬ 
take the provision of the material. Under proper 
management the Government institutions might 
easily be made self-supporting, indeed they might 
even prove a source of considerable profit, for it is 
obvious that if the preparation of vaccine were not a 
profitable undertaking there would not be so much 
private competition. Representations ought cer 
tainly to be made to the Government urging this 
view, but the only means of bringing pressure to 
bear would seem to be through the press. 

Deaths under Chloroform. 

The heading “ Deaths under Chloroform ” is a too 
familiar one to readers of both medical and lay 
journals. Too familiar, too, is the insufficiency of 
evidence as to the direct cause of death and the 
treatment adopted. In ninety-nine out of every 
hundred cases, we meet with the same paucity of de* 
tail and the usual generalities—" everything was done 
that could be done,'* and so forth. For many 
reasons, it is most desirable to give the procedure 
adopted to revive the patient, to say how much 
chloroform was used, to describe the apparatus em¬ 
ployed, to note thelengtb of time the patient was under 
theansesthetic, andto detail the resnltsof post-mortem 
examination. Not so long ago the stereotyped con¬ 
clusion in such cases was “ heart failure,” or “ fatty 
degeneration of the heart.” Within the year, we have 
known of such a return, when the post-mortem 
revealed a normal condition of the heart. The truth 
is, we shall never come to a proper knowledge of how 
to iise this powerful antesthetic, chloroform, until the 
coroner’s inquest is made a searching one, and all the 
details of the administration of the drug, and the mea¬ 
sures taken for the safety of the patient, are fully set 
forth. Should a death occur from the administration 
of opium or strychnine, it is considered necessary to 
tell how much of the drug was given, when it was 
given, and the mixture in which it was administered. 
Why should these particulars not be given in a case 
of chloroform poisoning? The knowledge that 
every detail of the administration must be given at 
an inquest, would necessitate the keeping 
of a careful record of each administration, a 
much to be desired rule. Chloroform may or may 
not be the lethal drug it is said to be. The lethal 


result may be inherent in the agent, or simply due 
to carelessness. A searehing inquiry into the cause 
of every death would be a step towards eliminating 
carelessness. We purposely avoid the consideration 
of such questions as how chloroform should be given, 
or the best means of resuscitating an asphyxiated 
patient. We do no more than urge a searching 
inquiry into the cause of every death under chloro¬ 
form, in the hope that by so doing the importance 
of the duty may be impressed. 

Bone-setters. 

The question of the status of the “ bone-setter” has 
been raised by a remarkable controversy lately con¬ 
ducted in the columns of a sporting contemporary. 
The matter began by a certain Atkinson, a notorious 
bone-setter, being requested to give his services to 
the crippled children of the Potteries Cripples 
Guild, a charitable institution recently started. The 
local medical practitioners, who had previously 
offered their services to the; institution, naturally 
withdrew in a' body, on the ground that Mr. Atk inson 
was not a qualified medical man. Availing himself 
of the hospitality of our sporting contemporary, the 
bone-setter had the impudence to suggest his being 
allowed to demonstrate hissuperiorlknowledgeof bone- 
setting before a committee of, the medical profeesion. 
It is hardly necessary to point out that such a 
challenge could be made with perfect safety, since 
no medical man of standing would consent to act on 
such a committee, a fact of which the astute bone- 
setter was probably well aware, though he thought 
it worth while to avail himself of this oppor¬ 
tunity of advertising himself. It is strange to 
see this well-worn subject revived, for it was 
settled so long ago as 1867 by Sir James Fsget 
in an article in the British Medical Journal. Sir 
James pointed out that many cases of old sprains 
and stiffened joints after injury were often benefited 
by the forcible wrenching practised by bone-setters. 
He also mentioned the fact that the patients who 
are cured by these men boast of their wisdom in 
acting against the advice of their medical man, but 
those who are damaged are ashamed and hold their 
tongues. Obviously all the methods used by bone- 
setters are well known to every competent surgeon- 
They may, in some instances, do good where a timid 
surgeon fails, but the damage they cause in the 
ARgT^g&te is probably considerable. 

Fires in Oil Shops. 

The frequent recurrence of disastrous fires in oil 
shops, but too often accompanied by loss of life, is 
a matter which might usefully engage the attention 
of municipal authorities. These shops, which 
almost invaribly form part of ill-constructed build¬ 
ings, the ready prey of fire, are filled with the most 
infiammable material, in fact, a chance spark is all 
that is required to set the structure in a blaxe. The 
rem^der of the bouse is often let out in single 
room tenements into which whole families are 
crowded and escape becomes impossible owing to 

Digitized by Goog e 


52c Thb Midicai. i^bbb. NOTES ON COBBENT TOPICS. Nov. 13, 1901. 


the absence of any structural provision for this not 
unlikely catastrophe. Last week a fire broke out in 
an oil shop near Easton Boad, at 2 o’clock in 
the afternoon. The residents in the upper 
part of the building received prompt warn¬ 
ing, in spite of which three of them perished 
miserably in a few minutes, before assistance could 
be rendered, although this was near at hand and 
was promptly available. It is not too much to ask 
that special regulations should be drafted to prevent 
a repetition of such terrible disasters. No building 
should be employed for the purpose of an oil shop 
until it has been certified as suitable by the Council’s 
surveyor, who would, as a matter of course, insist on 
a fireproof floor between the shop and the upper 
part of the building. It is open to question 
indeed whether, under the circumstances, it 
should be allowed to convert such buildings 
into tenement bouses at all. We trust that no 
time will be lost in attending to this matter. 

Tlie Betirement of Dr. Glover. 

Wb receive with much regret the intimation that 
considerations of health prevent Dr. Qlover present¬ 
ing himself for re-election on the General Medical 
Council. During the fifteen years of Dr. Glover’s 
tenure of office he has consistently and temperately 
advocated the interests of the profession, and more 
particnlarly of the general practitioner before the 
Council. Thanks to his conciliatory attitude he le- 
tained throughout the goodwill of his fellow mem¬ 
bers, even such as were constitutionally opposed to the 
views which he sought to impress upon the Council. 
Dr. Glover was not in the habit of making speeches 
^ fffet, but confined himself to measures of reform 
which appeared to him to be attainable. This led to bis 
being reproached with lukewarmness, b\it those who 
bad opportunities of observing his management of 
affairs are fully aware that be lost no opportunity of 
furthering the interests of bis constituents. His 
assistance in committee work was always greatly 
appreciated, and we can quite understand that this, 
in addition to the strain of a large general practice 
to which, of late, the fatigue of electioneering was 
Buperadded, proved too much. It is satisfactory to 
note that this step has been taken not in deference 
to any actual ill-health but on medical advice ; in 
fact, it is prophylactic rather than curative. We 
part company with Dr. Glover with regret, and we 
truat his successor will cultivate his amenity of 
manner without on that account sacrificing the inte¬ 
rests confided to bis charge. 

The BfTects of Lead upon Lead Workers. 

So many ill effects have been, from time to time> 
attributed to working in lead, that it is of interest to 
note the opinions of anyone whose personal experi¬ 
ence has enabled him to state facte which tend to 
show that the evil has been somewhat exaggerated. 
Dr. F. Shufflebotham has contributed to a contem¬ 
porary the results of a systematic examination of 
the workmen employed iu lead processes in thirteen 


of the Staffordshire potteries. Iu these factories 
between 6,000 and 7,000 persons are employed, and, 
of these, 528 are engaged in lead processes^iS men 
and 179 women; 255 men and 41 women bad worked 
in lead for periods varying from five to more tbsi 
thirty years. Dr. Shufflebotham examined all the lead 
workers with speoial reference to the symptoms which 
are usually associated with lead poisoning. Hefortber 
obtained the history of the pr^nancles of the wives 
of 188 men who were married. His conclusions are so 
opposed to the popular notion of the effects of lead 
poisoning that they are worthy of being recorded. 
It must, however, be remembered that Dr. Shuffle- 
botham draws a distinct line between cases of lead 
poisoning and cases in which there is only evidence 
of the presence of lead in the system. Among 527 
cases of lead workers there was only one case of lead 
poisoning. Indlvidn d symptoms, which at first sight 
might have been attributed to lead poisoning were 
found on closer examination to be due to other causes. 
The health record of the lead workers was excellent, 
and would compare favourably with that of a like 
number of workers in any averagely healthy trade. 
Ninety-one operatives, who had worked in lead for 
more than twenty years, were not suffering from any 
ill effects, although they had worked for years under 
practically no reg^nlations. In conclusion, Dr. 
Shufflebotham states the very obvious but still often 
forgotten truism—“ It must be remembered that lead 
workers are subject to the common ailments of life 
just in the same way as other people.” 

A Fatal Tattoo. 

A LAB died a few days since at Newport (Mon.) as 
the result of pymmia, consequent on his having been 
tatooed by a travelling showman. Although a catas¬ 
trophe of this gravity is certainly very rare as the 
result of this silly practice, numerous instances are 
on record in which syphilis has thus been inoculated, 
the menstruum of the colouring matter frequently 
being the saliva of the operator. Under the circum¬ 
stances, we are not sure that the practice does not 
constitute a criminal offence, and it is a matter for 
surprise and regret that the coroner’s juiy did not 
append a rider to their verdict condemning it. 

Untrustworthy Serum. 

An outbreak of tetanus in children following in¬ 
jections of diphtheria antitoxin is reported from St. 
Louis, U.S.A., resulting in eleven deaths. This 
lamentable occurrence, which will certainly be closely 
investigated, is on a par with that reported not long 
since from Italy. Obviously the presence of the 
tetanus poison in the serum may have been dae to 
careless manipulation in the laboratory, not a very 
probable thing, or to the employment for the pre¬ 
paration of the serum of an animal suffering from 
the disease in an unrecognisable, or, at any rate, an 
unrecognised form. The first contingency would be 
rendered impossible by dealing with diphtheria 
serum only in laboratories exclusively devoted to its 
preparation, and it will be for bacteriologists to intro- 

D -:i(ized by CjOO^Ic 


Nov. 13. 1901. 


NOTES ON CURRENT TOPICS. 


Tbb Mbdical Pkbbs. ^^7 


duce a method of detecting incipient tetanns in the 
animals employed in order to obviate this terrible 
rieb. A simple plan, which ought never to be 
omitted, would be to test the action of each batch of 
serum before issuing it lo the public. A few more 
catastrophes of this magnitude would go far to 
inspire grave doubt in the public mind as to the 
trustworthiness of bacteriological methods. 

The Penalty of Wilful Negligence. 

Tbe Metropolitan Asylums Board have the legal 
power to recover tbe cost of maintenance of patients 
suffering from infections disease treated in their 
hospitals, but for some reason this right has never 
been enforced. There may be valid reasons why 
this should be so, but, as was pointed out by Dr. 
Gubb in a letter published in The Timet last week, 
no such indulgence ought to be extended to persons 
who, or whose children, contract small-pox in con¬ 
sequence of their wilfully or “ conscientiously ’* 
omitting to avail themselves of tbe protection 
afforded by vaccination. If the Board would cause 
proceedings to be taken to recover the expense of 
maintenance in all cases of unvaccinated smail-pox 
patients it would be brought home to a certain class 
of tbe population. that “ conscientiousness " confers 
responsibilities as well as immunities. 


The Surgery of the Large Intestine. 

The operative treatment of stricture of the large 
intestine is one of the most remarkable features in 
abdominal surgery. Though the diagnosis of this con¬ 
dition is frequently made with comparative ease when 
tbe case is presented to the surgeon’s notice, it is 
often far from easy in the early stages. It must 
probably ever remain impossible to diagnose stric¬ 
ture of the intestine as early as could be wished, 
since temporary and fallacious improvement 
80 frequently takes place when the patient comes 
under the regimen of careful dieting and medi¬ 
cinal treatment. An excellent article by Mr. F. 
M. Caird has lately appeared in a contemporary, ia) 
on *' Operative Interference in Cases of Stricture of 
the Large Intestine.’’ Twenty oases are described 
on which the author has operated, and his re¬ 
cord is one of which be may well be proud. 
As it is obviously impossible to give in detail 
the clinical history of each case—when tbe number 
is so large—in the space available in a journal, it is 
to be hoped that Mr. Caird will embody his experi¬ 
ence, and tbe judgments he has formed from it, in a 
more pretentious form. Tbe paper is concluded by 
some eminently practical remarks. It is pointed out 
that “ carcinoma of the sigmoid readily gives rise to 
obstruction, and this may occur suddenly without 
any marked antecedent symptoms. In such cases 
the sensitive distended csecum may simulate the site 
of stricture.” This is an observation of importance. 
The fact that the transverse colon has been 
found contracted while the ceecum was distended, 
has led to the conclusion during operation that tbe 

(a) The ScoltUk Medical and Surj/ical Journal, September. 


constriction was higher up than was really the case, 
with the result that a “ ring ” stricture of the sig¬ 
moid has been overlooked. The apparent passage of 
the long rectal tube beyond the limits of the rectum 
I before operation was undertaken lent colour to 
the opinion at the operation that the stricture 
was higher up tbe bowel Mr. Caird, in our opinion, 
very correctly placee a high value on tbe use of 
enomata for diagnostic purposes. Needless to say 
they are best given either by tbe surgeon himself or 
by some one under his direction and in bis presence. 

A Elnighthood for Mr. George Anderson 
Critchett. 

We hasten to offer our cougratnlations to Sir 
George Anderson Critchetr, P.R.O.S.Ed., Surgeon- 
Oculist to His Majesty, and Senior Ophthalmic 
Sut^^eon to St. Maiy’s Hospital, on his selection for 
the honour of knighthood. Indeed, it is not without 
a feeling of surprise that his inclusion among tbe 
recipients of birthday honours” reveals to us tbe 
fact that it still remained for him to be knighted. 
Mr. Critohett’s pre-eminent position among ophthal¬ 
mic surgeons in the metropolis, and bis long record 
of surgical work, keeping aflame the torch banded on 
to him by his eminent father, constitute a legitimate 
claim to titular distinction; and the recognition of 
this fact by those in power awakens a feeling of 
satisfaction, which, we doubt not, will be generally 
echoed in medical circles. 

Small-poz in London. 

The steady extension of the outbreak of small-pox 
in tbe metropolis cannot ful to excite the gravest 
appiehensions on the part of all who are acquainted 
with the natural laws that govern the spread of that 
highly infections malady. The very size of London 
constitutes one of tbe most serious elements of tbe 
situation. It means that a great number of un¬ 
protected individuals are brought into daily contact 
with one of the most communicable of all the infec¬ 
tious diseases. Moreover, owing to the anti-vaccina¬ 
tionist tendencies and tactics of many of the boards 
of guardians, the unprotected cases are in many in¬ 
stances congregated in particular districts. When 
small-pox once gets afoothold in an unprotected com¬ 
munity, its progress is likely to be marked by devasta¬ 
tion such as that recorded by history in some of the 
islands of the Pacific, where the disease found virgin 
soil wherein to propagate. Fortunately, in spite of 
the thickheadedness of anti-vaccinationist guardians 
and of the foolish backsliding of Mr. Balfour’s per¬ 
missive vaccination Act, the evil will always e 
checked by the presence of a fair percentage of sane 
persons protected by vaccination here at home in tbe 
United Kingdom. For all that, the returns of the 
present outbreak in London are of a most disquiet¬ 
ing character. The progress hitherto has been 
steadily in an upward direction, so that at the end 
of last week there were no less than 309 cases under 
treatment in tbe various metropolitan fever hospi¬ 
tals. Tbe gravity of the situation may be to some 
extent gauged when we attempt to realise the mean- 



528 Thb Mtoioal Pk«8. notes ON CURRENT TOPICS. 


Not. 18, 1901. 


ing of BO large a number of centres of infection 
scattered among tbe dense population of the metro* 

politan area. - 

Human and Bovine Tuberouloais. 

This subject was discussed at a meeting of the 
Council of tbe Central and Associated Chambers of 
Agriculture on NoTember 5th, and the report was 
adopted that no change in legislation concerning 
tbe slaughter of tuberculous cattle should be made 
till tbe result of the Royal Commission was known. 
This question is one of great importance, owing 
to the recent remarkable statements of Professor 
Roch, who, it will be remembered, declared that 
tuberculous infection in man r<>rely, if ever, arises 
from tbe milk and meat of tuberculous cattle. The 
opinion of such an authority must naturally be re¬ 
ceived with attention, but in view of the importance 
of tbe matter to the public health it is certainly 
wise to defer any change in tbe strictness of legisla¬ 
tion till a Royal Commission has made its report. 

A PBOPOSAii has been brought forward to offer a 
small remuneration to the junior medical staff of the 
Birmingham General Hospital; but in view of the 
present tmsatisfactory financial position of the insti¬ 
tution, this suggestion has met with opposition. It 
really seems hardly fair to ask duly qualified men to 
discharge the onerous and responsible duties apper¬ 
taining to these posts without covering their out-of- 
pocket expenses, and certainly an annual stipend 
of £50, tbe sum Buggested, does not err on the side 
of extravagance. - 

A DISCUSSION on tbe various aspects of small-pox 
and vaccination is announced to take place at the 
Hunterian Society to-day (Wednesday) at 8.30 p.m. 
Dr. MacCcmbie and Dr. Major Greenwood will con¬ 
tribute papers bearing on the subject, tbe former on 
"The Present Position of Small-pox and Yaccina- 
tion,” and the latter on “ Tbe Diagnosis of Small¬ 
pox, with Remarks on Prodromal Rashes.’’ Dr. W. 
A. Bond has promised to take part in the discussion. 

Thb Autumn Session of the General Medical 
Council will be opeced on Tuesday, 26th inst., at 2 
p.m., when important business wUl be considered. 

FEBSONA.L. 

Da. Hxnbt Dutch has been elected representative of 
the Grosvenor Ward on tbe Council of the City of West¬ 
minster. — 

Da. Cant, of Coleshill, has been appointed medical 
officer to the Marston Oreen Homes, Birmingham, having 
been selected from among three candidates. 

Sib Wk. Dalbt will preside at the second annual 
dinner of the Otologioal Society, which is to take place 
on Monday, December 2nd, at the Caf4 Monico. 

pBorxssoB Watson Chbtnb delivered an address on 
** The Treatment of Wounds in War ** at the opening 
meeting of the Midland Medical Society at Birmingham 
on Thursday last. 

Db. Thos. B. Fbasbb, F.B.C.S., Professor of Materia 
Medica and Clinical Medicine in the University of 


Edinburgh, has been elected President of the Edinburgh 
Medioo-Chirurgioal Society. 

SiB William Bboadbxnt preeided at the Boyal 
United Service Institution yesterday, when Dr. Leigh 
Canney gave alectnre on “Typhoid, the Destroyer 
of Armies, and its Abolition.'* 

Thb M.D. degree with honours was bestowed on Hr. 
David L. Cairns, M.B„ at tbe Graduation Ceremony of 
tbe Glasgow University last week. No other candidate 
obtained bononrs, but several were '* highly com¬ 
mended.'* ■ 

Dr. Fbane Ooston, of Dunedin, New Zealand, has 
been appointed medical officer of health for the southern 
half of the South Island. Dr. Ogeton is also Leotureron 
Medical Jurisprudence and Public Health in the Univer¬ 
sity of Otago. - 

Wb hear that Mr. Mayo Bobeon, of Leeds, has acquired 
No. 8, Park Crescent, Portland Place, as a London reti- 
denoe. He will, however, continue to occupy the poei 
tion of Emeritus Professor of Surgery in the Yorkshire 
College, and of Senior Surgeon to tbe Leeds Znflrmtry 
in oonneotlon with his practice in Leeds, dividing his 
between tbe two cities. 

Subobon- Gbnbbal T. P. O'Dwtxb, A.M S., who is 
vacating his appointment ae Principal Medical Officer 
at Aldershot, was entertained at a luncheon last week 
at the Boyal Hotel, when the Chairman of the Distriot 
Counoil bore testimony to the splendid service he had 
rendered, and assured him that he would leave Aider- 
shot to the regret of the whole community. 

It does not frequently happen that medical men 
become Masters of the ancient City Corporations. We 
are glad, therefore, to record that on Wednesday last 
Dr. George Flux and Sir Edward Montague Nelson, 
E.C.M.G., took their seats ae Prime Warden and Renter 
Warden respectively of tbe Worshipfnl Company of 
Dyers, they having been previously elected at the last 
General Court. ■ - 

As will be seen in another column. Dr. Glover has wit . 
drawn his candidature for the Medical Council on health 
grounds. There is no farther addition to the list of 
names, but we are informed that a large Committee 
has been appointed to promote the candidature of Dr. 
Norman Walker for Scotland, of which Dr. A. Gibson is 
chairman, and Dr. F. D. Boydand Dr. B. J. A. Berry are 
seoretaries. 


BIRTHDAY HONOURS. 


Knighthood on George Anderson Critohett, Esq, 
M.A. Cantab., F.R.C.8. Ed. 

C.M.O. 

William Robert Henderson, Esq., M.D., Principsl 
Medical Officer of the Gold Coast. 

Lieat.-Colonel George Hart Desmond Gimlette, M.D., 
Indian Medical Service. 

Honorary Major Thomas Henry Hill, lately Senior 
Assistant Surgeon, Indian Subordinate Medical Depart¬ 
ment. 


India Ofvicb, Nov. 9, 1901. 
Eaisab-i-Hind Mbdal roB Public Sbbvicb in 
India. 

Tbe King has been pleased to approve of the grant 
of the Gold Medal to the following: — 

Major Herbert Edward Deane, RAM.C. 

Major Thomas Edward Dysco, M.B., C.M., Indian 
Medical Service. 


Digitized by 


Google 



Not. 13, 1901. 


SCOTLAND. 


The Medical Pbeu. 629 


LieTit.>Colonel JameB M'Cloghrj, F.B.C.S., IndiAn 
Medical Serrice. 

Captain Edmund WilkinBon, F.E.C.S., Indian Medioil 
Serrice. 


^cotlanb, 


[fbou ona own cobrsbpondentb ] 


The New Gabtnavel i ppointment. — Dr. Oswald, 
Medical Superintendent of the Olas^w District Asylum, 
Oartloch, has been appointed Physician Superintendent 
at the Glasgow Boyal Asylum, in room of Dr. Yellowlees, 
retired. The salarr is, of course, considerably reduced, 
liecause Dr. Yellowlees is a man of great reputation and 
exferience, and Dr. Oswald is a young man. The Beard 
has been feeling fora long time that the salary of ^2,000 
was much too large, eren apart from age altogether, 
inasmuch as a consultation practice goes along with it. 
On this point, however, we will not grumble, ^r, being 
medical men, we feel ^nnd to support our profession, 
though we feel that the position is a sufficiently re- 
ui neratire one. Dr. Osw^d is a man who will do it 
justice, and he has worked very hard. He has alre^y 
made his came, and will get due distinction for the 
ntme of lunacy administration in Scotland. 

Plaque in Glasgow. —It is gratifying to be able to 
re|ort that the plague, if not stamped out, at least 
shows no sign of spreading in Glasgow. No fresh cases 
have been reported, and the four patients at present in 
the Fever Hospital are progressing satisfactorily. It is 
stated that the rats destroyed in the Central Hotel 
have been proved to be infected, and while this state of 
matters remains there is, of course, always the fear of 
recrudescence. 

Death of Two Fbominent Scotch Pbactitionbbs.— 
Two of the best-known Scotch provincial practitioners 
have been taken from our midst during the past week. 
The death of Dr. Connel, of Peebles, was announced on 
November 4th, and only a day or two later that of Dr. 
McEelvin, of Oban. Dr. Connel was a well-known 
%ure in Edinburgh medical circles, and both there and 
in his own country he will ^ missed by all who 
knew him. He took an active interest in things 
medical, and was at one time President of the 
local branch of the British Medical AssooiatioD, of 
the Edinburgh Obstetrical Society, and of the Harveian 
Society. Few men were more respected than he, and 
his name was a houshold word over the whole eastern 
border. Dr. McEelvie was one of the most prominent 
medical men in the West Highland, and his name will 
always be associated with the isolation hospitid which 
he gave to Oban. It is said that he was instigated to 
this act of generosity by being called to attend a 
wealthy American tourist, residing at one of the Oban 
hotels, when, finding that his patient was suffering 
from an infectious dmease, he was compelled, fauU de 
miewe, to isolate him in the poorhouse. With ebarao- 
terististic energy he at once eet to work to remedy this 
anomalous state of matters, and the present isolation 
hospital is an evidence of his success. Though he had 
failed in health lately, his death came as a surprise, as 
he was doing his usuid work only two days previously. 

Glasgow Ophthalmic Institution.— A course of 
post-graduate lectures on Diseases and Injuries of the 
Eye was inaugurated on Tuesday last, under the presi¬ 
dency of Professor John Glaister. There was a numer¬ 
ous attendanoe of general practitioners. In addition to 
a presentation of clinical cases and a display of stereo- 
soppio photographs, Dr. Maitland Famsay gave a lantern 
demonstration on CoDjunotivitis, specif reference 
being made to the microbio origin of its vations forms 
and tbeir treatment. I 


Kew Mnnlflcent Donation to London Hospitals. 

The estate of the late Mr. Matthew Whiting, of 
Ancklands, Wandsworth Common, has been valued at 
Jil69 104 8s. gross, indnding personalty of the net value 
of £140,870 1^. 7d. After disposing of about £20,000 to 
relatives, Mr. Whiting left the residue of his property, 
in trnst in equal shares, for twelve London hospiti^. 


ELECnON OF DIEECT EEPRESENTATIVES TO 
THE GENEBAL MEDICAL COUNCIL. 

Fellow Pbactitionebs of England and Wales,— 
Yon are perhaps aware from announoemenfn in the 
medical journals that I have been forbidden, at w^t 
seems a moat inopportune moment,*by my m^ioal ad¬ 
visers, to take part in public meetings They do not go 
so far as to advise me to abandon my candidature, but 
they counsel some diminution of work. I am in the en¬ 
joyment of my usual health, and my eye is almost itself 
again. Still, I am bound to respect advice given me by 
my truest friends, whose names wonld command the 
respect of the profession. 

The relinquishment of practice wonld be distasteful to 
me, and altogether beyond the necessities of the case. 
The only other way in which I can relieve mvself of 
work is b; retiring from my candidature for the honour¬ 
able office of representing j ou in the General Medical 
Council. I can do so now without putting the Council 
to the inconvenience and expense of a separate election. 

These circumstances determice me to withdraw from 
the present contest. I cannot tell you with what reluct¬ 
ance I do so, especially at a moment when questions of 
great interest to the public aud the profession are before 
the Council in which I have, as I bdieve, taken a part 
representing th4 general judgment of my fellow practi¬ 
tioners—nor c-AH I say how grateful I feel to the pro¬ 
fession for its kindness and oonfidenoe daring the last 
fifteen years, and of the continnanoe of which I have 
ample testimony on the present oocasioo. I ask you to 
accept my best thanks. 

The office of a Direct Eepresentative in the General 
Medical Council, with a constituency of over 23,000, is 
not an easy one. Many questions present themselves at 
the Connell Board in a very different light from that 
in which they appear when viewed from a purely pro- 
feesional standpoint. And the Direct Eepreseatative 
has to act accordingly. I ask yon to believe that on all 
such questions I have tried to remember the interests 
of the profession, as well as those of the public and to 
harmonise the two. 

I have endeavoured to advanoe medical education, to 
maiutain the standards of professional conduct, and to 
keep the Btgi ler pure. Tlmt 1 have erred often goes 
without saying, but 1 am sure you will be more blind 
than critic^ towards my faults, and will give me credit 
for having tried to maintain the cause of Direct Eepre- 
sentation in the General Medical Council, which, after 
all, even its critics mnat admit, is the g^reat Council of 
the profession. 

'With deepest thanks, I am, Fellow Practitioners, 

Your obedient servant, 

James Gbbt Gloteb. 

25 Highbury Place, N. 


Candidatube of Mb. Obobge Bbown and 
Mb. Geobge Jackson. 

Manchisteb and Distbict Committee. 

At a meeting of practitioners held on Friday after* 
nooD, Novemlwr 8th, at the Deansgate Hotel, Dr. John 
Watson, of Ardwick, in the ohair, it was resolved to form 
a committee to take steps to secure the election of Mr. 
George Brown aud Mr. Georgs Jacksou as direct repre- 
Bentativee of the profession on the General Council of 
Medical Education and Registration. 

Only a few hours’ notice of the meeting had been 
given, oonseqnently but a small number of the fifty in¬ 
vited were present. Several replies were reoeived ex- 
pressing a desire of the authors to be placed on the com. 
mittee, and already twenty-nine representative general 
practitioners have personally promised to serve, and 
many others have pledged their votes to these two 
oan<iUdates. 

The following officials were appointed:—Chairman: 
Jas. Brassey Brierley. Treasuier: G. H. Broadbent, 
M.E.C.S.. L E.C.F.I. and L.M. Hon. Sec.: J. Peroival 
Brown, H,B., Ch.B.,Vio. 

Ebbatum. —In the first line of Dr. Brierley's post¬ 
script to his letter on the above subject in our issue of 
last week the word “refuse” should read rstvm. 


COfiRESPONDBNCE. 


Not. 18. 190h 


530 Xjq Hbdical Pb>88. 


(Zr0rrt0]r0nbnt£t. 


fWedo not bold oomlTMioipoiuible for tba opinioiu of our 
corraapondents.] 

DEGREES FOE LONDON STUDENTS. 

To iko Editor of The Medical Pbebb and Cibculab. 

Bib,— In yonr last i&eae there appealed an interesting 
leading article nnder the above heading in which you 
refer to the aims and objects of the " London Licentiates’ 
and Members’ Society.” 

There is little doubt that opposition will be forth- , 
coming if the ]^yal Colleges obtain povera to grant. 
degrees. I submit that such opposition is not just, and 
therefore should have no weight. 

Why »honId not London, with its 4 646,762 (in 1899) 
inhabitants, equalling the whole population of Scotland, 
have two bodies granting medical degrees when that 
nmall division has no less than four? The old Univer¬ 
sity of London would continue to grant a degree of an 
honors standard, and the Royal Colleges a pass degree 
in medicine. 

Why should not the abov^named bodies combine to 
perform these respective functions in conjanction with 
one another? Why is the suggestion that the Royal 
College of Physicians of I«ndon be requested to rescind 
its bye-'aw, do, considered impracticable ? 

The Royal Colleges have as much right to give their 
diplomatee the courtesy title of Dr, as any Provincial 
University has to concede this title to their Bachelors 
of Medicine outside the preointe of the University. 

As to the suggestion respecting the holders of the 
F.R.C.S. and M.RC.P.Eng., they already haveasnp^ 
rior professional status, and require no enhancing in 
value. In fact, the Royal Colleges have seen the 
necessity of safeguarding the holders of these titles by 
reserving the gre*t London Hospitals as their special, 
preserves, forgetting the interests of their Licentiates 
and Members, the latter not having the franchise of 
their Colleges. 

T submit, therefore, to the consideration of the Royal \ 
Colleges, that if th^ ate unable to adapt themselves to ' 
the times they can hardly expect men to enter for the 
conjoint diploma when, with the same amount of time 
and study, and the passingof similar examinations, they 
can obtain a provincial d^^e, with its many advantages, 
professional, social, and pecuniary. 

I am. Sir, yours truly, 

F. W. COLLINOWOOD. 

63, Wimpole Street, W. 


THE “ELUSIVE SECRET » OF CANCER 
CAUSATION. 

To the Editor of The Medical Pbess and Cibculab, 
Sib,— In your editorial note referring to the German 
Emperor and his steps to promote the study of “ Cancer ” 
you remark, “ The secret of the cansation of cancer is 
so elusive that, if mankind can ever hope to wrest it 
from the hand Nature, it is only by means of a concen¬ 
trated, sustained, and well-equipped attack.” Will yon 
permit me to record an emphadc protest against the 
opening words of this sentence ? First, on the grounds 
that they are not altomther true in substance or in 
fact. Secondly, that they lend countenance to that 
regrettable featnre in modem lay journalism which so 
often displays itself by sensational paragraphs anent 
“ Cancer," assuuiing therein a mystery which does not 
exist, and attributing to the medical profession a prac¬ 
tical impotence in its treatment which is enormously 
exaggerated. 

venture to submit that there is no secret or obicurity 
wnatever about the gross causes of “cancer,” using the 
word “ causes" in its familiar acceptation, to denote 
immediate antecedents, or forces, operating to produce 
a definite result in an intelligible manner. If we pass 
further to teleology, we assuredly find mystery enongh ; 
but no more in the development of cancerous maladies 
than in any other morbid or even physiological process 
—than in the law of gravity. 

No tingle inttanee of ordinary cancer ev :r appears with¬ 


out such well'Tecojnited and ascertainable anUeedents. 
Take, for instance, the familiar mammary carcinoma of 
woman. We have hero an organ which, after a period 
of development, followed by one of functional activity, 
passes into a third of devolution, of final degeneration 
and decadence. Any conditions gravely interfering 
with the natural slow and gradual course of the last 
stage result in gross disease. Cancer is only one of the 
necessary consequences of this perturbation. Cysts and 
oUier forms of benign tumour are generated in exactly 
the same way. But we invariably find that the ante¬ 
cedents have been operative in full force for a consider¬ 
able period of time, amd, excluding teleology, of course, 
we can have no difficulty in comprehending how the net 
result has accrued. The same with nterine ameer. 

Take, ag4in. Epithelioma, the prevalent “ canew ” of 
the male. We And an unhealthy mnoona membrane in 
an elderly man. Or, occasionally, in a younger one we 
see this structure depraved by chronic alcholism or 
syphilis. A little crack casually occurs and refuses to 
be^. It is continnally rubbed or chafed by some agency, 
which need not be specified. After a prolonged oonne 
of such treatmentthe ordinary phenomena of maligoao^ 
appear. Where is here the secret or mystery ? The 
above is a very ordinary and fsuniliar train of events. I 
have been accustomed in lectures to instance it as “ an 
experiment in cancer-production performed every day 
by Nature before our eyes.” 

We do not certainly comprehend why the particular 
cells concerned, whether mammary or mucous, should 
change their natural behavionr, and should bee'me the 
active agents of those grave phenomena summarised by 
the phrase “ cancer process." The autositic theorypur- 
porte to explain this transformation ; bnt still that is no 
more than a theory awaiting experimental elucidation. 
Exactly the same could be said of the nltiiuate pheno¬ 
mena of any disease which could be named, or of the ordi¬ 
nary process of healthy growth. 

It involves no end of fallacy to talk of “ cancer " as 
though it were a single disease. In fact, one might as 
well talk of “fever.” Every separate tissue has its own 
special form of malignancy, and the causes which operate 
upon each of those before its special malignant keion 
is generated are exceedingly diverse and varied. For 
those who care to study the matter from a more scientific 
point of view than that of the average lay journalist, the 
group of diseases popularly known as “ cancer” is a snffi- 
cienUy large one. The fint stop towards scientific seen- 
racy is a recognition of that fact, and particululy in 
discussing the causation, the inclusion of all the a^ve 
under a single term is peculiarly misleading. 

Mesmwhile, with all due respect, I would urge on your 
consideration that the gross vxoiting causes of each 
and all these growths is pwfeotly well known, has been 
formulated over and over i^ain, and can hardly be 
admitted as even within the sphere of l^^timate oontre^ 
versy. While so much remains truly obscure, it is 
surely a great waste of force to keep ou professing 
doubt about well-attested sequences. No reasonable 
man now cares to argue that the world is round. 

I am. Sir, yours tru'y, 

Hbbbibt 8now. 

Senior Acting-Surgeon, 

6, Gloucester Place, Cancer Hospi^. 

Portman Square, Nuv. 7th, 1901. 


(DbitURTB- 


ALEXANDER HUGHES BENNETT, M.D., F.E.C.P. 

We have to record the death of Dr. Alexander Hughes 
Bennett, at Ladbrook Grove, Nottini Hill, ou November 
1st, at the age of 53. He aas the only son of the late 
Professor John Hoghes Bennett, who for many years 
held the chair of Institutes of M-^cine in the Univer¬ 
sity of Edinburgh. Alexander Bennett took his M.D. 
in that nniversity in 1872, obtaining the gold medal for 
a thesis on the pharmscologiotl actio is of thaine, 
caffeine and allied substances. After a short time passed 
in the service of the P. aud O. Company,he cam-« t*) London 
and was appointed Medical Registrar at the WestJiinster 



Nov. 13. 1901. 


LITBRA.TURE. 


Thb Mboicil Pbibb. 531 


Hospital in 1875, and two years later assistant physician. 
He early devoted himself to the study of diseases of the 
nervons system, and published a series of lectures on 
** Epilepsy,” and various papers on ” Spastic Paraplegia ” 
and “ Muscular Hypertonicity.” Metallosoopy and 
Metallotherapy for a time engaged his atteotion, but the 
rebults failed to answer his expectations. For some years 
he was on the staff of the Hospital for Epilepsy and 
Paralysis, and the West End Hospital for Diseases of the 
Nervous System. The drudgery of out-patient work was 
but littie suited to bis temperament, and in 1893 he 
eevered his connection with the Westminster Hospital. 
His knowledge of medicine was profound, but. unlike 
his illustrious father, he had no epecial gift as a 
-clinical teacher. For many years he suffered from 
a painful affection of the nervons system, which 
was supposed to be of the nature ot tabes with- 
•out ataxy, and for which he consulted most 
of the specialists both in London and on the Continent, 
but without deriviug much benefit. The paroxysmal 
pains, which were the most prominent feature of his 
uomplaiot, compelled him to relinquish active practice. 
He was a man of exceptional abi ity, who nn^r more 
favourable circumstancee would have been a successful 
phybician. His last public appearance was in July last, 
when, at the opening of the Hughes-Bennett Laboratory 
of Experimental Physiology, given by bis sister, Mrs. 
Cox, to the University of Edinburgh, he was in capital 
spirits, and made a most excellent speech. The imme- 
'diate cause of death was a pyrnmic abscess, for which he 
was attended by his former colleague, Mr. Walter 
Spencer. 


MATTHEW LBDWITH, M.A., M.Ch., M.B., Q U.I. 

Wb regret to announce the death of Dr. M, Ledwith, 
of Mullingar. The deceased gentleman was taken 
suddenly ill on the 28th nit., when be was found to be 
suffering from pneumonia, which terminated fatally in 
forty-eight hours. Deceased was very popular in the 
district, where be commenced medicsd praotioe tome 
seven years ^o. He was medical attendant, as civilian 
surgeon, to the troops stationed in the town, and for 
years past was surgeon to the National Foresters. 

SIR JAMES WILSON AGNEW, MD. 

A Bbutbb telegram, dated Hobart, Nov. 9, says:— 
Sir James Agnew, formerly Premier ot Tasmania, died 
yesterday. The deceased, who settled in Tasmania about 
sixty years ago, was universally respected.” Sir James 
Wilson Agnew, M.D, J.P., was admitted a member of 
the Royal College of Sn^eons (England) in 1838, and 
M.D. of Glasgow University in 1839 Soon afterwards 
he emig^ted to Tasmania, and for many years practised 
his profession in Hobart He became a member of the 
Legislative Council in 1877, and was elected Premier and 
Chief Secretary of the colony in 1886. He was vice- 
president and hon. secretary of the Royal Society of 
Tasmania, and f«/r many years a member of the Tas¬ 
manian Council of Education, and a member of the 
Council of the Tasmanian University. 




MEMOIRS OP SIB JAMES PAGET, BART, (o) 
This charming work will appeal not only to all who 
had the privilege of knowing Sir James Paget and to 
all ” Bart’s men,” but to the whole medical profession. 
It is not only the story of an extraordinarily arduous 
career, but it is full of anecdote and quotations from 
the works and addresses of an undoubted master mind. 
Among the reasons which contributed to his successful 
career. Sir James himself attributes the early study of 
botany. It introdnoed him into the society of studious 
and observant men s it encouraged the habit of observ¬ 
ing, of really looking at tbings and learning the value 
of exact descriptions i it educated him in habits ot 
orderly arrangement, and although this knowledge was 


in itself useless to him in after life, the discipline of 
acqu'ring it, he says, was beyond price. A certain 
ednoaticn. t<w, in the fine arte help^ him to see in 
things more than others could see; it strengthened 
the power of remembering tbings seen, and made it easy 
to illnstrate bis lectures. “ The facility of speaking 
had BO great infiuence on my career, it helped to gain 
for me so many appointments in good repute, and was 
judged to be a sign of so much more mental power than 
it r^ly implied that I may venture to say more about 
it. 1 never spoke on any considerable occasion without 
careful preparation, at the best preparing every word 
long before, and learning, if I could, every word by 
heart. Indeed, as between speaking and writing, the 
choice of words for speaking seems to me the more im¬ 
portant. It is not prudent to wish for extempore 
speaking if it cannot be done more than pretti/ well, 
for * pretty good’ extemporaneous 8peakin< is hardly 
more pleasing than are pretty good eggs.” Sir James 
goes on to say that he was very sensitive to ridicule 
and inattention, and very anxious to be in good repute 
with the best judges. These things wnuto him 
on all but the commonest occasions very careful 
and fearful of failure, anxious, and often very nervous. 
” I could,” he remarks, ” conceal my nervousness, but 
it always weighed upon me,” &o. 

Some figures with r^ga^ to Sir James Paget's career 
may be interesting. His schooling cost eight gniaeas per 
annum, his apprenticeship guineas. He got 
engaged on nothin/ a year as soon as be was qualified, 
and waited for his wife eight years. His earnings from 
private praotioe for the first sixteen years did not exceed 
J6100 per annum. He learnt how to subdue hunger by 
raisins and dates. On giving up operating his income 
dropped from £10,000 to £7,000. If he hM died before 
be was forty-seven he would have left no savings, and 
his widow and children would have been in extreme 
TOverty, and they would have still been poor had he 
medat sixty. He always worked sixteen hours a day, 
and had pneumonia six times between 1861 and 1870. 
He travelled from 5,000 to 8,000 miles a year. Sir 
James noticed "that there was much larger loss of 
raotioe after every illness than that which was 
ireotly due to inability to work. It often made me 
think tiiat idiocy would be less hindruioe to sncocss 
than invalid health was.” At forty-seven the first real 
holiday for seventeen years was taken. Sir James 
never learnt any sports or active games, and had 
not the least belief in the opinion tiiat a g<x>d u 
likely to be the better for being a good rower or in any 
way a distinguished athlete. Rather, perhaps, by giving 
more opportunity for the satisfaction of the love of 
praise, they tend to diminish, in some minds, the 
ambition for sneoees in the proper business of life. He 
believed that thoxe have done best who have hsid the 
most single mind for the proper duties of their lives, 
and have set no limit to their work but the limit of their 
strength. The work is so interesting that one hardly 
knows what to note. Possibly, Sir James Paget had his 
limitations. Who has not? His highest excellence was 
not in operating, but in his calculation of all the com¬ 
plex force! at work on a patient—heredity, tempera¬ 
ment, habits, previous illnesses; in his insight into tbe 
variations and abnormalities of ^sease, and in his patho¬ 
logical knowledge of the characters tendencies, and 
developments of surgical diseasea 


McCALLIN ON MEDICAL JURISPRUDENCE, (o) 
This book contains a useful bird's eye view, so to 
speak, of the essentials of medical jurisprudence. It 
deals concisely with its subject, which the author defines 
as " the l^al aspect of a medical practitioner's work.” 
The information thus given should certainly be in the 
possession of every medical mao, and may be conveniently 
bron/ht back to the memory by reading this little 
volume. We note, however, on page 8 that speaking 
of the fees payable to a medical witness, no mention 
is made of the special fees often paid to expert wit- 


(o) “ Sir Janes Paget. Uemoira and Lettera." Sdlted by his 
Son, Stephen Farat, F B.C.B. With Portraits and other Ulnatra- 
tiona, London: Longmans, Qreen and Co 1901. Price ISa. Sd. 


Joriewnt_ _ _ __ 

MoCalUo, M.D., D.F.H., Barristar-at-Law, Inner Temple. lK>ndon ■ 
Bailliere, Tind^ and Cox. 190L 4a I 

> gl‘ 







532 Thb Mbdicai. Pbbm. 


MEDICAL NBW8. 


Not. 13. 1901. 


BMceB in oiimiDBl and other courts. Mooh of tbeadrioe 
given is extrenely sound, as that following the state¬ 
ment that the cause of death is not oonclusively settled 
by the verdict of a coroner’s jury, as far as a life insur¬ 
ance policy is concerned. Therefore, if a medical 
witness, at the inquest of a pers.>n whose life has been 
insured, indulges in indefinite statements and vasne 
opinions, be may afterwards be picked to pieces in the 
witness-box in another court.” Ur, again, touching the 
making of wills, a point that is sure sooner or latw to 
crop op in the experience of every general practitioner, 
the writer says:—“If, through urgency, a medical 
attendant has to write his patient's will, the simple rule 
is to ascertain the extent and nature of tna tes¬ 
tator’s property, to state as plainly and as fully 
as possiole the manner and order in which be 
wishes to dispose of it, and to avoid ambiguity 
and the use of technical language. It is usual and 
proper to appoint one or more ezeoutois. The law does 
not require any particular form, provided the testator 
intends the instrument to take effect after hie death. 
To be validly executed a will must be signed, at the 
foot or end of it, by the testator, or by some other 
person on his behslf, in his presence and by his direc¬ 
tion, and such signature must be made or acknowledged 
by the testator in the presence of two or more witnesses 
present at the same time, who must subscribe their 
names as witnesses in the presence of the testator.” 
The latter half of the book is devoted to a concise 
description of the common poisons and their detection. 
This little volume may be recommended as an accurate 
and trustworthy sketch of the leading facts and prinoi* 
pies of the subject with which it deals, and should be 
useful both to lawyers and to medical men who are 
inteiested in medico-legal matters. 


HEATH ON MINOR SURGERY, Etc. (a) 

This is one of the books with which no student, or 
even practitioner, would willingly dispense. Its useful- 
nesB has augmented pari poriv with its increase in sise, 
but even in its present up-to-date form its dimensions 
have not been allowed to become unwieldy. Mr. 
Hilton Pollard has been entrusted with the task of 
bringing the work into conformity with the require¬ 
ments of modem surgery, and no fault can be found 
with the way in which he has fulfilled it. The work is 
replete with useful practical instraction in de¬ 
tails, and it embraces the whole realm of surgery. 
The chapter on aneesthetics by Dr. Dudley Bux¬ 
ton is, perhaps, the least satisfactory. He lays 
it down, towards the end of the chapter, that 
"chloroform is best given by a regulating inhaler,” but 
he prefaces his remarks by the statement that ” chloro¬ 
form may bo given by the open method,” a dangerous 
permission shioh, in practice, is responsible for a very 
htf ge proportion of the fatalities caused by this powerful 
but, when properly administered, fairly safe ansstbetic. 
Nowhere does he insist on the risk insepamble from this 
rough and readyunscientifio mode of administration, nor 
does be lay emphasis on the fact that stragglmg is due 
to a sense of impending asphyxia, itself the immediate 
result of too large a proportion of chloroform vaTOur. 
So long as this teaching prevails, so long we shall have 
to deplore almost daily catastrophes from chloroform 
narcosis, well-nigh invariably determined by ** the open 
method.” 

The illustrations are numerous and excellent, and the 
present edition is certain to maintain the popularity 
which its predecessors for the last quarter of a century 
have gained. 


MURRAY ON DISEASES OF THE THYROID 
GLAND, (b) 

Da. Hubbat writes for a large class of readers; in fact 
for all, whether students or practitioners, who can benefit 


(a) "A Munal of Minor SniyeiT ^adasing.” By Ch^ 

topher Hofcth. F.E.C.8., LL.D., ConvnlUos Su'groa to DidTereity 
CollORO HotpiUI, Ac, B«Tl*ed by BUton FoUa^, F.E C.8., Bur- 
won to UniTotaity College Hoapital. Twelfth Edition. London: 
J. and A. ChnrchiU. 1901. , „ , 

(b) *■ DiwMM of the Thyroid Olnad." Part I.: Myzcednma and 
Cretiniam. By Qeoije B. Murray, M.D., P.B.C.F., «e. London; 
H. S. Lewie. 1901. 


by reading a well-written book on a most interesting 
croup of diseases. For students such books are invalu¬ 
able. A chapter in a text-book may contain all the 
facts, bat the illnmioating power of a monograph such 
as this, which takes but litue longer to read and digest, 
is, without exaggeration, tenfold. The opening chapter, 
without being pedantically complete, gives what is 
perhaps an adequate account of the structure and func¬ 
tions of the gland, and review of the progress of know¬ 
ledge in thie sabjeot during the last quarter of a century} 
the two remaiaiug chapters in this, the first part of the 
work, contain illustrated accounts of the diseases 
myxcedema and cretinism. If in the next edition Dr. 
Murray is enabled to include the final results of the experi¬ 
ments which he had begun when writing this one, upon 
the differentiation of the fnnctions of the parathyroid 
glands as distinct from the thyroid, his book may 
become a valuable addition to the scientifio literature of 
the subject. 


Litbbabt Noras.—Professor W. H. Thompson, 
Queen’s College, Belfast, haa translated the work of Pro¬ 
fessor Pawlow,'of St. Petersburg, to which the Nobd 
Prise was awarded, entitled " The Work of the Digestive 
Glands.” The publishers, Meesrs. Chas. Griffin and Co., 
of London (through the traaslator) have arranged with 
the distinguished author for the publioatiott of the Eng¬ 
lish edition, whioh srill include the later volume, eutitld 
" The Experiment,” See., together with the notM of the 
most recent researches of Professor Pawlow, and will 
oonstitate the sole antborised edition for England and 
America of this important wort. 

A Haw medical journal has just made its appearance, 
called The MidUmd Medical Journal, whioh is described 
at the official organ of the Birmingham and District 
General Praotitionere’ Union. It is to be poblisbed 
monthly, and the initial number, which is of very modest 
compass, contains an " Introdnotion ” by Sir James 
Sawyer, formerly editor of the BtrmmyA'ifM Medical Be- 
view, and oontributiozu appear from Dr. Arthur Foxwdl, 
Dr. £. E. Hamilton Williams, Dr. T. Sydneg Short, Dr. 
E. D. Kirby, and Dr. W. H. Line. 

Tub well-known and decidedly popular American 
text-book of " The Prinoiplee and Practice of Medicine,” 
by Dr. Osier, is now issued in this country by two firms 
Mr. Eimpton, of London, and Mr. PenUand, ef Edin- 
bni^b, the only apparent variation being in ^e colour 
of tiie binding. The book was formerly pablished at 
218., but British competition has rednoM the price to 
IBs., and thereby the medical public are benefits by a 
squabble between publishers. 

JKcbtcrtl ^etos. 

AniBsthetlc Fatalltlea 

A DiATH under ether is reported as having occurred 
at the Royal Surrey County Hospital, Onildford, iMt 
week, following one chronicled by us last week in 
London. The victim was a labourer 36 yeArs of age, 
and was undergoing an operation for the relief of aento 
intostioal obstraction. Death was attributed by the 
medical witnesses to the patient’s condition, and not to 
the ansesthetio. It was mentioned that this tlm 
only catastrophe of the kind at the hospital since it 
vas opened.^A death under chloroform at the Royal 
Free Hospital, Lcodon, was the subject of an inquest 
on the 4th inet., the victim being a man, tet. 52, who 
was being operated npon for the removal of a growth 
in the neck. Miss Blake, who administered the anes¬ 
thetic, stated that this was the first fatal oocurranoe in 
2,600 oases.—Another death under chloroform occurred 
at Liverpool, in private praotioe, the victim being a man, 
et. 80, about to be operated on for fistnla. It was stated 
that only 40 to 60 minims of the drag had been given. 
We gather that in both these oases the 80 -<^led ” opea 
method ” was employed, and one would like to k^w 
why it ii that ansetbetists persistently decline to make 
use of a regpilating inhaler. 

The Medi ca l aervlee of the London school Board. 

Thi London Bohool Board have adopt^ a new mode 
of regnlations in anticipation of the leeiguativn of Dr. 


C 


PASS LISTS. 


W. B. Smith, which tales effect in April next. It was 
resolred: “ That the staff of the medical department 
(with their dntie*) be conetitated for ^e present, sabjeot 
to alteration, as follows1. Examination of male can¬ 
didates for employment, risitii to schools where there 
has been an outbreak of infeotioos diseases, and 
geuerallj to do such work oondnct such inquiries, and 
give 'sn^ advice as may be required of him from time 
to time. 2. Assistant (lady), half-time. —Examination 
of fem^e candidates for employment. Crippled children. 
Examination of defective children in spare time. 8. 
Two assistants, half-time.—Examination of defective, 
blind, and deaf children. Any spare ti i e to be given 
to visitinz schools in which there has been an 
outbreak of infections disease. In advertising, specify 
skill as oculist and aurist as essentiid in one case, and 
eiperienoe of feeble-minded children in the other. 4 and 
6. Two oculists, temporary, for one year. -For the pur¬ 
pose of testing the eyesight of the children in senior 
departmeuta. Part of their duty will be to correct errors 
of refraction, and to make arrangements wi^ opticians, 
similar to those made at ophthsdmio hospitals, for pro¬ 
viding the necessary glasses at hospital rates on pay¬ 
ment by the children. A further part of their duty will 
be to look into all eases of disease or affections of the 
(yes, oontagioQS or otherwise. 

out to ths Boyal CoUsgs of Physicians of London. 

Tax Coll^ hu accepted a lency of A2,000 from 
Mrs. Fitxpal^k, for the purpose of endowing a lecture¬ 
ship on the history of medicine, in memory of her late 
husband. Dr. Thomas Fitvpatri^. 

Medical Suicide. 

Am inquest was held a few days since on the body of 
Dr. Adam Argo, who committed suicide by taking poison 
while of nnsound mind. The deceased had been in prac¬ 
tice for some time at Arlesey, North Herts. 

Irish Medical Schools' and Qraduates’ Assodatlan. 

Tbb autumn genenl meeting of the Association will 
be held in London, at the Cecu Hotel, on Wednesday, 
November 27tb, at 6A0 p.m. On the same evening the 
Association will dine at the Victoria Had of the Cecil 
Hotel, at 7.16 p.m., when the President, Dr. William 
Alexander, will tske the chair. The guest of the Asso¬ 
ciation will be Sir Charles Crosthwaite, E.C.S.I. (late 
Lieutenant-Governor of the North-West Provinces of 
India). 

University OoUese, BrlstoL 

Tbb following prizes have been awarded in the medical 
departmentSommer semion Pathology, prize, J. 
Cretin. Medical Jurirprudence, certificate, C. Corfield. 
Operative Surgery, prize, C. Corfield. Midwifery, prize, 

A. Short. Practio^ Medicine, Surgery, amd Midwifery, 
certificates, W. Webb and A. Short Ftaotical Physi¬ 
ology, prize, W. H. J. Pinniger; certificates, W. Bing, 

B. Bc^mu), C. E E. Herapath, F. Perry, W. Lennox, 
H. Goodden,B. Vaughan, and F. G. Bergen. Pbarmaco- 
logy, prize, S. Hayman; certificate, T. Pratt. Materia 
Medloa, prites, F. 6. Bergin and W. Pinniger. Practical 
Chemistry, prizes, C Plnmley and W. King; certificates, 

B. Lecky, B. Vanghan, and G. H. Smi^. Anatomy, 
prize, W. Pinniger; certificates, F. W. Perry, A. Thomas, 
and J. 8. Avery. University Entrance Scholarship (£50), 

C. S. Bivington. Lady Haberfield Entrance Soholwhip 
(£30), A. E. lies; Martyn Memorial Fatholoric^ Scholar¬ 
ships of £10 each, A. B. Short and C. Corfield ; Tibbits 
Memorial Prize (£9 98.), P. W. White; Committee’s 
gold medal for the student of the fifth year who has 
most distinguished himself, J. E. Sparks} Augustin 
Prichard Pnye (£6 68.), C, J. Taylor; Clarke Si^olar- 
ship (£15), A. Short; Henry Marshall Prize (£12), A. 
Short; Seders Scholarships, J. E. Sparks (£22) and C. 
Corfield (£11); Specisd Midwifery Certificates, W. 
Blatohford, J. Clayton, F. Budge, and C. J. Taylor. 

Vital SUtlstloa 

Tbb deaths registered in the u eek ending November 
2Dd in 87 large towns of the United Ein^om corre¬ 
sponded to an annual rate of 17*8 per 1,000 of ^eir 
abrogate Mpulation, which is estimated at 11,468,026 
ppsons in ue middle of this year 

Belfast 22, Birkenhead 17, Birmingham 20, Blackburn 28, 


Bolton 14, Bradford 16, Brighton 13, Bristol 16, Burnley 22, 
Cardiff 11, Croydon 8, Derby 16, Dublin 22, Edinburgh 16, 
Glasgow 21, Gateshead 14, Halifax 17, Huddersfield 18, 
Hull 16, Le^s 17, Leicester 11, Liverpool 21. London 17 
Manchester 19, Newoastle-on-Tyne 21, Norwich 16, 
Nottingham 13, Oldham 17, Plymouth 16, Portsmouth 14, 
Preston 22, Salford 22, Sheffield 20, Sunderland 18, 
Swansea 10, West Ham 18, Wolverhampton 12. The 
highest annual death-rates per 1,000 living, as measured 
by last week's mortality, were:—From measles, 1‘2 in 
Sheffield, 19 in Norwich, and 3*3 in Blackburn; from 
whooping-cough. 1'4 in Sunderland; from fever. I’O in 
Halifax and 1-4 in Salford; and from diarrhceal diseases, 
1'4 in Preston and in Sunderland. In none of tie 
Urge' towns did the death-rate from scarlet fever 
reach 1*0 per 1,000. The 78 deaths from diphtheria 
included 86 in I^ndon, 6 in Liverpool, 4 in Glasgow, 4 
in West Ham, 4 in Sheffield, and 3 es^ in Edinbni^h 
and Bristol. Six deaths from small-pox were registered 
in London and 1 in Plymouth, but not one in any other 
of the large towns. 

Univenlty of Olasgow. 

At tile graduation ceremony on Thursday last, the 
M.D. Degree, with honours, was bestowed on David L. 
Ciume, M.B., Cb.B. 

M.D. Degi^with Commendation.—John Aitken, H.B, 
Ch.B., Arthur J. Ballantyne, M.B, Cb.B., George Coatf, 
M.B., Ch.B., John Henderson, M.B , Ch.B, James D. B. 
Munro, M.A.. M.B., C.M. 

Ordinary Degree.—Agnes F. Blaokadder, M.A., M.B., 
Ch.B , William B. Brodie, M.B, C.M., William Cullen, 
i M.B., O.M., Bcbinson S. Dixon, M.B., C.M., Charles H. 
Hall, M.B., C M., John H. Lyell, M.R., C M., Eva M'Call, 
M.B., Boderiok: A. Mac'eod, M.B. C.H.. Edward J. 
Morris, M.B., C.M., William Eoxbnrgb, M.B., C.M. 
Alexander B. Sloan, M.B., Ch B., Hugh G. Stewart, 
M.B., C.M., Ernest Watt, M.B, Cb.B. 

Bachelor of Medicine (M.B.) and Master In Surgery 
(C-M.).—George W. Milne. 

Bachelors of Medicine (M.B) and Bachelors of Surgery 
(Ch.B.).-Bobert W. Auld, John J. Young Campbell, 
Edwsrd S. Chapman, George H. Clark, Duncan J. 
Fletcher, Thomas Forsyth, William Gemmill, James D. 
Gourlay, Archibald Gow, Janet B. Higgins, Alexander 
Linn, Walter J. M'Feat, William F. M'Glasban, Earen 
Myhra, Bobert Orr, Mary Potter, Andrew Beid, Eliza¬ 
beth N. MaoBean Boas, John Stewart, M.A., Bobert 
Bennie Swan, Bobert Qeo. White, M.A., B.Sc., Jamee 
Wilson, William Bobertson Wylie, Henrietta Young. 

Dublin Unlvsrslty School of Pbsrsic. 

Thi following candidates have passed the medical 
examination in the nndermentioned subjects 

Anatomy and Institutes of Medicine.—High marks: 
Cunningham, M’Neight, eq.; Wade.Pearson; C'ampett, 
J. H. C. Thompson, Wal^, Wilmot, eq.; Walton, 
Wyatt 

Physics and Chemistry.—High marks: Nanan, Usher, 
eq.; Alexander, Corley, Powell; Willington, Elliott 
eq.: M'Entire, M'Creery; Harnett, Stewart, eq.; Egan, 
M'Quaide, MacFetridge, Mitchell. 

Botany and Zoology.— Ferguson, Leech, Hogan; 
Atwell, MacFarlane, Moyers, eq.; Creaser, ElUott, 
Greene, J. H. Elliott, DuBedat, Garstin. 

Conjoint Examinations in Ireland by the Boyal CoUefo of 
Physicians and Boyal Collofs of Surgeons. 

THxfoUowingoandidateebavepassed the supplemental 
preliminary examination of the Boyal College of 
Pbraoians and Boyal College of Surgeons;— 

Honours in Order of Merit—N. Y. Stewart J. B. 
Hobson, B. H. McGillionddy, H. Eennedy. 

Pass Alphabetically.—F. J. Adams, Wm. Anderson, 
S. Black, A. L. Clarke, M. Cohen, Miss E. Dillon, J. J. 
Dwyer, P. Ferguson, R. H. Ford, J. C. Healy, J. Hum- 
phrays, D. Johnston, J. B. Leaky, F. J. Morris, B. H. 
MacCr^ 8. B. Maonamara, T. O’Brien, B. 6. H. Sulli¬ 
van, J. Walker, C. L. Waters, J. Walsh, C. H. Wilson. 



534 Thi M.di(ui. Pbmb. NOnOBS TO OORBBSPONDBKTS. 


Nov. 18, 1901. 


fitAittB ta 

dTnrreajrmibtntB, gkmrt ^tetttra, itL 


Cojuuapovsnra requiring e reply in thie oolnmn ere per* 
tiaulerly leqneeted to meke nee of > ditUnetivt $% fmatur « or 
iniUmU , end evoid the prectiee of tigalng themielTee '* Beader,’* 
* Snbeoriber.’* **01d Snbeoriber,'’ fto. Mnob oonfnxioB will be 
■pered by ettention to tbie role. 

OUB ABHT. 

To the Bdit'.r of Tbx Mxdical P&xss avd CiBCCLAit. 

Sib,- I don't know whether it hae stmck otben beeldee myself, 
hut iteeeme rery deer that the bead of the British Army, at the 
present lime, is “ Qeneral Pi^^aie." 

1 am. Sir, yours truly, 

Loxo Barge. 


Ha. Walter Jacebor (Connemrtra).—The samples hare been 
reoeited, and will be noticed in due course. 

THE APOTHECABIES' HAT,L AND THE UNrVBBSITT 
QUESTION. 

To the Editor of Tbb Medical Press ard Cibcular. 

Sib, Should it he decided, as a result of the report of the Uni¬ 
versity CommisBion, to establish a new Univerntji In IreHni, 
surely some amngement might become to whereby it would form 
alicensing and examining board conjointly with the Apothecaries' 
Hall. Such a scheme would obviate the neoessitv of increasing the 
number of licensing bodies -a most undesirable thing; and should 
also render unnecessary the importation by the Apotb ecaries' Hall 
of examioers nominatra by the Qeneral Medical Council. I pre¬ 
sume that the Conjoin Board ao formed would grant a lower quali- 
ficstion such as L.M., L.S.,andL.A.H., whiist the ordinary M.B. 
would be obtainable as a result of further examination. Cwrainlv 
such an arrangement would tend to the betterment of Irish 
medical examination. 

I am. Sir, yonrs truly, 

J. C. MCW ALTER. M.A., D.P.B. 

Dublin, Not. 5th. 1901. 

Ubi^ub.—T our letter is unavoidably held over this week and 
will appear in our next. We cannot insert any more letters os 
the subject, which might, in onr opinion, be allowed to drop. 

“HYDBOPS BBONCHIALIS” AND THE BBONUaiTIS 
KETTLE. 


OCB publisher has received several applications for copiM of this 

I onmal ror January 25th, ISbS, in consequence of the letter of Dr. 
*earse in onr last week's iasne. This number, containi^ an article 
special^ written for these psgee by the late Sir B. W. Bionardson, 
M.D , F.B S.. on the above subject, has been out of print for some 
years, but in accordance with the request of many of our readers 
we propose reprioting it In an early number. 

M. P.—The matter has not eecaped onr attention, but we are not 
yet in possession of the necessary data. We hope to be able to 
deal with it in the near fnture. 


AN AMBIGUOUS TESTIMONIAL. 

Trvlh bse nneartbed from among the testimonials pnblished by 
the New York Institute of Bdence the following, which reminds 
one of the testimonial given (in PitncAi to a certain soap :—** Dear 
Sir, -1 wish to state my case as best I csn. Th« day I commenced 
j/ovT treatment I had paralytU, which deprived me of tbenaeof my 
right band. My right leg was also oonalderaby aftectsd." The 
treatment. It is suggested, got to work promptly enough in this 
case. The patient gOM onto state that she la getting over it by 
degrees. Bne may think benelf lucky I 


Jftcetings of the gocietics. 

LONDON. 

Wbdhebdat, Nov. 13th. 

Dbbkatolooical Bocibtt or Lokdor (11. ChandM Street. Caven¬ 
dish Square, W.).- 515 p.m. Demonstration of Coses of Interest. 

Burtbbiar SociBTT.-^London Instituiion.Finsbury Circus,E.C.). 
—8.30 p.m. Discussion on Small-pox and Yaocination, in which Dr. 
W. A. Bond, Major Greenwood, and Dr. MacCombio will take part. 
PaperDr. Major Qreenwo^: The Present Poaition of Small-pox 
ana Yaccinatlon. Dr. Mac^mbie: Tbs Differencial Diagnosis of 
Small-pox, with remarks on Prodromal Bisbes and Vaccination. 
Thdbsdat, Not. 14te. 

HARyxiAR SociETT OR LoRDOR (Stafford Booms, Titebbome 
Street, Edgware Boad, W,).— 8.30 p.m. Mr. B. Browne : Twenty- 
five Yean'Experience of Urinary Surgery (Harvelan Lecture). 
British Otrhcolooical Society (20, Banover Square, W.).— 8 

& m. Specimenswill be ahown by Dr. H. Macnaugbton-Jonee, Mr. B. 

'Caliwhan, and others. Paper: Dr. H. Suow : Prophylaxis in 
OyiuBcdogy. 

Friday, Not. 15th. 

Society roR THE Study or Disease ir Childrem ill, Chondos 
Street, CavendiBh ^uare, W.).—5.S0 p.m. Cases and Specimens 
will be shown ^ Hr A. H. Tubby. Dr. D. Walsh, Mr. B. Stephen¬ 
son. Dr. E. Cautley, and Mr. W. G. Nash. Papers:—Dr. E. 
Csntley: Ohserrations on the Etiology and Morbid Anatomy of 
Tuberculous Meningitis, 5ir. Q. Fernet: A Family Epidemic of 
Impetigo Contagloea Bullosa. 

DUBLIN. 

WiDRBBDAY, NOT. 13 tH. 

Boyal College of Physicians, Special Meeting, 4.30 p.m. 

Friday, Not. 15th. 

Boyal Academy of Medicine, Dub'in. Medical Section. Intro¬ 


ductory Bemarks by the Presirfent. Papers: fl) Dermatitii 
Gangrenosa, by Dr. Finny; (2) A Csaaof Paranoia Hallncinktoria, 
by Dr, Conolly Norman. 


Ain^oiirtnunts. 

Babtor, G. a. H., M.B.C.8., L.B.C.P., Honorary Aosesthetist to 
the City Ortbopcedlc Hospital. 

Bbewertor. Elkorb, F B C.S.Eng.. Assistant Surgeon to the 
Boyal Westminster Ophthalmic Honital. 

Browr J. Waltke, M.B., B Cb , B.U.I., House Surgraou to the 
Boyal Victoria Hospital. Bouniemonlh. 

Eadbs, a. j., L,R.C.P. and 6.1., Senior Assistant Medical Officer 
ihe County Asylum, Winwick. 

Hadley, Clrxbkt, M.B.C.S., UK.Q.C.P.I, Certifying Surgeon 
under tba Facton Acts for the Shilton Uie’gict of Warwick. 

Hall, J BaSiL, M.C.Cantab., Honoriry Surgeon to the Bradford 
Boyal Infirmary. 

Howard. Vircert, H.B.C.S., L.B.C.P., Certifying Surgeon nnder 
the Factory Acts for the Borough and District of Bnckingbaio. 

HooG, John A., L.B.C.F.. M.B.C.8.. Medical Officer of Health to 
Castle Donington Bural District Council. 

Jacxsor, D., M.D.Glosg., Medical Officer of Health for tbeUrbso 
District of Hexham. 

Largrah, W., L.B.C.F., L.B.C S Edin., Medical Officer of HealUi 
for the Axminster Bural District. 

Llswbllyr, j. M.B.C.8,, L.S.A.. Medical Officer for the Sherbum 
District of the Scarborough Union. 

Murrelu Csristihe M., M.B, B.a.Lsnd., Assistant House 
Phyeieian to the Boyal Free Hospital, London. 

Fabry T. W., M.H., B.S.Cantab., Certifying burgeon under the 
Factory sots for the Youlgreave District of Derlmhire. 

Ware. George Stefher, M.B., B.S.Darh.. L.B.Cf.P., M.B.CE., 
Medical Officer for the Fourth District of the Barnstaple Union. 


^acandes. 

Birkenhead Children's HospitaL - House Surgeon. Salary £100 per 
annum with board, residence, and laundry. Applications to 
E. H. Tilby, Hon. Secretary, 53, Groivenor Bead. Birkenhead. 

Brentford Union.—Assi-taiit Medical Superintendent. &Iary £100 
per annum, with famished apartoeuts, rations, washing, &c. 
Applications upon forms to be procured of W. Stopbens, ClerE 
to the Guardlsns, Union Offices, Isleworth, W. 

Chester Cta'-ral Infirmary.—House Physiclau. Salary £90 per 
annum, with residence and maintenance in the house. Furth er 
particulars mar be ob ained on application to the Se ire'ary. 

Conn^ Asylum, Miokleover, Derby —Senior Assistant Medical 
Officer. Salary commencingat £>30, with beard waabing, Ac. 
Also Junior AMstant Me lical Officer. Salary £110 tisint to 
£180 per annum, with furnished apartmente, board, wsshinc, 
and attendance. A ppllcations to the Medical Superintendent 

County Asylum, Prestwich.—Junior Assistant Medical Officer. 
Salary oommenciiig at £150, with board, Ac Applicatious to 
the Medical Superintendent. 

Glamorgan County Asylum, Bridgend—Fifth Assistant Medical 
Officer. Salary £i70, with boaz^ lodging, and washing. Apph- 
oations to the Mi^oal Superintendent. 

Manchester Corporation. Monsall Fever HospitaL First Medical 
Assistant, at £180 per annum, with board and lodging. Appli¬ 
cations to the Cbainnan of the Sanitary Committee, Public 
Health Office, Town Hall, Mancheeter. 

Newcastlc^n-Tyne Diipensaiy.—Yisiling Medical Asaiatant Salary 
commencing at £i00. Forma of application of the Beaiilent 
Medical Officer at the Diapensuy. 

Sheffield Bojvl Infirmary. Casualty Oflcer. Salary £l00 per 
annum, with board, lodging, and wasbing. For duties of post 
apply to the Secretary. 

Somerset and Bath Lunatic Asylum, Cotford, Taunton. Assistant 
Medical Offlow. Salary £150 per annum, with fnmishedapart- 
menta, board, fuel, lighting and washing. Applications to the 
Medical Superintendent. 


Airtha. 

Etarb.—O n Nov. 3rd, the wife of 0. C. Panrhys Evans, M.D., of 
22, Church Street, Kidderminster of a daughter. 

Frahxish. On Nov. 6tb, the wife of W. J. Frankish, L.B.C.P. 

Lond., A'l, 102 Sloane Street, London, of a son. 

Gibbs. -On Nov. 8tb, wife of Charles Gibbs, F.HC.S., 115, Harley 
Street, London, W., of a danghter. 


Coward—Bbdshfield.— On Nor. 6th, at St. Peter’s Church, Bud- 
leigh-SaltertOD, Devon, Ernest G. Coward, M.B^ of Almond- 
bun, Huddersfield, youngest son cf the late J. Eyrea Coward, 
M.R.C.S.E., to Eleanor Miliar youi^at daughter of T. 
Nadanid Brushflel l.M.D., of Buileigh-Srlterton. 

Ewart Carter. -On Nor. 7, ai St. k^y Abbot’s Church Ken 
sington, J. H. Ewart, M.D., AUershaw, Folkestoue, sooond son 
of the lite Colonel C. U, Ewart, I.8.C., to Florence, daughter 
of tbo late Capt. Willoughby Carter, Annaghkean, oo. 
Galvmy. 

GoaDOR-WiLSOH— Bisch.- On Nov, 2nd, at St. John's C arch 
Blackheatb, Alexander Gordon - Wilson, M.D. Loud., 
F.BCB.£Dg., of Lyell House, Folkestone, to Louisa Mary 
Priedericke Bisch 

Bavill—Blacxaddeb.— On Nov. 2nd. at St. Mary Magdalene's 
Church, Dundee, Thomas D. SavUl, M. D Jjond.. to Agnes F 
Blscka^er, M A. St. And., MJ).OIasg> 


xm anil Ct^imtlat 





“8ALUS POPULI SUPBEMA LEX.” 


VoL. CXXIII. WEDNESDAY, N 0 V E M B E E 20, 1901, No. 21. 


Original Corntnunications. 

THE PERSONAL FACTOR IN 
TUBERCULOSIS, (a) 

By Sir DYCE DUCKWORTH, M.D., 
F.R.O.P.Lond., F.B.C.P.I., 

PtijaicUn to St. Bartholomew’s Hospital. 

TiiE author prefaced his remarks by poiDting out 
Low at the present time the whole of medioine, and 
in particular the science of pathology, were domi* 
nated by bacteriological ideas. 

Amidst the enthusiasm with which these 
momentous discoTeries in this field had been 
receiTed, he could not but feel that some important, 
although older, doctrines had been lost sight of. 
Respecting the modem views as to the nature of 
tuberculosis, be felt that too little regard was 
now paid as to the peculiarities of the host, and 
perhaps too much to those of the infecting para* 
site. So much was this the case that modem 
writers disregarded the question as to the particular 
habit of body which presented the most favourable 
soil for such infection. Those whose studies were 
confined to pure pathology might, perhaps be par¬ 
doned if they paid little heed to the question of the 
personal factor in disease, but inasmuch as physi¬ 
cians had to treat patients and not diseases they 
could not ignore the intimate relations between the 
host and this infecting element. The condition of 
body which was most prone to become invaded by 
tuberculosis was that long known as the scrofulous 
or strumous diathesis. The doctrine of the diatheses 
received little or no attention in these days, but 
bacteriology had not done away with these textural 
conditions, although it bad temporarily ovei*- 
ehadowed the recognition of them. The modem 
doctrine was laid down that “ scrofula was tubercu¬ 
losis.” 

This the author absolutely denied, and he main¬ 
tained that it was possible to be scrofulous through¬ 
out life without .becoming tuberculous. The essen¬ 
tial character of scrofula was a textural vulnerability 
to irritation of all kinds, and especially to tubercu¬ 
lous invasion. Scrofulous persons reacted badly to 
all morbid processes, and all inflammatory disorders 

(n) Abstract of paper read before the Liverpool Medical InsU- 
Cutioa, October 84th, 1901. 


in them tended to be lingering and rebellious to 
treatment. Many of the ailments from which they 
suffered were of a non-tuberculous character. The 
vulnerability of their lymphatic system, which was a 
marked feature, did not depend on tuberculosis. 

The opinions of Simon, Watson, Paget, and 
others were given in illustration of these contentions, 
and that of Virchow, to the effect that vulnerability 
was the keynote of scrofula, was enforced. The 
teaching we were now asked to accept was that there 
was no scrofula without tuberculosis, and that if any 
individual presented signs of struma be was already 
tuberculised. This was a vain doctrine, and set 
forth in defiance of obvious clinical observations. 
Strumous conditons supervened on debility and con¬ 
tinued struggles against nature. The lextural 
frailty, with its peculiarities and proclivities, power¬ 
fully modified the character and progress of any 
malady which occurred in those thus impressed. 

It was next shown how persons of gouty predis¬ 
position were thereby largely immunised against 
tuberculosis, the offspring of the gouty manifesting 
none of the peculiar delicacies of the strumous. 
Tuberculosis when it occurred in the gouty made 
little progress as a rule, and tended to t^solescenoe. 
What was bad for the gouty was good for the 
strumous. The course of a tuberomous process 
when it oconrred in the gouty was largely modified, 
and fibrotic changes were associated with it. In the 
strumous the lesions tended to soften rapidly and 
disorganise the affected sites. Hence it was obvious 
that there were at least two pathogenic factors to be 
regarded in any case of tuMrculosis—(a) the host, 
and (b) the infecting parasite. The younger patho¬ 
logists now “ reckoned without their host.” If both 
factors were recognised, as clinical medicine required, 
lit became obvious that much of the preventive 
procedures against tuberculosis must relate to 
the personal factor, and that our duty was to 
fortify the host against invasion, as well as 
to intercept and destroy the invader. It was 
probable that the best preventive measures would be 
found in strenuous efforts to render such persons as 
were prone to infection as immune as we conld make 
them by securing for them appropriate dietary and 
the best hygienic environments. Lastly, a 
was made against the modem idea of “ oaring ' 
culosis. All we could do was to place the patient 
in conditions favourable to an arrest of the process. 
The malady was so often arrested as tuberculosis, 
but noDO were more ready to relapse at any period 
within the lifetime of the patient. A better com¬ 
prehension of the textural proclivities of the indi¬ 
vidual might enable us to frame a sounder prognosis 
in respect to liability to relapse after the occurrence 
of an arrest. More than this we could not do. In 
any case, bacteriology was not the “be all ” and 
“ end all ” of clinical medicine as it was so commonly 
supposed to be. 


protest 

tuber- 









536 Ths UxDicAL Pbbb6 » OfilOINAIi COmdUDIGATI01^6. Nov. 20, 1001* 


Wxt ^arbcian l^cctuus, 1901. 

TWENTY-FIVE YEARS' EXPERIENCE 

OF 

URINARY SURGERY IN ENGLAND. 
Delivebed befobb the Hxbvbian Socibtt of 
London, Novbmbbb 7th, 1901, 

By G. BUCKSTON BROWNE, M.R.0.8.Eng. 

Abstbact of Lbctdbb I. 

Aftbb some introductory remarks the author 
proceeded to consider the question of urinary ferer, 
which, he said, is at the bottom of the whole of 
urinary surgery. At its outset this fever is purely a 
suppression of urine, varring from merely transitory 
to tne most complete ana absolute, due to the inhibi¬ 
tion of the action of the kidney from urethral shock. 
The nerve supply of the urethra is remarkably gene¬ 
rous, and the penis itself is most intimately con¬ 
nected in this way with the i-est of the body. An 
excellent illustration of the ve^ liberal nerve supply 
of the urethra and of its intimate connection with 
the rest of the body is afforded by the study of the 
marvellous phenomenon of erection. In the pre¬ 
chloroform ^ys many a man has died upon the 
operating table simply from the shock of an amputa¬ 
tion of the penis. If a bougie is passed up on the 
average young man in the standing posture, he will, 
in many oases, in a few moments, be writhing on the 
floor in what is practically an epileptiform convul¬ 
sion ; let him be put to bed, and a good perspiration 
encouraged, and he will soon be well; but if an 
old man be subjected to a similar shock he 
does not always recover. Many surgeons of 
suflicient experience will be able to rei^ some 
case of an elderly man who has had a catheter 
passed, and who has never secreted another drop of 
urine, and has died. The hypodermic injection of 
morphia an hour before passing the bougie has been 
followed by the happiest results. In another 
(elderly) patient I was min to perform my operation 
of internal urethrotomy at one sitting, under an 
ancesthetic, so marked was the shock following the 
catheterisation. There was no fever, and the patient 
lived for several years in perfect urethral comfoH. 
We often find in practice that the stricture patient 
can bear a certain sized bougie well, but if an instru¬ 
ment at all larger is used its introduction is sure to 
be followed by lever. Women and children curiously 
enough never suffer from this fever. These facto 
prove that the fever is due to nervous shock, 
to urethral shock. The male adult's urethra is 
a sexual as well as a urinary tract, whereas the 
urethra of the woman and child is a urinary 
tract only, and they consequently do not suffer. 
Deal gently vritb the male ure^ra and all will 
probably m well; use violence and the results 
may be disastrous. Narcotise the patient with 
opium or with chloroform and vou may use violence 
up to a certain point, and still have no fever. Yon 
may often out ue urethra, if you do not stretch it, 
and have no fever. You may one day pass a catheter 
and have no fever, and next time and on the same 
patient you may not be so skilful and successful, 
ou may blunder, and hurt the patient and make 
im bleed, and severe fever will follow. Then again, 
certain nationalities are more prone to this fever than 
others. The French are certmnly much more sus¬ 
ceptible than the Germans, and amoog the British the 
Irishman is far more likely to suffer than the English¬ 
man. These more susceptible people are certainly the 
most nervous, this term being used in its highest 
and best sense. Even among people of the same 
nation, the more highly tnuned, the mora educated. 


the more refined the subject, the more likely is'he 
upon due provocation to suffer from this fever. All 
these clinical facts prove that the onset of urinary 
fever is due to nervous urethral shock conveyed to 
the secreting tissues of the kidneys by the urethral 
nerves and inhibiting the secretory action of these 
organs to a lesser or greater extent, producing 
suppression of urine, from the most complete and 
absolute to the slight^t and most transient possible. 
In fact, urinary fever is suppression of urine. If 
the suppression of urine is complete or considerable, 
the kidney naturally becomes engorg^ with bloo^ 
inflammation ensues, and in bad oases suppuration 
follows, and the patient frequently sinks into a state, 
often and deservedly called typhoidal, and dies. No 
doubt this suppuration is more likely to occur if 
there be surgic^ impurity in the bladder, and hence 
the necessity for caranl antisepticism from the very 
commencement of any surgical urinary treatment. 
My view, therefore is, that while this urinary fever 
may undoubtedly run on and develop into septicism, it 
is not, primarily, blood poisoning. 

In lo75, when I began practice, a man with a stone 
in his bladder was subjected either to perineal 
lithotomy or to lithotrity, and occasionally large 
quantities of small stones were simply washed out 
of the bladder by Glover's apparatus, a good instance 
of this latter operation being published by the late 
Mr. John Foster in the Lancet for October 10th, 
1874, four ^ears before Prof. Bigelow published his 
paper on Litholapaxy. The woman with a stone was 
generally cut, and ^ys and girls were always cut 
Lithotrity was unquestionably an unpopular opera¬ 
tion. The general surgeon was opposed to it, 
although Liston, Brodie, and Fergusson had all 
given it their countenance. Sir Henry Thompson, 
in his time, was almost alone in this country as an 
advocate and champion of the operation, ui^ng its 
adoption not as a substitute, but as a complement to 
the operation of lithotomy. The early lithotrituto, 
of course, had to practise without anssthesia, and 
they found that patients bore badly the repeat^ in¬ 
troduction of instruments, and that the more instru¬ 
mentation they underwent the more severe was the 
resulting urinary fever. This led Civiale, the father 
of lithotrity, to inculcate the importance of short 
sitting and of the employment of greart g^tlecess, 
and it was with this teaching that Thompson 
was imbued when he began his surreal career 
in London. This principle of gentleness is a 
great one, and is still of vast importance, 
^though the introduction of anmsthetics has 
made it subject to certain modifications. The 
lithotrites of 1860 were the ingenious and unhandy 
instruments of Brodie and Fergusson, and the pm^ 
feet instrument of modem days is entirely due to 
the suggestion of Thompson, and to the mechanical 
genius of the elder Weiss. No one but the Utho- 
tritist can realise the value of the cylindrical handle 
which they introduced. For some years Sir Eeniy 
Thompson practised lithotrity, removing much of 
the dearie between the blades of the litnotrite, and 
leaving the rest to be expelled by Nature's e&rts, 
and it was not until 1866 that the late Mr. Clover’s 
name began to be associated with the operation of 
lithotrity. In the Lancet of May 11th of that year 
he first described his apparatus for evacuating the 
debris after the crushing of a stone. No one has 
ever done sufficient honour to the memory of Mr. 
Clover. He was an Englishman educated at Univer¬ 
sity College Hospital, London, full of ingenuito andre- 
source. His inventions were numerous, and he was a 
pioneer in the modem art of anesthesia, and in that art 
bis inventions are still in use and are of great value 
In turning his attention to anesthetics it seems to 
me uncertain whether art gained, or general suigeiy 
lost, the more. At any rate, his apparatus for 


C 


Nov. 20, 1901. _0B1G3NAL COMMUNICATIONS. Thi Midical Pbiss. 637 


evacuatinf; stone after litbotrity, is nnqnestionablpr 
tbe prototype of all modem evacuators, and in it 
lay the germ of tbe whole of modem litbotrity. It 
is curious, in reading tbe early literature of this sub* 
jeot, to note bow right Clover was in everything be 
taught and pointed out from tbe very Mginning. 
Twelve years afterwards, when Profeesor Bigelow, 
of Boston, introduced his evacuating apparatus, it 
consisted of Clover's syringe with the receptacle of 
glass below, and tbe top connected with tbe evacu* 
ating catheter by a long flexible tube. Clover bad 
taught and explained that the nearer tbe glass re¬ 
ceptacle was to tbe penis the better, and after more 
experience Professor Bigelow accepted Clover’s 
teaching and did away with all connecting tubing. 
Clover taught that tbe smaller the evacuating tubes 
tbe less water would they contain, and therefore 
the brisker tbe cun'ent within them. Bigelow’s 
immense tubes have been found unnecessary and 
Clover’s smaller ones employed. Clover’s tubes 
were short ; Bigelow’s were long, and now all our 
tubes are as short as possible. Every one of Clover’s 
tubes was fitted with that important adjunct, a 
flexible stylet. Bigelow's tubes bad no such stylet, 
though he spoke of clearing his straight tubes vrith 
a rod, and now no Htbotritist would use a tube with¬ 
out ite being fitted with a flexible stylet, agiin show¬ 
ing how right Clover was. Clover’s tubes had lateral 
plates or eyes at the distal ends. Bigelow's had not 
these lateral plates, which permit of tbe easy rotation 
of the tube when in tbe bladder and of the compres¬ 
sion of tbe penis, rendering the route to the bladder 
all tbe shorter, now every operator uses these plates 
or rings. 1 think all this makes it quite clear that 
even Bigelow himself, and certainly all bis followers, 
had to go back to Clover's principles, and for these 
principles, I sssert, sufficient acknowledgment has 
never been made to our distinguished counti^man. 
1 believe Clover never operated for stone in his 
life ; if he had been an operator it is more than 
likely that using his evacuator, and with tbe assist¬ 
ance of ansssthetics, he would have anticipated Pro¬ 
fessor Bigelow by twelve years, instead of that he 
banded h s apparatus to Sir Henry Thompson, and 
contented himself with the administration of anses- 
theticB. At this time, 1866, Sir Henry Thomps'n was 
beginning to employ aneeethetics during his sittings 
of litbotrity, but only in private practice. 

In the hospital he still operated without chloro¬ 
form, and in employing Clover's bottle there, he 
found that while the patient bore tbe introduction 
of the lithotrite in the crushing of tbe stone, with 
fortitude, be would often complain, and that bitterly, 
when the bladder was distended in tbe operation of 
evaculation. This led him to employ the evacuator 
without great enthusiasm, but when I joined him we 
took it to every operation and invariably employed 
it. Our practice then was nearly all in private, and 
the patients therefore alw^s acEestbetised. In the 
autumn of 1878 Professor Bigelow proposed to treat 
calculi within tbe limits of litbotrity by crushing 
and evacuating a( one eitlinff. Tbe principle was 
soon recognised to be of the very first importance, 
and it was accepted with remarkable openness and 
fairness of mind. I have done my woi^ since 1878 
acting upon Professor Bigelow’s principle, but with my 
litbotrites and my evacuating tubes practically un¬ 
changed, but employing Professor Bigelow’s im¬ 
provement on Cloveris bottle. The improvement in 
that instrument consisting in putting the rubber 
syringe above tbe glass receiver instead of horizont¬ 
ally l^yond it, while at the same time I have taken 
away Bigelow’s internal tube, reducing the interior 
of the tube to ite original simplicity. 

It has not been generally recognised that there are 
really three ways of removing a stone from the 
bladder. It may be removed by vesical incision 


(lithotomy), it may be crushed and washed out 
(litbotrity), and it may be washed out whole through 
a tube; and it is to this latter proceeding that I 
would confine the term litholapaxy, introduced by 
Bigelow to designate a prooednre which is only 
litbotrity on a large scale. 

Litholapaxy, in my sense of the term, is the simplest 
and safest of the three methods, and if the stone or 
stones be small tbe operator should always attempt 
removal by means of tube and aspirator, and should 
only crush if the stone be too large to come tbrongh 
^ No. lB, 17, or 18 (English scale) tube. Litbotrity, 
that is to say Bigelow’s litbotrity, litbotrity at a 
single sitting, is the operation for boys and girls, 
women and men, in all uncomplicated cases of stone 
in tbe bladder. The surgeon will be well advised if 
he subject his patient to lithotomy in all cases where 
he feels nneertain that he will he able to break and 
bring away every particle of stone at one single 
operation, for that is the essence of modem Utho- 
trity. 

It is when faced with large stones in elderly 
feeble men, and pai'ticulariy when tbei'e has been 
long-standing prostatic or other obstmetive disease 
that I think the modem lithotritist should pause. 
Supposing that thestone is not mechanically beyond 
the limits of the lithotrite, it must be remembered 
that tbe old man’s urethra ill bears tbe repeated 
introduction of I&tm litbotrites and tubes. The 
prostate may be so disturbed that no urine is passed 
afterwards except by catheter, and the mucous mem¬ 
brane of the bladder may be so injured that phos- 
pbatic deposits readily occur, and plague and torture 
the remaining rears of life. In many of these cases 
the interests ot the patient will often be best con¬ 
sulted by the removal of the stone through a supi'a- 
pubic vesical incision. Then there are many cases 
where it is impossible to thoroughly clear an old 
bladder from stone by instruments introduced 
through the natural passages owing to the presence 
of pouches or sacculi. 

Then, too, tbe bladder itself in many of these cases is 
actually coated with phosphatio matter, which can¬ 
not be got away with the lithotrite. I would say, 
therefore, that if on examining an elderly man his 
urine is found to be clear and free from pus and the 
stone is felt to be of uric acid or of oxalate, and not 
large, say not over three ounces, it will probably 
safe to perform litbotrity. But if the urine is pura- 
lent and alkaline, tbe prostate very large, and the 
stone large and phosphatic, I think in most cases 
the best result will W attained by a supra-pubio 
lithotomy. 

One of the old axioms in the art of lithotomy was 
that you should never cut for the stone, without 
having felt tbe stone with staff or sound immedi¬ 
ately before making the incision, b\it even this 
valuable old rule has its exceptions. I remember a 
case in which, when ready to operate I was unable 
to touch the stone. In spite of that, a day or two 
later, I performed supra-pubic lithotomy, found an 
extraordinarily deep post-prostatic pouch, and at ite 
bottom a stone measuring five inches in its largest 
circumference. The patient made a good recovery. 
It is the difficult cases that must be cut, and it is pre¬ 
cisely the difficult cases where supra-pubic lithotomy 
is the operation. 1 look upon perineal lithotomy 
as obsolete. No finger is long enough to thoroughly 
explore tbe bladder through a perineal incision, and 
even if it be admitted that it is lon^ enough to 
make a complete diagnosis, it is certamly not long 
enough to do any work in the bladder, to turn a stone 
out of a pouch, or to stretch and dilate the neck of 
such a pouch before getting out tbe stone. With 
^ refei'ence to the return of stono after operation, I do 
not think statistics are important. It must be 


538 Th. Uidical PBies ORIGINAL COMMUNICATIONS. 


Nov. 20, 1901. 


remembered that after crushing or cutting the same 
constitutional conditions remain, and that the con¬ 
stitution may just as easily after one operation as 
the other form another stone. The same local con¬ 
ditions will also remain, so that if phosphatic cal¬ 
culus quickly follows the removal of a phosphatic 
stone by litbotrity, it does not follow that lithotrity 
is to blame. Ir, on the other hand, phosphatic 
calculus does quickly follow the removal of 
an acid stone by lithotrity, it is very probab’e 
that either the vesical mucous membrane was 
injured, became indamed, and offered a rough 
surface for the deposition of phosphates from 
the urine or that fragments and dehria were 
left behind. If lithotrity be undertaken it must be 
on the understanding that the operation must be 
completely finished, every particle of the stone 
must be removed. For this purpose it will be well 
to fragment and not to pulverise the stone. Pul¬ 
verisation has been recommended, but this fine sand 
or mud is very difficult to entirely remove •, it gets 
entangled in the mucous membrane and attracts 
phosphatic deposit, while fragments come away 
easily and are less likely to be left behind in the 
bladder. If a surgeon has been led by error in 
judgment to perform litbotrity in a case not ^to¬ 
gether suitable for the operation, and if he thinks 
he has unavoidably left some particles of atone be¬ 
hind, or indeed if he has the least suspicion that such 
may be the case, I advise that in four or five days 
after the operation, either with or without the aid of 
an anaesthetic, an evacuating tube be introduced and 
an aspirator applied. It will be found that particles, 
difficult to get away at the time of the operation, 
will have become loosened and will come away 
readily. It is often justifiable to undertake litbo¬ 
trity even when all the conditions favourable 
for lithotrity are not present. The patient may be 
too feeble for the surgeon to think him fit to bear in¬ 
cision. In these cases a second or final sitting of 
lithotrity, to ensure as far as possible the removal of 
every particle of stone, will be a wise proceeding. 
We thus see that in surgery, as in Nature, there are 
no hard and fast lines of demarcation, few absolute 
rules, and that the rule of modem lithotrity to re¬ 
move a stone at one operation has its wise and very 
proper exceptions. When the stone is very large 1 
am altogether in favour of supra-pnbic lithotomy. By 
this incision we have complete command of the 
bladder, there is little hsmorrhage, the stone is easily 
manipulated, and if necessary can be broken up and 
washed out. The delivery of a large stone supra-pubi- 
cally is not always an easy proceeding. I do not like 
forceps, which are apt to project bwond the stone, 
and BO unnecessarily tear the bladder. The best 
instrument is a scoop, placed well under the 
stone, while the stone itself is steadied by the 
operator’s left forefinger. There are many forceps 
for breaking up a stone after the bladder has been 
opened by the knife, and there is no reason why 
Forbes Keith’s giant lithotrite should not be used 
in this situation rather than from the perineum as 
practised by him. 

India has for centuries offered an unrivalled 
field for the performance of stone operations, 
and there are surgeons there who can boast of 
such lists of cases that no surgeon in Europe or 
America can expect to equal. The remarkable results 
obtained in that country which indicate what I have 
elsewhere referred to as the tolerance of the Indian 
bladder must not be taken as our guide and model. 
To English surgeons this vesical tolerance in India 
is wonderful, we watch and we admire ; but we must 
not be tempted to imitate. I am convinced that if 
we do we shall push lithotritv to dangerous extremes, 
and bring it into discredit. Lithotomy will continue 


to live—it has existed for thousands of years. It is 
the useful partner, not the jealous rival, of lithotrity 
and litholapaxy. 

COMPLETE UTERINE PROLAPSE. 

By FREDERICK HOLME WIGGIN, M.D., 

New York. 

Some recent editorial comments on the subject 
in The Medical Press and Circular suggest 
to me that my experience of the treatment of ** Com¬ 
plete Uterine Prolapse " may be of interest. 

Of the various local, chronic diseases to which 
women are liable, complete uterine prolapse produces 
the greatest disabili^ and discomfort. The condi¬ 
tion is best described as a reducible hernia through 
the pelvic floor, the sac, which is the inverted vagina, 
confining besides the uterus, tubes and ovaries, a 
large portion of the small intestines, the bladder and 
the rectum. 

The causation of the disorder, as is well known, is 
a primarily a separation—often submucous—of the 
tendons oi the muscles forming the pelvic floor 
where they unite in the median line; this is usually 
due to the passage of the child during parturition. 
This separation of the tissues which hmd the rectum 
in its proper position, allows the lower and anterior 
portion of the gut to bulge upward and forward into 
the vagina, pushing the vaginal tissues before it. 
This mal-position of the bowel is more or Lss in¬ 
creased by lifting heavy weights, but more particu¬ 
larly by every act of defeecation and straiiung at 
stool. As the muscular force expended follows the 
line of the least reeieisnee it tends in these cases not 
to expel, as it should, the bowel contents through the 
anal opening, but to force the gut throuf^ the 
hernial opening into the vagina. The difficulty ex- 
I perienced by the sufferer in emptying the rectum 
causes her to exert an ever-increasing force, and 
gradually and steadily, day by day, the rveto- 
cele increases in size, and as it d^oes so fotce 
is necessarily applied to the attached uterus 
in a downward direction. It also gradually begins 
to sag, and its ligaments, which in normal 
conditions serve simply as stays to hold it in place, 
are gradually stretched and lengthened by the weight 
of the descending organ upon them. The descending 
uterus must necessarily take the bladder with it. 

The process is hastened, after it has fairly begun, 
by the added weight of the small intestines which, 
being contained largely in the pelvis, find their way 
by gravity to the lowest point. Thus, after a period 
of longer or shorter duration, varying usually in 
accordance with the natural vigour of the patient 
and the amount of work she is called upon to do by 
reason by her environment, a complete inversion of 
the vagina occurs, and a hernial sac of large size 
appears outside of the body, and we have the condi¬ 
tion known as complete uterine prolapse to deal 
with. 

This complete form of the disease does not, as a 
rule, appear until rather late in life, although the 
patient has suffered more or less discomfort for 
many years. 

In the treatment of this disorder in its various 
stages gynecic surgeons have displayed much in¬ 
genuity and recommended various operations on the 
anterior and posterior vaginal wall^ and have also 
advocated the radical operation of hysterectomy, 
but, unfortunately, without very satisfactory per¬ 
manent results. 

In the writer’s opinion these disappointing results 
have been due to the failure to recognise the fact 
that the vaginal wall is practically a hernial sac with 
other contents than the uterus, tubes, and ovaries, 
and that consequently the simple repair of the ex- 


Nov. 10 , IflOl. ORIGINAL COMWUNICAriONS. Th. M*dical Pbibp. 539 


teroal perineal bodj, the removal of tbe larf^r or 
smaller portion of the vagioal walls, or even removal 
of the uterna itself would not correct tbe greatest 
caase of the difficulty, namely, the mal^position of 
the small intestines. 

In the patients who have come nnder the writer's 
observation, suffering from this disease, the uterus 
bad not been abnormally enlarged, and consequently 
could not be considered as a factor in tbe causation 
of the trouble, and in many of these cases the tumour 
was of large dimensions. 

In view of the foregoing facts the treatment re* 
quired for tbe successful management of the class of 
cases under consideration evidently calls for an opera¬ 
tion which will obliterate the hernial sac—or inverted 
and stretched vaginal wall—and a restoration of the 
damaged perineal structures as nearly as possible to 
their normal condition. The treatment, which has 
in tbe writer'sexperience.bestanswered these lequire- 
ments has been as follows : 

The patient on coming under observation is placed 
in bed in the recumbent posture and che tumour is 
reduced. Gravity is employed to help retain the 
parts in normal position by raising tbe foot of the 
oed about six inches. Tampons moistened with 
glycozone are also placed in position, and tbe parts 
are treated until all ulcerations on the vaginal walls 
are healed, tbe general condition of the patient 
during this time being carefully looked after. 

The next step in the procedure is to perform a 
laparotomy on the patient after the usual prepara¬ 
tions have been made, anmsthesia being produced by 
the use of ether or chloroform, or spinal cocainisa- 
tion. Before the abdomen is opened the patient is 
placed in tbe Trendelenburg position for tbe purpose 
of getting tbe aid of gravity in drawing the bowels 
out of the way. They are usually found in 
these cases, more or less attached to the vaginal 
walls by adhesion, which must be broken up. 
The uterus, which has been previously stated, is in 
elderly women usually small, is found and pulled 
upward by the aid of bullet forceps, thus drawing 
the vaginal wall attached to it upward also. When 
this has been accomplished, a needle armed with 
kangaroo tendon is passed through the fibres of tbe 
uterus about the point of ite attachment to tbe 
round ligament, and is carried up and down the 
broad ligament in the form of a purse-string 
suture, the needle being fioally made to emerge 
about the point of entrance, so that when the two 
ends of the suture are drawn upon, the broad ligament 
on that side is folded up and drawn together so that 
excessive length is done away with, and the 
uterus has a new point of attachment near tbe 
insertion of this ligament at the pelvic brim. Tbe 
same process is repeated on the opposite side, tbe 
abdomen flushed with saline solution, a quantity of 
which is left in, and tbe abdomen is closed rapidly in 
tbe usual manner. Tbe patient is again placed in 
bed, tbe foot of which is sl’ghtly raised, and after 
tbe abdominal wound bu healed tbe patient has 
usually recovered, four or five weeks later, she is 
again placed on the operating table and the sepa¬ 
rated tendons of tbe mtiscles are brought together 
with the submucous sutures of ca'gut or kingaroo 
tendon. 

At the time of this second operation it will be 
found, if tbe first operation has been properly per¬ 
formed, that the redundant vaginal walls have prac¬ 
tically disappeared, and the operator is in a position 
to find the separated tendons and can then easily 
bring them together. 

The operation just described has been performed 
by me a considerable number of times on aged 
women, and it has been his experience that the opera* 
tion is well borne by such patients because it can be 


quickly performed in both of its stages, and does 
not involve any considerable loss of blood. The 
following cases seive to illustrate these state¬ 
ments:— 

Casi I.—Mrs. M. L., set. 73. was admitted to the 
Gynaecological Division of the New York City Hospital 
on Apnl25th, 1901, suffering from a complete uterine pro¬ 
lapse. The patient stated that an operation had been 
performed upon the anterior and posterior vagioal walls. 
This operation had evidently been a failnrs, since when 
she was seen by the writer an external tnmonr was pre¬ 
sent abont six inches in diameter. 

Jane 24ih, 1901, after the patie ntwas prepared in the 
nsual manner ^ gr, of cocaine was injected into tbe 
spinal canal; this failing after half an honr to produce 
satisfactory aososthesia, it beca me necessary to allow the 
patient to inhale a moderate c\nantity of ether; after a 
little while, however, it was apparent that tbe action of 
the cocaine was effective, and the administration of 
ether was discontinued during the rest of the operation. 
Tbe abdomen having been opened, tbe operation of 
sntaring the broad ligaments, as already described, was 
performed, the abdominal wonnd was closed and the 
patient retamed to bed. Her convalescence was nn- 
eventfnl. and four weeks later the separated tendons 
of the perineal floor were fonnd and brought 
together with buried sutures. The patient made a 
rapid and satisfactory recovery from the second opera¬ 
tion, and when examined two months later seemed to be 
entirely cured of her difficulty, and was getting about 
with comfort. 

Case II.—Mrs. B. B., set. 83, was admitted to the same 
service at the City Hospital, April 13th, 1901, Buffering 
from complete uterine prolapse. She stated that when 
she was 38 years old she had given birth to one child. 
Ten years prior to admission she first noticed a prolapse 
of the vaginal wall, and within 18 months after that 
time the tumour had reached its fall size, which was 
about five by six inches, notwithstanding the fact that 
she had been treated by means of various pessaries. 

Jane 24tb, 1901.—Tbe patient was prepared in the 
nsaal manner and l-6th gr. cocaine was injected into 
the spinal canal. In abont twenty minutes the patient 
was safficiently aneesthetised to permit tbe performance 
of a laparotomy, she having first been placed in the 
Trendelenburg posture, and the broad ligament and 
the redundant vaginal wall were sntnred as described. 
On completion of tho operation at 3 p.m., the patient 
was retnmed to bed suffering slightly from nausea and 
headache. These symptoms, however, soon disappeared 
and she was able three hours later to take and retain 
nourishment. Her convalescence was uneventful, and 
four weeks later perineorrhaphy was performed in the 
manner previously described. She was seen and ex- 
aznined two months later ; her trouble had disappeared 
and she was able to walk abont with reasonable comfort. 

These cases, with many others which have come 
under the writer’s observation, would seem to prove 
tbe statement that the abdominal operations not in¬ 
volving loss of blood and not requiring much time for 
their performance can be easily undertaken, if neces¬ 
sary, even though the patient is nearing the end uf 
life. 

Farther experience with spinal cocainisation may 
demonstrate that it is particularly suited to this class 
of patients. If, as in cases just narrated, no injnrious 
effects follow ite administration, and the patients 
recover promptly from its use, being able to take and 
digest uourienment a few hours after the perform¬ 
ance of a serious operation, the field of application 
of this procedure to elderly people will be very much 
widened. 


The Annual Meeting of Fellows and Members of 
the Royal College of Surgeons of England taes 
place to-morrow (Thursday) at 3 p.m. at the College. 
A copy of the agenda will be sent to any Fellow or 
Member on application. 




540 Th> Medical PRsee- 


ORIGINAL COMMUNICATIONS. 


Nov. 20. 1901. 


AN APOLOGY FOR BACTERIA, {a) 

By R. TRAVERS SMITH, M.D., F.R.C.P.I., 

Aasistaot Ph^siciAn to the Wbitworth Hospital, Dublin. 

Aftib eome introdootoiy remarks, the speaker said 
that it was necessary to dispel the popular belief that 
all bacteria and man were natural and deadly enemies. 
The belief resulted from the ceaseless attention which 
is drawn to the microbe ori^n of disease. In fact, 
bacteria, like man, are sufferers from the welhreco^ised 
phenomena of evil report ever outstripping good. 
A homely classification of bacteria might be 
made into (a) bad masters, the pathogenic; (b) 
good servants, other bacteria, an account of 
whose stewardship constituted the address. Bacteria 
were first considered in their rCiU of soarengers. 
Were it not for those faithful toileis all dead animals 
and plants and the waste material of living ones would 
have remained as such on the surface of the earth, and 
would have accumulated till, by their very bulk, they 
had left no room for the living. Bacteria, by processes 
variously called deoomp'sition, putrefaction, decay, and 
fermentation, are perpetually cleansing the world of its 
dead organic matter. Bacteria were next discussed in 
their most important function—namely, as purveyors of 
suitable food to plants. The vegetable kingdom extracts 
the necessary food for its growth from an originally 
limited stock of soil, air, and water. Did not Nature. 
provide a method by which the material so used is re*' 
stored to whence it came in a form again available as 
food for plants, vegetable life would become extinct from 
starvation, binkrupt from perpetually drawing on ite 
capital. The extinction of the vegetable kingdom 
would soon be followed by that of the animal, since 
their interdependence is absolute. The food which 
plants take from air, soil, and water is, chemically 
speakintr, very simple. In the plant body it is 
built into much more complex chemical bodies, 
starchy substances, albumens, fats, Ac. These materials 
then feed animals, becoming more highly chemically 
complex in the animal bodr. It is obvious, then, that 
the (onroee of renewal of plants* food are three: dead 
plants, dead animals, and the excretions of living plants 
and animals; and that in order to be again available 
food to living plants, all thr>e must be reduced from 
complex to simple form. This feat in analytical 
chemistry is performed by bacteria, which, while 
scavenging waste organic matter, converts it once more 
into suitable food for plants. Herein Nature has 
devised a wondrous and indispensable plan for economi¬ 
sing her limited store of fo(^ by making it traverse a 
circle ; first, leaving air, soil, and water, and passing to 
plants, thence to animals, to be brought back once more 
from the dead and from the wa.sto products of the 
living to air, soil, and water, through the might of 
bacterial activity; without bacteria this circle would 
be incomplete, and the continuity of all life on the earth 
interrupted. Allusion was made to the ruthless waste 
of plant food caused by the prevalent systems of drain¬ 
age. Instead of animal and vegetable waste being 
restored to the soil, it is swept into the sea. “ Sewage 
farms " are a great step in the right direction. In this 
system of drainage the sewage is stored in tanks, where 
it is reduced to suitable food for plants by bacteria, and 
then thrown on the soil. The circulation of nitrogen 
round the food circle was considered more particularly 
to illustrate the etsential and subtle part played by 
bacteria in Nature’s scheme. Nitrogen exists in the 
dead bodies of animals and plants as proteids, albumi- 
noids, Ac, and in the excretions of living animals, chiefly 
as urea. Putrefactive bacteria convert the nitro¬ 
gen thus stored up into ammonia and some free gaseous 
nitrogen. Other bacteria then oxidise this ammonia to 
nitritM, and others oxidise the nitrite to nitrates. In 
the form of nitrates nitrogen is absorbed by the roots 
of green plants in general, so, unless it can be rescued 
from the atmosphere in some way or other, the amount 
of nitrogen in the food circulation will be ever diminish¬ 
ing. Bacteria again saves the situation. Leguminous 

(a) Absti act of tbe Inaugural Address delivered before the Uni* 
versity of Dublin Biological Association November Uth, 1901. 


I plants, as peas, beans, Ac., have on their rootlets itt’e 
I nodnles, which are impregnated with bacteria. These 
bacteria have the power o? fixing free atmospheric nit¬ 
rogen, which they then nneelfiehly yield to the plant, 
especially to its seeds. Once bMk in a legumlnons 
plant, the nitrogen, which was lost by putrefaction, has 
again entered the food circnlation, and is devoured by 
animals in the form of peas, beans, Ac. Mention 
was next made of tbe snppoced port bacteria, which 
lay in tbe formation of soil and coal. A few of the 
more important industrial applications of bacteria were 
discuseeA In the making of the best hotter bacteria 
were indispensable. Tne value of butter mainly 
depends on its flavour and aroma. These were due to 
certain bacteria that flavoured tbe cream before it was 
obnmed. In tbe icientific manufacture of butter the 
cream is sterilised, so as to free it from all bacteria t^t 
might produce undesirable flavours; after this a pure 
culture of bacteria of known repute for producing ex¬ 
cellence of flavonr and aroma is added to the cream. 
By employing d’fferent bactoris^ butter could be made 
of any particular flavour to suit any particular market 
with corresponding peenniary advantages to the mann* 
facturer. In a similar way tbe tastes of different 
cheeses were due to the action of different varieties of 
bacteria on fresh curd. In the manufacture of smoking 
tobacco from tbe tobacco plant, bacteria are eesentiaL 
Tbe crude leaves are subjected to varicus fermentative 
processes, for which bacteria are responsible. Tbe par¬ 
ticular species of organisms at work have been separated 
in pure culture. By judicione employment of such cul¬ 
tures tbe manufacturers can som^ify tbe fermentation 
of the leaves as to produce desirable smells and flavours 
for the finished lobaccos. Tbe “retting” of flax, 
whereby the linen fibres can be readily separated from 
the valueless portions of tbe plant, is accomplished by 
bacteria. No mechanical means has ever been discovered 
that can dispense with bacteria in the mannfactnre of 
linen from the flax plant. Time would not permit men¬ 
tion of any more industriea in which, consciously or 
nnoouEcionsly, bacteria were employed. The list is a 
longcne. Tbe President concluded bis remarks with a 
strong expression of opinion that these much-maligned 
microbes constituted a vital force, tho full comprehen¬ 
sion of which was still in its infancy. Prosperity awaits 
the country that scorns not to lavish time and money 
upon the cultivation, development, and utilisation of the 
loirliest of her subjects, the bacteria. 

‘^hcvapciitir ^otes. 

By Geoeob M. Fot, M D., F.R.C.S., 

Snrgvon to the Whitworth Hospital, Dnimcondnt, Dublin. 

DIONINE. 

This ethyl-morphine derivative has been a snffi- 
oiently long time ^fore tbe medical profession to allow 
of a furly accurate opinion being formed of its thera¬ 
peutic value. It is one of a gronp of new morphine 
derivatives to which benzyl * morphine and diacetyi* 
morphine belong. When von Mering, the discoverer, 
intr^uoed it to the profession, through E. Merck, of 
Darmstadt, some few years ago, a description of the 
preparation appeared by me in Tux Mkdical Psksb 
AND CiBCULAB ; since then the chemical has been 
submitted to the test of clinical experience both 
in France and Germany. So far tbe results have 
been most favourable, and have borne out tbe phy¬ 
siological experiments and fully justified the opinion 
that was formed of its action from its chemical formula. 
Indeed, the production of a salt such as dionine, the 
hydrochlorate of ethylmorphine, by the substitution of 
an organic radicle for one of its hydrogen components,, 
points to a future in which existing alkaloids will be 
modified by the chemist so to meet tbe wants of tbe phy¬ 
sician, that the latter will merely have to ask for a chemi¬ 
cal to produce certain therapeutic effects, [and it will be 
provided. Dionine possesses tbe sedative and analgesic 
effects of morphia, the alkaloid from which it is pro¬ 
duced. But the preparaticn is not so powmnl 
either as a narcotic or as an analgesia It is, however 

C 


Nov. 20, 1901. 


TRA.N8ACTIONS OF SOCIETIES. 


Ths Msdical Fas88. 541 


valaable ia diseases of the respiratory system: pnen* 
monia, bronohitis, tnberoulosis, asthma and whoopiog- 
ooogh. In gynsecology dionine is, according to Bloch and 
Walther, indicated in paiofnl periods, especiaUy inflam* 
matory dysmenorrhcei, also in paiofnl inflammatioos of 
the pelvis, both of the parametrinm and perimetiinm, 
and also in malignant non-operable neoplasms of the 
oterns and its adnezes. Ophthalmologists employ it 
eitensively on the Continent as a means of inducing 
lymph stasis in affections of the cornea and conjanctiva. 
To the general practitioner it will be found a valuable 
substitute for morphia in the treatment of pnen* 
monia, its sedative effect on the respiratory centre 
not l^ing so strong as that of the alkaloid; neither 
does it tend to dry up the secretions or intetfere with 
the expulsion of mucus. For children it is a useful 
adjunct to the ordinary syrup and muoil^e mix- 
tire for bronchitis. Asthmatic cases benefit greatly 
ffo® its use; it seems to cut short the attack and to 
diminish the severity of the succeeding one. Both in 
the treatment of asthma and whooping-cough Dr. 
Rudolph Schmidt (^rs^. Cent. Zeit.), who has had a 
large clinical experience of the chemical, strongly 
recommends its use. In whooping cough he looks on it 
as a specific, and in asthma it has in bia hands given 
better results than any other drug. 

He hMds the opinion that in dionine we possess a 
drug posoessing the sleep-producing and pain-killing 
properties of morphia without any of those unpleasant 
after-effects with which all physicians are familiar. For 
alcoholism and acute delirium tremens the preparation 
on theoretical grounds bhould be well suited, as it neither 
depresses the heart nor injuriously affects respiration, 
and ytt exerts a sedative effect on the cerebrum and 
cerebral nerves. It has the further advantage of being 
practically non-toxic. 

SPANISH PRESCRIPIONS. 

To Check Vomitino ; 

R Hydrochlorate of cocaine, 0'05 grammes. 

Menthol, O'lO grammes. 

Strong chloroform water, 75'00 grammes. 

Distilled water of the aloe, 75*00 grammes. 

A teaspoonfnl every two boars. 

An£iiia (No. 1): 

9 Precipitoted snlphor, 10 grammes. 

Sugar of milk, 20 grammes. 

Ft. pulvis. 

A small quantity to be taken at the beginning of each 
meal. 

(No. 2): 

R Powdered digitalis leaves, 2 grammes. 

Lactate of iron, 2 grammes. 

Extract of gentian, a snlficiency to make thirty 

pills, of which two are to be taken daily. 
Insomnia: 

K Extract of belladonna, 0 25 grammes. 

Extract of cannabis indica, 0 25 grammes. 

Bromide of sodium, 15*0 grammes. 

Hydrate of chloral, 15 0 grammes. 

Simple syrup, 100*0 grammes. 

One or two tablespoonfuls daring the night. 
Hemostatic Pills : 

Ik Extract of hydrastis canadensis, 002 grammes. 

Extract of hammelis virginica, 0 02 grammes. 

Ei^otine, 10 0 grammes. 

Damien, a sufficiency to make a pill. 

One every four hours. 

Hbmicbania: 

B Autipyrine, 0 50 grammes. 

Bromide of potassium, 0*50 grammes. 

Hydrochlorste of cocaine, O'Ul grammes. 

Caffeine, 0*02 grammes. 

Powdered PauUinia sorb., 0 60 grammes. 

Make a powder. 

El Siglio MSdico, 

Mb. C. B. Ball, Regius Professor of Surgery in the 
University of Dublin, has been offered a seat on the 
Advisory Board to be established under the scheme for 
the reorganisation of the Army Medical Service. 


‘^rattBactions of gonctiea. 

EDINBURGH MBDICO-CHIRUBGICAL SOCIETT. 

HbETINU held WlDNBSDAT, NOVBKBSB 6 tH, 1901. 
Mr. A. G. Hilleb, President, in the Chair. 


Db. Melville Dunlop showed a case of chloroma. 
The subject of this extremely rare disease was a boy, 
set. 6, and the symptoms had not lasted for many weeks. 
The patient was admitted to hospital with signi of 
ansemia and slight fulness abont the eyes, and the 
blood coont showed a lenoocytosis amonnting to 24,000 
leucocytes. The leucocyte count had gone steiHlilynp, 
reaching 61,000, and with this there had been progres¬ 
sive weakness, and development of the characteristic 
facies. There was marked proptosts, caused by retro- 
ocular lymphoid growths, which could be felt above and 
below the eyeballs, there was also a considerable amount 
of lymphoid deposit abont the malar region, and latterly 
two swellings bad appeared on the palate. The con¬ 
dition was extremely rare, and this was a very typical 
ase of the disease. 

Df. Nobman Walker showed three cases of lupus. 
Ooe of these had been under treatment by exposure to 
the Rontgen rays for severid months, and now the con¬ 
dition was, for the time being at least, cored As a 
rMuIt of the X-rays there had teeu a very marked reac¬ 
tion, the cheek had become inflamed, and an nicer had 
formed, but notwithstanding this the treatment had 
been persevered in, and the ulcer had healed very 
rapidly. There was no doubt that these rays ezeroiBed 
a markedly stimulating effect on the growth of epi¬ 
thelial tissnes. That conM be seen in this case, where 
the cntaneous epithelinm ha 1 actually grown over the 
oonjonotival mnoous membrane at a spot where the 
Inpus had caused ectropion. The second patient snffer^ 
from multiple lupus. One patch, about ten inches in 
diameter, on the buttock, h^ been treated successfully 
by excision and skin grafting; a second, on the arm, had 
been extirpated by the galvano-oiutery; a third, on 
the face, was being subjected to the X-rays, while 
a fourth had healed spontaneously. The third 
patient was being treated by the X-rays, and had im¬ 
proved considerably. Dr. Walker exhibited a Finsen's 
apparatus and explained that if the hand was pressed 
against the bnll’s-eye lens it became quite translncent, 
except for the blood-vessels, through which the rays of 
light did not penetrate. In using the light, therefore, 
it was necessary to press the glass firmly against the 
affected tissnes, so as to render them auEemic, otherwise 
the rays did not penetrate the parts. 

Mr. Stiles showed (1) a girl after operation for plezi- 
form angioma of the scalp. The difficulty iu such oases 
was to control hsemorrhage, and, as the dilated arteries 
had extremely thin walls, and sprang from vessels em¬ 
bedded in the firm tissues of the scalp, it was impossible 
to ligature them in the ordinary way. He had, there¬ 
fore, made a transverse incision through the scalp over 
every artery which entered the angioma, so as to divide 
the vessel completely. The vessels were then ligatured 
by passing catgut under their divided ends with a fine 
needle. The process of knotting the ligature caused the 
edges of the emsll wounds to approximate, and no 
stitches were required. Altogether twelve arteries were 
dealt with in th’S manner, and electrolysis was per¬ 
formed about ten days later. The condition was mnch 
improved, and it was now proposed to excise the mass, 
which could be done without much risk from bleeding. 
(2) Skiagrams from a case of congenital dislocation of 
the hip in a patient, aged one year and nine months. 
This was the yonngest case be bad seen, and the dia¬ 
gnosis had been a matter of some difficulty. Relying 
on the fact that the limb could be adducted more 
readily than its fellow—it conld be crossed over the 
upper third of the opposite thigh, whereas normally it 
sbonld not cross higber than the lower third, and that 
doing so made the head nnusnally prominent, as well as 
on the fact that the degree of possible abduction was 
diminished, Mr. Stiles concluded that this mast be a case 
of congenital dislocation, and the skiagram confirmed 



542 Thk Msdical Ibxss. TBANSACTTONS OF cOCjBTIES. Nov. 20, 1901. 


bis opinion. (3) A child after operation for tuberculous 
disease of tbe frontal bone. (4) The calvarium of a 
child who had suffered from multiple tuberculous osteo¬ 
myelitis of the cranium. (5) Darning-needle removed 
from tbe abdomen of a child. (6) Sac of a hydrocele, 
with constriction corresponding to tbe external abdo¬ 
minal ring. (7) A hernial sac and strangulated testicle 
removed from an infant fourteen days old, during opera¬ 
tion for irreducible inguinal hernia. The swelling had 
been present for forty-tight hours when tbe child 
arrived in hospital, and fsocal vomiting bad ret in. On 
opening the tac the bowel was found to be glossy, and 
could returned without difficulty. The strangulated 
testicle was then found, the strangulation being appa¬ 
rently due either to direct pressure of the knuckle of 
bowel, or to torsion of the cord caused hy the presence 
of the bowel in the scrotum. 

Mr. Alxxis Thomson showed a sarcoma of the small 
intestine, causing incomplete obstruction. 

Dr. Habvkt Littlxjohn showed specimens of (1) 
extra-peritoneal rupture of the bladder following a kick 
on tbe abdomen, and (2) enormous dilatation of tbe 
pulmonary artery, the vessel measuriog six inches in 
circumference. The heart was hypertrophied, tbe left 
lung completely fibroid and airless, the left branch of 
the pulmonary artery was occluded, while the right 
admitted three fingers easily. 

Dr.ALxxANDKB Bbuce lead a paper 

ON TEX MOTOB LOCALISATION IN THE LUHBO-3ACBAL 
RtaiON OF THX COBD. 

As a preliminary to tbe study of the subject it was 
pointed out that (as Dr. Bruce’s researches shown), 
the arrangement of the groups of nerve cells on the 
grey matter of the cord is constant in different persons, 
and that it is possib'e by examining any section to say 
to which segment it belongs. Secondly, there is a con¬ 
stant reaction on tbe part of nerve cells where motor 
nerves have been divided, as has been described by 
Nissl and Marinesco. The nuclei of tbe cells become 
lateral instead of being central, tbe Nissl bodies dis¬ 
appear, and the whole cell assumes a granular 
appearance. These changes develop constanuy after 
fourteen days have elapsed since the section of a motor 
nerve. It is thus possible to make out the motor centre 
of a mnscle hy observing the degenerative changes which 
ensue upon its removal. Dr. Brnce’s material consisted 
of two cords, one from a case of amputation just above 
the knee-joint; a second from a case where the whole 
leg and the greater part of the ilium had been amputated. 
In tbe normal Inm^-sacral cord the following groups 
of cells could be distinguished: (1) Antero-latei^ , 
group, extending down to the second sacral segment, and 
attaining its maximum size at the first sacral; (2) pos- 
tero-Iateral, which increases in size downwards to the 
first, and ends in the third sacral; (3) a post- 
postero-lateral in the first, second, and third sacral; (4) 
a central group, extending down to tbe third sacral; (5) 
a mesial gronp, which di8apx>eared at the fourth lumbar, 
and reappear^ at the third sacral. Sections of the cord 
of the first case, in which all the nerves going to the 
muscles of the leg below the knee and the small 
muscles of the foot had been divided, showed a 
degeneration of the cells of the postero-lateral 
gronp in tbe segments from the fifth Inmbar to 
the third sacral, as well as of those of the post-pos- 
tero-lateral group in the first three sacral segments; tbe 
antero-lateral, mesial, and central groups escaping. A 
case of van Gehuchten's practically agreed with this one 
of Dr. Bruce's. The speaker’s second case vas one in 
which all tbe muscles of tbe leg had been removed 
except the psoas and iliacn8,the obturator intemus, tbe 
pectinens, l^e pyriformis, and the two gemelli. In the 
sections of this cord the antero-lateral and postero¬ 
lateral groups were partially degenerated in the second 
and third Inmbar segments, tbe nndegenerated cells 
probably representing tbe centre for the psoas and 
iliacns. All the cells were degenerated in the fourth lum¬ 
bar, while in the first and second sacral a few nndegene- 
rated cells were present In the antero-lateral group only. 
These apparently represented the centres for the pyri- 
formis, obturator intemus, and gemelli. From these two 


cases it seemed that the thigh muscles had their centrea 
in the antero-lateral group from the second lumbar to 
the second sacral and in the ^ostero lateral group above 
tbe fifth lumbar, while tbe centres for tbe calf and leg 
muscles were in the postero-lateral group from the 
fifth lumbar to the third sacral, and those for the 
foot muscles in the post-postero-lateral group. 
There was reason to suppose that the pudic nerve 
was injured at the operation, and degenerated cells 
were found in tbe mesial group of tbe third and 
fonrtb sacral segments. This mesial group of coUa 
has a curious distribution; it disappears in the 
upper racral and lower lumbar regions, is well 
developed in the dorsal region, and again vanishes in the 
cervical enlargement. There is reason to believe that 
it contains tbe cenires for tbe moEclee of the trunk, and 
the degeneration of cells with injury to the pudic nerve 
was of interest in this connectiou. 

Dr. Bbtou Bramwell congratulated Dr. Bruce, and 
Dr. Faton remarked that whereas the cortical centres 
represented physiological movements lather than indi¬ 
vidual muscles, this did not seem to be so in the cord. 

Dr. David Watkrston described tbe grouping of the 
nerve cells in tbe lumbo-sacral cord of the cetacea. 
There tbe lower limbs were rudimentary, while the peri¬ 
neal muscles were enormously developed. He had 
found that the antero-lateral and postero-lateral groups 
were insignificant, while the median group was largely 
developed. 

Dr. Bbucx, in reply, said that tbe arrangement of 
these centres was not w^at be had expected. He had 
thought that they would be grouped together so as to 
represent msvements. Apparently this was not so, and 
one found that individual moscie, rather than combina¬ 
tions of them, had special centres. Bis observation ex¬ 
plained how one saw infantile paralysis begin in the foot 
and suddenly spread to the buttock. The two sets of 
muscles were close together in the oord, not several seg¬ 
ments apart, and a lateral spread of the poliomyelitis, 
not a vertical one, was all that was required to explain 
each a case. 

The retiring President, Mr. A. O. Millxb, then de¬ 
livered a valedictory address, in which he shortly 
reviewed tbe work of the past two years, and oongratn- 
lated the Society on its increasing mem^rship and the 
greater interest which members were taking in its pro¬ 
ceedings. Two foreign members bad died daring the 
year, one extraordinary member, and nine ordinary 
members ; to these app.opriate allusion was made. 

Tbe following office beurers were elected for the en¬ 
suing year:—President, Dr. T. E. Fraser; Vice-Presi¬ 
dent, Dr, James Eitcbie; Council, Mr. A.G.Miller, Drs. 
Paton, Eoasell, Logan Turner, Ballantyne, Kerr, 
Douglas, and Mr. Stiles; Treasurer, Dr. Harvey Little¬ 
john : Secretaries, Dr. Melville Dunlop and Mr. Alexia 
Thomson; Editor of Transactions, Dr. Craig. 

EOYAL ACADEMY OF MEDICINE IN IRELAND. 

Surgical Sxction. 

Thx Opening Address was delivered on Friday evening, 
the 8th Inst, by Mr. Thomas Mtlxs, President of the 
Royal College of Surgeons, President of the Section. 

Mr, Mtlxs took for his subject tbe advantages of ope¬ 
rative interference in complicated fractures of tbe long 
bones, as practised by Mr. Arbutbnot Lane in London. 
He compared the surgical audacity of operative mea- 
Butes on the abdominal contents, and the timidity which 
surgeons exhibited in the more aooessible regions of the 
upprr and lower extremities in cases of fracture. Tbe 
O der classifications of fractures were, he considered, too 
artificial to be helpful, and were, to the beginner, 
stumbling-blocks to diagnosis. Cases of fracture com¬ 
plicated with dislocation were difficult of diagnosis, and 
where, as was sometimes the case, calcareous deposita 
formed, the Rbntgen rays gave little aid. He met one 
such case in which a fracture of the anatomical neck of 
the humerus was complicated *with dislocation of ^tbe 
bead of the bone, and the deposition of a large calcareoua 
mass which extended up to the clavicular articulation. 
All the classic symptoms of separation of tbe greater 

> 8 



Nov. 20, 1901. 


TRANSACTIONS 


tabero&ity were present, and the pathological condition 
was only made known by raising the deltoid masole. 
In such doubtful cases he recommends that the deltoid 
be separated from its brachial insertion, and the part 
exposed so that the lesion may be recognisHl. The 
operation presents no difficulties, is quickly performed, 
and is comparatively free from risk. 

LAPAROTOMY FOB INTESTINAL OBSTBOCTIOH. 

Mr. Lentaigns read a paper on a case in which 
laparotomy had been twice performed, with six months 
interval, for the relief of intestinal obstruction, resulting 
from the presence of large concretions in the colon The 
patient, a boy commencing his teens, had been addicted 
to chewing woollen fabrics, blankets, and such like, and 
when admitted to hospital was suffering from constipa¬ 
tion and vomiting, which daily became worse. For a 
week he got injections through an O’Beime’s tube, 
which were unattended with any good results. An 
operation was performed. The abdomen was opened, a 
large concretion removed from the colon, and the boy 
made a good recovery. Six months afterwards be was 
again admitted to hospital, and again after a fair trial 
of injections a laparotomy was performed and the colon 
opened and evacuated, in the performance of which the 
old silk continnons sutnres of the previous operation 
were come on and found to have remained unimpaired. 
An attempt was made to create a fistula in order to 
prevent the recurrence of the condition. The fistula, 
however, closed, and the boy, now convalescent, left 
hospital, to retnm some time afterwards with the same 
symptoms—vomiting and constipation. A finger in the 
rectum now detected a large concretion, whl(^ was in 
part scooped out and washea oat. The boy made a good 
recovery; has discontinued the pernicious habit, and 
remains well. 

Mr. Myles considered the paper very instructive, as 
showing the difficulty of diagnosing abdominal tumours, 
and said that in a somewhat similar case he bad seen 
good results obtained from olive oil injvctione, followed 
by the nee of electricity, which prodnoed free vomiting 
and purging. 

Mr. Cbolt thought palliative treatment by injections 
might have been gives a more extended trial before re¬ 
sorting to colotomy. He thought the second operation 
nnneceesary, and there wsis nothing to indicate that it 
had been advantageons. 

Mr. McA.bdlx quite agreed with Mr. Lentaigne in the 
necessity for early operation in such oases; nothing was 
gained by delay, and it was sound surgery to operate 
and remove the concretion from above. He was par¬ 
ticularly pleased with the fulness of detail with which 
the paper was presented. 

Mr. Mitchell (Belfast) congratulated the author of 
the paper on finding an hypertrophied colon. In one of 
his cases the colon was so mnch attenuated that the 
tissue could not hold the sutures, the wound opened, 
and the boy died. 

Mr. Obusby gave an instance of a patient of his who 
ate her hair, nibbling off portions until she produced a 
iniuM of matted hair in her stomach, which he excised. 

Mr. Doyle drew attention to the tendency of alimen¬ 
tary concretioi s to simulate malignant disease of the 
bladder. A patient of his, treated for malignant growth 
of the bladder, was found after death to have a healthy 
bladder, the trouble having been caused by an immense 
accumulation of charcoal in the rectum and descending 
colon. 

Mr. Chance instanced the case of a boy, who, from 
eating straw, formed a massia bis ileum about the else 
of a banana, which necessitated operAiion. 

Mr. Lentaigne, in reply, thought that any farther 
use of palliative remedies would have done away with 
all prospect of success. The second operation was not 
attendtd with any benefit, but having performed it he 
thought it but right to mention it. 

Mr. H. Gbat Cboly showed (a) child, eet. 4, showing 
results of excision of astragalus for tuberculosis; [b) 
child, set. 7, showing results of excision of astragalus 
and end of fibula, with gouging ol os calois for tubuca- 
losis; and the astragali removed from three patients. 

Mr. £. H. Tatlob showed (a) parent in whom the so- 


OK SOCIETIES. The Medical Fbesb. 543 


called excision of the superior maxilla has recently bees 
performed for sarcomatous difease; (6) oases showiug 
the result of operation for complete cleft of the hard 
and soft palate (own operation); (c) case presenting 
extensive varicosity of the veins of the right upper 
extremity. He also exhibited (a) parts removed in the 
operation of supra-pnbio prostatectomy; (b) kidney 
removed for calculous disease; (c) sarcoma of superior 
maxilla; (d) comminuted fracture of the atlas vertebra 
the result of a fall. 

The meeting then adjourned. 

LIVERPOOL MEDICAL INSTITUnON. 

First Oboikaby Meeting of thc Sesssion held 
October 20rH, 1901. 

The President, Mr. Edgar A. Browne, in the Chair. 

CASE OF ANSUBISHAL VABIX OF FEMORAL ARTERY. 

Mb. B. C. Dun showed a patient suffering from 
aneurismal varix of the femoral artery and vein in the 
upper part of Scarpa's triangle on the left side resulting 
from a Mauser ballet wound. Very severe hicmor- 
rhage had immediately followed the receipt of the 
injury. The oommanicetion between the artery and 
vein bad apparently developed on the third day after 
the wound was inflicted, as indicated by the snpsrven- 
tion of pnlsation and thrill over the vessels. For the 
past year the patient had been doing full work as a 
tailor, suffering comparatively little inconvenience. 
There was no distinct tnmour in Scarpa's triangle, 
merely in ill-defined swe'ling. Expansive pulsation and 
marked thrill were present, with a very loud rumbling 
bruit resembling the noise beard when travelling in a 
train passing through a tunnel. There was no cedema 
of the limb, below, or varicosity of veins. The pulsa¬ 
tion and thrill gave no inconvenience to the patient 
after long standing or walking, and the limb was 
readily tired. It was not considered advisable to 
attempt aoy operative interference. 

Mr. Bdshton Pabkeb referred to a formidable cue 
of the kind operated on by Professor Lister in Edin- 
bnrgb, over twenty years ago. The femoral artery was 
tied above snd below the aperture, and the mnch 
dilated vein was stitched up with antiseptic catgut, and 
its channel preserved. Though much blood was lost in 
a prolonged operation, the patient recovered with a 
useful limb. 

BING STBICTUBE OF THE SlGXOtD FLEXDBB. 

Mr. Qeobob Hamilton mentioned several cases of 
ring stricture of the sigmoid flexure, which he had pre¬ 
viously brought before the Society, and which were still 
alive and well. Stress was laid first on the fact that 
carcinoma of the intestine was not nearly such a malig¬ 
nant disease as carcinoma elsewhere; secondly, that an 
operation for removal was best conducted in two stages, 
no attempt being made to unite the divided bow^ at 
the primary operation. A very nuusual cise was related 
of a schoolmaster who was set. 68, and who suffered from 
a carcinoma of the sigmoid flexnre, which bad become 
(owing to a long me-'ocolon) attached to about the 
middle of the transverse colon. In order to remove 
this growth it was found necessary to take away sixteen 
inches of large bowel. The man had made an admir¬ 
able recovery. Mr. Hamilton made some farther remarks 
on the advisability of recognising these ring stricturee 
before much intestinal obstruction occurred. 

Mr. Bdshton Pabkeb agreed with Mr. Hamilton that 
in cases of this kind it was the best practice to tie tubes 
in the cut ends of the gut and bring them out of the 
wound, reserving to a future operation any attempt that 
might be made to reunite the gnt. 

Sir Dyce Duckworth read a en^eative paper on 
the personal factob IN tuberculosis, 
an abstract of which will be found in another column. 
In the discuseion that followed 

Dr. T. B. Qltnn considered that Sir Dyce Duck¬ 
worth’s remarks on the importance of recognising the 
part played by the constitution of the host in the 

Oi .M-v 



PRANCE . 


yov. 20, 1801 


544 The Medical Pbiss. 


dBTeloptDent of taberoaloBis were folly warranted, owing 
to the attitode of certain physicians at tbepresen ttime. 
He had the oppoitooity of seeing a nomber of medical 
Tefwrts on the health of applicants for insoranoe, and 
ihad noted that some medical examiners, in cases where 
there was a history of phthisis in a family, made soch 
remarks as this:—“ Some of the relatives have died of 
tobercolosis, bat this affection is no longer considered 
hereditary, and it is not necessary to charge an extra." 
The pathologist in his inocolation experiments studied 
only one aspect in the etiology of tuberoalosis, but he 
ooold not understand bow the physician could fail to 
rec^niss the importance of the other aspect—predis¬ 
position, hereditary or acquired. He thought that for 
the most part what was formerly known as the strumous 
diathesis would now be recognised as degeneracy. 

Dr. W. C&RTSB agreed that it was an necessary to 
consider the soil as the seed, but he believed that most, 
if not all medical men, took this view. Fact) bearing 
on the importance of the nature of the soil were too 
patent to he mistaken, such, for example,as tuberculosis 
coming after small-pox, &c., the different order in which 
structures were attacked in the young as compared 
with the aged, the greater degree of susceptibility 
of the coloured races, &o. In every caee it seems to be 
a stiuggle between destructive and defensive forces, for 
the probability is that there is no absolute immunity 
in any individual of any race. It reems probable, also, 
that the bacillus tubercu'osis can grow on different 
media and produce different toxins accordingly. 

Dr. Wabbimoton recognised the greater vulnerability 
cf some to tuberculous disease, arising either from in¬ 
herited defects or acquired conditions of lowered vita'ity. 
He considered, however, that it mu^t be a very difficult 
tssk to point out ench speeifie /eatur«t in individual 
physiognomy as would enable an observer to state with 
reasonable probability which individuals were more 
liable to tuberculosis. Similarly he coustdered it would 
be difficult to predict of several individuals, previously 
healthy and whose family history was unknown, whicdi 
individual was, on exposure to cold and fatigue, most 
liable to rheumatic fever. The pneumonia bacillus 
inhabiting the mouth of a healthy person might be as 
virulent as that found in one suffering from the disease. 
There must, tbeiefore, have been some change in the 
host, but this change could not be recognised. The 
statement be would emphasise is that the proof of a 
diathesis is often the proof of a diseare. 

Dr. Thouas Habbis (Manchester) scarcely thought 
that the modem pathologists so completely ignored the 
general equation of the suitability of soil in favouring 
or retarding the development of tuberculosis, as the 
nthor of the paper inferred. There could be no reason¬ 
able doubt that the suitabi ity or otherwise of the soil 
not only affected the tendency to the development of 
tuberculous foci in the first instance, but also played a 
great part in the subsequent progress of such foci. The 
favourable results following the modem treatment of 
tuberculosis in open-air sanatoria were doubtless due 
to the rendering of the human organism a less suitable 
eoil for the progress of the lesion, and resulted in many 
oases in an arrest of the disease; it was quite right to 
use the term " arrest" in reference to such cases, and to 
avoid the term " cured." 

Drs. Buchanan and Barr also spoke, and Sir Dtcb 
Duckwobth replied. 


Jcpavtmcnt of l^unacij. 


LUNACY IN FOBFAE3HIEE. 

At a meeting of the managers of Montrose Asylum, 
held on the 6th inst., it was reported that Dr. Fraser, 
Commissioner in Lunacy, who lately visited the asylum, 
raid in his report it would be evident that the provision 
of additional female accommodation was urgently re¬ 
quired, and be understood with satisfaction that they 
bad resolved tc erect a villa for females. It was hoped 
that there would be no further delay in providing this 
extension. The dayroom accommodation for fema’es in 


the hospital was overcrowded, bnt adequate dormitory 
space was obtained by utilising rooma ori^nally iu- 
tended for the brspital staff. The margin of spare 
accommodation for male pauper patients throughout 
the asylum was small, and it would be obvious that the 
erection of a villa for Bix»y feuales would not whol'y 
relieve the overcrowding in the female sections which 
at present existed. The Commissioner had also con¬ 
gratulated them on the way iu which the asylum was 
being conducted, for which they had to thank Dr. 
Havelock and the other officials. It was the intention 
to build a home to accommodate sixty patients, bnt it 
is manifest ibat a house of that size would not even 
meet the present reqniremenfa, and therefore, provision 
for about 100 patients would have to be made. How¬ 
ever, discussion on the subject was delayed. Dr. 
Fraser's report was considered a tborongh one. 

TYPHOID AT MORPETH ASYLUM. 

It was reported by the Committee of Visitors of 
Morpeth Asylum at a quarterly meeting of the Northum¬ 
berland CountyCouncil,held at Newcastle on the 7th inst., 
that there had been a serious outbreak of typhoid fever 
at the asylum and in the cottages. In all, fifteen persons 
bad been affected, and the Cimmittee regretted to my 
four of the patients had died. The Medical Superin¬ 
tendent attribnted the outbreak to the introduction of 
the disease from without, through the medium of files, 
which is a very likely hypothesis. A serious neglect in 
the want of an isolation hospital has given rise to the 
spread of the outbreak. The nurses were said to lie in 
touch with each other, ac>d the patients were lying near 
one another. If this statemei>t be correct, things Ic ok 
indeed very serious, and we are amazed tbat the attacks 
were limited to the few reported. 


cfrancf. 

[VBOM ODB OWN C0BBB8PO5DBKT.] 

Paris, KoTtmber 17tb, 1901. 

Ttphoid in Pabib. 

Thb typhoid fever epidemic in the north-east part of 
Paris is spreading to an alarming extent. Over 
100 patients were admitted to hospital on one day 
last week. Several nurses have been attacked with 
the disease, and two have died. Eighteen ca^ea 
have occurred among the soldiers quartered in the 
Tourellee Barracks. The epidemic is attributed to com- 
taminated water supp'y. 

No Mbntonb fob the Phthisical. 

Mentone has hitherto been looked upon as par txcel- 
Isnce the resort for consumptives, but the l:otel propr.e- 
tors of that town are apparently of opinion that their 
presence is prejudicial to the higher interests of this 
delightful spot in that ic tends to scare away the 
healthy and wealthy whose pationage they would prefer- 
This is the inference which is to be drawn from the 
resolution lecently passed by the hotel proprietors in 
solemn conclave assembled, bnt they had better have 
a care, since one of the first results would probably be 
the construction of sanatoria specially destined for the 
reception of phthisical patients. 

Damages fob Pbeh«tube Bcbial. 

A sensational case has just beeu tried in France, at 
least 60 it is reported, iu which 200.000 francs damages 
were awarded to the father of a lady who arrived in 
France from Senegal, suffering from yellow fever, who 
died, as was believed, and was buried, but on the body 
being exhumed the deceased was found to have given 
birth to a child in the coffin, whereupon it was aeeumed 
tbat she bad been buried alive. The Couit apparently 
endorsed this view, and gave heavy damages against the 

) 0 ' 



Not. 20, 19J1.__ GERMANY. Th* Msdical Psbs. 545 


certifyiog doctor ssd the Goreinment. It ia hardly 
necessary to point ont to medical readers that posthn- 
mons delivery by no means jnstifies the assumption of 
premature hnrial. The contraction of the muscles in 
ri^o * mortii will explain the expulsion of the infant > 
indeed, we believe that instances of the kind are on re¬ 
cord. Nevertheless, the occurrence is one which may 
well be held to tell against the practice of prompt in¬ 
humation which obtains in some countries, France 
among the number. 


Germans. 

[PROU OUR OWN COBRESPONDINT.] 

Beblix, November 16Ui, 1901. 

Vaginal Punctubb and Incision. 

Hr. H. Franz, of the Boyal University KUnik for 
Women’s Diseases, Halle, has a paper on this subject 
in the Mvmh. Med. IFocA., 31/1901. Vaginal juncture 
is, he says, first of all a welcome aid in di^^osis in the 
case of tumours lying in Douglas’s pouch. It is also 
serviceable in the diagnosis of tubal swellings whether 
they be of inflammatory nature or leeultiug from tubal 
gravidity and in exudative peritonitis. 

It is also of therapeutical insportanoe in dealing with 
growths in the posteiior pelvic region. Twenty oases 
of this kind were completely removed by inoision, 
eleven improved, two remained in the same condition* 
and two died. By far the best results were obtained in 
cases of simple abscess in Douglas’s pouch, whether 
the result of infection after operation or from inflamma¬ 
tion near the csecnm. These oases all recovered. The 
reason of this good resolt is clear. The abscess cavity 
being opened and drained recovery mnst of necessity 
fol'ow if there are no further sources of infection. It 
is different when tnbo^varian tumours are incised. 
Complete recovery rarely takes place here by simple 
incision. The inflamed ovaries and tubes being left 
readily give rise to fresh inflammation. StUI more 
unfavourable is simple inoision for hicmatooele from 
extra-uterine gravidity. Here it is only justifiable 
whin the collection has become foetid or septic, and 
operation by the abdomen is nnusoally dangerous owing 
to the septic condition present. 

Puncture is made at the lowest fluctuating part of the 
swelling. If the contents of the cavity escape through 
the tube the cervix is seized with a pair of forceps and 
pushed forwaids and upwards. By this means the 
vaginal mucous membrane is made tense round the 
trocar, and the opening can be readily enlarged with a 
knife. A pair of forceps can then be passed in and the 
opening enlarged by separating the blades of the for¬ 
ceps. When the contents have escaped a rubber 
drainage-tube can be inserted and the remainder of the 
cavity packed with iodoform gauze. The drain must, of 
course, be kept clear. Cases generally recovered in 
from two to three weeks. 

At the first meeting of the Medical Society Hr. V. 
Bergmann gave an address on 

Amputation in Fhlsohosis. 

He recalled Virchow's work on life in the blood, wherein 
it was shown that the blood was not for long the 
carrier of foreign bodies. The view often held that the 
life of the patient was lost so soon as deleterions . 


material circulated in the blood was erroneous 
A proof of this was shown by many cases observed in 
the Klinik. In phlegmosis the process of disturbance 
was plainly shown clinically. We were not powerless 
as regarded the advance of the process. Appropriate 
incisions of the skin, the connective tissue, the fascia, 
and the tendon sheaths bad given extraordinarily good 
results, as be had shown in a previous address. If the 
blood were examined in such cases micro-organisms 
were fonnd which were looked upon as exciters 
of disease, streptococci, staphylococci, Ac.; proof 
could be furnished by cultivation in animals or upon 
agar. If deep incisions were not enough to evacuate 
the pus which formed early in the sheath of the ten¬ 
dons, and did not relieve, the question aroise whether 
removal of the affected limb would not be of service. 
On many sides the question had been answered in the 
negative, and it had been htld to be very dangerous to 
remove limbs when micro-organisms were already circu¬ 
lating iu the blood. Ddrfler, of Begensburg, had cha¬ 
racterised such operations as surgical heresies, against 
which the State antborities ought to bestir themselves. 
Whilst this author was in such extreme horror of such 
amputations, he, the speaker, as urgently counselled 
them. The question as to the beat time when such ampu¬ 
tation should be undertaken was when incisions did no 
more good, when, therefore, in spite of wide openings 
the phlegmon extended further and further, when, in 
other cases, the result had been favourable, then was 
the time to carry out the amputation. His assistant, 
Wolff, had much interested himself with the 
question, and of six oases of spreading phlegmon in 
which amputation had been successful in saving life, in 
five of them micro-organisms had been shown to have 
been present in large quantities in the blood, as proved 
by inoculation and onltivation. He mentioned as espe¬ 
cially convincing the case of a student, st. 20, who was 
admitted into the Eiinik on September 27th last, who 
had been so unfortunate in springing from a street car 
as to omsb the greater part of the hand. The conser- 
va'ive treatment at first tried failed. Even on Septem¬ 
ber 29th the little finger of the left band bad to be 
removed, but the phlegmon rapidly advanced. Farther 
examination of the blood from the wound and from the 
right median vein gave a positive result- streptococci 
were found which killed mice inoculated with them. 

Extensive inuisions were now made on the back of the 
forearm, the swollen arm was incised, on October 8rd 
the wrist-joint, Arhich already contained pus, was opened. 
The fever did not subside, however. The patient became 
de'itious and exhibited the other signs of grave septic dis¬ 
turbance, and the number of micro-organisms circulating 
in the blood increased. On the evening of the same 
day on which the extensive openings had been made 
amputation was performed. Examinations of the blood 
were made twice on that day, and the result was in¬ 
teresting. At first large numbers of mioto-organisms were 
still found in the blood, but the number gradually dimi¬ 
nished, and in a few days they had quite disappeared. 
An inoculation made on October 11th was without result, 
whilst streptococci were still present in the pus from the 
wonnd. They disappeared from that also, and the 
wound granulated, and was now soundly healed. The 
speaker was therefore unconditionally in favour of 
amputation in such esses at the stage mentioned. 

Digitized ; ^"^^3 ^ 



A.II S T R I A 


Nov. 20, 1901. 


54r6 Th* Midical I'iiebb. 

(Austria. 

[VBOM OUB OWN COBBIBPONDBNT.] 


ViEVNA, November 16tb, 1901. 

Bibb's Conqsbtion on tmi Divxlopuint or Bonk 
Callus. 

At the “ GesellschiftBam ^ave the Society an 
accoant of his rescits in a series of experiments con¬ 
ducted at the “Wiener Universitat'’ nnder ProfesBOr 
Faitauf, and with the assistance of Professor Biedl. 

The object of the experiments on animals was to prove 
to their own satisfaction the correctness or incorrectness 
of Bier's theory of venous congestion, or “stannngs- 
hyperffimie,” having any practical value in local tuber- 
culcsis. A close examination of the morbid changes 
that take place in these animals when under experiment 
positively proves the complications that obscure any 
attempts at elucidation. The results, however, are 
somewhat satisfactory, and plainly demonstrate that the 
infiuences in operation that cause the increase of tissue 
mast be of an anti-parasitic nature, and that the in¬ 
flammation is an aseptic one. It is the physiological 
change that takes place in the repair of fractured bone 
or cartilags. 

Since the days of Dnmreicber, similar empirical 
practices have been carried out by bandages to consoli¬ 
date pseudoarthrosis, while Nicoladini aimed at nutri¬ 
tive irritation of the tissues, which produced a 
hyper cemia. 

Bum's experiments were first conducted on guinea 
pigs, and Wter on dogs. The tibice were diapbysially 
fractured and '* gypsum '* bandages applied. The right 
and left were symmetrically broken, ao that observations 
could be compared on each leg. The right leg was 
daily congested for one or two hours just above the 
knee-joint. Some of the animals died while others were 
killed. On the congested side this imbibition of serous 
fiuid was extensive in the subcutaneous intermuscular 
fibrous tissue of the peripheral parts with great increase 
of callus and restriction of bone union. He showed 
sections which demonstrated extensive calcification and 
ossification of the periosteal callns. 

Onychoobaph. 

Castagna showed an apparatos to the Society for 
registering the pulse at the nails, which is termed an 
“ Onychograph.” It is omposed of a metal knob which 
lies on the finger nail and records the pulsation through 
a lever on a rotating drum. 

Qlandulab Fbvbb. 

At “ Doctoren CollegiumHochsinger brought the 
subject of glandular fever before the meeting. This 
term, be said, was fiist introduced by Pfeiffer, of 
Wiesbaden, in 1869, it preferably attacks children 
between five and eight years of age, resembling infec¬ 
tious diseases, having pain in the glands which often 
went on to suppuration, but in the greater number of 
cases ended in spontaneous resolution. The glands 
attacked were the cervical and sabmaxillary with knots 
in the lymphatics. The attack was uiually ushered in 
with general malaise, pain in the limbs with restless¬ 
ness. 

The tongue was red and coated, but fauces clean; 
pain in ihroat when swallowing, as well as in active 
and passive movement, the patient often bolding the 


head as in torticollis. In severe cases there were often 
hoarseness and rnnning at nose, enlargement of spleen 
and liver, with severe pain in the middle line of abdo¬ 
men between nmbilicns and symphysis, associated with 
nephritis. 

Hochsinger gave a number of examples having no 
connection with tubercle or syphilis, and occurring 
among young children, commencing with a number of 
irritative inflammatory points in the skin, mucous mem¬ 
brane, as well as the head and face. 

Another type of these form glandular swellings in the 
throat, and others after acute infectious diseases, with¬ 
out any rise of temperature, which are often slow and 
persistent. There is yet a third type of this disease, 
occurring after acute specific fevers, in which the south, 
nose, and throat become involved, with a high range of 
temperature and large gland. 

Hochsinger was inclined to believe these glandular 
fevers were secondary, as Manfredi had so ably sup¬ 
ported by showing the presence of virulent micro¬ 
organisms in the diseased glands, which bad probably 
re-infected the organ. The disease might be termed a 
local glandular inflammation, and not idiopathic as some 
would have ns believe. There is no uniformity in eithtr 
the eetiology or clinical symptoms. It may first be con¬ 
sidered ai a deposit in tbs retropharyngeal tissues, and 
subsequently forming an abscess. Hochsinger affirms 
that he has often seen the fever preceded by a reddening 
of the hard palate, resembling the infection of Luschka’s 
tonsils, which raises the question of a preceding 
pharyngitis or tonsillitis. The low resistancs of the 
adenoid rings in the throat at this tender age may be 
advanced as a cause of the disease; but more probably 
the true cause may be a previous catarrh, tonsilla 
pharyngea, or lymphadenitis febriles oerricalis. An¬ 
other gives it as a previous inflammation of Luichka’s 
tonsils by an infectious toxin like inflaenxa, As. 

The theore'ical objection to “ gland fever ” is the 
probability of its being scrofulous. 

The treatment adopted by Hochsinger is either a lotion 
of the acetate of alnm, or Goulard water applied to the 
glands. After the fever has subsided he prescribes an 
ointment of icbtbyol, Ao. Tbe prophylaxis presided in 
treatment of the laryngeal glands, but he dreaded the 
name of gargle. Pastilles and such like, impregnated 
with the pre^ribed drug, were beneficial and frequently 
very powerful disinfectants. 

Weil wondered at Hochsinger’s objection to a gargle, 
as be considered a 5 per cent, solution of creosote a very 
powerful antidote in the nates and pharynx. Another 
excellent mode of treatment was by iasufflation with 
sodinm sozoiodolicum, which can be easily performed in 
tbe case of children. 

Finus was of opinion that all hyperplasia of the 
lymphatic glands was a secondary phenomenon. This wa i 
indubitably manifested in scrofular inflamed gland. 
The beet prophylactic, to bis mind, was the nasal douche 
of Pinos with a washbottle, which the patient can do 
himself, bathing tbe whole of the pharynx. 


Db. Lazabus Bablow, of tbe Westminster Hospital, 
who has been gravely ill in consequence of septic poison¬ 
ing contracted while making a post-moitem examina¬ 
tion, is reported to be slowly improving. 

Digitized by 'OO^IC 



Nov. 20. 1301. 


THE OPERATING THEATRES. 


The Medical FKsee. 547 


©pccatittg ^Iteatrc®. 

KOYAL FREE BO&PITAL. 

Behoval of all the Contents of th* Obbit foe 
Malignant Growth. —Mr. H. TTobk Eodd operated 
on a woman, fct. S8, who bad been admitted for an 
nlceratlDg growth of the lids and orbit on the right 
ride. The history of the case, Mr. Dodd said, was pe¬ 
culiar in that the patient said that eleven years ago 
she was troubled with a small pimple or nodular growth 
under the right upper eyelid, which growth was snipped 
off with EciesoiB by a doctor. After a few months it 
presented ittelf again, and hss since increased, some¬ 
times slowly and sometimes quickly, to its present size, 
until four years ago it began to be really a visible 
trouble, about which period it commenced to ulcerate 
at the border of the lower lid. There had been no par- 
ticnlar pain, with the exception of latterly some dull 
aching in the area. On admission the right 
eye was very nearly closed, the outer two thirds 
of the eyelid were prominent and filled up in between 
them by exuberant granulations. There was distinctly 
to be fe'.t a solid growth, filling at least the outer half 
of the orbital cavity and extending outwards under the 
skin beyond tbe outer edge of the orbit for about half an 
iuch; tbe growth was apparently somewhat firmly adhe¬ 
rent to the bone in this region, though at the outer part 
the skin moved freely over it. On separating the lids the 
eyeball was found to be displaced towards the nasal side 
of the orbit and to be buried in altered tissue. There was 
a fair amount of thin discharge; the vision in the eye 
was good, but tbe movements of the globe were limited, 
especially in the outward direction. There was 
an enlarged gland in front of tbe ear on tbe 
same side, which was hard and somewhat painful 
to the touch, the skin conld be moved over it, and the 
gland itself was movable on its base, but not freely. 
Tbe clinical appearance of the growth pointed towards 
a diagnosis of an epithelioma uf a slow and quiet type 
though there existed a possibility of its being a rodent 
ulcer; there was no history of syphilis to lead to any 
suspicion of its arising from that source. To render 
the diagnosis more certain, some days before operation 
the patient had been pnt under an antesthetio, and a 
small portion lemoved across the base and tbe edge of 
growth, so as to take ulcerated as well as non-ulcerated 
tissue for microfcopical examination; the result of this 
had cot been decidedly satisfactory, there being some 
doubt ae to what tbe growth really was; ithoweverwas 
held to he of a malignant nature. Proceeding rather 
on the clinical aspects of tbe case than on the patho¬ 
logical, it was determined to remove the whole 
growth as far as possible, which would probably 
lead to the clearing out of tbe whole orbital 
contents. Tbe patient having been placed under an 
ansssthetic, an incision was made starting just outside 
tbe punctum lacbrymalia of tbe upper ltd, carried 
upwards and outwards to jnst below the eyebrow, reach¬ 
ing tbe orbital edge at tbe junction of tbe middle and 
inner third, and then travelling along the orbital border a 
little below tbe eyebrow to about an inch and a-quarter 
outside the exteinal cantfans. The lower incision com- ' 
uiencsd in a similar place just external to the lower 
punclnm, running down well on to the lower edge of the 
orbit and travelling outwards al«.ng its border in an 


almost straight line to meet the extremity cf the upper 
incision in such a way as to include the growth external 
to tbe orbit. Tbe whole contents of the orbit were then 
loosened from the bone, starting from above and on the 
outer side, by means of the finger, tbe periosteum de¬ 
tacher, and the knife; Snally, the optic nerve was 
divided as far back as possible with curved scissors and 
the mass removed en hloe, together with the poition 
of growth external to the'orbit, and the upper and 
lower lids ss cirenmteribed by the two incisions. 

T he outer orbital border in the region of the giowth was 
then attacked with the chisel and mallet; tbe sui erficial 
part of the hone round this locality being thoroughly 
chiselled away, after which the outer wall of tbe orbit was 
scraped with a spoon. The original incision was then con¬ 
tinued backwards and outwards over the centre of the en¬ 
larged gland in front of tbe rightear in order toiemove the 
gland and its immediately surrounding tissues; this was 
successfully accomp)i.>hed. This last incision was closed 
by intermpted and continuous sutures. The two incisione 
encircling the orbit were brought together in front of 
that opening, after they bad been loosened above and 
below, in order to cover tbe large and ugly cavity, a 
space being hft about the size of a sbillinga little to the 
inner side of tbe normal situation of the eye. The cavity 
of the orbit was stuffed with cyanide gauze, and suitable 
dressing applied externally. Mr. Work Dodd remarked 
on the absolute necessity of freely removing all tissues 
in tbe immediate vicinity of snch a growth, and fointed 
out that even an eye which possessed good vision had to 
be sacrifi<%d to attain that object, not to mention that 
the appearance of the patient had to be terribly altered 
for the worse. He remarked that it was quite possible 
that some facial paralysis might result from injury to 
the facial uerve, during tbe removal of the gland. He 
proposed, after a suitable interval, iu addition to closing 
the opening as far as possible, which he bad done, to put 
in skin grafts on to the granulating surfaces of the 
orbital cavity in order to change this surface into skin, 
so that the walls of tbe orbit would be lined with skin, 
thus doing away with all discharge, and at the same time 
protecting the cavity from external influences. 

Three weeks after operation the patient was doing 
well, tbe wonnds being perfectly healed; the cavity of 
the orbit bad been most auccessfully grafted a week 
before by Dr. Cunning, Senior Resident Medical Officer, 
very nearly its whole surface being now covered with pro¬ 
perly growing akin. There bad been no indication what¬ 
ever of facial paralysis. 

Dublin Death-rate. 

In the Dublin Registration Area the deaths regis¬ 
tered for Ihe week ending Saturday, November 9th, 

1901, represent an annual mortality of 23 8 in every 
1,000 of tbe population. Within tbe city proper the 
death-rate ranged from 257 in the Clarence Street Dis¬ 
trict to SO'3 in the South Earl Street District, and 
reached as high as 36 0 in the LUbum Street District, 
figures which show how dependent the high death-rate 
of Dublin ia on tbe tenement houses ia wnich the city 
labourers are huddled. 

Grants In Aid of Sclentiflc Besearch. 

Ws are requested to call attention to the fact that the 
Odontological Society of Great Britain is prepared to 
receive applications for grants in aid of the furtherance 
of scientific research in conncc'ion with dentistry. For 
further particulais and forms of application apply to 
the Hon. Sec, Scientific Research Cominittee, Odonto¬ 
logical Society, 20, Hanover Square, London, W.. ^ ^ 

uiLiiii^ea I IV / 




548 Thi Midical Pbxss. 


LEADING ARTICLES. 


Nov. ao, 1901. 


Beoistbkbd fob rBAMsmssioa Abboad. 

Jflfiital Jrm anb (ttirnilar. 

Publiahed mry WedsMdBj morningr, Pne*5d. Peat fr«e, Sid. 


ADTBETI8EICEHTS. 

#OB OVB IvaxBTiov:-Vbole Page, £6 Oa. Od.; Half FB«e, 
£S ICa, Od.; Qurtor Page, gl 6a. t Oae^gbtb, ISa. e<L 

Fob a SBBika or laaMTioras— Whole Page, tbirteen inaertiona 
(weeklj, fort&igbtly, or montbly), at AS lOa. Od.; twanty*aii 
ioaertloiia (weekly or fortnightly) at £8 Sa. Od. j flfty-two 
inaertiona (weekly) at £8 each. Half Page, thirteen inaertiona 
at 36a.: twenty-six at SSa.: flfty-two inaertiona at SOa. eaob: 
Quarter-page, thirteen inaertiona at 18 b. twenty-aix inserttona 
at 1 <Sb. : flfty-two Inaertiona at lAa each. 

Ginal] annonneensenta of Practices, A aaiatandea,Vacancies, Booka, 
fto.—Beren lines or under, 4e. per insertion j 6d. per line 
beyond. 


(JHcbiral JnsB anJ» Ctuular. 

*' 8ALUS POPtJLI 8UPBBHA LSI.** 


WEDNESDAY, NOVEMBER 20, 1901. 


“ IDEALS IN MEDICAL EDUCATION. ’ 

It ig no secret that the changes made of late 
in the medical curriculum are viewed with scant 
favour. That some change was necessary scarcely 
required argument. The introduction of new sub¬ 
jects, the subdivision of others, and the bringing of 
a few more into greater prominence, without any 
being given up or their importance being diminished, 
could not go on for ever. As it was, the unfortunate 
student was overloaded to such an extent as to make 
anything like a satisfactory mastery of th e subjects 
impossible. A fifth year was therefore added. 
That it has resulted in an improvement com¬ 
mensurate with the increased expense involved is 
very questionable. Unfortunately the change brought 
in itj train in many places an increased number of 
examinations. The medical student's life is one 
continuous struggle with examinations. He has 
come almost of necessity to look upon each course 
solely as a prepai-ation for an examination. He 
becomes an adept in discerning tbe points which are 
likely to have gi-eatest examination value. Tbe lec¬ 
turer whose discourses aie considered to most 
nearly suit tbe examination which is to follow is most 
carefully listened to; the professor whose lectures are 
calculated to enable tbe student to justly appreciate 
the great principles of the healing art, or to dip below 
the surface of the subject, rather than to help him to 
pass the examination, finds his discourses neglected. 
These teachers become, unwittingly, the greatest 
friends of the “coach.’’ In an address on “Ideals 
in Medical Education,’’ before the Melbourne Medi¬ 
cal Students' Society {Intercolonial Medical Journal 
of Australasia), Dr. J. T. Wilson, Professor cf 
Anatomy in the Sydney University, took an 
extremely broad view of the whole subject. Many 
of bis remarks had reference to local difficulties, 
but be nevertheless points out in a masterly manner 
some of tbe defects of tbe systems which hold j 


generally in English-speaking countries. If we are 
not prepared to entirely abolish intermediate exami¬ 
nations he would favour “ examinations only when 
tbe student is about to pass from one definite 
phase of study to another.’’ Tbe address well 
deserves the careful perusal of all who are interested 
in the subject of medical education at home and 
abroad. Dr. Wilson cautions teachers against 
taking too narrow a view of their duty, which is to 
train prof- ssional men rather than give a profes¬ 
sional training. In his opinion it is possible to 
embody the whole ideal of an university in a medical 
school, yet he does not lose sight of tbe fact that 
Harvard Medical School, in the United States, has 
enacted that “ it is their intention to require a 
preliminary college course in ai^ of four years’ 
duration as a qualification for admission to 
tbe medical curriculum, also of four years.” 
This is particularly significant in a country 
where tbe practical side of affairs is kept so well to 
the front. Johns Hopkins University has already this 
system in operation. Dr. Wilson believes that “ tbe 
mo&t serious charge brought against the curriculum 
with which ’’ he is “ most familiar is that the last 
two years of it are alone available for clinical work 
in hospital.” His argument against this practically 
consists in asserting that since the student goes to 
hospital better prepared, he acquires a knowledge of 
clinical work more readily. “But,” be says, “not. 
withstanding all this I am disposed to believe 
that we in Sydney have gone a little too far 
in tbe reduction of the period of clinical 
study to two years only.” Ue would welcome 
the introduction of a “Lebrjahre’’ to the student 
course. This means adding a sixth year, except that 
the student would be able meanwhile to earn a small 
ealary.or at any rate to live independently. The sys¬ 
tem of “ elective studies ” is discussed, and the promi* 
nence it has reached in that great land of inventions, 
the United States, is shown. It is stated that at 
Harvard, “in the Medical Faculty alone the staff 
consists of twenty-two professors and eight assist¬ 
ant professors, twenty-six instructors and demon¬ 
strators, forty-three assistant-instructors, and 
ten special clinical instructors independent of 
teachers in the preliminary scientific subjects* 
with an output of not more than about one 
hundred and thirty graduates per annum.’’ 
One is tempted to ask, Do the teachers teach ? Tbe 
Professor of Anatomy of Tale University is quoted. 
“ We already note,” he says, “ that the experience of 
tbe clinician can rarely do more than effect improve* 
meats in methods, while the new principles come 
from tbe laboratories.’ ’ It might be added that only 
too often these new principles have had to be sent 
back to the laboratories for repairs after a very abort 
time. It is curious to compare Dr. WiUon's com¬ 
plaint that clinical work once started fasci¬ 
nates the student into a neglect of tbe more 
scientific branches, with that of Graves in 1842, 
when be said “ the chances are that tbe chief 
energies of hie (the student’s) mind will be mis- 

Digitizedb. ^ 


Nov. 20, ISOl. _ LEADING ABTICLE8. Tbi MiorcAL Psieb. 549 


spent with the fascinating experimentB and doc¬ 
trines of chemistry, electricity, magnetism, and the 
polarisation of light.’’ Clinicsl work will ever remain 
the Bobject which will attract the large majority of 
medical students and win from them the greatest 
interest and induBtry, and it is well that it is eo. One 
would justly tremble for the welfare of the public 
were it not that though the medical student is very 
heavily handicapped in hie clinical work he is to-day 
as much attracted by the study of the problems 
which await eolution in eech patient he sees, as were 
the students of long ago. 

THE TBEATMENT OF PTLORIO CANCER. 

Foe some years past surgeons in various parts of 
the world hare exercised their ingenuity in devising 
measures having for object to obviate the distressing 
consequences of cancer affecting the neighbourhood 
of the pylorus. The symptoms associated with 
cancer in this situation are almost entirely due to 
the mechanical obstacleto the onward passage of the 
gastric centents created by the resulting stenosis. 
At first surgeons restricted their efforts to 
removing or circumventing the obstacle, either 
by manual dilatation, as suggested by Loreta, 
or by one orotber method of gastro-enterostomy, 
thus short circuiting the upper part of the alimentary 
canal. The study of the post-mortem appearances 
subsequently emboldened surgeons to go a step 
further, and by removing the diseased portion of the 
stomach to attempt a radical cure. Although, so 
far, the ifsults of this form of surgical intervention 
have not realised the, perhaps, too sanguine hopes of 
the operators, the measure of success has been 
snfiBcientto justify further observations. Atpresent 
it is open to question whether the extra risks attend¬ 
ing the major operation of pylorectomy,are compen¬ 
sated by greater comfort and prolongation of life as 
compared with the relief afforded by the compara¬ 
tively mild operation of gastro-enterostomy. The 
relief to the urgent and distressing symptoms of 
pyloric stenosis afforded by the latter operation is 
immediate and pronounced, and the only drawback to 
its usefulness is the ephemeral duration of the 
improvement. In view of the extremely unfavour¬ 
able condition of a large proportion of patients 
suffering from gastric dilatation following pyloric 
cancer it is urged by some eminent surgeons that 
gastro-enterostomy ought always to he performed 
in the first instance, advantage being taken of the 
subsequent improvement in general health to attempt 
the radical cure later on. Against this suggestion 
must be placed the fact that, as it is, these cases 
do not as a rule come under surgical treatment 
until the progress of the disease is such as to defy 
its entire eradication and any further avoidable delay 
is therefore to be strongly deprecated. This brings 
us to the question of diagnosis. Here,a8 in so many 
other departments of surgery, surgeons complain 
that they are not asked to operate \mtil success is 
jeopardised or rendered impossible by the extension 
of the growth. Physicians defend themselves by 


alleging the extreme difficulty of making an early 
and trustworthy diagnosis, and it cannot he denied 
that these cases do sometimes present well-nigh 
insuperable obstacles to a correct diagnosis. If 
we await incontrovertible evidence of the localisa¬ 
tion of the disease in the region of the pylorus it 
will in the majority of instances be too late for 
effectual surgical intervention. It is open to question 
too whether further experience will enable us to sur¬ 
mount this difficulty which appears to he inherent to 
the anatomical circumstances. The only alternative 
is to cut the Gordian knot by having early recourse to 
an exploratory incision in all cases presenting the 
classic symptoms occurring in patients at what we 
may call the cancerous age. Special importance is 
attached, in the diagnosis of cancer, to the absence 
of hydrochloric acid in the gastric contente. In 
the discussion on a paper read at the last meeting 
of the Clinical Society of London by Dr. Moyni- 
han, an abstract of which we published last week, it 
is pointed out that in 70 per cent, of the cases of 
gastric cancer the growth is so situated as to allow 
of its extirpation, and farther, there is a curious 
absence of secondary growths in the liver. The 
present attitude of surgeons towards operations for 
cancer of the stomach, as was pointed out, is very 
much that which they took twenty years ago towards 
removal of the breast for cancer. Little by little 
the scope of the operation was enlarged so as to in¬ 
clude the lymphatic area, with proportionally more 
favourable results. No doubt in the near future 
they will follow these lines in dealing with cancer of 
the stomach, removing lymphatics and other possi¬ 
ble sources of recurrence, and thus advancing 
towards the object which they have in view—the 
radical cure. 


THE METROPOLITAN ASYLUMS BOARD 
AND SMALL-POX.—I. 

To say that the progress of preventive medicine 
must always be closely regulated by the thorough¬ 
ness which attends its practical administration is 
simply to formulate a general law. In the United 
Kingdom there would be difficulty in citing examples 
of all degrees, both of excellence and of its reverse, 
in the matter of sanitary local self-government. 
Among a host of administrative bodies the Metro¬ 
politan Asylums Board stands out pre-eminently on 
account of its size, its importance, and of its com¬ 
pleteness of organisation. The duties of the Board 
are multifarious. It deals with the infectious 
sick of the greatest city in the world, together with 
its insane population and the training and medical 
care of a great number of Poor-law and “ remand ’’ 
children. The centralisation of these branches of 
work has been necessitated by the vast and increas¬ 
ing size of the Metropolis, but the work of the Board 
conveys its lesson to every municipal and county 
sanitary authority throughout the Kingdom. The 
value of central control has been abundantly 
demonstrated by the measures taken to deal with 

the small-pox epidemic that has now obtained a 

Uigiiized I 



650 Th» Medical Pb*m. NOTES ON CURRENT TOPICS._ Not. 20. 1901. 


foothold in London. In the present day, with 
its increasing and rapid inter • communication 
between the “ uietropolis ’’ and all parts of the 
Kingdom the maintenance of a first-rate line of de¬ 
fence against small-pox in London is a matter of 
importance to the safety of every town and hamlet, 
however remote, throughout the length and breadth 
of the British Islands, to say nothing of our colonies. 
Owing to the fluctuating nature of that malady, 
which we fain would liken to the flickerlngs of an 
expiring conflagration, it is exceedingly difficult to 
gauge the extent of standing hospital accommoda¬ 
tion that should be maintained. To take a few 
illustrations: In the year 1885 there were treated in 
the Board's hospitals 6,146 cises of small-pox; in 
1889 there were only 5; in 1893 the figures rose to 
2,376; in 1898 they bad again fallen to five; while in 
1900 there were 66. Clearly the task of keeping up 
under these circumstances a means of defence in the 
shape of properly equipped isolation hospitals 
saddles the Board with a constant drain upon its 
resources. According to their own statement the 
cost to themetropolis, exclusive of ambulance charges, 
of this insurance against small-pox outbreaks is 
about £10,000 per annum. Considerable as this 
annual charge is compared with the number of 
patients treated, its value is tested by London’s com¬ 
parative freedom from small-pox, and when we look 
at the cost of past epidemics, both in lives and in 
money, and at the dislocation of trade thereby in¬ 
volved, it will not be deemed excessive by reasonable 
persons. In the present year, unfortunately, the 
resources of the Board are likely to be heavily taxed 
by the small-pox outbreak that is still steadily in¬ 
creasing iu the Metropolis. When we consider the 
expenditure of energy and of money, both of which 
are poured out like water in the attempt to extermi¬ 
nate small-pox, and on the other hand the creation 
of an unprotected population that is bound to follow 
the retrograde policy inaugurated by Mr. Balfour’s 
Yaccination Acts, we realise the inconsistency of the 
national attitude with regard to the whole question. 
The existence side by side of the Asylums Board 
small-pox organisation and of the " conscientious 
objector ” is an anachronism, a ludicrous con¬ 
tradiction and a I'eproach. With regard to 
other infectious diseases, it is somewhat en¬ 
couraging to note that the total admissions for 
scarlet fever, although they reached the high figure 
of 10,343, were 22 per cent, less than those of the 
preceding year. We are also g’ad to note that 
during 1900 no patient suffering from that disease 
was refused admission, a fact that recalls the in¬ 
adequate provision that has provoked severe criticism 
for many years past. There has been an increase in 
enteric fever cases, chiefly owing to local outbreaks, 
some of which were of mysterious origin. Diphtheria 
is still on the increase, as the numbers of patients 
admitted to the Board's hospitals have increased 
steadily from 722 in 1889 to 7,873 in 1900. 
The total number of patients under treatment in the 
infectious hospitals for the year 1900 was 26,6141, 


with an average stay of 60'5 days. They were 
drawn from a district that covers an area of 
about 121 square miles, and comprises nearly 1,900 
miles of streets and road, and nearly 600,000 in¬ 
habited houses, with an estimated population of 
at least four and a half millions. Taking the erratic 
behaviour of infectious diseases into consideration it 
becomes evident that it is an extremely difficult 
problem to determine the proper number of beds 
required for the accommodation of so vast a com¬ 
munity. To that task the Metropolitan Asylums 
Board has come full of vigour and sound latterday 
sense and information. It has spared no expense in 
furnishing fii-st-rate modem hospital housing and 
treatment to patients, while it has encouraged the 
study of the scientific aspects of infection. The 
Board has bad an absolutely free band in the ex¬ 
penditure of public money, and it has been our duty 
from time to time to criticise the action of the Board 
in various particulars. In our next issiie we propose 
to comment upon several uatters that in our opinion 
invite public consideration. On the whole, how¬ 
ever, the work of the Board may be commended by 
reason of its earnest and thorough administration. 

on Current topics. 

Marriages among the Deaf. 

Thb important bearing of marriages between 
persons one or both of whom are afflicted either in 
bodily or mental capacity is, perhaps, not sufficiently 
insisted upon. We pay far more attention to the 
breeding of our animals with a view to the improve¬ 
ment of a species than we do to our own. Even in 
the serious condition of mental deficiencies we do 
not stop to consider the possible effects upon future 
generations. Much has been written on the subject 
of heredity by able exponents, but the conclusions to 
which they aiTive are seldom acted upon; perhaps 
if they were there would be less mental and bodily 
disease in the world, as well as less criminality. A 
not unimportant phase of the subject is the 
result of marriages among the deaf. Recently, 
Professor E. A. Fay has carefully examined the 
records of 4,500 such unions, and he has discovered 
that, while taking the marriages cf deaf persons as 
a whole, nearly 9 per cent, of the offspring are deaf, 
as contrasted with less than one-tenth, or 1 per cent, 
of deaf children as a result of the marriages of 
normal persons. A very different and much more 
favourable result is found to obtain when the deaf 
persons Lave no truce of deafness in their families. 
Marriage of deaf persons without deaf relatives is 
no more 'ikely to result in deaf children than any 
marriage in the community at large, while the 
marriage of healthy persons who, though not defi¬ 
cient themselves in bearing, have deaf relatives, is 
just as likely to result in deaf children as the 
marriage of the deaf. We do not think that Pn> 
feasor Fay has arrived at much that is new in 
his investigations, but the facts that be has 
deduced will bear frequent reileration.1 There 
Digiiized t IC 



Nov. 20, 1901. NOTES ON CTTBBENT TOPICS. Tbk lUisicii. Fuags. 551 


18 one point, hcwever, to •which we would wish 
to draw attention ; it ie by no means seldom the caae 
that it is lees the deafnces that is transmitted than 
the causes which lead tbeieto. The chief causes of 
deafness arising from middle ear diseases are the 
occurrence of catarrhal conditions of the upper air 
passages, conditions which, perhaps, depend more 
upon adenoids than upon any other abnormality. 
The hereditary transmission of adenoids is by no 
means established with certainty, although there is 
strong presumptive evidence that ttey are so trans¬ 
mitted. Among chi'dren who are suffering uith 
adenoids and their consequences there is often found 
in their parents a history of symptoms which points 
to their having similarly suffered in their earlier 
years. The comparatively recent discovery of 
adenoids precludes certain data upon the subject of 
their inheritance, but this is a deficiency which 
futuie generations will clear up. 

Bate Supported Hospitals. 

The view that hospitals ought to be municipalised, 
that is to say, supported and governed by represen¬ 
tatives of the ratepayers, has something to commend 
it, although we see no immediate prospect of any 
such transference of powers and responsibilities. 
Short of taking over the hospitals altogether, it 
might be left open to municipal authorities to sub¬ 
scribe to the maintenance of these and similar insti¬ 
tutions. In the case of Devonport, power to do so 
was expressly embcdied in a recent Act of Parlia¬ 
ment, and an offer has accordingly been made to the 
governors of the Boyal Albert Hospital of a yearly 
subsidy of £'100, coupled, however, with the proviso 
that acceptance will carry with it the right to appoint 
three members on the Committee of Management, 
Under these circumstances the offer was declined 
with thanks, the governors feeling, no doubt, that the 
offer was but the thin end of the wedge which would 
gradually oust individual initiative from the control 
of the institution. It is a significant fact that the 
voting on the offer was equal, and the amendment 
declining it was only carried by regulating the voting 
power according to the amounts of subscriptions. 
The refusal is approved by t ome critics on the ground 
that other donors of £100 are not admitted to the 
Board, but this is hardly a fair comparison, seeing 
that the municipality occupies a fiduciary position in 
the disposal of funds, and is under amoral obligation 
to see that they are rightly applied. 

Anglo-Saxon Energy and South African 
Refuge Camps. 

There can be no doubt that the* death-rate is 
disastrously high in the camps established by the 
military authorities in South Africa for the Boer 
refugees. From reports, the credibility of which 
must be accepted, the fact is established that the 
mortality reaches something like 264 per thousand 
per annum. To grasp the significance of that state¬ 
ment one has simply to remember that the average 
for the worst districts in London is nowadays about 
thirty, while in the central districts of India, when 


in the threes of plsgue and famine, it falls short of 
seventy. The retuins undoubtedly prove that the 
refuge camps must be unfitted for human residence 
by reason of bad sanitation, bad medical organisation, 
bad bousing, bad feeding, or one and all of these or 
allied conditions of faulty environment. With the 
policy that made these camps necessary we have 
nothing to do. 1 hat matter is for the nation and the 
Government to settle. As medical journalists, how¬ 
ever, we feel it incumbent to protest against tbe 
continuance of such a state of affairs, which can he 
dne only to a defective health environment. In 
striking contrast to the apathy shown by the nation 
in the matter of this terrible refugee camp mortality 
may be taken the action of the Liverpcol School of 
Tropical Medicine in attacking the mosquito pests 
of Sierra Leone. About £6,000 a year is being 
spent in that task, a sum that is subscribed freely 
by tbe British public. Surely, there would be no 
lack of response if those generous benefactors 
realised how Boer women and children are dying 
wholesale in British camps. The question of moneys 
however, according to Mr. Erodrick, does not stand 
in the way of sweeping out these pestilential camps, 
compared with which the towns of Sierra Leone are 
mere health resorts. 


“Medicinal" Vegetables. 

It is extraordinary what nonsense is presented to 
tbe public under the guise of medical information. 
No quackery is too blatant, no superstition too siFy, 
no vulgar belief too extravagant, no fool’s reasoning 
too fantastic to be dished up by tbe writer of medical 
paragraphs for the lay newspaper, who must have a 
poor opinion indeed of bis fellow-countrymen if he is 
attempting to reach the level of his readers. A 
short while since a Sunday newspaper gravely pub~ 
lished a mass of rubbish about tbe medicinal pro¬ 
perties of varions vegetables. Asparagus, it main¬ 
tained, was of value to the lungs and kidneys. 
Carrots are “ very good for ths complexion,” and 
celery is “ useful for rheumatism and gout.” Onions 
and apples are “ soothing to the nerves,” and horse¬ 
radish is a good nervous tonic, while parsley purifies 
tbe blood and tomatoes are “excellent for the liver.' 


Can it he that the physicians of Harley and Grosvenor 
Streets are all wrong? That, instead of prescribing 
hepatic stimulants, and this, that, and the other 
drug secundum artem of the therapeutic school in 
this year of grace 1901, they should deal with patients 
somewhat in this manner:—“My dear Sir,—After 
careful examination I find your liver is out of order, 
your neives all to pieces, and your blood impure. 
Kindly eat asparagus at each meal, with an abundance 
of onions and apples, also tomatoes and parsley, 
and make horseradish sauce a standing dish. And 
then, that mnddy complexion, we had almost over¬ 
looked that. Please add to diet eight ounces of 
boiled carrots daily.” And yet the scientific authori¬ 
ties of materia medica were thought to have invest!. 


;ated the properties of our edible vegetables to the 

D.zed. oogle 



562 Th« Midioal Pbisb. NOTES ON CURRENT TOPICS. 


The Unqualified Asaistant ae a Court Aseet. 

The practical ralae of a law is clearlj the extent 
to which it is carried ont. Acting npon that prin* 
oiple the medical profession will do well to see that 
the existing conditions as to the employment of un¬ 
qualified assistants are properly enforced. The 
following case appears to f^l prithin the rule of 
offences in that direction, as defined by the General 
Medical Council. At the Shoreditch County Court 
a medical man, Br. Haddens, sued a tradesman for 
payment of three guineas for medical attendance- 
Tbe defendant pleaded that his child had been 
attended, not by Dr Haddens, but mainly by his 
unqualified assistant, whom be would not have 
allowed to attend bad he been aware of the 
fact that he did not possess a medical qualifica¬ 
tion. There appears to have been no attempt 
on the part of the plaintiff to deny either that the 
assistant was unqualified, or that he attended the 
case. The judge ultimately allowed plaintiff one 
guinea to cover the cost of his own visits, while the 
cobvious law was laid down that the fees of an unquali¬ 
fied assistant are not recoverable. The case points 
its own moral to medical practitioners, and should 
serve as a warning to the unpleasant complications 
that are liheiy to arise from the mistaken economy 
of engaging the services of unqualified assistants. In 
all likelihood the difficulties of the unfortunate 
plaintiff may not end in the local county court. 

The Contagiousness of Psoriasis. 

PsoBiASis is one of the most common of skin 
diseases, but one the origin of which is still obscure. 
The question is frequently asked by patients “Is it 
catching P ” and the invariable answer is “ No.” But 
are dermatologists justified in makin’^ such a dog¬ 
matic statement? In 1889 a French physician, 
Destot, scarified his arm and inoculated it with a 
psoriasis scab. In a few days an eruption appeared 
having all the characteristics of psoriasis, and this 
eruption recurred four times in two years. The 
diagnosis was probably correct, but, as in all similar 
cases, there is always the possibility of coincidence 
A similarcase has been recently reported in which 
a man is supposed to have acquired psoriasis through 
the operation of tattooing, he not having suffered 
from the disease previously. On the whole we 
cannot regard the evidence in favour of the con¬ 
tagiousness of psoriasis as conclusive. One of the 
chief arguments against this view being the fact that 
it is very common for one married person to have tho 
disease for years without passing it on to the other. 

The Cause of Alopecia Areata. 

The stiology of alopecia areata has for long been 
the subject of much controversy, some authorities 
maintaining that the disease is due to a parasite, 
others that it is of nervous origin. Till recently 
opinions were fairly evenly divided on the question, 
but lately Drs. Norman Walker and Marshall Rock¬ 
well have published the results of a careful investi¬ 
gation of sixty-three cases. In two cases pieces of 


Nov. 20, 1901. 

skin were excised, when organisms found in the fol¬ 
licles and cultivations were also obtained. In 70 per 
cent, of the cases seborrhoea was present. These 
observations, therefore, tend in favour of the para¬ 
sitic theory of the origin of the disease. The question 
>8, however, by no means settled, for the bacterio¬ 
logical examination of sections of skin from only two 
cases out of siity-three can hardly be considered a 
sufficient proof. 

Women Residents in Hospitals. 

We were under the impression that tie opposition 
to women doctors had to a great extent subsided, but 
an incident which has just come to x>^8 bI Maccles¬ 
field shows that the feeling is still rampant in medical 
011 *0168. The fact that most incidents of the kind 
happen in the provinces is no doubt to be explained 
on the ground that in London, so far, no such appoint¬ 
ments have been made in any of the large general 
hospitals. It seems that on the governors electing 
a qualified woman to succeed Miss Bose, who had 
held the post of senior resident, the honorary staff 
resigned in a body. It is quite possible that personal 
reasons may sometimes render it difficult to work on 
satisfactory lines with a fema'e resident medical 
officer, and from this point of view every case 
must be judged on its merits. In the general 
proposition that women ought not to be allowed 
to occupy these posts we must admit we are 
quite unable to concur. Once women were ad¬ 
mitted to qualify as medical practitioners it 
was too lute to regard sex as a disqualifica¬ 
tion for any medical post. So long as women 
agree to work on professional lines, and so long as 
they do not subordinate the interests of the profes¬ 
sion to their own, they have a right to fair treatment 
It is only a question of time for qualified women to 
take their place in our ranks on terms of perfect 
equality. They are not likely to oust men from the 
higher posts for the simple reason that but few, if 
any, could adequately discharge the onerous duties 
which such posts entail, bnt that is not a reason for 
debarring them from obtaining the invaluable ex¬ 
perience which the tenure of resident posts in hospi¬ 
tals offers. 

Herbalists and the Apothecaries Act. 

In an action brouglit against a Limehouse herb¬ 
alist in the Bow County Court last week, at the in¬ 
stance of the Apothecaries Society, the defence was 
based on an Act the very existence of which appears 
to have been forgotten, viz., the Act 34 and 35 
Henry VIII. This Act provides tnter alia that “ it 
shall be lawful to every person . . . having 

knowledge and experience of the nature of herbs, 
roots, and waters, or of the operation of the same 
by speculation or practice ... to practise, use 
and minister in, and lo, any outward sore, uncome 
wound, apoatemations, outward swelling or disease 
any herb or herbs, ointments, bathe, poultess 
and emplaisters, according to their cunning 
experience and knowledge.” Judge French held that 
this Act had not been repealed and gave judgmen 
Di'-'/ed bv O 


Nov. 20, 1901. 


NOTES ON CUBBENT TOPICS. 


Pbx Medical Pbxss. 553 


in favour of the defendant, adding that “ had there 
been any Billing at high prices, any trading on the 
credulity of the public, be would have struck with a 
strong hand.” It is true that this exemption only 
applies to the treatment of outward affections, but it 
is nevertheless a great blow to the already moderate 
efficacy of the Apothecaries' Act, and unless an 
attempt be made to maintain the powers and privi¬ 
leges conferred upon the Society by getting the 
judgment reversed on appeal, the field will be thrown 
open to unqualified practitioners of every kind, since 
they will only have to allege that they were treating 
some outward manifestation of disease to get ” privi¬ 
lege of clei^,” so to speak. 

“The Times” and Quack Propaganda. 

Medical readers of The Times for some months 
past have been much exercised in their minds by the 
prominence which this eminently respectable journal 
has given to methods of medical treatment which, to 
pot it mildly, do not repose on any sound scientific 
basis. To say nothing of the egregious pretensions 
of Mr. Alabone, who is pertinaciously referred to as 
“Dr.” Alabone, a designation to which he was never 
entitled, a long telegram is devoted to the blatant 
utterances of one Dr. Gilman, of the fiahnemann 
Medical College, Chicago, who claims to have obtained 
uniform success in the treatment of cancer by “.giving 
medicines which will supply the material for rebuild¬ 
ing the destroyed tissues,” subjecting the patients 
at the same time to the influence of X-rays “ for 
weeks or months as the case may be.” Is it possible 
that a professor, even at a Hahnemann College, can 
be unaware of the well established physiological fact 
that destroyed tissues are never under any circum- 
stances replaced P There is evidently someone on 
the staff of The Times who is imbued with dis¬ 
trust of what we may term the regular prac¬ 
tice of medicine, and who cherishes a child-like 
credulity in respect of empirical claims, the more 
grotesque the better. It is obviously by an over¬ 
sight that due publicity has not been given in that 
publication to the alleged curative action of an in¬ 
fusion of violets in cancer. 

An Apology for Bacteria. 

The newly-elected President of the .Dublin Uni¬ 
versity Biological Association is to be congratulated 
on the happy form which his inaugural address 
assumed. It is by no means an easy matter to select 
a subject which will permit of being treated in a 
manner of interest to all the various elements which 
meet at such a meeting. The President’s address 
must be sufficiently scitntific to meet with the 
approval of the heads of the medical profession. It 
must be sufficiently free from ultra-scientific terms to 
permit it to be understood by the quasi-scientific 
layman. Dr. Travers Smith’s address fulfilled these 
conditions admirably, and though perhaps there 
have been more scientific addressee delivered by pre¬ 
vious presidents, there have been none which were of 
more general interest to their hearers. Dr. 
Smith’s address was directed to dispelling 


the popular belief that all bacteria and men 
are natural and deadly enemies. The popular 
fallacy of the supposition that mankind would 
be benefited by the suppression of all forms of 
bacteria was pointed out. The various functions 
which these much abused oiganisms play in natural 
economy is an important one. Not only do they 
remove dead animals, plants, and other waste- 
materials but they aid in restoring the nitrogen to- 
the soil which has been removed by plants, and so- 
maintain the supply of fixed nitrates on which the- 
continuance of the world so largely depends. Then 
many industries are largely worked on hacterial 
lines. In the making of the best butter, cultures of 
certain bacteria are used to flavour the cream prior 
to churning. In the manufacture of smoking tobacco,. 
the crude leaves are subjected to various fermenta¬ 
tive processes for which bacteria are responsible- 
In the preparing of flax for linen, bacteiia again 
come to the aid of man. Consequently it is not too 
much to say with Dr. Smith—Prosperity awaits the 
country who scorns not to lavish time ani money 
upon the cultivation, development, and utilisation of 
the lowliest of her subjects, the bacteria. 

A Difference of Opinion. 

A DiSAOBBEABLB incident occurred a day or 
two since at the Marylebone Police Court in 
connection with a charge brought against a casual 
pauper of refusing to perform his allotted task. The 
workhouse medical officer had certified him fit for 
duty, but as the magistrate thought he looked U1 he 
obtained the opinion of the prison doctor. This 
official certihed that the prisoner was suffering from 
ulcerated throat of some days’ standing, whereupon 
the magistrate dismissed the case, stating that in 
future he should insist upon the attendance of the 
workhouse doctor in cases of this sort. After all it 
is only fair that the prisoner should have the advan¬ 
tage of substantiating his refusal to woik, and the 
magistrate's decision may have for effect to make 
workhouse medical officers more careful in dealing 
with recalcitrant casuals, who are admittedly a very 
difficult class of persons to take seriously. 

Criminal Experiments. 

If it be true, as reported, that a medical practi¬ 
tioner in New York has inoculated a nurse with 
bovine tuberculosis for the purpose of testing the 
truth, or otherwise, of Koch's recent statements, it 
is to be hoped that steps will be taken to punislb 
what is unquestionably a criminal offence. The fact 
that the subject was a consenting party to the experi¬ 
ment would certainly not excuse, though it might at¬ 
tenuate, the gravity of the offence. 27ie Times 
correspondent has probably grasped the situaUon 
when he describes the experiment as the deed of a 
'* young gentleman known to be exceedingly prone 
to self-advertisement.” Should anything untoward 
happen he may find to his cost that human life is too 
sacred a thing to be sacrificed in experiments con 
ducted under conditions which muet necessarily 
rob them of any scientific value. 





554 Th> Mcuical Pksbs. 


NOTES ON CURRENT TOPICS. 


Not. 20, 1901. 


Poisonous Fly-Papers. 

CoNSiDEBABLB mtercBt altaclies to a case heard 
recently at the^Vidnes Police Cotiit, when a chemist 
named Bostock was sommonedfor selling arsenite of 
soda without obserring the proTisions of the 
Pharmacy Act of 1868. The county analysta 
repoited that they had received a sample of 
fly-papers for analysis, and that it contained upwards 
of 5| grains of arsenite of soda, whereby each fly¬ 
paper was made capable of killing two men. It 
appeared that a woman bought six papers from the 
defendant, and was not asked to sign any book* 
though under the Pharmacy Act the quantities and 
the purpese of tie purchase should be entered in a 
book. The facts were admitted, but it was con¬ 
tended that entries were not necessary in the ose of 
Term'n killing poisons. Evidence was given for the 
defence to show that it was not the custom to enter 
fly-papers, and one witness admitted that he did not 
know that they were so strong. Finally the Bench 
dismissed the case on payment of £5 17s. 2d. costs, 
and declined to express an opinion. The case is an ' 
important one, for, if vermin killing articles, each of 
which centains enough poison to kill two men, can 
he bought by any person without let or hindrance 
there is every facility thus given to individuals of 
eriminal intent, and the Act which is destined to pre¬ 
vent the too free sale of poisons becomes absolutely 
useless. 

Night Sweats in Phthisis. 

All physicians know the difficulty of keeping the 
night sweat of phthisis in control. Almost every 
known remedy has been tried since the Greeks used 
-agaricin down to the present. Graves and Stokes 
used Dover’s powder, which in time gave place to 
mineral acids, zinc and belladonna, atropine, and 
a host of other specifics. To the long list Nolda adds 
tannoform, the external use of which be recom¬ 
mends In seven out of eight cases in which he had 
the front and back of the thorax dusted with pow¬ 
dered tannoform it checked the sweating {Bei 1. Klin. 
Woch.). This method of treating the symptom has 
the advantage of not interfering with the digestive 
function, which is usually so imperfectly performed 
in such cases, neither does it in any way preclude the 
use of any of the other antisudorifics. The power of 
itself should prove an agi'eeable application to the 
skin and promote the comfort which is such an 
essential factor in producing sleep in such cases. 

Infection ft'om Toys. 

We are all familiar with the pitfalls which are 
ever at onr feet throughout our wanderings through 
life ; we have heard of death in the pot, destruction 
in tinned meat, and disease in half a hundred other 
articles of domestic use. A very sensible letter in 
The Timee now calls our attention to another possi¬ 
ble source of infection, namely, in toys. The writer 
of this communication states that he recently had 
occasion to investigate the internal economy of one 
of those curious fluffy animals which children so 
delight is, and so often clasp in their arms when 


they go to sleep. The creature, which came from 
one of the best toyshops in London, was stuffed with 
rags which could only be called filthy; there was 
among other tbiugs, a man’s neck-tie, which was 
offensive, not only to sight, but to smell also, and 
which could only have come from the grimiest of 
wearers. One need scarcely speculate upon the 
possibilities of infection from such a toy as this. 
We feel sure that no parent who knew the history of 
the stuffing of rag-dolls bought in a toy shop would 
allow her offspring to run the risk of taking his 
favourite ‘Gollywog” or“Ludlow” to bed with him, 
or to cover it with affectionate childish kisses. Mure- 
ov« r, the I'emedy is obvious; cotton-wool is cheap and 
easily sterilised, and would make an admirable stuff¬ 
ing for such toys. 

Birmingham Consultative Institute. 

We tboujthttbat we had at last come to the end of 
the association which placed Dr. Irvine in so un¬ 
pleasant a position, hut a letter which appeared in a 
recent number of the Birmingham Daily Argiu calls 
for comment in our columns. In this communication 
Mr. .Arthur Chamberlain stigmatises the charge of 
advertising used against Dr. Irvine as “ hypocritical 
, and unfair,” and makes a gratnitoue and absurd 
attack upon Dr. Saundby. Mr. Chamberlain quotes 
the description given of Dr. Saundby in Kelly’s 
Directory, and suggests that it is nothing more or 
less than a six-lice advertisement. There could be 
uo statement more absurd than this, for a physician 
of Dr. Saundby's etandlog needs no such ad¬ 
vertisement. Mr. Arthur Chamberlain had done 
better by pieserving a discreet silence after the 
failure of the Consultative Institute than by making 
an unwarraated attack upon a justly respected 
member of our profession. Luckily Dr. Saundby 
can afford to treat such attacks with the contempt 
they deserve. 

Physically and Mentally Defective 
Children. 

The London School Board has done good work 
lately in the education of mental'y defective children. 
In the annual report on the schools for the special 
instruction of such unfortunates, presented to the 
Board by Mrs. Burgwin, it is stated that schools 
have now been opened in every division in London 
except the City, though it cannot yet be said that 
the accommodation in any division equals the demand. 
Between March, 1900, and March, 1901,128 children 
were examioed for admission to the special instruc¬ 
tion schools and rejected, being imbecile. Few, if 
any, of these find admission into the Poor-law 
schools, and their only alternative is a home or 
asylum, accommodation in which is very limited. 
Added to these rejections comes a number of 
inmates of the schools who have been dismissed after 
a fan* trial, as imbecile. Surely it would be a wiser 
economy to make provision for the permanent care of 
such cases as these P The work done in the schools 
has been exceptionally useful. Physically aud men¬ 
tally the teachers strive to makeevery child profit by 


Nov. 20, 1901. 


Thb Mxdical PsKSfe. &55 


PERSONAL. 


the mstniction given, eo that each child, accordingto 
his ability, may enter the ranks of the wage-earning 
community. Indeed, the work of these schools 
thoroughly confirms the truth of the sentence with 
which the report ends : “ There is no more interesting 
phase of psychology than that of the development of 
a weak- minded or low grade chUd into an ‘ intdiigent, 
self guiding person, with due regard to the rights of 
others.’ 

Plague at Odessa. 

A 8EKIOTJ8 report has reached London by telegram 
regarding an outbreak of plague in Odessa. Three 
oases of bubonic plague have occui-ed, so it is stated, 
in one of the city hospitals. In accordance with the 
official reticence that characterises Russian adminis¬ 
tration, it has been hitherto impossible to gain 
authentic information from the civic authorities. 
The importance of an outbreak of plague in a great 
grain centre like Odessa can hardly be over-esti¬ 
mated. From that port cargoes are distributed 
over the greater part of Europe, including the United 
Kingdom, to say nothing of African and Asiatic 
ports. One grave feature of the case is the enormous 
number of rats that live in the granaries and cannot 
fail, should the plague have secured a foothold in tl e 
town, sooner or later to carry the contagion to the 
cargo ships. Fortunately, the'sanitation of Odessa 
is good, and the Governor has taken energetic 
steps to cope with the invasion. The report is likely 
to create no little stir in the United Kingdom, the 
interests of which are so closely involved in anything 
that affects the supply of grain from foreign 


direct representation. It is worthy of note that the 
choice of the Government has fallen upon men all of 
whom have seen active service, and are, therefore, 
cognisant of the requirements of the State, on the 
one hand, and of the medical staff on the other. 

The General Medical Council Election and 
“Service” Voters. 

Medical practitioners belonging to one or other 
of the Services, resident in the United Kingdom, who 
are desirous of voting for the election of direct re¬ 
presentatives on the General Medical Council are 
invited to apply by post, enclosing their postal 
address, to the Registrar, and an announcement to 
this effect will be found in our advertisement 
columns. No time must be lost in complying with 
this injunction as the election is now near at band, 
and it is to be hoped that these members of the pro¬ 
fession will testify to their interest in its welfare by 
acquiring the power to vote. 

Guy's Hospital. 

An appeal has been issued on behalf of Guy’s 
Hospital for funds to enable the governors to com¬ 
plete structural amendments at a cost of £180,000, 
and to provide an additional income of £14,000 a 
year. There is no institution in the metropolis more 
deserving of support than Guy's, and it is to be 
hoped that in spite of the unfavourable circumstances 
of the moment this appeal will not be allowed to pass 
unheeded. We note that the medical and surgical 
staff of the hospital have contributed upwards of 
£2,000 towards the fund. 


countries. 

Ptomaine Poisoning at the Leeds loflrmekiy. 

An inquest was recently held at Leeds to enquire 
into the death of a girl aged seven weeks, which was 
tie second alleged to have occurred from ptomaine 
poisoning in the Leeds General Infirmary. The 
child was admitted on November 4th and died on 
the 6th. According to the evidence of Dr. Luckhoff, 
the deceased was saffering from inflammation of the 
eyes. Another child dying on the same day—the 6th 
—be was not satisfied as to the cause of death ex¬ 
cept by post-mortem examination. He made an 
autopsy, assisted by Dr. Telling, and they concluded 
that death resulted from ptomaine poisoning. The 
jury brought in a verdict in accordance with the 
medical evidence—that death was doe to ptomaine 
poisoning, but that as to how the poisoning got 
into the system there was nothing to show. 

The Advisory Board A.M.S. 

The composition of the Advisory Board which is 
to assist in shaping the destinies of the {“eformed 
Army Medical Service has now been made public, 
and, frankly, we think the list, so far as the civilian 
members are concerned, defies criticism. We can 
only hope that the terms and conditions of the 
appointment are snch as to allow the Scottish and 
Irish nominees to accept the offer, in view of the 
extreme importance to their respective schools of 


PERSONAL. 

Bb. Maubicb John Boidok has been elected Mayor 
of Glastonbury. 

Mb. H. T. Butlin is to open a discussion at the 
Pathological Society on Becember 8rd on “ Lympbade- 
noma in its Belstion to TuberculosiB.” 


Thb Bishop of London unveiled a window in the 
chapel of the Cancer Hospital, Fulham, on Saturday 
last, in memory of the late Dr. William Marsden, who 
founded the charity iu 1S51. 

Br. W. A. Dinolb, of Finsbury, has been presented 
with a silver fruit-basket and vases, in testimony of his 
good service to the inhabitants as honorary secretary 
of the Finsbury Square Committee. 


Be. Chamberlain, of Pateley Bridge, Leeds, has 
sustained severe injuries as the result of being thrown 
from his hoise. He was found lying nneonsoious in the 
road, but recent reports state that he is progressing 
favourably. 


Bb. Geobob Hxnbt Bbownx, J.F., Medical Officer of 
lealth to the Bryumawr Urban District, was thrown 
rom his trap early last week and sustained a fracture 
)t the skull which promptly proved fatal. His wife. 


(ho also sustained severe injuries 

Digitized b 


I, is^m 


critical 



556 Tmt M«pical Pbbbb. _ SCOT 

THE AfiMY MEDICAL SERVICE. 

Thb Secretary of State for War hae eeleeted tke 
following as the Chairman, yioe>chainnaD, and memb^s 
of the Advisory Board for the Sapervision of Army 
Medical Services:— 

Chairman.—The Director-General Army Medical Ser¬ 
vice, Sargeon-General William Taylor, C.B.. A.H.S.. 
M-D., C.M. 

Vice-chairman.—The Deputy Director-General, Snr- 
geon-General (temporary) Alfred Henry Keegh, C.B., 
A.M.S., M.D. 

Members—Officer R.A.M.C. (expert in sanitation: 
Major William Grant Macphersoo, £. A.M.C., M.A., M.B, 
C.M., D.Ph.Cambridge. Officer B.A.M.C. (expert in 
tropical diseasee): Lient.*Colonel David Bmoe, B.A.M.C., 
M.D., C.M. 

Civilian Members.—ChsrlesBent Ball (Ireland), M.D., 
F.R.C.S.J., F.R.C.S.Eog.; Alfred Downing hVipp, C.B., 
C.V.O., F.B.C.8. t Jamee Galloway (Scotland), M.A., 
H.D., F.B.C.8., F.B.C-P.; Edwin Cooper Perry, M.A., 
M.D., F.B.C.P.; Sir Frederick Trevee, C.B., K.C.V.O., 
F.E.C.S. 


§£otlanb. 

[fbok oob own cobbxspondxnts ] 

GENERAL MEDICAL COUNCIL ELECTION. 

Db. Norman Walkxb addrerseda meeting in sopport 
of his candidature on the 12ch inst. He said that be 
bad no desire to attack the Council from any point of 
view. The Coun^ was composed of Corporation repre¬ 
sentatives elected for safeguarding the legitimate inte- 
restsof those bodies of Crown representatives to see that 
the interests of the general public were looked after, 
and of direct representatives who represented the views 
of the profession as a whole. The first duty of the 
Council was edncationa], and it was on the basis of 
medical education, in which every practitioner was 
vitally interested, that he claimed their support. The 
question of tbe position of primary soientifio education 
had recently bera brought up by the action of the 
College of Physicians, an^ though he did not think that 
that body had gone about matters in tbe wisest possible 
way, he cordially agreed with tbe position they took up. It 
was not a mere matter of words whether they relegated 
chemistry, biology, and physics to a preliminary 
scientific course, and followed this by a four years* 
curriculum, or whether they included them in a five 
years' curriculum. By the former plan the student 
must pass tbe examination in these subjecta before 
beginning his more professional course, and thus had 
four years clear for study. Space would thus be left 
for oraer important subjects, in particular for bac¬ 
teriology. which should undoubtedly be introduce into 
the curriculum. The next duty of tbe Council was as 
regards examinations. The doty of the Council in this 
respect was to enforce a uniform standard, which they 
could easily do by extending the present system of 
visitation. It would also be advisable if at the 
present time a system of Imperial registration 
could be adopted, to replace tbe existing Colonial 
registers. As to remo^ of names from the 
Registtr that was a judicial matter, and each 
case was considered on ite merits. He thought 
it a pity that there was only one penalty, but in bis 
opinion the warnings issued by the Council were very 
^cacious, and, in addition, he believed that private 
warnings were given to individuals which never 
came under the notice of the general body of the profes¬ 
sion. All these meatinres tended to the maintenance of 
discipline in the profession. As to the midwivee ques¬ 
tion, that was a subject in which he bad taken a deep 
interest for many years. He was entirely and absolutely 
opposed to the creation of an independent class of regis¬ 
tered practitioners. Hie solution was that certain hos¬ 
pitals qualified to teach should be granted power to give 
certificates. This would do away with the system of 
private teaching and giving of diplomas, and the 
women, being properly trained, would have learned 


land. _ Nov. 20, 1901. 

when a case was one to which a doctor was required. 
It was obviously impossible to define a normal labour, 
and it was only by instructing midwives properly ttiat 
this difficulty could be got over. As to the ^pensing 
of drugs, there was no possible objection to 
tbe sale of medicine to patients, and tbe custom 
had the sanction of usage over great parts of England 
and Scotland. Even the sale of soap and tooth powder 
would not be interfered with by tbe Council; the only 
thing that body bad set its face against was ^e sale of 
scheduled poisons by any unqualified person acting as an 
assistant. Personally, be entirely accepted the position 
of the CounoiL It had been said that there were three 
ways of dealing with any question: one might accept or 
reject it, or deal with it diplomatically. It seems to 
him that Dr. Bobertson rejected the Council's deciaion, 
while Dr. Bruce dealt with it diplomatically. There was 
an attendance of about seventy at the meeting, which 
V ae presided over by Dr. Gibeon. A number of questions 
were asked, from which it appeared that Dr. Weaker pre¬ 
ferred levelling the standard of present examinations to 
instituting a uniform State examination. A motion to 
support Dr. Walker's candidature was carried unani¬ 
mously. 

Dr. Chas. Bobertson, cd Glasgow, has issued ao ad¬ 
dress to the practitioners of Scotland relative to bis can¬ 
didature. In it he claims for all medical practitionera 
the same rights as registered chemiste—namely, that 
when an unqualified dispenser is convicted of selling a 
schednled poison tbe master be not held liable. The 
constitution of the General Mescal Council reqnixee 
reform, and the direct representatives should ^ in¬ 
creased until they form a majority of the Council. 
Dentists ot^ht also to have a repreeentative. As r^ards 
the finauciid position of the Counoil, aU bodies return¬ 
ing members ought to contribute to their expeuees. 
The Council ought to seek Parliamentary powers to de^ 
with counter prescribing, bone-setters, quacks, Ac. It 
is, of course, no secret t^t Dr. Bobertson's candidature 
etands or falle by his views on the question of tbe sale 
of poisons. Medical men in the West of Scotland main¬ 
tain that they are liable to vexatious prosecutions for 
doing as their predecessors have done, and they feel 
aggrieved by the action of the Council in refusing to 
receive a deputation last summer, when the queraou 
was before the CoancU in its judicial capacity. 

PLAGUE IN GLASGOW. 

No fresh developments are reported. The Town 
Council have decided that plague is forthwith to be 
included among the diseases scheduled under the Com¬ 
pulsory Notification Act, and that the regulation shall 
remain in force till December, 1902. The deetruotion 
of rats goes on merrily, and the Central Hotel is said to 
be almost free of them. They are a business people in 
the West: in addition to oleanlinees and a moderate 
tariff, some hotele seek to attract visitore by claiming 
to be “ rat proof.” 

GENERAL COUNOIL OF GLASGOW UNIVERSITY. 

At a reotnt meeting of this body, Dr. Munxo Kerr 
moved that repreeentations be made to the University 
authorities in favour of tbe provision of a midwifery 
school iu addition to tbe present Maternity Hospiuh 
Dr. Murdoch Cameron seconded the motion warmly, 
and said that he had already been promised £11,000 
towards the equipment of snob an institution. At the 
tame meeting, repoiU ef sub-committeea dealing with 
medical education were presented, all of which strongly 
favoured tbe increase of practical instruotiou and a 
corresponding diminution of systematic lecturing. 

GLASGOW SOUTHERN MEDICAL SOCIETY. 

This society opened the session with a meeting in the 
Ophthalmic Institution on Thursday evening last. 
Several patients were presented, and a collection of 
stereoscopic photographs Mrtraying external diseases of 
the eye, and another oolleotion of coloured pictures 
illustratiog diseasee of the fundus were exhibited. A 
epecial feature was the demonstration of the electrical 
equipment of the hospital. The Fineen lamp, a Tesla 
ooil, and the X-ray apparatui were shown in operation. 
Thereafter Dr. Maitland Ramsay delivered a short lec- 


C 


Nov. 20, 1901. 


CORRESPONDENCE_ Thi Mkoioal Pbms. 557 


tnre on Hypopyon Uloer, this also bemg illnstrnted by 
Imitorn slides and micsoecopio propaTations. At the close 
of the proceedings Dr. J. Stewart, the president of the 
eociety, complimented the staff of the hospital on their 
admirable arrangements, and thanked Dr. R amsay for 
providing the members of his society with an enjoyable 
and inatmctive evening. 


(I0rrt6p0ttbnta. 

[We do not hold onTMlToetesponsible (or the opinions of onr 
oorreepondenta] 


UNTRUSTWORTHY SERUM. 


To (he Editor Thx Mxdical Pbxss and CiacnLAK. 

Sir,—T our editorial in this week’s isene (November 
13th) on the above subject refers to a report from 8t. 
Lonis, U.S.A., of “an outbreak of tetanus in children 
following the injection of diphtherit antitoxin,resulting 
in eleven deaths.” “ This Lamentable occurrence is on 
a par with that reported not long ago from Italy.” I 
noticed also in Thx Mkdical Fbxss and Cibculab of 
October 80th that your Vienna correspondent mentions 
*' three cases of tetanus reeniting from the employment 
of the anti diphtheritic eerum.” 

These occurrences remind me of an incident which 
happened in Germany about three years ago. At a 
meeting of scientists held in Dnsseldorf, when the sub- 
ject of diphtheria was under disonssion. one of the 
members expressed a doubt with regard to the connec¬ 
tion of the L5fier bacilli with diphth^a, for the 
liOfler bacilli were present in abundance in the mouths 
and throats in cases of slight gastric derangements and 
even in healthy persons, whilst they were absent in 
^nnine cases of diphtheria. He had also the temerity 
to mention the clinical fact that the antitoxin inocula¬ 
tions give rise, in a number of cases, to heart and kidney 
diseases, and to general prostration from muscular 
paralysis. I am crMitably jpformed that the gentleman 
nanowly efcaped being lynched for his blasphemous 
thesis. To question the efBcacy of a drug which had 
been acknowledged by the Faculty and printed in text¬ 
books as a sovereign remedy! — that could not be 


tolerated. 

Indeed, it would have been rather awkward, after 
cabling the good news to all parts of the world that “ we 
have, at last, found an infallible remedy for the diph¬ 
theria scourge ”; “ antitoxin (as the name implies, anti¬ 
dote to the poison) acts like a charm”; “ one inoculation 
causes the false membrane to shrivel up ”; “ diphtheria 
has lost its dread "—these and other pithy statements, 
with the authority of Professor X., who furnishes statistics 
confirmatory of the glad tidings; it would have looked 
foolish, after all the fuss, to turn round and say that it 
was all a mistake. 

The muscular scientists have, by methods of their 
own, silenced cxintradiction; but, whilst we have been 
lull^ into security and contemplate the existence of 
diphtheria with equanimity, having got an antidote to 
render it innocuous, there comes the distressing news 
from different parts of the world tiiat the antidote is 
more disastrous than the disease. 

I am. Sir, yours truly, 

Edinburgh, Nov. 16th, 1901. M.D. 


DEGREES FOR LONDON STUDENTS. 

To the Editor of Thx Hxdical Pbxss and Cibculab. 

Sib,—T he time is gradually approaching when 
definite steps will have to be taken to remedy the posi¬ 
tion of London students regardmg the degree question. 

The advantages of a mescal de^ee in plam of the 
old-fashioned licence to practice medicine are undoubted 
and are becoming more evident daily. 

Universities are from time to time springing up in 
the provincial cities, and it is no longer considered 
necessary for the student of medicine to oome to ^ndon 
to receive an adequate training or qualification in 
medicine, for the provincial Colleges now have teachers 
in their schools, and practical physicians and surgeons 
on the stuffs of their hospitals, in every way equal to 
those in London. 


Nor is this aU. The provincial graduate in medicine, 
by merely passing a final examination over again, imme¬ 
diately after his degree final, can add the further quali¬ 
fications of the London Colleges to his name. Not so 
the London diplomate. who, having once passed through 
his lengthy medical studies, in every way equal to and 
as arduous, but at a far greater pecuniary expenditure, 
as that of his more fortunate provincial broker, finds 
himself debarred from using the popular title of doctor, 
and is further out off from obtaining that title by a 
lengthy residence at a provincial University, and has 
his examinations to repass from beginning to end. 

London the greatest city in the world, and unable to 
offer an ordinary pass degree to her students! Smaller 

and less important cities enjoy this privily, while 
more than one poeseesee two universities. 

Surely, Sir, such a state of affairs Is absurd. Can no 
one of infiuence be urged to move in support of a cause 
which everyone must own is a just and natural one ? 
Are the Colleges too important a body to pay any atten- 
to the wants and grievances of their diplomates ? 

Surely some combination of the London licensing 
bodies with the University could be brought about to 
grant a pass degree in medicine, while the University 
still continued to grant its present degree as an Honours 
one, and the Colleges their higher qualifications as here¬ 
tofore. 

Even a new University would not be out of place, with 
the Royal Colleges as its Medical Piculty; bearing in 
mind the significant fact, as pointed out by Mr. Colling- 
wood in your last issue, that the population of London 
is equal to that of the whole of ScotUnd, which, however, 
possesses no loss than four Universities. 

If the right man would only choose to come forward 
in the right place, a difBcnlty could bo overcome which 
would materially raise the status and position of the 
average London student so as to compare favourably 
with that of the student of the lesser provincial towns. 

I am. Sir, yours truly, 

London. Lx Gxtt Wobsley. 

THE PROFESSION AND THE PUBLIC. 

To the Editor of Thx Mxdical Pbxss and Cibculab. 

Sib,— In my last letter with reference to the charge 
against the profes8i<'n deliberately made and reiterated 
by Colonel Le Poer Trench, I observed that “ if he stood 
alone or in a very small minority of the public capable of 
seriously holding and publicly asserting such a monstrous 
belief the fact would not be remarkable; but it certainly 
is a remarkable fact, and one well worthy full discussion 
that a large proportion of the public in every rank of 
life have equally little respect for the profession, have 
as little confidence in medical science, and are as ready 
to reject its authoritative opinion in favour of that of 
any pretender loud voiced and persistent enough in his 
claims to attention.” 

Two cases reported in the same number of your paper 
(November 6th) confirm my opinion. They are cases of 
a kind familiar to men in every department of the pro¬ 
fession, although most often, perhaps, presenting them- 
selves to the general practitioner. The average medical 
man, after spending from five to ten years over his com- 
, pulflory education and in post-graduate work, after 
having made himself an accomplished professional 
man, more highly educated for his caUing and more 
fully qualified for its exercise ttan the member of any 
other profession, finds himself in a position in wh^ his 
professional standing is of the verysmaUest value to 
him-in a position in which it brings him no respect 
and gives him no advantage over the most vulgar and 
ignorant pretender. The base ingratitude of the av^ge 
ratient is exemplified in the case of Dr. DowdaU, whilst 
the estimation in which the profession is hrid in 
comparison with unqualified quacks is illustrated 
in t^ case of Dr. Wearing. In this latter case 
the parents of the chUd pay X2 to a herbalist and ten 
gnin^ to a bone-setter, who “ reduced the dislocation^ 
in a case of hip disease, and refuse to pay Dr. WMrmg s 
bill £2 12s. for his conscientious services, including an 
of the wretched child’s malady. Cases 
of a ol^y similar kind occur in the frequent experience 

C 


558 Thb Mbdical Pbsss. 


CORRESPO N DENCE. 


Nov. 20. 1901. 


of practitioners in every rank of society, amon? simple 
and poor, ednoated and wealthy; among the classes 
figuring in the two cases 1 refer to, the families of a 
prison warder and a railway guard, and among people in 
tiie higher social grades like Colonel Le Peer Trench. 
If it is very bad for the profession, it is much worse for 
the public that such a state of things should continue 
and it is surely worth inquiry, whether the cause is 
discoverable and if a remedy can be found. 

The object of this letter is to start such a discussion. 
If the rank and file of the profession could be questioned 
I venture to affirm they would confess as a body that 
their lives have been mostly failures, and they would 
agree that for happiness as a medical man one needs to 
have the r^re qualities which permit of continuous self- 
sacrifice in spite of almost complete disregard and lack 
of appreciation from those for whom it is made. To 
most men this is a demoralising if not a heart-breaking 
position. If one wants to estimate both the incredulity 
of the lower social classes with regard to real mediesJ 
science and their amazing credulity towards gross and 
palpable pretence, one has only to look through the 
advertising columns of the popular newspapers, such as, 
in London, the Weekly Time* and Echo, a ^P^r, by the 
way, said to be the property of that distinguished 
phil^thropist, Passmore Edwards. If one wants to 
recognise the injury inflicted upon the public health 
by the cynical quacks whose advertisements fill 
to large a space in the columns of that kind of 
paper one has only to attend for a time the 
out-patient department of a general hospital. It is 
hither that a great number of the victims of quacks 
gravitate after having been bled of their hard-earned 
savings, and having t£eir disoasos rendered chronic by 
maltreatment or hopeless by delay. If any proof were 
needed as to what may happen in Uiis r^ard among the 
wealthier dasses it might be found in Colonel Le Poor 
Trench's letters and in those of others of bis social rank 
which during the still-continued discussion are appear¬ 
ing in The Timee. These are " ednoated " people from 
whose education all scientific knowledge and all training 
of the intellect giving the power to recognise what is 
ftcientifio reasoning and proof have been eliminated. It 
is this lack of scientific teaching and training among the 
whole people which is handicapping the British nation 
in every department of progress, and is in my judgment 
the cause of their deplorable attitude towage medictl 
science and its professors. Not only are the people 
ignorant of science, but large numbers of the educated 
olasbes beeides hate it and devote their lives largely to | 
disseminating hatred of science and scientific methods i 
by the most active and virulent propagandism. | 

I am. Sir, yours truly, 

Nov. flth, 1901. Ubiqu*. 


THE "ELUSIVE SECRET” OF CANCER 
CAUSATION. 

To ihe Editor of Tbz Usdical Press and Circular. 

Sib, —It is amusing to read, in your issue of Novem¬ 
ber 13th, Mr. Heibert Snow’s description of the onset 
of cancer, as instanced in epithelioma (see p. 530): " A 
little crack casually occurs and refuses to heal. It is 
continually robbed or chafed by some agency, which need 
not be specified. After a prolonged course of such treat¬ 
ment the ordinary phenomena of maligoancy appear.” 
On p. 510 of the same number Mr. Austin Meldon, ez- 
President of the Royal College of Surgeons, Ireland, 
saps, more guardedly : ” As yet we must look on the 
parasitic origin of cancer aa more than probable. 
Bepond this we cannot go at present.” 

There is, however, in Dr. Creighton’s article on *’ Vac¬ 
cination in the E»cylcpxdia Dritannica, edit, iz., vol. 
zziv.p p. 26, the following :—“Cowpoz ‘undisturbed by 
the milker's hands* has no ezistence in the oiiginating 
cow: it isthe persistent irritation that makes it a poz ”— 
a sentence which even surpasses tbestatementof Mr. Her¬ 
bert Snow quoted above. fVe had better leave these two 
astute gentlemen to answer thequestion: Why doee the one 
sore when irritated produce a poz and the other a cancer P 
But there is another question to be asked, namely, 
How came the editor of the Encyclopedia to insert Dr 


Creighton’s article on vaccination, when he himself 
(then —that is, in 1888—a comparatively young man) says 
that “ the views ezpressed in the present article diverge 
in many points from the opinions generally received 
among medical men,” and, he might have added, from 
those set forth in the article on Jenner, to be found in an 
earlier volume (ziii.) of the same Entyelopiedia. 

1 am. Sir, your truly, 

D. Biddle. 

Eingston-on-Thames, Nov. 14th, 1901. 

P.8.—As Dr. Creighton admits cowpoz to be an infec¬ 
tive disease, and says “the milkers can usually point out 
some one cow in which the disease began,” it is difficult 
to see why he should imagine it to arise differently in 
the “ originating cow ” than in those infected from 
that cow.— D. B. 


DEATHS UNDER CHLOROFORM. 

To the Editor of The Medical Press and Circular. 

Sir, —It has been with far more than ordinary 
pleasure that I have read your remarks on the adminis¬ 
tration of chloroform in las Medical Press and 
Circular of the 13th. They ought to be copied into 
every paper in the kingdom. 

Some time ^o I wrote to the same effect, urging that 
in all cases of deaths from chloroform the apparatus 
by which it was administered should be describe, and 
the amount of chloroform used should be stated. 

Why such a common sense requirement should be 
evaded I am at a loss to imagine, and in the public in¬ 
terest it ought to be demands and insisted on. 

I cannot conceive death ocourriog with the Krohne in¬ 
haler, when in the hands of any competent adminis¬ 
trator, and I have again to-day taken chloroform in 
order to demonstrate to one or two medical friends its 
perfect ac'ion and freedom from, not only danger, but 
from any bad after effects, when properly administered. 

1 am, S’j, yours, &c., 

C. J. Harris, M.R.C.S., Ac. 

1, Kilbum Priory, N.W., November 16th, 1901. 


Jmiirobcb ^ebical Jlpplianres. 


THE “80L0ID” URINE TEST CASE. 



The improved “Solold” Urine Test Case, rnsnufac- 
tured by Messrs. Burroughs Wellcome and Co., which 

we have been 
invited to in¬ 
spect, is a 
marvel of com¬ 
pactness. The 
case, which 
measures 6 < 
3 X 1| ins. is in 
heavily nickel¬ 
ed metal. It 
contains a nii- 
nometer and 
an Esbaota's 
tube (for the 
quantitative 
estimation of 
albumen), also a spirit lamp and the various " Soloid” 
re^renta for both the qualitative and the quantitative 
analysis of urine. Clear directions for use are given 
and all parts are replaceable. The case (for which 
there is supplied a doe-skin cover) can easily be carried 
in the pocket, and contains suppliee of reagents 
sufficient for a large number of analyses. It is so much 
more convenient and businesslike to make analyses of 
urine at the bedside that this compact little case will 
doubtless be esteemed a boon by practitioners, especi¬ 
ally by those whose practice eztends over long distances. 
It is sold at XI Is. 


POCKET ATOMISER. 

Messrs. Parke, Davis and Co. have submitted to us 
an ingeoious and very serviceable atomieer for the appli¬ 
cation of mefficated fluids to the ziasal muoout mem 





Nov. 20,1901. 


MEDICAL NEWS. 


Thi Usoical Pbssb. 559 


brane. It is very light and compact, and it delivers a 
flee spray. This apparatus is specially asefxtl in ad* 
miniateriDg sprays of cocaine, menthol, and adienalio. 



the last named agent, as is now well known, txerting a 
remarkable astringent and hcemoetatio acti jn on mneons 
membranes. The price is 2 b. 6 d. 


ePebicai <^ctos. 


Medical Temperance Association. 

A KXiTiNo was held in the Library of the London 
Hospital on Friday last. Professor 6. Sims Woodheaid, 
President, in the chair, when aboat eighty stadenta were 
present. Hr. J. J. Bidge introdaced adisenasionon the 
advantages of total abstinence. Headvocatedit on the 
ground that it was a more absolnte and necessary eafe- 
gnard from the e^ils of intemperance than vaccination 
against smallpox. He qnolM Sir Andrew Clark, who 
bad said, “ It is when I think of sU this (the efFeots of 
the abuse of alcohol) that 1 am disposed to give up my 
profession, to give up everything, and to go forth upon 
a holy crusade preaching to all men. ^ware of this 
enemy of the race.” He pointed out the physical ad* 
vantages of total abstinence as regards athletics and 
examinations, and showed from the results of friendly 
societies and life offices that abstainers bad on the 
average lees disease and longer life. They were all 
total abstainers from something or other, snon as opium. 
Be considered there was greater reason to abstain from 
alcoholic drink as a beverage. The question of alcohol 
as a medicine «as foreign to the subject Some objected 
to take the pledge, but they did not require it as a 
condition of membership, although he supposed they 
were all looking forward to signing the Hippocratic 
pledge after paseingthe Con joint Examination. Several 
students andothers took part in a useful and animated 
ducussion. 

Harvelan Society of London. 

Tax annual dinner of the Hatveian Society will take 
place at the Csfe Mcnioo on Thnrsdav, November 28th, 
at seven p.m. The Preaident, Dr. D. B. Lees, will take 
the chair. 

Doa'ha under Ansssthetlca. 

A DEATH under an antesthetio (it ia not stated what 
anffisibetio) took place at the Queen’s Hospital, at Bir* 
mingham, last week, the victim being a young man who 
was about to undergo an operation on bis hand. Death 
supervened before the operation had even been commenced. 
A similar catastrophe is reported as having occurred at 
St. Thomas’s Hospital, the victim on this occasion being 
a man, set. 66, who sneonmbed during an operation for 
the removal of a oanoerona growth. In this case the 
anrestbetic was gas and ether. This makes three deaths 
from ether in a fortnight, a most unusual seriee. 

Proceedings for Non-Notlllcation. 

Mb. John Paduan, M.B.C.S., of Bloomsbury Square, 
W.C., was summoned last week to answer a charge of 
having failed to notify a case of small-pox. He was con¬ 
sulted by a man employed at a neighbouring hotel, who 
presented what Mr. Padman evidently regarded as sus¬ 
picions symptoms, since be had the room inhabited by 
the patient stripped and disinfected, and vaocinsted bis 
fellow-employes. Nevertheless, he sent him Lome in a 
cab to Chelsea, where be was at onoe diagnosed to be 
suffering from small pox. It was urged for the defence 
that this was the fint case seen by Mr. Padman for 
many years, and be bad failed to diagnose it in conse¬ 
quence, and the Bench dismissed the snmmons. 

Fatal Counter Irritation. 

An inquest was held last week on an infant at Heath, 
near Wi^efleld, who bad died under peonliar circum¬ 
stances. It appears that the infant was suffering from 


bronchitis, for which the mother had applied a plaster 
I composed of paraffin and linseed, the effect of which wa» 
to cause a huge blister, this, in the opinion of the 
medical attendant, having contributed to the fatU 
result. 

Ptomaine Poisoning or Diphtheria ? 

Two children at Aston recently succumbed under cir¬ 
cumstances which led the medical practitioner to diag¬ 
nose ptomaine poisoning. As the evidence was not deem^ 
satisfactory, the throato of the deceased children were 
submitted to bacteriological examioatien, which revealed 
in one the presence of the bacillus of diphtheria. Medical 
evidence was adduced to show that the aymptomi of 
ptomaine poisoning presented great similarity to those 
of diphtheria, and a verdict of death from natural 
causes was returned, the foreman of the jury adding, 
however, that the jury were of opinion that the children 
were suffering from diphtheria. 

Another Antl-Vaoclnatlon Trick. 

What the local newspapers describsasan’* amusing ” 
vaccination case was heard the other day at Hounslow, 
where it was urged for the defence thatn) evilence 
was before the Court to prove that the child, the non- 
vaodoation whereof was the subject of the projeedings, 
was really inexistenoe. Ult'matelythefnrtber hearing 
of the case was adjourned for the prodnotion of the 
certificate of birth. It is not easy to see what advantage 
oan attend an objection which is mscely vexatious in its 
character, and we are rather surprised that the Beach 
did not at once over-rule it. 

Ulster Medical Sode^. 

The first meeting of the seasioa 1901-1902 was held in 
the Museum, Belfist.on November 7th, when the newly 
elected President, Professor W. Whitla, delivered 
an inaugural address on Some Worthies on the Mem¬ 
bership Boll of 1886. He gave interesting biogra- 
^ical sketches of members of the Society who had died 
since that year A vote of thanks, on the motion of 
Professor J. A. Lindsay, seconded by Dr. H. Whitaker, 
was tooorded to the President for bis address. The 
annual dinner is to be held to-morrow evening, 
November 2l8t. 

Memorial to Dr. Marsden. 

On Saturday last the Bishop of London unveiled a 
window in the ohapel of the Cancer Hospital at Bromp- 
ton, to the memory of Dr. William MarsAtn, its founder. 
The window has been erected through the generosity of 
the Worshipfnl Company of Cordwaiuers, of which Dr. 
Marsden was one time the Master. 

Symotic Diseases in London- 

The number of patients under treatment in the hos¬ 
pitals of the Metropolitan Asylums Board suffering from 
small-pox oontinnes to increase, tiie number on Monday 
being 863. Ihere were 3.294 sou-let-fever patients, 1,266 
with diphtheria, and 274 enteric oase^i, the last three 
showing a slight decrease on the return for the preesding 
fortnightly period- 

Damages for Arsenical Beef Paisoniog. 

An action was tried a”. Manchester last week—thefirst 
of its kind—in which a consumer sued the publican for 
damages caused by the preseace of arsenic in the beer, 
resulting in peripheral neuritis. The verdict was ia 
favour of the plaintiff, for £50 and ooate. 

Conjoint Examinations in Ireland.-Boyal Collage of 
rnyslolans and Koyal College of Surgeons, Irelanl 

Candidates have passed the following examinations 
as undernoted: — 

Final Professional Examination.—In all subieots: J. 
F. Fit^erald. Completed examination: J. M. Barry, 
Miss M. B. Bridgford, C. W. Conry, A. D. C. Cummine, 
S. G. Gordon, W. B. Meredith, S. B. MoCaosland, F. 0. 
Sharpe, B. C. Vernon, B 0. White, G. B. Wilkinson, 

^ F. W. Woods, Thos. Jos. Wright. 

Diploma in Public Health.—Lieut.-Col. U. J. Bourke, 
B.A.M.C., M. J. B. CosteUo, M.B., Aa, B.U.I.. H. A. 
Dongan, M.B., D. P. Ffrenob, M.B., B. Pox Symons, 
M.BC S., L.B.C.P., A. Moon, M-D., J. H. M'Anley, 
L.B.C.P.8I, C. J. Powell, F.B.C.S.I., C. L. Sansom, 
F.B.C.8 Edin. ^ , 

CoogK 




560 Th* Medical Pbege. NOnOBS TO CORRESPONDENTS. 


Not. 20, 1901. 


4t0tict0 to 

(ffnrrtJBpoitiinitjB, §kort ^tettero, itc. 

9 ^ COBBiiroTDiETB reqitiriiiE a rBply in tUa colnmn are par- 
tlanlarlx reqnestad to make ase of a difttncHr* npruifura or 
faitfolf, and aTold tb« practice of aiffninE ttaemaelTea ** Baader,” 

Snbaorlber,” "Old Snbaerlber,*’ de. Vnch oonfnaion will be 
apared bj attention to tbia role. 

Qbaduatx.—I t woald not be poef^ible for the College to introduce 
a bje-iaw of tbe kind contemplated b^ our oorreepondent. So 
radical a change c‘uM only be effected b; meana of a new charter. 

O. M. 8. (BirminEbam). - A care ia recorded of a man livlnfr with 
hi^ leper wife in Uolalai (ibe Itpir rettlemei t) for fifteen yeara, 
■ndhaTiDEbad i,y b<r foorUen cbitdnn. aid up to the present 
neither the man lor tbe children hare dereloped leprosy. 

AN ADMISSION. 

A xA5 purchased come reimin killer of a chemist, but not uainE 
it placed it in a cupboard wl ere some time after it was taken in 
error by hie motber-in law, fortunately without fatal result. The 
man beinE asked some time sfter ss to the character of the 
chemist said, ’* 1 can’t say any good of him ; be once deceired me 
over some Teimin.powder."- C'iimist and Druggist, 
t M.B.C. S.—Our correspondent is confusinf the meetinis of the 
" body corporate ” at the Koyal Colley of Surgeons (Eog.). Tbe 
annual meeting, held in NoTember,iB inclusive of both Fellows and 
Members, at which an ample quornm is always obtainable, and no 
intention exists of abolisbing it. The meetings of the "Fellows,” 
however, independently, which were introduced a few years a^, 
are likely to cease to exist owing to the lack of interest shown in 
them. At the present moment "college politics" have passed 
beyond the pale of dlscnssion. 

Db. Lxwis.- The method of spinal srssthesia is still on its trial. 
8o far it has found but little favour. Tropa cocaine is stated to 
have yielded the beet resnlts, being less toxic than the ordinary 
bydrocblorate of cocaine. But tne procedure is one which a 
general practitioner would te wue not to undertake without expert 
assistance. 

Dr. J, S. Horreb.—A pplication should be made to the War 
-Offica 

McDicus - The statement appears to ns to be distinctly libellons. 

Dr. Erkpst Willuxb.—a trial might be made of Coley's Fluid, 

Dr. S. B. O.—Mr. Budysrd Kipling has, as far as we know, never 
studied medicine ; he was a journalist before he became known ae 
a writer t f hooka 


of the Societies. 

LONDON. 

Thubsdat, Not. 218T. 

Harveiar &OCISTT OF LoRDOx (Stafford Booms, Titcbbome 
'Street, Edgware Bead, W.^.—S SO p.m. Mr. Bnekston Browrne : 
Twenty-five Years' Experience of Urmary Surgery in England (Third 
Harveinn Lecture). 

Childhood Socibtt (Library of the Sanitary Institute, Margaret 
Street, W.).—8 p.m. lecture. 

Medico Fstcbolooical Associatiok of Great Britair ard 
Irelard (11. Chandos btreet, Cavendish Square, W.).—12 noon. 
Educational Committee.- 2 mm. Council—3p.m. Genpml Meet¬ 
ing under the presideccy of Dr. O. Woods. 

Fridat, Not. 22rd. 


Clark, Pebct J., L.B.A., M.B.C.S., Aasiatant MediCRl Officer to 
the London Disprasary, Spitatflelds. 

Corbitt. J. A., M.B., B.S.B.n.L, Certifying Surgeon nsder the 
Factory Acts for the Bangor District of County Dovm. 

Dempsrt. Patrick, F.B.C.B.I.. L.B C.P.I., Surgeon for Diaoteet of 
the Throat and Noae t i the Mater Miserieordiie Hospital, 
Dublin. 

Qlekkt, Edxdrd, L.B.C.F.I.. L.B.C.S.I., Junior Honee Surgeon 
to Jervia Street Hospital. Dublin. 

Hardwick, Arthur, H.D.Durh.. L S.A.Lond, D.F.H.Lond., 
Medical Officer of Health forNewqnay, Cornwall. 

Ibtire, H. B.. L.B.C.P.. L.B.G 8 Ed., L.F.F.S.OIajg., Dispensary 
Medical Officer for Belfast No. 13 and Caatlereagh No. 1 Dia- 
tricts. 

McLorirar, W., L.B.C.P.I.. L.B.C.S.L, Dispensary Medical 
Officer of Cnuendall and Waterfoot Dintensary, oo. Antrim. 

PiDWiCK, J. C., kl.B.C.S., LB.C P.Lond., CeHifyin* Surgeon 
under the Factory Acts for the Borongh of Bridgnorth. 

Tarb, W., M.K.Edin., District Medical Officer, Teovil Union. 

Tbompsor, JiXES Arthur, M.B., B.Ch., B.AO.T.C.D., Senior 
House Surgeon to Jervis Str'et Hospital, Dnblin. 

Turner, A. H., L.B.A., Medical Officer of Health fur the Beecons- 
field Urban District. 

Walksr, Edtthe H. 8., M.B.Qlasg., Assistant Medical Officer at 
the Wi^rkhonse Township of Toxteth Patk, Liverpool. 


ImncieB. 

Bncebridge Aaylnm, near Lincoln.—Junior Assistant Medical 
Officer. Salary £125 per annu^ with apartments, board, at* 
tendance, Ac. Applications to W. T. Page, Jnnr., 5 and6, Bank 
Street, Lincoln 

Bradford Boyal Infirmary. - Dispensary Surgeon. Salary £100 per 
annum, with board and residence. Particulars of William Maw, 
Secretary. 

County Asylum, Mickleover, Derby —Senior Assistant Medical 
Officer. Salary coinmencingat £150, with furnished apartments, 
beard, vrasbieg, and attendance. Also a Junior Assistant. 
Palary commencing at £120. Applications to the Medical 
Superintendent 

County Asylum, Prestwicb, Manchester.—Junior Assistant Medical 
Officer. Salary commencing at £150, with board, famished 
apirtments, and washing. Applications to the Medical Super¬ 
intendent. 

County of Eaist Sussex. —County Medical Officer of Health. Salary 
£200 per annum, with fees Ac., for ape-ial visits. A list of the 
duties. Ac., can be obtained ofF. Merrifirld, County Hall, Lewea 

Olascow University.—Additional Examinerships in Medicine and 
lienee, with special reference to Chemistry, Materia Medics, 
Zoology, Practice of Medicine and Suigery. Farticnlara as to 
dates emoluments, Ac., on reference to our advertising columns. 

Leeds General Infirmary. - Besident Surgical Officer. &]ary£lC0 
per annum, with board, residence, atd woshiog. Applications 
to the Secretary. 

Middlesex Hospital.—Medical Officer and Begistrar to the Cancer 
Department. &lary £100 per annum, with board and re-idence 
in the College. Particulms of F. Clare Melhsdo, Secretary- 
Superintendent. 

Boyal Sea Bathing Hospital, MsrgRte. - Besident Surgeon to act as 
Junior for six months, and then as Senior for .the like period. 
The salary of tbe two offices is at the rate of £80 and £120 per 
annum respectively, with board and reaid< noe. 

Sheffield Boyal Infirmary. Casualty t>fficer. Salary £100 per 
annum, with board, lodging, and washing. For duties of post 
apply to the Secretary, 


girths. 


Clinical Socirit of London (20, Hanover Square, W.).—8.30 
p.m. Papers;—Mr. T. H. Morse: Case of Intracranial Section of 
the S'cond end Third Divisions of the Trigemini Nerve for Severe 
Nenraigia.-Mr. W. Haward: A Cose of Fmgilitas Ossium —Ur. 
S. H Habershon; Tbe Association of Movable Kidney on the 
Bight Side with SympU ms of Hepatic Disturbance. 

Mordat, Not. 25th. 

Odortolook'al Societt of Great Britain (2(b Hanover Square). 
—8p.m Annual Beport. Commnnicalions by Mr. E. W. Boughton 
-on " A Case of Alveolar Abscess, followed by Necrosis, Cellnlitis 
and Fatal Hsmonhage.'* Mr. Arthur 8. Underwood on "Unex- 

S icted Ontcome of a Reguli tion Casa." Paper by Mr. W. Cass 
rayston on " Science in Dentistry." 

DUBLIN. 

Wbdnesdat, Nov. 20th. 

Dublin University Final Medical Examination. Sections A, 
-and C. 

Thursdat. Not. 218t. 

Connell Meeting, B(»al College of Bnrgeons. 

Dublin University Biological Asscoiation, Front Hall, Trinity 
-College. 8.30 p.m. 

Fridat, Not. 22kd. 

Boval Academy of Medicine in Ire'and. Section of Obatetrica— 
'Specimens—Tbe President: Two Specimens of Fibiomyomata. 
Dr. Alfred Smith i Three Interesting Specimens of Fibromyomata. 
Dr. Jellett: Uterus and Aprendages removsd for Chronic Salpingo- 
oophoiitla. Papers-Dr. Jellett; Notes on a case of Snppurati^ 
Ovarian Cyst and Intra-peritoneal Abscess, with specimen. Dr, £ 
H. Tweedy: Modem Te^nlqne of Vaginal Cuellotomy, Dr. Home: 
Notes on a case of Ctesarian Section. 

Boyal College of Physicians. 8.30 p,m. 

Mordat, Not, 25th. 

Dublin University Final Medical Examination. Sections B. 
.and D. 


Atkinson.— On Nov. 14th, at Elmhurst, Hampton Hill, N.W., the 
wife of G. L. Atkinson, M.K.t’.S., L-R,C.P., of a daughter. 

Osborn.- On Nov. Uth, at Ennismore Bouse, Dover, the wife of 
Fraccia Aithnr Osborn, LB,C.P.Lond„ M.B.C.S.Eng., of a 
daughter. _ _ . .. 

Paul.—O n Nov. 11th, at 26, Qneensborongh Terrace, W., the wife 
of J. E. Paul, M.D., of a son. 

Bkndall.— On Nov. l7tii, at Ewell, Surrey, the wife of Percy Ben- 
dall, M.D.i of a son. 


iKarriages. 

Harris-B iDKLL.— On Nov. 9th, at Stowmarket, Robert James 
Harris. M.B.C.S.Eng.,L.B.C.PLoDd.,of Eochdale, ssoond son 
of the late Henry Harris, M.B.C.S.E., of Dei mark Hill, Londi n, 
to Ethel Marie, eldest daughter of tbe Bev. Alfred Bedell, of 
Stowmarket. . , , 

Htdb-Bollkston.— On Nov. 12th, at St. Mary-le-Strand, London. 
Patrick G. Hyde, M.B., B.A.M.C., elder eon of the late CoL 
Bobt. Hyde, &A.M.C.. to Minnie, only daughter of the late 
Archibald Bolleston, of Drofbed^ ~ ...v /-.u v 

Nswbould—Barrow,— On Nov. 13th, at 8t. Cnthberte Chnrch, 
Darlington, Addison John Newbonld, Taknna,_New Zealw, 
to Fanny, widow of Charles A. G. Itorow, M.B C.8., L.HC.P.. 
SuttOD, SnntT, daughter of tb© lalo S. £, 

r.B.C.8., Darlin^tons_ 

Seathfi. 

PARK.-On Nov. 10th. at Hampstead, Arthur H. E-““ 
of John W, Psre, M.D., lS. 8., of 64, Brook Street, Grosvenor 

8xKE?-^^’ltoT. Ith at his honso, The Grange, Oarshalton, Alfred 

HntchisonSmee, MAC.S.,J.P. forSorw-y. _ 

TATiOR.-On Nov. 11th. at his residence, 6, Grove Park, Laverpool, 
is his 8Dth year John Stopford Taylor, M.D. 


n$s and Ckmlat 





“SALUS POPULI 8UPREMA LEX.” 


VoL. CXXIII. WEDNESDAY, NOVEMBER 27, 1901. No. 22. 


^hc ^arbeiiiii ^cctuns, 1901. 


TWENTY-FIVE YEARS’ EXPERIENCE 

OF 

URINARY SURGERY IN ENGLAND. 
Delivered before the Habveian Society of 
London, November 14th, 1901. 

By G. BUCKSTON BROWNE, M.R.C.S.Eng. 

Abstract of Lecture II. 

Grea.t improvement bas taken place in tbe treat¬ 
ment of enlargement of tbe prostate gland duriog 
tbe bfcst quarter of a century, and tbe great success 
of modem treatment is undoubtedly based upon 
attention to antiseptic detail, better surgical instru¬ 
ments, and greater skill and knowledge In tbelr 
employment. Tbe prospects of the prostetic patient 
have of late been painted in the blackest possible 
ooloui's, but if tbe patient be not careless, and if be 
be judiciously treated, 1 would say that he was more 
likely than not to live to a considerable age. Tbe 
prostate is a sexual oi^n; it appears to exercise no 
urinary function whatever, although why tbe organ 
undergoes enlargement is not very clear. I think the 
affection is more common among tbe sedentary and 
well-to-do, but it is found among men who are the 
very reverse of this. It certainly is often seen 
after a second marriage, or after a marriage late in 
life, but on the other hand, I have met with great 
enlargement in men remarkable for their life¬ 
long asceticism, celibacy, and piety, so that 
with regard to the setiology of prostatio enlargement 
one is still at sea. If pressed, however, to advise 
how best this malady is to be avoided 1 should advise 
plain living, exercise on foot, and very moderate 
worshu) at tbe shrine of Venus after fifty years of 
age. It has often been remarked in writings on the 
enlarged prostate that if a prostatio patient who 
fails to empty his bladder be left alone a time comes 
when cystitis occurs, and the urine becomes cloudy 
and offensive. This is not so in tbe vast majority 
of cases unless instruments have been used, and 
almost always is due to some imperfection in tbe 
antisepticism employed. We will therefore begin 
by a consideration of tbe practicable antiseptics of 
catheterism. 

For many years 1 have provided the patient re¬ 
quiring the use of the gum elastic or rubber catheter, 
with the following outfit:—A tube of antiseptic 
pellets, one of which dissolved in a pint of boiled 
water, yields 1 in 1,000 of peroblorlde of mercuiy. 
A pint bottle. A glass tube 13 inches long, 1^ inches 
in diameter, and fitted with a cork ana stand. A 
box divided into seven compartments, each compart¬ 
ment holding a catheter, and labelled after the davs 
of the week, made of cheap material so as to be 


burned when soiled, and easily replaced, or of tin, 
and therefore easily purified by boiling. A pot of 
plain white vaseline, or with the addition of 5 per 
cent, of oil of eucalyptus. In his bedroom the 
patient is directed to keep a vessel with a lid, filled 
with water which has been boiled, and a supply of 
clean, small, soft, rough towels, so distinctive that 
they are not likely to be used for ordinary pur¬ 
poses. Tbe patient dissolves a pellet in the pint 
bottle 611ed with boiled water, and from this pint 
he fills bis upright glass tul:«. We will suppose 
that his catheters are handed to him in a pure 
state. He uses a catheter at 1>edtime, withdraws it, 
wipes it, and then washes it in soap and water, and 
places it in the upright tube for the night. The 
catheter being upright in the tube, tbe inside is 
thoroughly exposed to the antiseptic solution, and 
there is no need to have interiors of catheters 
smooth and polished, as has been proposed, which 
adds to their expense. If the catheter has been put 
into the tube at bedtime it can be taken out tbe 
next morning, rinsed in water which has been boiled, 
dried, and put away in its compartment in the 
seven-comparbmented box, until its day for use comes 
round again. If a catheter is required four or five 
times in the twenty-four hours it can, after each 
using, be washed aud put back into the tube during 
the day of usage, although one finds in practice that 
simple washing during tbe day is sufficient if the 
catheter have its antiseptic bath at night. Men 
engaged during tbe day away from home, and 
travellers, oarr^ two or three or more clean catheters 
in little metal boxes (which can be boiled) in their 
pockets, transferring tbe catheters when used 
to another pocket, and waiting until evening 
and their bedroom is reached, before washing them 
all and placing them in the antiseptic solution. One 
tubeful of perchloride solution will purify five or six 
well-washed catheters. Gum elastic catheters by 
ood makers will bear twelve hours’ immersion in 
in 1,000 of perchloride of mercury well, and care¬ 
fully used in this way will last for peal's. Yulcanised 
indiambber catheters may. if desired, be left in this 
antiseptic bath altogether, without sustaining any 
injnry. The receptacle for the Inbrioant emp'oyed 
shoald be small, so that tbe latter is freouently 
renewed, and the former should be frequently cleaned. 
Tbe glans penis must be kept clean with soap and 
water, and tbe hands well washed. If these simple 
directions be carried out tbe urine will keep sweet 
and clear, and cystitis will never be set np. All 
metal instruments, such as silver catheters and 
vesical and urethral sounds, should be boiled, and 
no prostatic patient should be touched by any instru¬ 
ment which the surgeon is not perfectly satisfied 
with, and would not nse, if necessary, upon his own 
person. For, if one impure contact be made, 
tbe patient may never m the same again, and 
it may be the starting point of almost endless trouble. 


D -iiii7s,i byCjOO^IC 








562 Th» UsDioAL Fbms. OBIGINAL COMMUNICATIONS. 


Nov. 27, 1901. 


At one time I tbou;;ht tbat the bladder never became 
infected unless impure instruments bad been used, 
but I have bad occasion to change this view, having 
found bacterial urine in the male blaf'der, virgin to 
all instruments, but this is very exceptional, and we 
must insist upon practicable antisepticism in urinary 
surgery. 

When an elderly man requires the use of a catheter, 
it may be that he simply fails to empty the bladder 
by bis natural efforts to the extent of a few ounces, 
or that he has an acute atttack of retention of urine, 
or that he has for a long time failed to empty the 
bladder, that organ having become distended and 
containing hab tually a large quantity of urine, the 
urine passed naturally being simply overflow. But 
whatever the precise reason for the catbeterism, the 
patient may lie said to be standing on the brink of a 
precipice, and the surgeon who comes forward to 
lead him to firmer and safer ground must act from 
the very first with cautioD,otberwi8eit is possible that 
both surgeon and patient may fall into the abyss, the 
patient losing his life, and the surgeon his reputation. 
In other words, the absolutely necessary catbeterism 
may result in illness leading to the death of the 
patient, and to the destruction of the surgeon’s repu¬ 
tation as a healer of men. Here, just as in the sur¬ 
ge^ of stone, we are face to face with urinary fever, 
and we must act from the very outset so as to avoid 
it if possible. Instrumentation must be gentle and 
skilful, and the patient be kept warm and quiet, for 
exposure to cold, and shaking of the body, as in tra¬ 
velling, both tend to still further embarrass the 
renal action if it has already been disturbed by 
catbeterism. Therefore it is always well to attend 
the patient in his own w arm room, and elderly feeble 
men should be kept for a few days altogether in bed. 
If a patient has sought advice in time, and has been 
properly attended to, he will probably never have com¬ 
plete acute prostatic retention of urine, and certainly 
will never come to the chronic state of retention of 
urine where the bladder is fall and the urine dribbles 
away. If a patient come to acute retention of urine, he 
certainly has to he introduced to the catheter, under 
the most unfavourable circumstances, and with very 
little ceremony. The bladder must be relieved as 
speedily as possible, for the longer the retention the 
less likely is the bladder to regain its contractile 
power. H is in these cases that so often great diffi¬ 
culty is experienced in passing a catheter, and 
catbeterism proving unsuccessful the patient is sub¬ 
jected to some formidable operation. We often read 
in the medical press statements of which the two 
following are fair examples. A surgeon writes of 
his patient, est. 81. suffering from retention, “The 
prostate as felt per rectum was enormously enlarged, 
and no catheter could be passed, the growth block¬ 
ing the urethra completely.” 

Another surgeon writes of his case; After this 
it was impossible for two days to introdnce a 
catheter.” In both these cases the patients were 
promptly castrated. Now in such cases as these 
there is no doubt as to the existence of a urethra 
from meatus to bladder; I take it that t here was no 
urethral stricture, and I do not admit that there is 
snob a thing as prostatic stricture, therefore the 
only reasons why a c-atheter did not pass along the 
nrethra and into the bladder was that the canal was 
tortuous, that is to say, irregularly bent and winding; 
and it is obvious that, given faith, determination and 
skill, which in this connection is only another term 
for experience, it must really have been possible to 
pass catheters into these bladders. I wish, indeed, to 
take this opportunity of asserting most emphatically 
that there are no cates of •prottaiie disease where it is 
impossible to pass a catheter into the bladder. When 
once a catheter is passed, the patient is on the high 
road to recovery, and be is spared the risks of severe 


surgical procedures when, owing to his state of 
health and his age, he is particularly ill-fitted to be 
the central figure in an operation scene, at a time 
when “ the keepers of the house shall tremble, and 
the strong men shall bow themselves, and the grinders 
cease because they are few, and those that look outof 
the windows be darkened.'’ If a catheter will not pass 
readily in a case of prostatic retention, it will be 
because the curve forwards of the vesical end of the 
urethra is too acute for the instrument to follow it, 
or because the point of the catheter has caught in 
one or other of the two prostatic sinuses on either 
side of the capnt gallinaginis. These sinuses form 
most perfectly contrived pockets or traps, which re¬ 
ceive toe poinc of the instrument, and effectually bar 
its onward progress into the bladder. When, there¬ 
fore, the introduction of the catheter is arrested in 
these cases the point impinges upon the posterior 
wall of the urethra, or is caught in one of the 
pockets situated in that wall. It follows that for 
successful introduction the point of the catheter 
must bug the anterior wall of the urethra, and so 
the whole art of catheterising the prosthtic urethra, 
with soft instruments consists in maVing their points 
avoid the posterior wall. In successful prostatic 
catbeterism one of two things always occurs—either 
the catheter takes the form of the urethra or the 
urethra that of the catheter. In the first case, 
when the catheter conforms to the urethra, the in¬ 
strument must necessarily be a soft one, and when 
a soft one is employed it is undoubtedly better for 
the patient. The india-rubber catheter is the safest 
of all, and will often pass when all others have 
failed. Indeed, Mr. Jonathan Hutchinson (the intro¬ 
ducer of the rubber catheter) considers that there 
are no cases where it will fail, and in his skilful 
hands it has been a great success. It will be well 
always to begin with these catheters. But in my 
experience, especially if other instruments have been 
previously unsuccessfully attempted, this catbeer 
may not always pass, and it will then be well to try 
the coudee catheter, keeping the beak well upwards 
all the way in. Next in point of usefulness comes 
the btcoudec catheter, which is a \ery efficacious 
instrument, especially when the difficulty arises 
from the prostatic sinuses. The olivary catheter, 
and the English gum catheter are rarely of use in 
cases of real difficulty. The value of the rubber and 
of the ewdee catheter may in certain cases be much 
enhanced by the use of a metal stylet. MetaUtylets 
are of three kinds: iron, lead and silver. The iron 
stylet gives form and strength to the main body 
of the catheter, while the end of the catheter 
may be left free to follow the curve of the 
urethra. The leaden wire gives substance and 
backbone to the catheter without rigidity, and I 
know no more invaluable instrumfnt in cases of 
great difficulty than a rubber catheter fitted with a 
leaden stylet, stopping short of say three inches from 
the eye of the catheter. The silver stylet occupies a 
position between the other two; it is very yielding 
and at the same time full of spring, and if well 
curved will often carry a soft catheter safely through 
a greatly deformed, prostatic urethra, when the curve 
forwards close to the bladder is very acute. If no 
soft catheter, either with or without a stylet, can be 
passed, then we must make the urethra conform to 
the catheter, in other words we must use a silver in¬ 
strument. The very worst cases can always W 
relieved by a silver instrument if the patient be 
antesthetised, and if the surgeon guide the point of 
the instrument with bis left forefinger in the rectum. 

I have found a large silver catheter. No. 14, ^th a 
short curve and fitted with a gum stylet very useful. 

It is too large and blunt to catch in the prostate 
sinuses, and the short curve comes readily forward 

L Oi gU 


Nov. 27, 1901. 


ORIGINAL COMMUNICATIONS. 


Thb Mxdioal Pbx68. 563 


on depressing the shaft of the instrument. The gum 
stjlet is useful in preventing plugging of the catheter 
from blood clot. After the bladder has been emptied, 
a soft catheter can always be passed in, if moulded 
on an iron stylet to the exact shape of the success¬ 
ful instrument. 

But perhaps the most grave and anxious cases are 
those where the retention has been allowed to become 
obronic. No surgeon should consent to treat such 
cases as out-patients. In such cases catbeterism 
must be commenced with care, and with every anti¬ 
septic detail, and the bladder should only be very 
gt^ually emptied. I generally practice catbeterism 
every six hours, and if about seventeen ounces be 
drawn off each time it will be seen that, supposing 
the original contents of the bladder to m forty 
ounces, it will take four or five days before an;^ one 
catbeterism empties the bladder. If any pain be 
experienced towards the end of catbeterism, the 
catheter should at once be withdrawn. If 
these largely distended bladders are suddenly 
emptied there is almost sure, within a few hours, to 
be some haemorrhage from the vesical veins, which 
have been too suddenly relieved from a condition of 
chronic and severe pressure, the kidneys suffer 
severely from the shock, urinary fever follows, and 
the patient almost invariably dies; while if these 
bladders are only slowly emptied there may not be a 
rise of temperature, and, if one may so express one’s- 
self, not even a pus or blood corpuscle may be seen 
throughout the treatment. All depends upon close 
and constant surgical attention, and perfect sub¬ 
mission on the part of the patient. If a prostatio 
patient properly introduced to the catheter, and 
tf necessary continues to use it with care and cleanli¬ 
ness, his prospects of life are good. There are, 
however, exceptional cases, where there are unusual 
difficulties and sometimes complications, and where 
simple catbeterism will not alone suffice or is impos¬ 
sible. These are the cases which have been unfor¬ 
tunate in their introduction to the catheter, where 
cystitis and possibly intense irritation have been set 
up—cases where catbeterism is very difficult, and 
where anto-catheterism is well-nigh impossible, 
owing to blindness, shaking palsy, cripplea hands, 
and even the loss of a hand. These latter diffi¬ 
culties are, of course, got over by securing, when¬ 
ever possible, the services of a good attendant. 
Then there are the cases where the prostate is 
very much enlarged, and often enlarged into the 
bladder, the prostate projection acting like a foreign 
body, and oausing.great irritation, and cases where, 
hidden away but none the less irritating and tortur¬ 
ing, there is a stone in the bladder, not to be de¬ 
tected by the ordinary method of search by a sound 
introduced through the urethra. A prostatic case 
where the calls to empty the bladder are constant, 
and where perhaps catbeterism is difficult and 
painful, and toe relief obtained by catbeterism evan¬ 
escent, and where no vesical calculus cui be found 
by the ordinary method of examination should in the 
first place always be thoroughly made a patient. 
He should be kept at rest in a warm room. His 
catheter should be introduced rather too often than 
too seldom, by a skilled attendant. The bladder 
should be washed out by mild solutions of nitrate of 
silver, boro-glvcerine, or glycerine and borax. Anti¬ 
septics shomd be administered by mouth, such as 
boracic acid or nrotropine, and the bowels should 
be kept gently active. If the case is one of 
simple inflammation the improvement which 
may take place is often astounding, and the 
improvement can often be rendered permanent 
b^ the patient learning exactly how to take care of . 
himself. But if improvement does not take place, I 
a careful examination should be made under an ' 
ansesthetic, a calculus may in this way often be 


detected, while the extent of the prostatic growth* 
may be defined by the finger in the rectum, and the 
sound in the bladder. During sueb an examination, 
it will be well also to use an evacuating tube, and a 
litootrity aspirator should be employed, in order to 
wash out any irritating phosphatic concretion which 
may have eluded detection by the sound. If a stone 
be found it can be crushed and removed, unless for 
any special reasons it is thought best to perform 
lithotomy. But supposing lithotomy was not per¬ 
formed, and that in spite of all done so far the 
patient's difficulties continue, it becomes a question 
what the next step should 1 m. Many would, under 
such circumstances, recommend vasectomy, and 
others, bolder still, would advise the removal of the 
testes. Now nothing that I have ever met with has 
recommended these operations to me. I have never 
performed either of them, for I have seen so many 
patients after these operations, not one whit the 
Mtter for them, but in many ways the worse, that I 
have put them aside as even worse than useless. 
I believe that castration does no real good in genuine 
cases of prostatic enlargement, and I gnow that it is 
' fraught with great dangers. Many patients become 
insane, many become decrepit, and many sink alto¬ 
gether under the operation. The same remarks apply 
to vasectomy, and as for single vasectomy it cer¬ 
tainly appears to me that such an operation ought 
never to be performed. 

I am satisfied that there is only one thing to do 
for a prostatic patient, whose sufferings cannot be 
cured or mitigated by the treatment already dis¬ 
cussed, and that is to open the bladder supra-pubi- 
cally, in order to explore di^tally for stone, or 
tumour, and at any rate to obtain drainage and rest 
for that organ. No attempt should be made by the 
perineum, but the bladder should be opened above 
the pubes, where, however large the prostate may be, 
the finger can reach every nook and comer of the 
bladder and deal with whatever may be found. I 
would in passing, point out the importance of 
opening the bladtkr m such cases upon the point ol 
a staff. When the prostate is large, that organ oftoi 
comes up well above the pubes, and unless a staff is 
' employed it is possible to incise the prostate and not 
' the distended bladder, and thus cause serious embar¬ 
rassment and trouble. It is quite curious how often 
a bad prostatic case will prove to be really a case of 
calculus, often hidden away in one of the many 
pouches to which such cases are subject. When once 
the finger is in the bladder, these stones, with care, 
are easily found, and generally easily turned out, and 
the case from being one of anxiety, uncertainty and 
disappointment, becomes a brilliant success._ If a 
stone be found and the intra-vesical prostate is not 
very large, the prostate had better be left alone, but 
if there be much intra-vesical CTowth it will become 
a question for the judgment of the surgeon whether 
or not it should Im attacked and removed. If no 
stone has been found, and there is considerable 
intra-vesical growth, I think it will be good 
policy to attack the growth by the perform¬ 
ance of the modem operation of prostatectomy. 
Prostatic hypertrophy may be either (1) extra-vesical, 
(2) intra-vesical, or (3) both extra- and intra-vesical. 
It is the intra-vesical growth which chiefly causes 
difficulty in micturition, and, in my opinion, it is the 
growth which can be removed with reasonable safety. 
The vesical urethral orifice should be left with noth¬ 
ing surrounding it, but level and continuous with the 
floor of the bladder. Quite lately, although prosta¬ 
tectomy has been a recognised operation for twelve 
years, there has been much discussion about the 
“ Total Extiroation of the Prostate by Knuclea- 
I tion,” and it has been heralded as a new and most 
promising epoch in operative surgery. But surely 
such phraseology is misleading, and no anatomist 



Thx M.D1CAL Pbisb original COMMUNICATIONS. 


Nov. 27, 1901. 


would use such terniB. Tbe prostate can no peutical intervention, being more rapid and con- 


more be extirpated 
knife than can a 
abaolutelj one with 


without 
piece of 


ut the use of the 
of intestine; it ia 
urethra and bladder. 


venient, ie aleo more efficient 
There is'another ^eetion of transcendent import¬ 
ance, in which the A-rajs have assisted our investd- 


The phrase total extirpation of the prostate has been gation with such cleamees, that this peculiar aspect 
used in error, and by surgeons who have been for- of the question justifies our fixing it in onr attention, 
tunate in having only met with tbe simpler or I refer to glandular tuberculosis, the commencement 
adenomatous form of prostate hypertrophy, where in many cases, of pulmonary tuberculosis, and in all 


la^e masses are easily shelled out the inseparable companion of the disease. 

Then again, in connection with prostatectomv, it Badioscopyconstitutesapowerfulmeansofstudy- 
has been denied that when the bladder has long been ing the dynamic forces. It is not possible to see 
dependent upon the catheter, say for twelve months, by radiography all tbe functions and all the move- 
it can regain its natural expulsive power when tbe ments that characterise each function. For this 


prostatio obstruction has been removed. 


reason the normal physiolof^y of, for example, a joint 


proved that the bladder can act naturally and com- during tbe different phenomena which constitute 
pletely, and for many years too, after the removal of movement and action, can alone be seen on the 

fluoroscopic screen, an impossibility with the 
I radiographic plate. 

j The two phenomena to which we are about to refer 
I appertain to actions of an organ in a state of move- 


E rostatic obstruction (Medical Society of London, fluoroscopic screen, 
[arch 6th, 1893). I would, therefore, strongly re- radiographic plate, 
commend all prostatic patients and there advisers to The two phenomei 
be content with the catheter life as long as it is appertain to actions 


tolerable, and in the vast majority of cases with ment, and for that reason can only be observed by 
reasonable care it will r< main tolerable into extreme radioscopy. The first is tbe heart. Ever since 
old age, until the end comes probably through other Wells drew attention to the diagnostic value of 
channels. I believe, as Mr. Jonathan Hutchinson tachycardia, all specialists and those who devote 
once said to me, “ good surgery may often be com- themselves specially to tbe study of tuberculosis, have 
bined with bad practice.” The work of tbe world is set great store upon this datum, raising it to an im- 


not always done by those who are completely well. 
It is not wise for the elderly to run grave risks only 


portant position in the early diagnosis of tuber¬ 
culosis. One of the most efficient means of verifying 


on the chance of obtaining complete comfort. There this datum is by fluoroscopy. As we never loee sight 
is much truth in what Thomas Hardy says of one of of this diagnostic resource in our department of 
his most fascinating bei'oines, “ in considering what tuberculosis, we can affirm, in an indubitable manner, 
she was not, be overlooked what she was, and forgot that, with the fluoroscopic screen, the datum of 
that the defective can be more than the entire.” Welle is seen in moie than 94 per cent, of cases of 


THE 

X-RAYS AS A MEANS FOR THE 
EARLY DIAGNOSIS OF 
TUBERCULOSIS, (a) 

By De. ESPJNA T CAPO, 


Wells is seen in moie than 94 per cent, of cases of 
tuberculosis, with so much clearness as to remove 
all doubt on this subject. I shall, moreover, refer to 
a sign which, I think, has not been touched upon by 
other authors, namely, that this tachycardia is not 
rhythmical. 

The second example that may be taken for 
radioscopy, being essentially functional, and one 
which we have not seen referred to by any other 
author, appears to our observation with as much, or 


Of the Bojsl Medical Academy of Mtdrid, ProfcMor of Tubaco- Wa 

lode In the Provincial Ho»pital of Madrid, Inspector of Public e^en more, constancy than tacbyt^rdia. We relCT 
Health, Ac. to the visibility of the diaphragmatic excursion, both 

My work comprises three parts: first, radioscopy; |n inspiration and expiration, a phenomenon that, m 
secondly, radiography; and thirdly, the technique of i" easily underet^d, ran be apprwiated neither by 
both in relatioi to tiberculosis. In ihe fiistpartl common means of exploration nor by radiography. 
shaU speak of radioscopy in rases of soun^ and Tbis phenomenon, which under normal condition 
tuberculous lungs; in the second of the use of is rhyt&mic^ and symmetned on both sides, m 
radiography in the different stages of the disease, ^herculosis is neither rhythmic^ nor symmetneaL 
whilst in the technical section I shall refer to the We have observed, that m tuberciUosis the dia- 


beet method of obtaining the moat satisfactory re- P>ragm does not rise to the same height on the 
suits in both healthy side, and that when the two 

Radt(MC(^'-Radioscopy as a means of diagnosis Inngs are affected the ascension is sho^r on the 
in tuberculoeia, since its appearance in tie clinical worse aide; m such manner in the rase of atubexcu- 
field, baa been one of the means in which tbe greatest lous patient whose diaphragm on one side has no 
hopes have been placed, so much so that since the ascension, or where it is very short, we deduce from 
foirth congress o£ tuberculosis held in Paris, it has this the correspondingly greater or impermeabihty 
been considered to be the equal in importance both of the lungs. 

percussion, superficial and profound, and of auscul- Radiography .—Accepting also in tbe case of radio- 
tation. grephy of tuberculous lungs, as mucb as we have 


Part'aan as I am of the parasitic doctrine, I will related respecting the several degrees of transpar- 
not treat of the radiographic diagnosis of obvious ency and depth of shadows in the first stages, dark- 
pulmonary tuberculosis, because the analysis of ness in the tract of tbe ganglionic and lymphatic 
Mutum, and the presence in it of the bacillus of vessels, opacity in the congested lung, and very 
Koch, affirm so positively the existence of tuhercu- great transparency of the caverns, we shall only say 
losis, that no physician can cavil with this method, with regard to radiography that it is possible wi^ 
Radioscopy, in the case of open tuberculosis, serves it to discover the data, also of a certain novelty, in 
only as a means of settling the topography of tbe the radiogram of the tuberculous, 
lesions, and although this is very important, it does In our remarks on tachycardia when dealing with 
not deserve to fix our attention, because we prefer radiography, we said that the heart gives^ a sign 
to employ our time studying the true use of the easier oi record by radiography than radioscopy. 
X-rays in the diagnosis of pulmonary tuberculosis Since the adoption of this valuable means of dia- 
in its first period full of doubts, and in which thera- gnosis, the small size of the tuberculous heart has 

, , ^ - 7—r~r~^:iZ~r7. - - . attracted our attention, being a true cardiac byper- 

loiul iSSwiT**” trophy. If this, as we believe, is a positive indW 


ORIGINAL COMUUNICAnONS. 


Tbb MimCAL Pbbsb. 565 


Not. 27, 1901. 


tion of tnberculosia, we shall arriye at a defioitiye 
early diagnosis with greater ease if we find in our 
radioBCopic and radiographic explorations small 
heart, espeoially if the inyestigauons are accom¬ 
panied by taohycai'dia; moreorer, we hare an 
explanation of the relations existing between the 
smallness of the heart, aortic narrowness, and the 
frequency of tubercnlosis in snob sahjects, which 
detei'mine the rule existing among these pheno¬ 


mena. 

Another datum that may be observed is the pecu¬ 
liar shaj-ie of the intercostal spaces. In other works 
relative to the same matter we hare referred to the 
difficulty of performing percussion on tuberculous 
patients. The causes of this difficulty are two: the 
first the extreme narrowness of the intercostal spaces, 
it being impossible to place the fingers between the 
ribs, and the second the conical form of the tuber¬ 
culous thorax. Now before the appearance of the 
Ronton method we could hardly understand these 
difficulties, but since the clinical adoption of this new 
system, the reasons become apparent. In the radio- 
Bcopic imsge is observed a disposition of the ribs 
strongly resembling the peculiar arrangement of 
roof tiles, in such a manner that the inferior rib 
almost touches the anterior face of the inferior rib, 
the intercostal space being so email, particularly 
from the fourth rio downwards, that it is difficult to 
place the finger upon which percussion is made. 
With radioscopy this disposition of the ribs is very 
clear, and functional phenomenon corresponding to 
tfie diminution of the respiratory excursion in the 
tuberculous, impossible of diagnosis in any other 
manner, is very evident. 

The transient nature of the radiosoopio image, 
and the necessity of taking it permanently, em¬ 
phasises the need of closely following with radio¬ 
graphy the images descried in radioscopy. It 
is true that radiography cannot give us any infor¬ 
mation as to function, but in exchange, with this 
second method, anatomical acts remain permanently 
indelible, as a book ever open to study. 

Among the most interesting facts are deformities 
of the TOues characteristic of tuberculous thorax. 
There are in the thorax certain bones, which in their 
bearing on respiration and also from the muscles 
that originate from them, are organs of transcen¬ 
dental importance in the osseous respiratory 
^paratuB. They are the clavicle and the scapula. 
Their position, form and size also produce very 
importwt modification in tuberculosis. In taking 
a radiograph of a tuberculous subject, we see the 
modifications of these bones; the clavicle principa'ly 
presents an augmentation on the inflection of its 
external extremity, and resembling a hyperplasia, 
but without being sufficient to constitute an ^tera- 
tion of the tuberculous epiphysis, takes the shape of 
the head of a mace. Toe scapnlm are higher, and 
the internal and superior vertex is more elevated, 
swinging towards the centre the point and internal 
edge which are raised on account of the peculiar 
disposition of the ribs and spinal column. 

Besides these deformities of the skeleton, radio- 


gw 


also shows us the small size of the heart. 

_ re’ first thing to note is the greater extension of 
the heart toward^s the lines of Traube and Friedreich 


on the right side, this fact showing, in our opinion, 
a compensatory insufficiency of the tricuspid valve, 
and, consequently, ventricular hypertrophy on the 
right side; the radiographic image of the tired heart 
in tuberculous persons thus acquires a strong re¬ 
semblance to the image of the tired heart of the 
emphysematous. The second observation refers to 
the special form of the heart of tuberculous subjects, 
similar to the foot of a Chinese woman, in its left 
ventricular bolder, bearing in mind the growth of 
the ^formed foot of the Chinese. 


Technique of Badiotcopy .—To observe the pheno¬ 
mena of radioscopy under the best conditions of 
visibility complete (urkness is necessary. 

Another trouble that must be got over is the diffi¬ 
culty of applying the fluoroscopic screen, which is 
commonly rigid and mounted in a frame. In this 
form the screen can, in tuberculous cases, only be 
applied upon the sternum or upon toe internal edge 
of the scapula. It is known that in radiographic 
images size and intensity depend upon the distance 
between the part under observation and the surface 
of the screen, so that with rigid screens it is not 
possible to obtain corresponding equality of defini¬ 
tion and intensity over all the surface, and to obtain 
such a result it is necessary to use a flexible screen 
mounted on card-board in such a manner that it can 
be adapted to the convexities of the thorax. One of 
our colleagues, a veiy competent person in these 
matters, Doctor Bedondo, Fleet Surgeon of the 
Spanish Navy, advisee the employment in radioscopy, 
as a radioscopic screen, of the strengthening screen 
whose Image resembles in depth of tone the radio¬ 
graphic image, and gives as fine detail as the ordinary 
fluoroscopic screen. This application of the strength¬ 
ening screen makes the solution of the problem 
easy, because it avoids having to change in the 
laboratory the fluoroscopic material, of which, as we 
have said before, the rigid screen is constructed. 
This modification of the fluoroscopic technique is 
important in relation to the examination of patients 
who must have fasted previously in order to obtain 
with more clearness the semi-lunar space of Traube, 
and to observe with greater ease the phenomenon of 
the dia|>hragmatic excursion previously referred to. 

Radtographical Technique .—Among the incon¬ 
veniences attending the use of strengthening screens 
is the turbid and disseminated nature of the image. 
When, therefore, we are dealing with images that 
require great detail, obtained in subjects capable of 
enduring the exposure—a very shoH time—that s 
required to-day to obtain a radiograph, we prefer to 
work without a strengthening screen in order to 
obtain a clear image, with richness of detail, espe¬ 
cially in pleurisies and patients with but small 
cavities. 

Another interesting subject in radiograpbical 
technique, which also gives clearness to the image, 
and riconesB of details, is the distance between toe 
tube and the plate. Without discussing theory, but 
confining ourselves to the collected facts, we have 
succeed^ in fixing this distance at 50 c.c. from the 
thorax, at which we obtain the maximum ritoness of 
detail 

The last matter that will occupy us in this address 
refers to the development of radiographic plates. 
We have tried nearly all modern and old-fashioned 
developers, and we have deduced the necessity of 
never developing in radiography with ready-made 
liquids in anv uniform propotoion, and this applies 
as much to the developing as to the fixing agents; 
we use the diamidophenol in 12 per 100, with sul¬ 
phate of soda (crystallised) in 6 per 100 as a de¬ 
veloper. and Enckel’s (Swiss) hypo-sulphite in 25 per 
100. With these products we make our baths as 
required, that is to say, for two or three radiographs 
only. 

In view of the persistent lack of medical officers 
for South Africa it is anticipated that the War 
Office will shortly issue a further appeal for the 
assistance of civil surgeons. More generous terms 
will probably have to be offered, however, before 
any considerable number of qualified men will deem 
it worth their while to confront the perils and hard¬ 
ships of the campaign. 



666 Thi Mbdical Pbbbb. ORIGINAL COMMUNICATIONS. Nov. 27, 1901 


SOME OBSCURE INJURIES 

FOLLOWIKO THB 

TOXIC USE OF ALCOHOL. 

Bj T. D. CROTHERS, M.D., 

Sopcriatendeut Walont Lodge Hospita], Hartford, 
Conoecticnt. 

Alcoholic intoxication is the first cause of manv 
equally serious diseases and neurO'pBychoseB, although 
this fact is latgely unknown and unrecognised bvtlbe 
profession. The conditions which are traceable to 
the first toxic action of alcohol may be diiided into 
two classes: 1. The direct injuries which follow from 
alcoholic poisoning. 2. The psychoses following 
this state manifested in the alcouolic craze and in¬ 
ebriety which follows. 

Persons who become neurotics in the best condi¬ 
tions and surroundings of life and then unexpectedly 
drink or take drugs to great excess are often found 
to have a history of some early profound intoxica¬ 
tion with slow recovery. These instances are un¬ 
recognised, but can be traced in many cases; and 
the connection between the first intoxication and the 
later stages can be established without much doubt 

A leamng business man became intoxicated at a 
wedding for the first time in his life, never having 
used sprits before. He was sick for a week, then 
recovered. Prom this time he was conscious of in¬ 
creased nervousness, loss of power of attention, was 
fearful, and worried about matters which previously 
gave him no concern. He described his symptoms 
by the phrase that “he had lost his nerve’'and 
could not control himself as in former times. He 
complied of weakness and a disinclination to 
either think or act, and said it all dated from the 
intoxication at the wedding. This increased until a 
year later hemiplegia appeared. Two years after¬ 
ward he died of some acute disease. The interval 
between the first toxic poisoning was marked by dis¬ 
tinct symptoms of Mth mental and physical 
changes, and fatal breakdown which have not 
received any study so far. 

Many persons become intoxicated at long, irregular 
interv^s, depending on some unknown causes ; and 
while there are no pronounced symptoms of neuro- 
psychical disease wnich attract attention, there are 
often S 5 mptoms of debility and weakness which are 
overlooked. Such persons suffer from organic and 
functional disorders and acute diseases that are 
ascribed to other causes. Neuritis and obscure 
forms of so-called rheumatisms are common. An 
instance occurred recently of a physician who was 
seized with what was called anattacsof rheumatism, 
and after a few hours of acute pain died. It ap^teared 
that for the past five years he uad been intoxicated 
at least six times, and on each occasion suffered 
from severe pains in the legs and severe heart de- 

S ression. The last intoxication was four days before 
eatb, and be was out as usual attending to business 
the day after drinking. No doubt there was some 
connexion between the alcoholic poisoning and the 
death which was not recoraised. 

It may be stated as a met that every intoxication 
from alcohol is both a physical and psychical con¬ 
cussion to the brain centres and the beginning of both 
organic and functional changes which may go on 
rapidly or slowly. Frequent intoxications develop 
im^cility and masked dementise. This is seen from 
any careful study of chronic inebriates. The resist¬ 
ing power of the brain to continued intoxication varies 
widely, yet it is evident that after certain changfes 
have taken place the action of spirits ma^ seem less 
acute and prominent, but the degeneration is con¬ 
tinuous. Like repeated blows on the head, the effects 
are cumulative, and finally merge into well-marked 
organic neui*oeis. 


The phenomena of intoxication from alcohol are 
familiar, and yet their physiological and pathological 
significance is largely unknown. An outline view 
will be of interest The first glass of spirits pro¬ 
duces a sudden flushing or blanching of the vaao- 
motor circulation of the blood to ine face. The 
facial muscles are first agitated, then become fixed 
and have a stolid, palsied appearance. Or they maj 
twitch and quiver for a time, then settle down into a 
stolid, fixed state. The lips seem more firmly com¬ 
pressed, and when used rapidly have a spasmodic 
movement. The eye appeals bright and glittering; 
then becomes suffused with tears, and rolls about in 
an unusual way, oi settles into a fixed, palsied look. 
The voice is altered. Words come hurriedly or 
slowly, or very smoothly glide into each other, hotb 
with or without an effoH. Respiration is quickened, 
and a sense of shivering and agitation pervades the 
body. Brain activity is suddenly increased, rapidly 
merging into confusional states, with diflBculty of 
utterance. When more spirits are taken all these 
symptoms deepen. The ^t shock from a sudden 
interruption of the normal rhythmical flow of nerve 
ener^ passes away and a delusional period follows. 
This 18 anesthesia, with buoyancy, comfort and rest. 
The first action is that of shock and profoimd altera¬ 
tion of the functional activities of the brain. Later 
the special senses become impaired. Sight is 
diminished. Hearing is dnlled, Feeling, taste and 
smell are lowered. There is a fall in temperature. 
Muscular power is enfeebled. Memory is weakened. 
Rapidity of thought and power of concentration, 
with conception and perception and judgment, are 
all more or lees paralys^. Stupor and uncon¬ 
sciousness follow. Before this later stage a period 
of exaltation and delusional confidence, inability to 
think and act more wisely and clearly is nearly 
always felt. There is in ^ forms of intoxication 
first a shock and concussion to the brain and nerve 
centres. Secondly, a period of aneesthesia of the 
higher and sense centres, with delusional exaltations 
and boldness of mind. Thirdly, these all finally 
merge into stupor, palsy, and unconsciousness. The 
80 -umled stimmationis irritation and paralysis. 

Psychological measurements of the brain and 
sense functions as well as the organic functions at 
their earlier period show palsy. Yet the theory of 
stimulation is accepted as a true explanation. Each 
intoxication is a profound sudden paralysis of the 
brain and nerve function. 

A concussion from chemical agents acting in some 
unknown way, raising the heart's action then lower¬ 
ing it, acts with especial severity on the higher brain 
centres. 

The feeling of comfort, exaltation and superior 
vigour are delusions. The theory that the action 
of spirits will give new power and force in an 
emergency is an error. It brings recklessness and 
loss of judgment with failure of the finer conceptions 
of the relations of things, but nothing more. 

When alcohol is used to the state of intoxication it 
is always followed by symptoms which show in some 
degree the injury which has been done. The com¬ 
mon sequelae of intoxication are headache and exagge¬ 
rated sensations of head and stomach, with extreme 
debility ; these are significant signs of injury. The 
acuteness of these symptoms calls for more spirits, 
and finally, the suffering subsides because the higher 
senss centres are blnnt^ and anessthetised and fail 
to register the pain impressions. 

From our present knowledge of the action of 
alcohol on the brain and nervous centres, we are sure 
that recovery from its toxic effects is slow, and in 
some cases almost impossible. The damage may be 
covered up and not m clear except from a minute 
study of toe symptoms, and yet it exists. 



Nov. 27, 1901. _original communications. I’h. Midical Pi«8B. 567 


Intoxication soon after or near the age of puberty 
baa been the atarting-point of very aerioua neuroaea 
which continued Tears after, often breaking out in 
aomenenroaia or form of inebriety. 

Profound intoxication at from forty-five to fifty 
is very aerioua in the entailmenta which not unfre- 
quently follow from it. 

Some of the facta which I wiah to makeprominent 
are these:— 

1. Intoxication from alcohol to the extent of coma, 
with profound relaxation of all the functional activi* 
ties of the body, is often a aerioua injury to the 
brain and nerve centres, and is followed by neuroses 
and organic change. 

2. The significance of alcoholic intoxication in the 
study of obscure diseases cannot be overstated. It 
may be both an active and an exciting cause, and 
should alwa; s be considered in neuro-psychopathies 
or otherdisorders that follow. 

3. Intoxication at puberty and in middle life is 
often the starting-point of a circle of disease which is 
usually ascribed to other causes. 

4. Intoxication always predisposes to the diseases 
of inebrietT from alcohol or opium, which may come 
on suddenly at any time in after life. 

5. Poisoning from alcohol is far more serious than 
suDposed, both in its effects and the neuroses which 
follow. 


^bbreas (a) 

Dslivxbbd by Sib CHEISTOPHEE NIXON, M.D., 
President of tbe B 07 SI Coll^ of PbysicuuiB, Xrelsnd. 

Public Hxalth. 

Aftxb some introductory remarks, the speaker said 
that when on a previous similar occasion he bad 
delivered an address, he referred briefly to the important 
questicD of public health with a view of pointing out 
the opportunities which this branch of medicine afforded 
to those who devoted themselves to it and mastered the 
subjects required for tbe diploma in public health. Be 
then took a somewhat sanguine view of the changes that 
were likely to be effected in Ireland in the various 
urban and rural districts in the appointment of medical 
officers of health, who would be obUged to devote tbem- 
eelvee, as in England, exclusively to their special duties, 
with tbe result that the sanitary conditions of the poor 
should be improved, the spread of disease lessened, the 
death-rate diminished, and the burthens on tbe tax¬ 
payer reduced. It seemed as if we were on the 
point of taking a lesson from the sister country, and 
that tbe administration of public health laws in Ireland 
were to be assimilated to what obtains in the urban and 
rural distriots of England. The Local Government 
Board issued an order requiring the appointment of 
medical officers of health for a union, or combination of 
unions in Ireland, bnt, so far as be could learn, tbe order 
has been a dead letter, and the condition of 
things continne as bad as they have been. Nor 
can it be said that the attempt at public 
health reform in the provinces has been »ui- 
passed by what has been done in reference to our own 
city. On February 13tb, 1900, a committee appointed 
by the Local Government Board to inquire into tbe 
pnblio health of the city of Dublin, held its first meeting. 
After taking a considerable amount of valuable evidence, 
tbe oommiitee, with commendable promptitude, pre¬ 
sented its report. Amongmany important recommenda¬ 
tions of tbe committee were—that the duties of Medical 
Officer of Health should no longer be discharged by the 
sixteen Dispensary Medical Officers, and that in fntore 
those duties should be discbai^ed by an Assistant 
Medical Officer of Health who should receive an adequate 
salfuy and give his whole time to the duties of bis office. 
A second recommendation of most vital importance to 
the community of this large city was that a hospital 
should be provided for the treatment of small pox at a 
distance from populous neighbourhoods. Up to tbe 

(a) Dslirered st the Diatribation Of Prices at the Cstholio Uoi- 
versitr School of Mediciae, l>ubliii, on Nov. 23rd. 


present neither of these regulations have been acted 
upon, nor is there any indicatiou that he knew of to show 
that they will, in tbe near future, be carried into effect. 
At any time cases of such diseases as small-pox or plague 
might ^d their way to the city, and no provision what¬ 
ever exists for their isolation. It reflects not a little credit 
upon the Superintendent Medical Officer of Health that, 
considering the many avenues which exist in a large city 
like Dublin for the entrance of cases of infectious diseases, 
neither small-pox nor plague has appeared in our midst. 
It is scarcely possible, in this connection, to avoid 
urging upon those responsible for the health of 
Dublin to take steps to put the city on a level with what 
has been done in reference to tbe recognition of in¬ 
fectious diseases in the chief cities of England and 
Scotland. Take, for example, tbe arrangements ex¬ 
isting in Manchester, Liverpool, Edinburgh, aod Glas¬ 
gow. Id all, a special laboratc^ is provided, and the 
services of a municipal bacteriologist are secured, whose 
work embraces the examination of foods, water, effluents 
of all kinds, outbreaks of typhoid fever,scarlatina, diph¬ 
theria, cholera, plague, do. Examinations are made 
gratuitously for medicsd practitioners who send to the 
laboratory specimens for analysis in oases of suspected 
diphtheria, enteric fever, tubercnlosie, milk for tubercle, 
Ac.; and facilities are afforded by which the specimens 
are examined and the diagnostic results furnished with 
the utmost expedition. It is, surely, not too much to 
expect that Dublin should not lag behind when such 
progress is being made in England and Scotland. The 
present time is singubu-ly opportune for a move in this 
duration. Last year, in a short address which he 
delivered on tbe relation of veterinary soienoe to human 
medicine, be ventured to suggest that we shonld follow 
j the example set to ns by establishing in Dublin an in¬ 
stitute similar to the Jenner Institute in London, which 
received from Lord Iveagb the munificent donation of a 
quarter of a million. Sir George Duffy took up the 
matter most wazmly, and he and a representative Com¬ 
mittee have formulated a scheme for the foundation and 
organisation of an Institute of Beaearob and Pnblio 
Health, which upon its merits will, he {Sir Christopher) 
tensted, elicit generous and sympathetic support. There 
is one point in connection wit£ the proposed Institute 
which he would like to emphasise. Considerable sums of 
mon are often wasted, especially in departments of the 
State, by no efforts being made to oonotntrate works of 
a kindred natnre being carried out in a single institn- 
tion. The result is often multiplioi'y in tbe cost of 
management, of office expenses, ofdnpliution of officials, 
Ac. This should be carefully guarded against. To 
mention an instance in point. A clause was introduced 
into the English Lunacy Acts Amendment Bill, extend¬ 
ing the power of two or more local authorities, in pro¬ 
viding aod maintaining a district asylum, so as to 
include a power to ^ree to naite in providings 
and maintaining a laboratory for pathological re¬ 
search in connection with lunacy. This year a Bill 
was passed assimilating the provisions of tbe Irish 
Lunacy Acts in this respect to what obtains in England, 
BO that the Asylum Boaids throngbouttbe ooontry have 
the power of establii-hing a laboratory for research in 
connection with mental and hervooe diseases. It is to 
be hoped th^t this laboratory will form a part of the 
National Institute, so that every resource available may 
be employed to render it in all re-pects worthy of ite 
object and creditable to the country. 

THI COLLBOBS AND THB OBNBBAL MBDICAL COUNCIL. 

There is one other matter which he might bring 
under notice. It is in reference to tbe contention 
between tbe two Eoyal Colleges in England and the 
General Medical Cooncil as to the subjects of the m^i- 
cal curriculum. The Eoyal Colleges, as yon may be 
aware, recognise iostruction in chemistry, physics, and 
biology given in certain intermediate schools as in all 
respt'Ots equivalent to tbe courses given in medical 
schools, though in the latter requirements as to number 
of lectures, certificates, Ao., must be complied 
with. The Eoyal Colleges contend that they fnlfil 
the reqairements of the General Medical Connoil 
in making it necessary that five years should elapse 
from the time of registration as a medi^ student 


D 



568 Ths Mbdicai. Prxss. 


CLINICA.L RECORDS. 


until the candidate prefente himself for bis final 
examination, so that there is on their part no whittling 
down of the time limit recommended by the Council. 
On the other hand, it is contended that the acceptance 
of instruction in what have been regarded as subjects 
of the Medical Curriculum, from what are called Oram- 
mar Schools, really reduces the Medical School coarse 
to four years, and that thus the regulation practically 
means a return to the four years’ curriculum. This con¬ 
tention, he confessed, he had been unable to follow. The 
teaching of physics, or of botuiy and zoology, cannot be 
sufficiently specialised, no matter where taught, to make 
them medical subjects. These subjects, as well as 
chemistry, are taught iu the Univereities as parts of 
their Arte and Science Departments, so no case can be 
made as to regarding them as medical subjects. If this 
be conceded the issue is narrowed to this point:—Is 
there any advdntage to be gained by requiring special 
courses of lectures to be given in physics, chemistry, 
and biology in Medical Schools alone? The answer 
to this question may be taken as only inTolviug the 
case of students presenting themselves for the examina¬ 
tions of the licensing bodies, as he assumed the Univer- 
eities will always require the higher standard of educa¬ 
tion and perhaps currioulam. But, taking the case of 
students who are preparing for the examinations ef the 
licensing bodies, is the regulation requiring special 
courses in medical schools in physios, elementary 
chemistry, botany, and zoology, a necessary and 
useful cne ? No one is prepared to concede more than 
he did the necessity for medical studente having a high 
and broad degree of general culture before commencing 


Nov. 27, 1901 . 

of technical knowledge which will enable him to become 
a safe and skilful practitioner. 


dlinicul JfclctorbB. 


CASE OF ECTOPIC GESTATION WITH ESCAPE 
OF GESTATION SAC INTO THE PERITONEAL 
CAVITY, (o). 

Under the care of Dr. MACNXtroHTON-JoNxs. 

Tub patient, set. 33, had been married for upwards of 
four years; there had been no previous conception. A 
year previously she bad been treated for an erosion of 
the cervix. The last menstrual period occurred eleven 
weeks before the onset of her illness, whioh was on 
July lOth, when she was seised with acute pain in the 
abdomen, and sickness, the conseqaenoee, as she 
thonght, of a chill taken the same day. The pain was 
relieved by rest and sedatives, recurring, however, 
periodically. As ectopic gestation was feared, she wsg 
kept in bed and under obeervation. On the Idth then 
was a recurrence of the symptoms, followed by greater 
prostration, bat no uterine bsemorrh^e. Again she 
appeared to get better, hut on the 24th violent aMominal 
name set in, the pulse became very rapid, smd the f soe 
blanched; I saw her for the first time, in this condition, 
late the same evening. The abdomen was tumid and 
dull on perooBsion, the uterus fixed, and the pouch of 
Douglas occupied by a resistant swelling. Early the 
following morning 1 operated. She had rallied some¬ 
what from her condition of the previous evening, but 



ILLOSTBATINO DB UACNAUOHTON-JONBS’ CASB.— BHOWINO SAC OPBN—THB 8UBFACB WITH 

ADHESIONS IB NOT BBBN. 


the study of medicine. He must, however, frankly confess 
that, whatever one may think of the course taken by the 
Royal Colleges in connection with the General Medical 
Conncil, as that course simply was dictated by the in¬ 
flexible determination of the college not to accede to the 
Council’s requirement of their approval of the institu¬ 
tions recognised by the ooll^^, he believed the latter 
are in the right. The subjects of the first year are really 
not subjects of medical education. They can, he believed, 
be qoite efficiently taught in schools properly equipped 
and recognised for the purpose of tesohing after being 
duly inspected. The student having passed a st^oiently 
sealing examination in thoie subjects enters upon his 
course of medical studies perfectly free to devote him¬ 
self for four years to the subjects laid do wn in the curri- 
cnlum. Two of these years should be devoted mainly to 
the scientific branches of medicine, whilst the remaining 
two years should be exclusively spent in those branobM 


still the pulse was weak and fluttering, and the lips quits 
blanched. 

On opening the abdomen I found the cavity filled with 
blood. This, with masses of soft oo^ula, was removed. 
I quickly came on the gestation sac about the level of 
the umbilicus, with the placenti, the tomw being 
adherent to the bowel. It bled freely. The hsmor- 
rba^ was controlled digitally, and I still found blood 
welling up in quantity from the pelvis. I soon fonnd 
that the bleeding was proceeding from a large rent in 
the left broad ligament, running close up to the uterus. 
This was quickly stopped by the application of two long 
Doyen’s ohunps ronning at either side of the rent. Ths 
gestation mass was then removed, the adhesions being 
separated, and any bleeding points ligatured, liigatures 
were then passed at either side of the clamps with 

(a) Notes of the case read and ipeclmeos shows at the meeting of 
the Nritiah Griueoolosical Aasodation, November I4th, 1901. 




Nov. 27. 1901. 


TRANSACTIONS OF SOCIETIES. Th. Mimcal 669 


DescfaaiDp’a needles, and the broad ligament secured' 
Up to this 1 had not seen the fcetns, and failed to find it 
nntil I parsed my hand np under the diaphragm, where 
I found it in the left hypochondrinm. There was no 
farther bleeding and the abdomen was closed. Saline 
enbmammary injections had been administered daring 
the latter part of the operation, and were continued 
throughont the day, with rectal stimulating enemata. 
She rallied for some hours after the operation, but 
never recovered from the oollapee, surviving only nine¬ 
teen hours. Her surroundings were not the most pro¬ 
pitious for recovery, though her medical attendant left 
nothing undone to secure it. 


^raitBarlionje of gfituties. 


CLINICAL SOCIETY OF LONDON. 
Mxitinq hsld Friday, Novimbsb 22nd, 1901. 

"Mb. Howard Marsh, F.B.C.S., President, in the 
Chair. 

Mr. T. H. Mobsx on 

TWO CA8S8 OF INTRACRANIAL SKCTION OF TH* 8BC0ND 
AND THIRD DIVISIONS OF TH* TBIOXMINAL NIBVB 
FOB 8SVBRB NXUBALOIA. 

Reference was made to the articles published by Mr. 
Victor Horsley in 1891, those of Mr. Bose in 1892, also 
to those of Hartley, Krause, Jonathan Hutchinson, jun., 
and Lynn Thomas. Two cases were related in which 
the Hartley-Krause operation was performed, the bone 
being removed with mallet and gouge, and gouge catting 
forceps. After section of the second and third divisions 
of the fifth nerve the foramina ovale and rotundum 
were blocked with Horsley’s wax for the purpose of pre¬ 
venting reunion of the divided nerves. In both cases 
cure was obtained, the first having been done more than 
two years ago. 

Mr. J. Hutchinson, Jonb., showed four cases in which 
he had performed this operation, the last only six weeks 
since, so far with complete relief. In another case, 
operated four years ago, the patient had previously 
undergone several operations comprising division of 
nerves, Ac., and, lastly, an operation in which Meckel's 
ganglion was removed. Case 3 had suffered for 
many years, and in this case the Gasserian ganglion was 
removed by Krause’s method with success. The last 
case was one in which the neuralgia had spread to 
the occipital region. Krause’s operation was done and 
the ganglion removed, together with the two lower 
branches of the fifth nerve behind the ganglion. There¬ 
upon the occipital pain also subsided, showing that it 
was refiected pain. In none of these cases bad there 
been a return of the pain. He preferred the temporal 
operation in preference to operations through the 
pterygoid region. The advantages of removing only 
the lowerportion of the ganglion were (I) the cavernous 
sinus was not interfered with ; (2) there was no danger 
of injuring the ocnlo-motor nerves; (3) there was no 
need to tie the middle meningeal artery, and (4) there 
was no antesthesia of the cornea, although with regard to 
this point Horsley had stated that any damage to the 
cornea could be avoided by careful attention to 
antisepsis and sewing np the eyelids immediately after 
the operation. He, however, quoted a otse in which be 
had divided the ophthalmic branch of the fifth nerve, 
followed by comeal aneethesia. Some months later 
ulceration set in and eventually the eye had to be 
removed; (6^ neuralgia as a rule does not occur in 
the opbt^lmio branch of the fifth nerve. He did not 
think that it was necessary to make a large flap. In 
only one case did he have to tie the external carotid on 
account of fcsemorrhage. With regard to the position 
of the patient he much preferi^ that of sitting 
erect in a chair, whatever the uisesthetist might 
say. He pointed out that the ganglion could not 
be effectually removed by means of the curette, 
but should be cleanly cut out. Estimates of the 
mortality from the operation varied from 20 to 60 per 
cent., but in this country, at any rate, he did not 


believe that the mortality exceeded 10 per cent. He 
himself had done five cases without a death. He con¬ 
demned very strongly Doyen’s method of operating, 
which entailed an unnecessarily extensive operation. He 
rotested against the modifications of the operation 
eing tacked on to the names of various surgeons, which 
produc^ a feeling of bewilderment. He advised that 
the major operation should not be postponed too long; 
in fwb, whenever the pain was above the superior 
maxillary branch, only the major operation could be 
trusted to afford permanent relief. 

Mr. Ctjthbebt Wallacr mentioned a case in which 
he was much embarrassed by the bleeding from a wound 
of the cavernous sinus. With regard to the choice of 
operation he observed that this must be decided by re¬ 
sults. He had heard it said that the temporal operation 
had already fallen into disrepute in America. 

Mr.^ Ballanci said he .h^ performed the operation 
ten times. In two of the cases he had removed the 
whole of the nnglion, palling out the nerve beyond the 
ganglion on the proximal side. He did not think there 
was any difficulty in isolating the ganglion, the risk to 
the patient lying in the length of time it took, 
and the hsmorrhage. The beemorrhage, however, 
woitid never alarm them if they were prepmed 
for it. The beet preparation for the operation was care¬ 
ful study on the dead body. The more they studied 
the details the easier it became. No age was too ad¬ 
vanced for this operation; two of bis patients were 
sixty-four and seventy-one. He advocated performing 
the operation in several stages, thus avoiding shook. 
He did not believe that relief was likely to follow par¬ 
tial operations. He himself had removed a quarter of 
an in^ of the first division in the wall of the cavernous 
sinus. He bad never seen any oerebro-spinal fluid es¬ 
cape. By gentle traction one could get half an inch of 
the main nerve trunk from behind the ganglion. All 
operations from the pterygoid region ought to be 
bMisbed from their repertoire. He anticipated that 
the time would come when they would cease to raise the 
dura mater from the middle fossa to get at the ganglion, 
and he hoped that it would become possible to divide 
the sensory part of the nerve without touching the 
motor part. In reply to a question by Mr. Lucas, he 
said that be had ceued to replace the piece of ^ne 
removed, and Mr. Hutchinson replied that he ^d not 
replace it 

Mr. Warrington Haward on a case of 

FRAGILITAB OfSIUX. 

A boy, st. 10, was admitted into St. George’s Hospital, 
under Mr. Haward’s care, in October, 1889, on account 
of extreme deformity of the legs. He was a bright, in¬ 
telligent, and healtby-looking boy, with no signs of 
rickets. He sat upright, and his spine was straight. 
The bones of the arms and forearms were then bent 
and were curved outwards to a varying extent. They 
showed sins of many old fraotures. The hands were 
fairly devmoped and were need actively. The lower limbs 
were less developed than the upper. The bones were thin, 
and with sharp margins. The femora were both curved 
forwards andoutwards. [Thetibise both showed an extreme 
degree of forward curvature, so that the lower half was 
at a right angle to the upper half of the leg. There was 
evidence of numerous past fractures. The muscles of the 
legs were much wasted, and the skin was adherent over 
the most prominent pait of the tibia. Photographs of 
the boy and skiagraphs of the bones were shown. The 
boy’s health appear^ in most respects to be good, with 
the exception of a remarkable condition of the urine. 
The urine when passed appeared nattual, but on standing 
deposited a large amouct of calcium salts, which formed 
a mortar-like sediment. An analysis of the utine 
kindly made by Mr. J. A. Gardner showed 
it to contain a Ivery larro excess sf lime salts. 
The history of the case told that tho boy was of healthy 
parentage, and that of eight children none but this boy 
showed any signs of disease. The only notable point in 
the family hi^ory was that before the birth of this 
child (the seventh) the mother had been weakened by 
rapidly sucoeeding pregnancies. When bom this chi’d 
was found to have fractures of both humeri and two 

C 


570 Thb Mxdical Fbibs. 


TRANSACTIONS OF SOCIETIES. 


Nov. 27, 1901 


ribB, and subsequently twenty-three fractures of long- 
bonee were recorded, all from slight cauees. He had 
never walked alone. He bad lived in a healthy part of 
the country, and had been well fed and cared for. 
He was given, after admission to the hospital, cod-liver 
oil, and a highly nutritious diet, and attempts were 
made to straighten the limbs by extension, but without 
snocees. In January, 1900, be fractured the left femur 
when turning in bed, but the bone united well under 
ordinary treatment. In March, an analyeis of the 
urine by Mr. Gardner having shown that the excessive 
excretion of lime salts had ceased, Mr. Haward 
straightened tbe right leg by the excision of a wedge* 
shaped piece of the tibia, the ends of tbe bone being 
wired together. Tbe bones united soundly. The left 
leg was subsequently operated upon with similar 
result, and the boy was sent home with leather splints 
on. He is now learning to walk. Beference was made 
to a similar case recorded by Mr. Clinton Dent, and the 
paper concluded with some remarks upon the connection 
of tbe bone changes with the condition of the urine. 

Hr. Clinton Dbnt showed photographs and skiagrams 
of a case of ^e kind which he bad brought before the 
Medical Society some years since, the subject being a 
man, set. 29. He mentioned that the fractures were pre¬ 
ceded by pain in the spot, and the throwing out of a 
plastic callus. 

Dr. PoTNTON referred to a case in a breast-fed 
infant whom he had seen at the Hospital for Sick 
Children in which fracture was always preceded by 
tenderness and pain in the shaft, and not in tbe 
epiphysis. There was no history of syphilis in this 
case. 

Mr. Hutcbinbon, punr, mentioned a case of the kind 
in a child, the subject of inherited syphilis, but he 
was not prepared to susert that this was more than a 
coinddenoe. 

Mr. Lucas insisted on the importance of clearing op 
the infinence of inherited synhilis in these cases. 

Mr. Hawabd, in reply, said he could offer no explana¬ 
tion of the cause of this curious form of malnntdtion, 
but it was certainly not syphilis. In hie case there 
was never any tenderness of tbe bones. 

ROYAL ACADEMY OF MEDICINE IN IRELAND. 

8bctiok op Mxdicinb. 

Held in the Royal College of Physicians, Fbidat 
Evbnino, Nov. 16th, 1901. 

Owing to the unavoidable absence of Sir Christopher 
Nixon, M.D, President, the chair was taken by Dr. 
Jahks Little. 

Dr. Finny read the notes of a case of 
D1BKAT1T18 0ANGBBN08A, 

which occurred in a child, set. 2i, who died in Sir Patrick 
Dun’s Hospital, five days after admission, iu May, 1900. 
The child was extremely prostrate on admission, his back, 
thighs, penis, hands, face, scalp, ears, forehead and eye¬ 
lids were the seat ef circular punched out sores, varying 
in sixe from that of a threepenny bit to that of half-a- 
crown, more or less covered with a yellowish-green 
pultaceous scab. After poulticing with boracio acid the 
ulcers were clean, smooth, with sharply defined edges of 
a deep, raw meat colour. There were no bulls visible 
anywhere, nor any sign of varicella; and vaccination 
had been performed two years and a-balf before. There 
was no history of syphilis. On inquiring he found the 
child had not been in contact with any contagions 
disease. The ^gistrar-Geneial stated that there 
was no chicken-pox in Dublin, or in Ireland (except 
in a distant part of Donegal) at that time. 
The post-mortem examination revealed caseating tuber¬ 
culosis of tbe tbymoe gland, lungs, and bronchial and 
mesenteric glands. Before admission to hospital the 
child had been seen three times by Dr. W. Beatty, who 
noted it as a case of impetigo, which rapidly was con 
verted into gangrenous sores. Tbe eyes were in a state 
of pfm-ophthalmitis. Dr. Finny considered it a typical 
extreme example of the rare disease originally described 
by Dr. Whitley Stokes, in Ireland, in 1807, as eating 
bivea,” “ white blisters,” or ” pemphigus gangrenosus,” 


and snbeequsutly graphically depicted by Jonathan 
Hutchinson, in 1879 and 1882, under the name of 
“varicella or varsccinia gangrenosa,” a designation 
adopted by most writers since then. Dr. Finny, how¬ 
ever, preferred the more comprehensive title “der¬ 
matitis gangrenosa'’ given by Dr. Croker. Die- 
onssing the aetiology, be considered the disease to 
be due to some special microbic infection attacking 
children suffering from some pustular disease. One 
of the bands affected by the disease and photographs 
of the child were exhibited. 

Dr. 'Wallace Beatty never met with an identical 
case to the one described, though he met with a curious 
form of impetigo, in which the pustules were, though 
discrete, close. They were unhe^thy looking, exnded 
a glairy secretion, and had a dark base. In a case of 
injury to the hand a rash resembling impetigo appeared, 
and was followed by ulceration. 

Dr. Chables Moobe, some forty years ago h^ » 
number of such cases as those described by Dr. Finny 
under bis care in Cork Street fever hospitaL From the 
appearance of the gangrenous sore they were called 
“ burnt holes.” 

Dr. Waltbb Shite looks upon gangrene as a much 
less common occurrence than reasonably might be ex¬ 
pected. Gangrene occurs under so many conditions; 
m<w>nLTiiftAl^ t^rmal, and so forth. Mere aurterial con¬ 
striction is not sufficient to account for gangrene 
following tbe use of ergot. It is due to poisons from 
within and poisons from without falling on suitable soil, 
hence tbe occurrence of gangrene in diabetic patients, 
boepital gangrene, acute gangrene in nervous ciseases, 
acute bet^ore of Charcot in hemiplegia, more common 
in left side hemiplegia, in syringomyelia. The setiology 
of neorosis is as yet imperfectly understood. 

Dr. L. Symbs, whilst acting as registrar to SirThomas 
Barlow, saw two cases similar to that described; they 
occurred in girls between six and seven years of age. 
Tbe ulcers gave out a thick, viscid, glycerine-like dis- 
cha^. One case that died was tnberoi^one. He, io 
up the literature of the disease, found that it was looking 
describ^ by an Irishman whose name he could not 
remember, and was called “ burnt boles.” 

Dr. McWebkey found some two years ^o wh^ 
making an autopsy on a patient who died of ^phoid 
some of the gangrenous holes they had heard of, there 
were some half-dozen of the “ bnmt-faoles.” Be exa¬ 
mined them, sectioned them, and made some cultivi^ 
tions, of which on a future occasion be hoped to detail 
the results to the Academy On the surface of the skin 
be found numerous cocci, but these cocci had nothing 
to do with the ulcer, which was due to a minute bacillua 
in the deeper tissue, which by oultivatiou nve asimi^ 
bacillus like to that of cancmm oris. He did not notice 
any bulloe on the subject he examined. 

Sir John W. Moobe said the case he embodied in bis 
work on continued fevers was not due to varicella gan- 
firrenosa, its cetiology was to be found in bacterial throm¬ 
bosis. 

Dr. Buboess, wbo had known the patient of the late 
Sir 'W. Stokes, said there were two gluteal ulcers of large 
size, like to the cavity of a carbuncle. 

Dr Knott drew attention to the frequency of "burnt 
boles ” during tbe famine years. He looked upon 
disease as closely related to " noma.” The inflammation 
of tbe eyes in Dr. Finny’e case he considered to be the 
outcome of nutritional changes 

Dr. James Little thought that all the cases to which 
reference had been made could not be included under 
tbe same class as that of Dr. Finny’s patient. Tbe 
case was an extremely rare one, and he was sure they 
^1 felt grateful to Dr. Finny for bringing it before 
them. Some of them told of recoveries, but he thought 
it was too much to expect recovery in such a tuberouloua 
patient, and Dr. Finny replied. 

Dr. Connolly Nobhan read a rqwrt of a esse of 

PABANOIA HALLUCINATOBIA. 

The case was of interest as presenting a form of 
tactile ballnciuation not heretofore deeorib^, and also 
unilateral auditory hallucinations (both common and 
verbal) beard in ^e right ear./- The patient suffered 



Not. 27, 1901. 


TBANSAOTIONS 

from absolute deafness of the right ear, doe either to 
auditory nerre or labyrinthine disease. Halluoinations 
of the other senses were bilateral The tactile hallaci- 
nation consisted in a sensation of the finger tips 
as if they were dry and polished. This sensation Dr. 
Norman compared to that which is produced by the in¬ 
gestion of belladonna. In mentioning that this patient 
exhibited, together with other true gustatory hallucina¬ 
tions, an hallucination of the flarour of alum, the author 
claiired that to the four sensations commonly recognised 
as the only true gustatory feelings, namely, sweet, sour, 
bitter, and salt, there should be added the sense of 
aetringency (su(^ as occurred in the form of hallucina¬ 
tion in this case), and probably also the sense of pun¬ 
gency. Incidentally Dr. Norman also <daimed a special 
position for the sensations connected with the respiratory 
functions, a group of sensations often concerned in 
hallucinatory states, as occurred in the case reported 
upon. 

Dr. Dawson desired to hear from Dr. Norman if the 
hearing was lost before or after the auditory hallucina¬ 
tions commenced. The delnsire interpretations of the 
senses was one of the most frequent phenomenon of 
insanity. One of his patients, hearing a railway whistle, 
answer^ as if the sound were a voice. Dr. Norman’s 
case was peculiarly interesting from the number of 
special senses implicated and the fact that the auditory 
hallucinations were unilateral. In a case of early 
general paralysis in a patient he examined the delusiTe 
interpretation of the visual sense was well marked. At 
first as the cornea became clouded the patient saw moss, 
finally devils, monkeys, and ultimately declared that a 
hospital bad been built at the back of his eyes to blind 
him. 

Dr. Waltxb Smith would like to know if auditory 
hallucinations were not the most commonly met with. 
Special sense hallucinations following the toxic action 
of certain drugs are deeply interesting in this connec¬ 
tion : the visual haUnoinatious of acute alcoholism, and 
the auditory ballucinations that occur so early in cocaine 
poisoning are examples known to all. 

Dr. Bkwlxy, referring to auditory hallnoinations, told 
of a deaf patient who heard voices upbraiding him for 
crimes committed in youth. Ignorance is a fruitful 
source of misinterprebation. Children afraid of dark¬ 
ness. The insane halluoiaations often arise from 
attempts to interpret sounds that the sane ignore. 

Dr. Norman replied, and the Section then adjourned. 


BRITISH GTN.5]CODOGICAL SOCIETY. 
Mxktinq h£ld Nov. 14ts, 1901. 


The President, J. A. Mansell Moullin, M.A., M.B.C.P., 
in the Chair. 

Exhibition of Spxcimbns. 

Du. Fbxdibick Edob (Wolverhampton) showed the 
following specimens:— 

I. Ruptured Tubal Oe$tafion .—The interesting fea¬ 
tures of the case were that the tube was adherent, and 
that the mass being situated in the neighbourhood of 
the appendix the symptoms seemed to point to appen¬ 
dicitis. On operating, however, the case proved to be 
one of simple tubal gestation, the appendix not being 
involved. 

II. Afyoma .—In showing this specimen. Dr. Edge 
remarked that while theoretically he was a strong sup¬ 
porter of pan-bystereotomy, he had gradually Income 
impressed with the simplicity of the snpra-vaginal opera¬ 
tion, uid the very satisfactory results which followed 
its performance. It was by the snpra-vag^inal method 
he removed the specimen exhibited. 

HI. Uterus Removed by Vaginal Hgsterectomy for the 
relief of Prolapse .—Two years previously he had per¬ 
formed plastic operations on the vagina which were not 
attemdel with the desired result The patient having 
pawed the child-beiring period, be performed vaginal 
hysterectomy. He drew attention to the fact t^t a 
.certain amount of vaginal mucous membrane wss 
attached to the cervix. Modifying the procedure 
adopted by Mr. Christopher Martin, who dissects the 


OF SOCIETIES. _ The Mbdical Fbebs- 571 

vaginal mucous membrane from the subjacent structures, 
before performing hysterectomy, he had performed 
anterior and posterior coeltotomy, brought the fundus out, 
ligttured the uterus fro3 above down, and divided the 
cervix. He then finds it an easy matter to strap the 
vaginal mucous membrane down as far as necessary, 
and contends that haemorrhage is more fully con¬ 
trolled, and that there is greater expedition than when 
the dissection is done from below up. 

Dr. Hbtwood Smith advocated snpra-vsginal hyste¬ 
rectomy, and Dr. Macnauohton-Jonbs referred to the 
importance of examining the appendix before closing 
the abdomen in every case cf laparotomy. 

Mr. O’Callaohan showed the appendages of a patiei t, 
Dct. 28, which had been removed for double pyowalpinx. 
There were hsemato cysts in the right ovary. The dis¬ 
ease was traceable to the gonococcus. He also showed 
a myoma enucleated from the anterior wall of the 
uterus by (xeliotomy, and another myomatous tumour 
removed by hysterectomy. All three cases made good 
recoveries. 

Mr. Jbsbbtt and Dr. Hbtwood Smith questioned the 
propriety of removing the ovaries when healthy, and 
Dr. Macnauobton-Jonbs {thooght that the plw of 
leaving one ovary was the more prudent to adopt. 

FROFHTLAXI8 IN aTN.fiCOLOOT. 

Dr. Snow, in his paper, dwelt on the evil effects of 
the corset in inducing pelvic auomalies, referriug 
specially to its infinenoe in promoting the development 
of myomata, noting the fact that in primitive peoples 
myoma_ was very rare. Its tendency to cause back¬ 
ward displacements was dwelt on. Among other pro¬ 
phylactic precautions advocated was a more close^and 
active attention to htbitual constipation, while the evil 
consequences following on too frequent pregnancies was 
considered. 

USB OF ABTIFICAL SBBUM IN PBOLONOBD OPBBATION. 

Dr. Macnauohton-Jonbs showed the adnexa of a 
patient, set. 40. Some short time before operation she 
had been curetted, and a polypus remov^ from the 
uterus. There had been a history of pelvic pain ex¬ 
tending over seventeen years, since her last pregnancy. 
Before operation she suffered from intense pain, frequent 
fainting fits, and symptoms of collapse. At the operation 
the inlet of the pelvis was discovered to be completely 
closed by a smooth and firm plastic bed, completely 
obscuring the adnexa. On breaking this down, the 
latter were found to be converted into thickened, 
adherent, and enlarged tubes with old pus sacs, Ihe 
ovaries also being exUai^ed and cystic, with purulent 
infiltrations. Their removal was extremely difficult. 
As one pus sac ruptured an iodoform drain was left in, 
and this was finally removed on the fourth day. The 
recovery of the patient was uneveatful. The case, with 
one recently exhibited, well illustrated the danger of 
temporising with such adnexal conditions, which often 
necessitated the performance of an operation far more 
difficult and prolonged than any ordinary hysterectomy. 
In this particular instance, save for the use of artificial 
serum, it is doubtful if the operation (the entire dura¬ 
tion of which was close on two hours) could have been 
completed. 

Dr. Macnauohton-Jonbs also read notes of a case of 
*' Ectopic Gestation with Escape of Gestation Sac into 
the Peritooeal Cavity.” This will be found in another 
column under the head of “ Clinical Becords.” 


LAEfNGOLOGlCAL SOCIETY OP LONDON. 
Muting hbld Nov. Ibt, 1901. 

E. Cbbsswbll Babbb, M.B., President, in the Chair. 


Cases. 

Mb. W. G. Spbncer showed a case of tertiary syphi¬ 
litic laryngeal stenoBis treated by laryngo-fissure with¬ 
out tracheotomy, the result of which was most satis¬ 
factory; there was no dyspnoea, and the patient bad 
quite an audible voice. 

Mr. WiSTMACOTT showed a series of speoimena, photo- 


572 Th« Medical Pbess, TRANSACTIONS 

graphs, and drawings illustrating the inflammatory 
diseases of the nose and accessoiy cavities. 

Br. Hkbbzbt Tillxt showed two molar teeth in 
which the crowns were healthy but in which there was 
evidence of suppuration about the palatal roots; the 
patients from whom they were extracted both suffered 
from disease of the corresponding maxillary antrum. 

Dr. J. Dokblan showed a case of laryngeal syphilis 
with flxstion of the left vocal cord in a man, Dit. 52, and 
raised the question as to whether it was not malignant 
as well as syphilitic. 

Dr. St. Claib Thomson showed a man, set. 33, who 
had been brought before the Society in April hist with 
chronic laryngitis and an ulcer on one vocal cord, who 
now presented marked lupus inflltration and alceration 
of the epiglottis. 

Dr. E. WAaoETT showed a case of (?) congenital fene¬ 
stration of the anterior pillars of the fauces. Many such 
cases bad been shown at the Society, and much dis¬ 
cussion had taken place as to whether they were of con¬ 
genital origin or the result of scarlet fever. 

Dr. Cliffobd Bb&lx said that since the last case of 
this sort was shown be had made inquiries at the fever 
hospitals, and had learned that fenestration aa the result 
of scarlet fever was practically unknown. 

Mr. St. Oxobqx Bxid showed a series of living cul¬ 
tures of those bacilli which simulate the bacillus tuber¬ 
culosis by staining reactions. 

Dr. Fitzoxbald Powell showed a case of papilloma 
of the larynx, which was peculiar in being of an almost 
pure white appearance. 

Dr. Dundas Gbant showed a case of epithelioma of 
the epiglottis. The operative treatment of such cases 
was discussed by Mr. U. T. Butlin and Dr. H. L. Lack. 

Dr. Dumdab Gbant idso showed s case of nasal 
stenosis, in which the symptoms appeared to be chiefly 
subjective. 

Mr. H. M. Bahsat showed a case of (?) tuberculous 
disease of the epiglottis. It was thought to be lupus, and 
suitable for treatment. 

Dr. J. W. Bond showed a case of swelling of the left 
ventricular band in a boy, et. 14. 


SOCIETY FOE THE STUDY OF DISEASE IN 
CHILDEEN. 

Mxxtiko hxld (Eooms of the Medical Society of 
London), Nov. 16th, 1901. 


Mr. Eobbbt Jones, of Liverpool, occupying the Chair. 


Casks. 

Db. David Walsh showed a girl, et. 14, with a 
tumour in the left flank diagnosed as hydronephrosis. 
An X-ray examination of the case showed a small 
oalonlus impacted in the ureter near the bladder, and 
also a hydronephrosis shadow. 

Mr. E. Cliuxnt Lccas suggested that before opera¬ 
tion was resorted to the patient should be examined 
per vaginam under a genenU ansesthetic. 

Mr. Stdkxt Stxphbnbon exhibited a ehild. seventeen 
months of age, who was suffering from acute miliary 
tuberculosis, with pulmonary and cerebral manifest^ 
tions. Double optic pnpillitis existed, and a typical 
tubercle was present in the choroid coat of the right 
eye. There was, in addition, a tuberculous ulcer in¬ 
volving the palpebral conjunctiva of one eye. The ulcer 
(in scrapings from which tubercle bacilli had been 
demonstrate) had destroyed a portion of the free edge 
of the eyelid, and was not associated with granulations. 

Mr. Gboboe Pbbbxt thought the oonjunotival ulcera¬ 
tion corresponded to the miliary tuberculous ulcer 
occurring sometimes about the edges of the lip. 

Dr. C. 0. Hawthobnx remarked that the optic discs were 
considerably swollen, and suggested that the pupUlitis 
might possibly be due to a tuberculous intia-cranial 
tumour, and not to tuberculous meningitis. 

Dr. C. O. Hawthobnx showed a boy, set. 6, with con¬ 
siderable enlargement of the lymphatic glands of the 
neck, with a similar but less marked condition of the 
axillary glands. The blood showed no excess of white 
corpuscles, but a relative increase of lymphocytes. He 
considered the case to be one of Hodgkin's disease. 


OF SOCIETIES. _ Not. 27, 1901. 

Dr. A. E. Sansom asked whether the spleen was en¬ 
larged ? 

Dr. B. Hutchison suggested that the case was one oT 
tuberculous glands. He doubted whether theie was 
really such an affection as Hodgkin's disease. 

Mr. Ferret and Mr. E. Clement Lucas also di6Cnsee() 
the case. 

Dr. Hawthobnx, in reply, said the lower end of the 
spleen could be felt. He pointed out that the glands 
were not matted together, and that their characteristics 
were different from those of tuberculous glands. 

Dr. G. A. SuTHXBLAND and Mr. Jackson Clabex 
showed a child, tet. 2, with marked shortening of all the 
limbs, six digito on each hand, slight hare-lip, and con¬ 
genital heart disease. They suggested that an achon- 
droplasic condition was present. 

The case was discussed by Dr. Hutchison, Mr. Perret,^ 
and Dr. Shuttleworth, and Dr. Suthxbland briefly 
replied. 

Dr. Edmund Cautlbt showed the heart of a chOd,. 
et. 16. who died from pulmonary regurgitation. The 
specimen weighed 11 ozs., and was firm and globular. 
The right ventricle was markedly hypertophied. The 
pulmonary valves were much thickened and puckered, 
and on two of them were warty vegetations with 
apparent lose of substance. 

Dr. Thkodobx Fibhxb thought the case one of infec¬ 
tive endocarditis, a view shared by Dr. A. E. Sansom, 
and Dr. Cautlbt replied. 

Mr. Giffobd Nash (Bedford) showed the kidneys 
from two children of the same family whose ages were 
six months and ten weeks respectively. The kidneys 
were the seat of congenital cystic degeneration, and the 
enlargement in each case was noticed shortly after 
birth. 

Dr. Theodobx Fibhxb inquired whether it is common 
for children with congenital cystic kidneys to live weeks 
or months ? 

Mr. Nash, in reply, said there were instances on record 
of such patients surviving to twenty or thirty years 
of age. 

Mr. J. Howson Eat (Manchester) showed specimens 
and Bketcb illustrating a case of congenital umbilical 
hernia of the size of a foetal head occurring in th» 
Children's Hospital, Manchester. 

Dr. Edmund Cautlbt read a paper on the 

iETIOLOOT AND MOBBID ANATOMT OF TUBXBCULOUS 
MBNINOITIB, 

based upon the post-mortems and clinical records of the 
last twenty-seven fatal cases under his care. Twenty- 
two occuired in children under five years of age, and 
only five during the next five years of life. A family 
predisposition existed in five cases. In two iDetanoes 
only was disease limited to the meningee. In twenty- 
thrM the mediastinal glands were caseous, and in four 
of these the mesenteric glands were also affected. Dr. 
Cantley summed up hie views shortly as follows t— 
Heredity means exposure to infection. Injury is 
rarely an exciting or predisposing cause. The respira¬ 
tory tract is the great channel of infection. The 
alimentary tract is rarely primarily infected. Tuber¬ 
culous milk is rarely, if ever, the source of infection. 
The prc^osis is very hopeless on account of the extent 
of the tu^rcnlouB disease elsewhere. The evidence- 
obtained from the examination of the brain shows that 
operative treatment may be discarded as experimental 
ratJier than useful. 

The paper was discussed by Dr. 6. A. Sutherland, Dr. 
Theodore Fisher, and Dr. Willmer Phillips. 


SHEFFIELD MEDICO-CHIEUEQICAL SOCIETY- 
Mbxtimo hxld Nov. 7th, 1901. 

The Ptesident, Dr. C. H. Willxt, in the Chair. 

Cases. 

Db. j. H. Kxklino related two cases of abdominal 
hysterectomy, and showed speoimens. 

Dr. D. Buroxss showed specimens from (1) a case of 
Addison’s disease in a boy, tet. 9; (2) a case of grannlar 

oog 


Nov. 27, 1901. 


GERMANY. 


TbB MiDICAL PBEtS. 573 


OontrAoted kidney in e boy, st. 16, a plnmber, who had 
suffered from lead poieoninv. 

Dr. A. J. Hall showed a simple method for the 
clinical estimation of hsemo^flobin. 

Mr. A. M. CoNNKLL showed specimens from the fol¬ 
lowing cases: (1) abdominal nephrectomy for sarcoma; 
(2) lumbar nephrectomy for tubercle. 

Dr. C. N. Gwtnnb showed a case of congenital dilata¬ 
tion of the sigmoid flexure of the colon. The boy, 
ffit. 161, had been subject from birth to an aggravate 
form of chronic constipation. Of late years his abdomen 
bad been much enlarged, and before admission had been 
rapidly increasing until it measured 31 inches in cir¬ 
cumference at the umbilicus. As no action of the 
bowels could be obtained, an iliac colotomy was per¬ 
formed. After the operation the boy improved in 
general health, and his abdomen gradually became 
reduced to almost normal dimensions. 


Germans. 


[fbom oub own cobbbbpondbnt.] 

Bsbliv, Not. 24th, 1901. 

Thb 80 callbd Banti'8 Dibiass. 

At the Medical Society Hr. Senator gave an address 
on this disease. Prof. Banti, of Florence, in 1894 
and subsequent years, drew attention to a disease 
characterised by swelling of the spleen, ansemia, and 
associated with these, cirrhosis of the liver and ascites. 
He called the disease} ansmia splenica, with cir* 
rbosis of the liver. The disease, though it had been 
scarcely mentioned in German literature, was not a new 
one, but to Banti belonged the credit of showing the 
connection between the individual symptoms. The 
affection had three stages: 1st. The antemic, in which 
antemia and enlargement of the spleen alone were pre¬ 
sent. The duration of this st^e was from three to five 
years, and in exceptional cases, ten to eleven yeare. 
Then followed a second or truisitional stage, in which the 
urine was scanty, containing abundance of urobilin and 
bile material,only of a few days duration; and, lastly, the 
third stage, of ascites, that runs a slow and painless, but 
steadily progressive course; the blood showed lessened 
numbers of red blood corpusdee, decrease of hemoglobin, 
in some cases decrease of leucocytes; the durstion of this 
stage was six to twelve years. In the first stage the 
case was nothing more than primary idiopathic enlarge¬ 
ment of the spleen, later on associated with lencsmia. 
Externally it was similar to Cohnheim’s disease, but in 
reality there was a difference. It was best described by 
Griesinger as antemia splenica. The disease had long 
been known under this name. The later stage had been 
described as cirrhosis of the liver with ascites, but with 
some peculiarities, the cases not falling in with any of 
the known types. They showed certain peculiarities 
(cirrhosis of the liver with pemicious ansemia with 
splenic or hypersplenomegaly, or with marked htemor- 
rhagic diathesis). 

Banti looked upon the disease as a direct result of 
the splenic affection, and not in the usual inverse sense 
of the splenic enlargement being due to the cirrhosis of 
the liver. Banti found the veins of the spleen and interior 
of the portal vein covered with atheromatous patches. 
The speaker also assumed that the spleen waa the seat of 
the primary diseaie; but then came the question how the 
cause of the disease got into the spleen. Probably 
the point of entrance of the poison was in the intestines, 
which either infected the blood in the spleen directly or 
set up mi autoxication that caused a secondary swelling 


thereof; the spleen could react to all dyscrasio condi¬ 
tions, both the acute and the chronic. Harmful material 
was therefore formed that irritated the spleen, caused 
atheroma, and excited hepatic cirrhosis. Bacteria had not 
been discovered, and the speaker's own examination of the 
blood had revealed nothing. Moreover, as regarded the 
literature in general no exciting caoses had been dis¬ 
covered. One could less ^ree with Bsnti’e explanation of 
the ascites; it did not occnr in all cases. In some cases 
the liver had been found free from cirrhotic changes. The 
clinical symptoms were also against the ascites being a 
consequence of the cirrhosis. The speaker bad observed 
two cases in which the ascites disappeared of itself or 
after puncture, whilst the disease itself progressed, the 
splenic swelling making more or less marked advances. 
If this were the cause the ascites must also have in¬ 
creased. As regarded symptomatology the tendency to 
hsemorrbage in the third stage was specially obarao* 
tenstio. Epistaxis, frequent and severe hemorrhage 
from the stomach, which sometimes ushered in the dis¬ 
ease, or sometimes appeared later, and repeated them¬ 
selves, or might close the scene; be had observed the 
last in one case. According to his own observations 
inteetinal hemorrhage must be a freqnent symptom. 
In five years he had observed seven cases, six of them 
with gastric, or intestinal, hemorthagss. Other 
hemorrhages also were present, bleeding from the 
gums, hemoptysis, purpura in one case (that of a physi¬ 
cian), hemorrhage into tbs vitreous. The transition to 
jaundice with urobilin was not always observed. The 
patients kept tbeir anemic appearance, and no sym¬ 
ptom appeared that pointed to cirrhosis of the liver. 
The blood changes were important. He had made 
accurate investigations of the blood in three cases, and 
had collected that of seventeen other oases. The 
ofaangee he most found were characteristic. Diminu' 
tion of red blood corpuscles, as considerable 
as constant $ in general there was oligocytbreuiia. 
Less important was the diminution of the heemoglobin, 
which bore no relation to the diminution in the blood 
corpuscles. In all bis oases there was striking diminu¬ 
tion of the leucocytes, but the extent varied. Other 
blood obaugee (increase of blood plates of the eoeino- 
pbile cells) were not characteristic; in the spinal cord 
the changes of grave ansemia were found. If these 
ohangee were confirmed by other observers they would 
afford valuable aid as regarded differential diagnosis. 
As regarded this there were tiie very large splenic 
tumonrs, for which no cause oonld be found, and the 
condition could not always be distinguished from pseudo- 
leucsmia. It was not unlikely that Banti’s disease was 
allied to lineal psendo-lencsemia. The plumodia would 
distinguish it from malaria, and possibly malaria was 
connected with the setiology in some oases. The diffi¬ 
culty would be great in the osue of cachectic children 
with splenic swelling and ascites. Jaoksoh had impro¬ 
perly described such cases as leocsemia infantum. In 
the later ascitic st^e cirrbosiB of the liver alone 
comes into consideration, but here there could be no 
mistake, as the splenic enlargement was greater ♦•■haw 
in any other disease, the spleen equalling the liver 
in size. Bearing this in mind noone oonld confound the 
two diseases. The tstiology waa unknown; malaria had, 
been mentioned, and so had syphilis and abuse of alcohol 
but there were oases in which all these oonld be discarded. 

c 




574 Ths Msdical Frsm. 


A.U STRIA 


Nov. 27, 1901. 


Prognoeis wms imoert&iii. As regarded treatment, we 
had, aooordiog to Banti, a remedy in splenectomy which 
kept the diiease in check and led to reooTery. This 
operation was not without danger, but one conld not 
always oppose it. Maragliano had recorded nine re- 
ooveries and two deaths from hsemorrhage after it- 
Iodine, iron and arsenic, and favourable climatic condi* 
tions were to be considered. In oonolusion, the speaker 
showed a man, set. 33, who showed symptoms of the 
disease, and who was first seen in 1895, when be was in 
the Charity with enlarged spleen. He was back again in 
1896 with ansemia and a trace of ascites. At the begin 
ning of the present year he came again with a good deal 
of ascites, shortness of breath, and cedema. Twenty-five 
litres of fluid were withdrawn, and no more had collected 
in seven months. There was no fever, but great ansmia; 
no swelling of lymph glands ; the spleen filled half the 
abdomen. In the blood decrease of erythrocytes, con¬ 
siderable incteaselof haemoglobin, remarkable lenoopenia; 
of the individual leucocytes, 26 per cent, multinnclear, 
the rest mononuclear. 


JtuBtna. 

[iBOK OUK OWN OOaBBSPONDBNT.] 

ViBSSA, Nov.SSrd, 1901. 

Ertthbxa Bullosuh bt Gtbatuh. 

At the " Geselltotaaft" Neumann exhibited oasts of 
a rare case of erythema bullosum et gyratnm occurring 
on the dorsum of the foot and the palms of the hands 
of a patient who had been treated for some time with 
arsenic for chronic famncnlosis. The patient was 
given three minims of Fowler’s solution at first, which 
was gradually increased. 

When admitted three months later under Neumann, 
the patient’s face was swollen and puffed, the eyelids red 
and partially covered with a crust. On the inner surface 
of the legs were small groups of bullao, extending to 
the anus, while the scrotum had a red weeping eczema. 
On the dorsum of the left foot and in the palm of the 
left hand were large pustules, with red circumferences. 
In the urine there was found a moderate quantity of 
arsenic. 

This is a case of peculiar idiosyncrasy, as the patient 
during the whole of the treatment did not take more 
than ten, or fifteen at the outside, of the Asiatic pills com- 
monly used in the Vienna clinics, and composed of—aoidi 
arsenicosi 0 5 gramme, piper nigr. 6 grammes, gam 
antbic 1 gramme, aqua q.s., fiat. pil. 100; this is 
equal to 6 milligrammes of arsenions acid in each pill. 
Therefore the total amount of arsenic taken would not 
exceed 0’16 gramme or 2*216 grains, which is a very 
small quantity to produce such extensive morbid changes. 

Lsmg said that he had drawn attention to this subject 
before, which had brought him into conflict with his 
colleagues. In one case some time ego, he says, hyper¬ 
keratosis cutis was produced by a very small quantity of 
arsenic given for psoriasis; in another the results were 
somewbat similar to those obtained in Neumann's case, 
where large patches of exfoliation in both hands and feet 
occurred. 

Neumann replied that the doubt was justified in the 
case of arsenic given for psoriasis, as frequently such 
cases developed hyperkeratosis when no arsenic was 
administered. 


Lupus. 

Lang next exhibited a patient covered with the 
efflorescence of lupus over which nodules of the disease 
were strewn. In the centre of a large area of the dis¬ 
ease the mammills were affected, whUe the areola 
around was quite free. A similar condition existed on 
the right forearm, which Lang treated in 1895, leaving 
a circumference unaffected. He excised the morbid 
tissno and subsequently filled in the gap ty Thiersch’s 
method. This part healed up entirely, but the place 
whence the graft was taken has not healed, but has be-' 
come the centre of a new area of the disease. These facts 
tend to prove that the disease la amenable to treatment 
although anomalous in its mode of recovery. 

In all cases with halos of healthy tissue the Kontgen 
rays are invaluable; the ultraviolet rays of Finsen are 
equaUy successful. 

He recalled that 800 patients were being treated by 
Finsen, at Copenhagen, for the disease, and that the 
Kaiser of Austria had now fitted up a place in 
Vieima at a cost of 10,000 kronen out of his privy 
purse. 

Anchtlostomoic Duodxnalb. 

I 

Hofbauer next brought forward a patient who 
had suffered severely from the ravages of anohyloetomnm 
duodenale. This defied the recognised treatment with 
thymol, which led Hofbauer, in despair, to try an ex¬ 
tract of male fern, with surprising success. Anothw 
point of note in this case is, that sdthongh the bsemo- 
globin of the blood was greatly improved the eosinophile 
cells present in the blood still stood at 7 per cent. 

Mannaberg asked what quantity of extract of male fern 
he gave, to which Hofbauer replied that he gave twelve 
capsules, which would represent about a gramme of the 
substance, and this was followed after three hours by 
a large dose of senna. 

Uannaberg related several cases in which the resist¬ 
ance to all the recognised drugs—felix mas, thymol, and 
menthol—was extreme. 

Hofbauer said he had used thymol to such an extent 
that the patient collapsed, remaining for some time in a 
very dangerous condition, but without any marked effect 
on the parasite. 

Pal drew attention to a lecture by Goldmann, of 
Brennberg, who had a large experience in anthelmintics 
particularly with the anchylostoma. He was in favour 
of the fern extracts, but complained greatly of their 
evil c(4lateral effects, such as collapse, Ac. 

Gruber asked what was the employment of the patient. 
Hofbauer replied that he was a miner in the Brenn- 
berger district. 

Mannaberg said be had a silver-miner suffering from 
the same thing in the same neighbourhood, who told 
him thymol was largely used among the miners as the 
most effectual remedy. 

Bontobn Bats and Epithblioua. 

Sobiff presented a patient whom be had treated with 
the Bbntgen rays for a recurring epithelioma over the 
zygoma. After twenty-seven sittings he was surprised 
to see the neoplasm disappear. 

He presented a young girl, «t. 7, who had suffered for 
some time with an iotractable rodent ulcer. He sub¬ 
jected her to thirty-two sittings under the Sdntgen 
rays, with the best results. 

Digitized by Google 



Nov. 27. 1301. 

^ht (Dpemtiitfl theatres. 

FBENCH HOSPITAL AND DI8PEN8AEY. 

Abdouinil Htstbbkctout. —Hr. B. O'Callaoham 
operat«d on a woman, set. 30, who had been admitted, 
After being nnder hia observation for a year, anffering 
from a large fibroid. Daring the last three months she 
suffered from irritability of the bladder and obstmetion 
of bowel. Bapid increase in the growth of the tumonr 
rendered an operation imperative. The patient having 
been ansesthetised, an incision was made from the 
nmbilicas to an inch above the (ubes; the tnmonr 
was fonnd to fill the whole of the pelvis, and was very 
difficult to deliver out of the pelvis, in which it was 
tightly impacted. On delivery it was fonnd that 
the large intestine presented on the top, and 
that the fibroid had borrowed into the left broad 
ligament. It wis therefore fonnd necessary, after 
tying the uterine arteries on both sides, to make an 
incision into the broad ligament, detach and drop the 
intestine frem the tnmonr (daring which process there 
was considerable htemorrhage), and next enucleate the 
growth, which proved to be an oedematons fibroid; it 
was finally removed along with the uterus, tubee, and 
ovaries, the aterns being amputated through the cervix. 
There being considerable oozing from the broad liga¬ 
ment a gauze drain was passed through the cervix into 
the vagina. The peritoneum was then closed from side 
to side by oontinons catgut suture, and the abdominal 
wound sewn up in two layers, the first being a continu¬ 
ous catgut suture for the parietal peritoneum and the 
second an interrupted one of silkworm gut for the 
remainder of the abdominil wall, each stitch of this last 
taking up also the stitched ridge of the parietal peri¬ 
toneum. Mr. O’Callaghan said that the case was a 
typicaloneof fibroid justifying operation, which, after 
being under his observation for two years, daring which 
time the patient exhibited perfect general health, and 
was able to follow her occupation with no discomfort* 
within the last three months began to develop sym¬ 
ptoms necessitating surgical interference, and in his 
opinion this was the only way for the surgeon to 
approach the vexed question as to when such a serious 
mutilation as completehystereotomy was justifiable. He 
pointed out that the operation was in this case rendered 
a little more difficult by the fibroid having become int a- 
Ugamentous, and also by the fact of the intestine l}ing 
over the tumour; this, however, accounted for the sym¬ 
ptoms of obstruction of the bowel. 

Three weeks after operation the patient was convales¬ 
cent. 

Nbphbobbhapht. —Mr. O’Callaohan operated on a 
woman, mt. 30, who had been admitted with a history of 
hepatic colic. On examination the gall-bladder was 
found normal, but the right kidney was freely movable 
to the middle line. Nephrorrhaphy was suggested, and , 
the attacks of pain had been so frequent and severe that: 
she gladly availed herself of any treatment which would 
promise relief. The operation was performed by an 
incision in the lumbar region between the last rib and 
the pelvis. The kidney was easily fonnd uid was 
anchored by two stitches of silkworm gut through the 
capsule to the abdominal wall; a drain was inserted 
down to the snbperitoneal fat and the wound closed. 
Mr. O’Callagban said that he considered the simple 


Tan Mxdioal Faxes- 575 

operation he had employed as being efficacious in these 
cases. 

The woman left the hospital in three weeks completely 
relieved of her very painful condition. 

CANCER HOSPITAL. 

SuBPiBiTONBAi. Htstbbxctoht. — Mr. Bowbxman 
JXEBXTT operated on a single woman, set. 42, who had 
been admitted to the hospital suffering from a tumour 
in the abdomen and difficulty in micturition. Sbe first 
noticed the tumour about a month before admission, her 
attention being drawn to it by her medical man, whom 
she bad consulted for (dironic dyspepsia. She had great 
discomfort after eating, vomited her food, bowels very 
constipated, periods regular and normal. Sbe com¬ 
plained of constant desire to pass water, and occasion¬ 
ally sbe was nnable to relieve herself. On abdominal 
examination a large, prominent, cystic swelling was 
seen to occupy the abdomen, extending to about an inch 
above the umbilicus; it had all the appearances of a uni- 
locnlar ovarian cyst. On examination per vayinam a 
hard mass was felt filling the pelvis; the os uteri lying 
directly underneath the pubes; per reetmm this tumour 
was found evidently to be connected with the uterus and 
very fixed. On examining the orifice of the vagina the 
urine was seen to be trickling from the urethra, yet the 
the patient said sbe bad passed water freely only half an 
hour ago. In view of the bladder history it was 
deemed advisable to pass a catheter when three 
pints of urine were withdrawn with the effect 
of the oystio tumour in the abdomen disappearing* 
and it became easy to examine the solid pelvic growth 
bimanually; it was found very fixed in the pelvis, and 
about the size of a large cocoa nut. Operation was reoom* 
mended and abdominal hysterectomy performed, the 
tumour and the uterus being with some difficulty ex¬ 
tracted from the pelvis and drawn out through the 
abdominal wound. The broad ligaments and uterine 
arteries were ligatured in the usual way, and amputation 
performed through the cervix uteri. Mr. Jessettsaidthat 
the interest of the case was that the patient had evidently 
suffered from this tumour for some time before seeking 
advice, and appeared to be quite ignorant even then of 
its presence; in fact, the reason for her consulting her 
medical attendant was with the view of getting r^ief 
from the severe indigestion from which she suffered. On 
examination by her medical attendant be discovered the 
cyetic tumour in her abdomen, and advised her to con¬ 
sult Mr. Jessett. This tumour bad all the appearances 
of an ovarian cyst, and might have easily been passed 
over as such, for the patient maintained she always 
passed plenty of urine, although sbe bad never evaonated 
a large quantity at a time, and it was only on account 
of this constant desire to micturate, and that some¬ 
times of a night she found her linen moistened, 
evidently from leakage of the urine, and from the 
history, that on some occasions when micturating the 
water stopped short and sbe was unable to pass more for 
some time that had induced Mr. Jesset to pass a catheter 
into the bladder with the result of drawing off a large 
quantity of urine and the disappearance of the abdomi¬ 
nal cystic tumour. The lesson to be learnt from this 
case was, he thought, as be baa seen in other cases, that 
if you have a patient suffering from a tumour occupying 
the pelvis, and at the same time there is acystio tumour 
in the abdomen, to always pass a catheter and evacuate 


—X y-x 


THE OPERATING THEATRES. 


D •• -ized I 


576 Thi Midical Pbkss. 


LEADING ARTICLES, 


Not. 27. 1901, 


the bladder; by this means the dia^osis otn be con¬ 
firmed, and the surgeon is able to find the extent and 
nature of the growth oooapying the pelvis. 

The patient made an uninterrupted reooTery. 

' ■ - - 

BXOISTBSBD fob rSAMSlIISSlOir ABBOAD. 

^he JElebical fxtsB anb Ctrntlar. 

PabUsbed ererj WedBeedsy momiDr, Friee 5d. Pest free, Bid. 


AOVEBTI8E1IE1IT8. 

PoB OvK Ixsxxnos t—Wbole Pare, £5 Os. 0d.{ Half Pace, 
CS 10s. Od.: Quarter Pace. Cl Ss.; One-elcbUi. IM. 6d. 

Fob a Bbbdb or Ibsxbtioss s—Wbole Pace, thirteen iaaerttons 
(weekly, fortnichtly, or monthly), at £S 10a. Od.; twenty-siz 
Ineertioiis (weekly or fmtnichtly) at C8 Ss. Od.; &t^-two 
insertions (weekly) at CS each. Half Pace, thirteen insertions 
at SBe.: twenty-siz at S8a.: fifty-two insertions at 80s. eaoh < 
Quarter-pace, thirteen Insertions at 18s. twenty-siz inaartioBa 
at IBs.: fifty-two inaertions at IBs each. 

Small annonneements of Practices, a — , Books, 
Ac.—Seven lines or nnder, 4s. per insertion ; Bd. p« Una 
beyond. 


Wxt <^(bual JrejBd anb (Strntlot. 


“SALtlS POPtlU SUPBBMA LIX.” 


WEDNESDAY, NOVEMBER 27, 1901. 


THE METROPOLITAN ASYLUMS BOARD 
II. 

The growth in popalaritj of the bospitalB for infec¬ 
tious diseases proTided by the Metropolitan Asylums 
Board is a moet encouraging sign of public interest 
in prevention. During the year 1900 the notifications 
in the Metropolis amounted to 35,247, as against 
42,285 in the previous year. The decrease is satis¬ 
factory, and has taken place in spite of an increase 
in diphtheria. Of the 35,247 oases, 30,243 were 
legally admissible to the managers’ hospitals. 
Of the 30,243 admissible cases 21,361 were 
actually admitted. The remainder, mostly cases 
of erysipelas, hut also including 237 cases 
of puerperal fever, were not admissible. It may 
be remarked, by the way, that so disastrous and 
eminently preventible a disease as puerperal fever 
might well be provided for by the managers. The 
ratio of admissions to notifications affords a most 
gratifying proof of the excellence of the accommoda* 
tion afforded by the hospitals. In the year 1890, the 
first complete year in which compulsory notification 
came into force, the proportion of admissions to the 
total number of legally admissible cases was 33 59 
per cent. Since that time the percentage has steadily 
increased until it reached its highest point of 
70'63 in the year 1900. It is obvious from 
these figures that a vast mass of infection is brought 
more or lees under control. Much remains to 
done in a similar direction. Some day, perhaps, the 
Board will be asked to deal with those most deadly 
infectious diseases, whooping-cough, measles, and 
summer diarrhoea. It might possibly be not too 
sanguine to hope that when that day of enlighten¬ 
ment dawns upon us there will be available hospital 


accommodation that has been rendered vacant by 
the disappearance of enteric fever and some other 
specific infections maladies. It is interesting 
to note that the Board has been loyally supported 
by the medical profession, notwithstanding the fact 
that the public hospitals have deprived the medical 
practitioners of a large and lucrative class of prac¬ 
tice. There is one point, however, in this connection 
as to which it may be well to indulge in a little plain 
speaking. In the course of the year 1900 no lees 
than 1,706 patients, or a percentage on the total 
idmissions of 7'8, were found to have been sent to 
hoepital on a wrong diagnosis. It is clear that if 
patients are sent off to hospital on the first ap¬ 
pearance of symptoms it is often impossible to arrive 
at a correct diagnosis at that early stage of 
invasion. An atypical case of enteric fever, scarlatina, 
diphtheria, or measles, again, may occasionally mis¬ 
lead the most skilled and cautious observers. Only a 
year or two since a whole series of cases of typhus 
fever were treated in different London hospitals 
and remained for a long time unrecognised. Mis¬ 
takes, therefore, may be regarded as unavoidable, 
and the hospital medical officers act as a kind of 
court of appeal, where there is leisure and oppor¬ 
tunity for fuller and more exact observation. Under 
such ciitsum stances it is needless to remark that 
without the utmoet tact aud consideration a great 
deal of injury might be inflicted upon general prac* 
titioners. In all cases we think the Board should 
treat the matter as purely confidential, and tend a 
private intimation to the notifying medical man 
as to the differing result of their examination. 
There will probably be little difficulty in smooth¬ 
ing the way to a businesslike undei-standing 
by a Board that has always adopted a prudent and 
conciliatory policy in its dealings with the medical 
profession. Were any serious friction to arise upon 
the point of errors in diagnosis, medical men would 
probably either keep the patients under observation 
until the disease were fully pronounced, or thej 
would send in an open diagnosis of “ fever.” In either 
case the work of tbe Asylums Board would be ham¬ 
pered and lessened in efficiency. With regard to 
scarlet fever it is satisfactory to learn that tbe 
Board bas now sufficient accommodation for all 
cases. Why this should not have been the case in 
former years is somewhat of a mystery, inasmuch 
as tbe Board has the command of unlimited re¬ 
sources. The lavish outlay in the case of tbe Brook 
Hospital, a satisfactoiy account of which cannot be 
said to have yet reached the public, shows that the 
Board has not failed in providing the requisite accom¬ 
modation because of a mistaken economy. There 
has been apparently a great delay in carrying out Mr- 
Chaplain's famous Order of April 2nd, 1899, whereby 
the Local Government Board authorised the man¬ 
agers to provide accommodation for Poor-law 
children suffering from ringworm, opbibalmiay 
mental or bodily deficiency, or who were remanded 
rom the police-courts. Ophthalmic children will not 
be housed before 1903 5 ringworm cases are to have 

Di;; -:zed by Google 


Nov. 27, 1901, 


LEADING ARTICLES. 


Tax Mxdical Paxes. 577 


temporary accommodation, but no date is mentioned; 
convalescent homes are nob yet established; some 
homes are in working order for defective children; 
but in the case of remand ” children legal difficulties 
have cropped up which it is hoped will bo overcome 
by an amending Act. This record does not seem to 
be altogether brilliant on the part of a public body 
armed with full powers and unlimited resources. 
Extravagant sums, moreover, seem to have been 
voted towards the erection of the necessary buildings 
in connection with the special accommodation needed 
for these classified children. The general work of 
the Asylums Board commands our admiration, 
especially in view of the fact that as a non-elective 
body it is beyond the direct control of the rate¬ 
payers. 

THE VICISSITUDES OP DRUGS. 

Okb of the most interesting of books is Sir Ber¬ 
nard Burke’s “ Vicissitudes of Families,” and we 
often thought that the vicissitudes of drugs would 
make an interesting narrative ol the fashions in 
therapeutics. We have known “ red gum ’’ to be 
brought from the recesses of a lumber room to the 
front counter case, where, as the eucalyptus roslrata 
gum, it long enjoyed therapeutic notoriety. The 
demand for Chio turpentine when Clay, of Birming¬ 
ham, believed he found in it a remedy for uterine 
carcinoma brought its price from a few pence a 
pound to as many shillings an ounce. Lactucarium 
has undei gone similar vicissitudes of fortune and ex¬ 
tract of hemlock, Canadian balsam, and many others 
might be added to the list. One of the latest to 
comeback into therapeutic favour is sarsaparilla. For 
centuries it found favour with the most distinguished 
European physicians. Boerhaave recommended its 
use as a necessity, and Baron Gerard von Swieten 
wrote a formula for a compound decoction of the 
plant, and it formed the principal ingredient in the 
decoctum diaetelicum of the immortal Sydenham. 
Almost a hundred years have passed since Dr. 
Charles Butler produced his liquid extract of sar¬ 
saparilla, thus utilising the broken pieces that fell 
from the bundles of the drug whilst unpacking it. 
Both the medical profession and the public looked to 
it as a trustworthy remedy for all forms of sores, 
ulcers, pimples, and such like. In time it became a 
legacy to quacks, and among English-speaking 
people gradually fell out of prescriptions. On the 
Continent it was not wholly forgotten in medical 
practile, and the Spanish physician still pre¬ 
scribes zarAaparilla: emilax syphilitica, in¬ 
deed, its introduction to Spain was considered 
at the time almost as a divine interposition. 
The veterans who bad accompanied El Gran Capi- 
tan, Gonzalo Fernandez de Cordova, to the siege of 
Naples in the year 1486 had returned. To the pen 
of Hernando del Pulgar we are indebted for the 
account of that siege and the memorable epidemic 
of the “ French disease,” which made such havoc 
among the Spanish troops. The pious historian 
tells us that thediscoverersof America were inoculated 


with the plague disease in reprisal for the violence of 
their conduct. Unchecked by treatment, the disease 
spread through' Southern Europe as a pestilence. 
Some time afterwards, early in the sixteenth cen¬ 
tury, Zarzaparilla was brought to Cadiz (E/ Stylo 
A/edieo). About forty years later Senbor Rodri¬ 
quez de Castello Bromeo published an account 
of the therapeutic virtues of the plant. One 
of its earliest recommendations for the treat¬ 
ment of syphilis was from the pen of M. 
Ferrier, who prescribed it for the Zues HispanicO' 
Once again the drug has become a favourite remedy 
under the name of Zittman’s decoction, which con¬ 
sists of a decoction of sarsaparilla, fennel, anise, 
liquorice root, and senna. To this is added alum, 
sugar, calomel, and cinnibar. The compound closely 
resembles a domestic remedy which at one time was 
much used in Ireland. Now it comes recommended 
by specialists as the most useful and trustworthy of 
our therapeutic agents for malignant syphilis. 
Under its influence lesions with a horrible stale, 
dead odour common to the fomenting secretions of 
moist fungating syphilides heal rapidly. Writing 
in 1697, Gerarde says, “ We have great plenty of the 
roots of this Bind-weeU of Peru, which we usually 
call zarza, or sarsaparilla, wherewith divers griefes 
and maladies are cured.” He adds, “The roots si's 
a remedie against long oontinuall pains of the joints 
and head, and against cold diseases. They are good 
for all manner of infirmities wherein there is hope of 
cure by sweating.” 


FOOD PRESERVATIVES. 

At Lancaster, a few days since, the county 
magistrates dealt with a case which, in the 
present uncertain state of the law, is of much im¬ 
portance. A Morecambe shrimp dealer was prose¬ 
cuted at the instance of the County Council for 
selling shrimps which were preserved with borax. 
The solicitor for the prosecution stated that for some 
time shrimps had been imported into this couctry 
from the Continent. With the intention of ascertain¬ 
ing whether they contained any harmful substance, 
an inspector of police went to the defendant’s 
premises and asked for some Dutch shrimps.” After 
the purchase was made, according to the evidence 
of the police—and before it was made, according 
to the defendant—the latter said, ” I never sell them 
in this state, they have to be soaked in salt and water 
for some hours, and then boiled.” On analysis they 
Were found to contain ninety-five grains of borax per 
pound. Mr. Williams, County Analyst, gave the 
result of bis analysis, and added that he considered 
the amount of preservative excessive. Dr. Sargeant, 
Medical Officer of Health for Lancashire, said that 
br>rax hardened the shrimps and made them indiges¬ 
tible. He did cot consider them a wholesome 
oi’ticle of diet. Professor Boyce, of Liverpool, 
concurred on the ground that borax inhibited the 
” rennet ” action in the stomach. He was- 
totally opposed to the addition of any chemical 

Digitized by Google 


578 Thb Mcdicai. Fbbbs. 


NOTES ON CURRENT TOPICS. 


• Not. 27. 1901. 


substance to preserve food. Mr. Spilsbnry, Ana- 
Ijtical Chemist, of Birmingham, for the defence said 
that he did not deem the amonnt cf borax added ex- 
oessive, and thought that anj less quantity would not 
be efficient. He had taken large doses of boric acid 
himself without experiencing any effect whatever. 
Mr. A. S. Barling, Surgeon to the Royal Lancaster 
Infirmary, said that be had given boric acid and 
borax to large numbers of patients. He had known 
sixty grains taken daily for many consecutive months, 
and had not seen any harm follow. Assuming that 
the ordinary dose of shrimps was two ounces, the 
amount of borax contained, t.e., twelve grains, would 
be absolutely innocuous. In cross-examination he 
admitted that he was not in favour of the unrestricted 
use of food preservatives. He did not consider that 
borax had a greater hardening effect on food than 
salt had. The magistrates, after patiently hearing 
the case for four hours, inflicted the maximum ' 
penalty, £20 and costs. Several convictions have 
been obtained in different parts of the country for 
adding boric acid to milk and cream, and at Liver¬ 
pool a dealer was heavily fined for selling margarine 
which contained fifty-one grains per pound. There 
have also been cases in which the court has 
found in favour of the defendant. Until the 
committee appointed by the Local Government 
Board reports it is likely that there will be 
different decisions in different courts. As regards 
the harmfulness or otherwise of boric compounds, 
the evidence given before the Committee is contra* 
dictory, but the general tendency seems to be to 
regard it at> harmful. Probably a middle course will 
be steered by the Committee, and they will limit the 
amount of preservative, and possibly also recommend 
that its presence be stated on the label. 

Jlotcs on Current l^opiro. 

The Latest Cancer Cure Fad. 

It has been announced in some of the public 
newspapers that Lady Margaret Marsham, sister of 
the present Earl of Romney, has been cured of 
cancer by the application of violet leaves. The 
growth, which affected the threat, is said to have 
disappeared entirely under the application of an 
infusion of the green leaves. The weak point in the 
story is the failure to prove that the disease was 
really cancer. Most medical men would at once say 
that to hope to cure cancer in the way indicated 
would be simply to beat the air. The old herbal 
books recommetded violet leaves for cancer, and had 
they proved effectual it is unlikely that their virtues 
would be still unratified in the present age of 
active scientific curiosity. It seems to be assumed 
that the verdict of the medical profession will be 
unhesitatingly against giving the humble violet a 
fair trial; yet, on the other band, it is stated, no 
doubt with an equal degree of truth, that its reme¬ 
dial action is being " carefully investigated at 
various London hospitals. One can but smile at 
these ebullitions of credulity of which the present 


silly season has been unduly and unusually prolific. 
It all represents “ cheap copy ” for the daily press, 
and this is a sore temptation in times of literary 
penury. 

The Origin of Uric Acid. 

The association of uric acid with gout has for more 
than a century attracted the close attention of medi* 
cal investigators. In spite of the advances of physi¬ 
ological chemistry, however, the origin of uric acid 
in the human body still remains a more or less un¬ 
solved problem. That the acid is a normal consti¬ 
tuent of the urine and that it is present in the blood 
of gouty individuals are propositions upon which all 
are agreed, but beyond that point the subject drifts 
into an outer sea that is vexed with a multitude of 
opposing theories. It was at one time bel^ by many 
observers that a definite ratio existed between the 
urea and the uric acid excreted in the nrine, and some 
physicians still impress that view upon their gouty 
patients and point to analyses obtained from pharma¬ 
ceutical chemists as a proof of the value or otherwise 
of the special course of ti'eatment that is being under¬ 
taken. The fact of the matter is that every indi¬ 
vidual appears to have his own normal ratio. Experi¬ 
mental diets, moreover, can be made to raise or lower 
the amonnt of uric acid excreted with precision. 
Taylor, for instance, on a diet free from nitrogen, 
had a daily output of 0*273 gramme uric acid, and 
7‘738 grammes of urea. On a purely milk diet the 
amounts were 0*284 uric acid and 36*213 grammes 
urea, and with a diet of 500 grammes of thymus 
and calf pancreas, together with bread and non- 
proteid vegetables, the uric acid rose to 1*5 grammes 
per day. From the first of these experiments it 
seems clear that the uric acid must have bad 
its origin in the breaking down of the nuclear 
or nucleinic material of the tissues. That 
indeed, appears to afford a rational explanation 
of a poHion of the uric acid excreted, while the rest 
comes from the pnrin compounds contained in the 
food. This two-fold origin, to some extent, accounts 
for the recognised importance of diet in the produc¬ 
tion of gout. At any rate the results obtained 
clearly demonstrate the fallacy of attaching any 
great importance to the urea and uric acid ratio in the 
urine. Another experimenter has found that three 
cups of coffee daily, whf n added to a normal diet, 
increased the uric acid excretion from 0 364 to 0 826 
gramme. Any medical man unaware of a fact of that 
kind might be led into all sorts of false deductions 
from test tube analyses. 

A Fee or an Inquest! 

In the course of an inquest held last week on a 
working man, at Ancoats, who had died very sud¬ 
denly, it was alleged that Dr. Moore, who was called 
in just before tbe man died, bad refused to give the 
certificate of death unless be received a fee of one 
guinea. Dr. Moore was invited by the Coroner to 
attend the inquest for tbe purpose of giving ui ex¬ 
planation, but he declined to do ao unless he received 


Digitized by Google 


Nov. 20, 1901. 


NOTES ON CURRENT TOPICS. 


The Medical Pbsss. 579 


a summons to attend, which the Coroner refused to 
issue. The Coroner, in summing up, animadverted 
very strongly on Dr. Moore’s conduct in certifj’ng 
the death of a patient, whom he had only seen in 
extremis, to be due to hsemorrhage, whereas a post* 
mortem examination showed it to be due to 
kidney disease. The coroner intimated his intention 
of laying the facts before the General Medical Coun¬ 
cil, but with the full evidence before us, as reported 
in the Manchester Courier, we do not see that Dr. 
Moore has brought himself within the scope of the 
penal clauses of the Medical Act. That his conduct 
was deserving of censure is possible, but as he did 
actually see the patient before death the demand for 
the payment of his fee before delivering the certifi¬ 
cate, even under the threat of causing an inquest, is 
probably not “ infamous conduct,” however other¬ 
wise reprehensible. It is, however, highly improper 
thata medical man should availhimself of bis power to 
withhold a certificate of death to secure payment of 

his fees. - 

Journal of Obstetrics and Qynsecology of 
the British Empire. 

It is finally announced that the first number of 
a new Journal of Midwifery and Diseases of 
Women, a periodical to be devoted to the considera¬ 
tion of the obstetrics and gynecology of the British 
Empire, will make its appearance in January, with 
Mr. Alban Doran as editor. He will be assisted by 
Dr. Berry Hart, President of the Obstetrical Society 
of Edinburgh ; Dr. F. W. Kidd, Professor of Obste¬ 
trics and Gyntecology in the Royal College of Sur¬ 
geons in Ireland; and Dr. W. J. Sinclair, Professor 
of Obstetrics and Gynmcology, Owens College, Man¬ 
chester ; and collaborators distributed through the 
colonies and dependencies. The new journal will 
be in the capable hands of Messrs. Bailliere, 
Tindall and Cox, as publishers for a limited 
liability company, and among the promoters we 
note the names of Sir John Williams, fiart.. 
Emeritus Professor of Obstetrics, University Col¬ 
lege, London; Dr. F. H. Champneys, obstetric 
physician to St. Bartholomew's Hospital; Dr. G. E- 
Hermf n, obstetric physician to the London Hospital; 
Dr. Peter Horrocks, obstetric physician to Guy’s Hos¬ 
pital ; Dr. R. P. Ranken Lyle, Lecturer on Obstetrics 
and Gjnmcology, University of Durham ; Dr. W. J. 
Sinclair, Professor of Obstetrics and Gynmcology, 
Owens College, Manchester; Dr. Edward Malins, 
Professor of Obstetrics, University of Birmingham . 
Dr. Murdoch Cameron, Professor of Midwifery and 
Diseases of Women, University of Glasgow; Dr. J. 
A. C. Kynoch, Professor of Midwifery and Diseases 
of Women, University of St. Andrews; Dr. A. R. 
Simpson, Professor of Midwifery and Diseases of 
Women, University of Edinburgh; Dr. William 
Stephenson, Professor of Midwifery and Diseases of 
Women, University of Aberdeen; and Dr. John W. 
Byers, Profeesor of Midwifery and Diseases of 
Women, Queen’s College. Belfast. This array of 
names affords a guarantee that the undertaking is 
powerfully supported. The prospectus is to be issued 
shortly. 


The Ethics of Public Vaccinators. 

In order to afford the public every facility for 
being vaccinated or re-vaccinated, bills have been 
posted in various districts of the Metropolis inviting 
all and sundry to avail themselves of the services of 
Dr. X. X., the names and addresses being given in 
bold type as public vaccinators for the respective 
districts. It ispointed out that the operation will be 
performed gratuitously and with Government 
b mph, a product of which public vaccinators have 
at present a monopoly. The object of this publicity 
is no doubt very commendable, although we fail to 
see the necessity for urging the public in this pro¬ 
miscuous fashion to obtain something for nothing 
irrespective of their ability or willingness to pay for 
the same. In any case we maintain that the un¬ 
blushing publicity given to an individual practitioner 
is not necessary to the object in view, and is in 
flagrant violation of the code of ethics which regu¬ 
lates professional conduct in general We see no 
reason why public vaccinators as such should be 
exempted from this beneficent law, and it remains 
for the profession at large to take such steps as may 
appear desirable to put a stop to the practice. 

Prognosis in Disease. 

The prognosis of diseaee is always an uncertain 
question, depending as it does on so many factors, 
many of which cannot be foreseen. This subject Is 
dealt with by Dr. Judson Bury in the Bradshaw Lec¬ 
ture on the Prognosis of Nervous Diseases. On the 
one hand many so-called curable affections, such as 
acute infective diseases, may leave behind them 
organic changes or permanent impairment of health; 
on the other hand, diseases supposed to be incurable 
may be arrested, or even apparently cured. E ven in 
the case of cancer instances of spontaneous cure have 
been reported. Of course the diagnosis is alwaya 
open to criticism, but the possibility of such 
an occurrence must be borne in mind. With 
regard to the nervous system the ordinary classifi¬ 
cation into functional and nervous diseases does, 
not agree with the divisions into curable and in¬ 
curable. Fxmctional diseases ai-e those in which, so 
far, no structural change has been found, but they 
are being gradually I'educed owing to increase of 
knowledge. Tet while the origin of many of them 
remains unsolved, they are none the less hopelessly 
incurable than those due to organic changes. Dr. 
Bury, in his lecture, insists that the time has not yet 
arrived for the basing of prognostic statements upon 
diagnosis and pathology. Prognosis depends less- 
upon knowledge of pathology than upon due regard 
to the value of symptoms. 

River Pollution. 

The pollution of rivers is a matter which con¬ 
cerns all classes from the point of view of public- 
health. This is especially the case in large manu¬ 
facturing towns, where all kinds of refuse are dis¬ 
charged into the, so-called, rivers, which are little 
better than open sewers. Antborities concerned with 
the carrying out of measures prescribed byj Act of 


580 Th« Mbdical PMasB. NOTES ON CURRENT TOPICS. 


Parliament for the prevention of pollution of livers 
have been engaged for some years attempting to 
solve the problem. Many rivers, however, as, for in¬ 
stance, the Irwell at Manchester, and the Aire at 
Leeds, are in a far from satisfactoi'y condition. Mr. 
Naylor, Chief Inspector of the Ribble District, 
states that progress is being made as regards purifi¬ 
cation of streams and treatment of trade refuse. 
'Satisfactory results have also been obtained from 
bacterial filters. Reports from Manchester state that 
the polluted water, after passingthrough bacteria beds 
at the rate of 500,000 gallons an acre per day is in a 
fit state for the Ship Canal, the purifying effect 
being due to surplus oxygen. The Ribble inspector 
calls attention to the unsatisfactory way in which 
the work is carried out, due apparently to the action 
•of the Local Government Board in refusing to sanc¬ 
tion loans unless land is taken up for sewage purifi¬ 
cation in addition to the tanks for the bacteria beds. 
The Royal Commission on Sewage Purification have 
expressed the opinion that it is practicable to pro- 
■duce by artificial processes alone, without the aid of 
land effluents, effluents good from a chemical point 
of view, and capable of being discharged into a 
stream without causing nuisance. Anyone who has 
travelled on the Manchester Ship Canal must have 
had the nuisance of river pollution brought before 
his notice in a concrete form likely to linger long in 
the memory. —- 

An Anti-Typhoid Serum. 

Dr. Chantsmbsse, of Paris, claims to have suc¬ 
ceeded in preparing an anti-typhoid serum possessed 
of marked anti-toxic and anti-infectious properties. 
In bringing forward his statistics to prove the velue 
of his serum, Dr. Chantemesse took the precaution 
to insist on the fact that the mortality of typhoid 
fever is higher than is generally supposed. He had 
collected figures which showed that the mortality 
is 29 per cent, in adults and about 10 per cent, in 
children, and the municipal returns for 1899 and 
1900 show a total mortality of 18'5 per cent. 
He has tried the treatment in a hundred cases, 
partly in hospital, and partly in his private 
practice. Only six of these proved fatal, and in 
two the patients were moribund when the in¬ 
jections were resorted to. Judging from the notes 
of the cases the injections are particularly efficacious 
when given early in the disease, that is to say before 
the eighth day. After that period the injection of 
the serum determines a fall of temperature which, 
however, is only ephemeral, and it becomes neces¬ 
sary to repeat it at intervals. He claims 
that under the infiuence of the serum the dura¬ 
tion of the fever is markedly curtailed, the 
general condition of the patient is improved, the 
diarrhaa ceases in the course of two or three 
days, and the blood pressure rises. Complications 
were rarely met with in the cases thris treated, and 
the febrile reaction which follows the injections is 
very moderate in degree. The number of injections 
required is proportional to the gravity of the case, 
and relapses sometimes occur in patients in whom 


Nov. 27. 1901. 


the disease has apparently been arrested by the 
serum. On the whole the results appear to have 
been very encouraging, but observations on a much 
more extensive scale, in impartial hands, will be 
necessary before this new serum can be admitted to 
the freedom of the therapeutical borough. 

Public Slaughter-Houses. 

Fob many reasons the substitution of public 
abattoirs in the place of private slaughter-houses 
constitutes a most desirable reform. The unfitness 
of many of the premises used by butchers under 
present conditions is notorious, and in not a few in¬ 
stances may be regarded as a danger to the public 
health. Then, again, with a number of private 
slaughter-houses proper inspection either of the 
living animals or of the carcases is impossible, for the 
owner may not only kill at any hour of the day or 
night, but is entitled to refuse admission to unwel¬ 
come visitors. There can be no doubt that 
the proper inspection of meat demands as a 
first step the abolition of private slaughter¬ 
houses. The latter proposal has aroused the most 
determined opposition on the part of the butchers, 
who evidently imagine that their interests will be 
seriously affected by any reform of the kind. In 
London the County Council has hitherto beenxmable 
to carry out the abattoir schemes, which were drawn 
up by the Public Health Committee in 1899. That 
fact alone is sufficient to show the power that lies in 
the hands of the meat trade. In the metropolia 
there are some 5,000 butchers, who between them 
own about 450 private slaughter-houses. The killing 
of the lower animals for food is a necessity imposed 
upon man by the conditions of his existence and en¬ 
vironment. Clearly it is the duty of the administra¬ 
tive authorities to see that the slaughter is carried 
out under circumstances that inflict no undue cruelty 
upon the animals themselves, while the consumer is 
protected as far as possible from the danger to health 
arising from unwholesome meat. 


A New Plea for Cremation. 

The advantages of cremation as a scientific means 
of disposing of the dead are manifold. At the stage 
of popularity to which the practice has attained there 
is little need to recapitulate the reasons that render 
quick combustion by fire safer, from a sanitary point 
of view than slow combustion by the lingering pro¬ 
cesses of putrefaction. A Bristol town councillor, 
however, has recently advanced another ground for 
advocating cremation, namely, that it would afford 
a guarantee against pi'ematnre burial. Perhaps it 
may help to assuage his anxieties on that pK>int by 
reminding him that no instance of live burial has 
yet been established wiUi that completeness of proof 
which is demanded by scientific investigators before 
accepting the truth of any assertion. In other 
words there is no evidence of any case of piemature 
burial, other than that afforded by hearsay or sup¬ 
ported by statements that are obviously riddled by 
fallacies of one kind and another. As a local news¬ 
paper remarks, cremation certainly gives assurance 
Digiiized: 



Nov. 27, 1901. _NOTES ON CURRENT TOPICS. Th* Mbdical Pbibs. 581 


against the horrible fate of waking up in one’s coffin 
from a cataleptic trance or some other form of sus* 
pended animation simulating death.” The writer 
then goes on to saj that the furnace is an agency 
that will make the semblance of death real with 
merciful celerity. We would suggest that medical 
science can determine with precision whether a person 
is dead or alive. Moreover, the ordinary process of 
shutting anyone up in an air-tight coffin would 
destroy life just as surely as exposure to a furnace. 
Baking a man to make sure he shall not be buried 
alive is a somewhat rough means of solving a diffi¬ 
culty. 

The Pla^e in India. 

The issue of the fifth and last volume of the monu¬ 
mental Report of the Indian Plague Commission 
furnishes the world with a document of intense 
human interest. Perhaps the g^atest lesson re¬ 
corded within its voluminous pages is the recogni¬ 
tion of the fact that the success of plague measures 
must depend ultimately to a great extent upon the 
sympathy of the native population. The day of 
coercion at all hazards has departed, and in its 
stead the milder but more hopeful methods of educa¬ 
tion and persuasion havs come into sway. The 
attempt to stamp plague out of a vast empire where 
bad sanitation is the rule rather than the exception, and 
where the customs and habits of the population are 
favourable to the spread of infection,presentsa task of 
a Herculean nature. The cardinal conclusion of the 
report appears to be that the observance of sanitary 
rules constitutes the first and moat important line of 
defence against plague. Unfortunately the results 
of inoculation against the malady have not hitherto 
been altogether satisfactory, but the practice 
has the support of the authorities, and in the 
process of time will probably be brought nearer 
perfection. The statistics of mortality during recent 
plague years are simply appalling. Up to Septem¬ 
ber, 1899, the total mortality from this cause was 
estimated at 430,000 deaths, figures that have during 
the past two years been advanced to something like 
three-quarters of a million. The sanitary subjuga¬ 
tion of our Indian Empire at this rate seems likely 
to be as costly and formidable a task as its original 
political conquest. 

The Phantom Concentration Camp Blue 
Book. 

Before our issue of last week we applied to the 
War Office for a copy of the Blue Book containing the 
Official Report upon the state of the concentration 
camps in South Africa, and were told that no such 
volume had been issued. As most of the leading 
London newspapers of November 16th contained 
articles dealing with the alleged book, the denial 
seemed not a little strange. On the 23rd the two 
other leading medical joumalB appeared. One of 
them, the Lancet, appears to have secured a copy of 
the book. The other, the BritUK Medical Journal, 
like ourselves, failed to obtain a copy either at the 
War or the Colonial Office. If vre are to infer that 


advance reports were issued to a certain number of 
newspapers and journals, all that can bo said is that 
such a preference is absolutely foreign to the 
national traditions and charactor. In any case, con¬ 
sidering the nature of the Report the earliest infor¬ 
mation should be supplied to the medical journals. 
Hitherto the present Government certainly cannot 
complain of the conduct of medical editors, who have 
preserved an attitude of strict moderation concerning 
professional matters where they might easily have 
ridden the whirlwind. The unwisdom of any attempt 
on the part of the Government, therefore, to take 
steps that suggest in the remotest degree the hood¬ 
winking or the ignoring of medical opinion is suffi¬ 
ciently obvious. With the political aspects of the war 
as a medical journal we have nothing to do. 
The state of the Army Medical Service and the mor¬ 
tality of the concentration camps, on the other hand* 
are things that come pre-eminently within our domain, 
and whether favoured by the Government or not with 
their Official Reports, we shall feel it our duty to dis¬ 
cuss those'particular matters without fear or favour. 

The Notification of Consumption. 

The Stoke Newington Borough Council have 
adopted the voluntary notification of phthisis. On 
the receipt of the intimation, the Medical Officer of 
Health will inquire into the circumstances and sur¬ 
roundings of the patient, with a view to the detection 
and removal of conditions likely to promote the 
disease. He will leave instructions, verbal and 
printed, and will offer to perform all necessary dis¬ 
infection of rooms, bedding, Ac. Arrangements will 
be made for the gratuitous bacteriological examina- 
of sputum in doubtful cases, and the usual notifica¬ 
tion fees will be paid to practitioners for information 
of the existence of any case of phthisis on.the same 
premises not previously notified. 

Annual Meeting of Fellows and Members of 
the Royal College of Surgeons of England. 

The Annual Meeting of the Fellows and Members 
of tbe Royal College of Surgeons was held on the 
21st inst., in the theatre of the College, when tbe 
usual series of sterile resolutions were passed, calling 
upon the Council to do this, that, or the other, in 
spite of the knowledge that such resolutions will be 
treated as mere obiter dicta by those in authority. 
One cannot but admire the patience and perse¬ 
verance of the gentlemen who, year after year, go 
through the empty formality of proposing, second¬ 
ing, or voting for stillborn resolutions. As a matter 
of history, we note that a motion brought forward by 
Dr. Thomas Moiton in favour of a certain propor¬ 
tion of Council members being elected by the 
members, was passed by a very large majority. This 
is distinctly a reasonable proposal, and tbe College 
would unquestionably gain in status by broadening 
its constituency. Mr. George Brown, who is very 
much en evidence just now by reason of the 
approaching election, proposed a motion censuring 
the College for its behaviour towards the General 
Medical Council in respect of the instruction of 



682 Th* Midical Pbkm. NOTES ON CURRENT TOPICS. Nov. 27, 1901. 


students in science. Mr. Bryant objected to tbe 
topic being introduced, on tbe ground that it was 
still, so to speak, su6 judice; but it was carried never¬ 
theless. At the instance of Dr. Danford Thomas 
the President promised that the proposed Medical 
Acts Amendment Bill, promoted by the British 
Medical Association, should receive tbe closest atten¬ 
tion. Lastly, a resolution which laid down the prin¬ 
ciple that tbe representative of the College on the 
General Medical Council should be elected by Fellows 
and members of over ten years’ standing was passed 
—an d there the matter ends. We are in sympathy 
with all tbe resolutions, but unless means can be 
found to gain tbe ear of tbe Council—or of Parlia¬ 
ment—we are fain to ask Cuihono ? 

The Improvement of the Human Race. 

A NY suggestion for the improvement of tbe race of 
mankind must of necessity command attention. It 
was tbe subject of the Huxley Memorial Lecture, re¬ 
cently delivered by Mr. Francis Oalton with the title 
'* The Possible Improvement of the Homan Breed 
under Existing Conditions of Law and Sentiment.” 
Mr. Galton suggests that wealthy persons might de¬ 
vote their surplus cash to the befriending of young 
healthy couples, and so produce a more healthy race. 
That such a condition of things is ever likely to occur 
is remote in the last degree, for it would reduce mar¬ 
riage to the level of a breeding pen. Moreover, it by 
no means necessarily follows that the race would be 
improved, except perhaps physically; for we know 
perfectly well that many great minds, which have 
benefited tbe world for all time, have been tenants for 
life of more or less debile or deformed bodies, a cir¬ 
cumstance which is not apparently incompatible with 
great intellectual activity. It is true that Mr. Gal- 
ton’s idea, if carried out, might possibly lead to the 
development of a race of athletes; but that it would 
raise the standard of intellect, or improve the human 
race on tlie whole, there is not enough evidence to 
show. 

Pseudotabes. 

As tbe physician grows in years he comes more 
and more to recognise tbe difficulties that beset 
accurate diagnosis. This is particularly tbe case in 
nervous diseases. Erb, writing in 1868, warned his 
readers of tbe accidental complications with central 
nervous disease that may mask peripheral paralysis. 
These difficulties of diagnosis were recognised since 
the days of Hippocrates, and described by such 
writers as Galen and Bonetus. And Todd, of ency- 
clopredic fame, writing in 1847, urged the adoption 
of the term inco-ordination in place of paralysis 
in tabetic troubles. Romberg, in his classical 
description of spinal diseases, and afterwards 
Ducbenne and Trousseau recognised the difficulty of 
accurate diagnosis in spinal diseases. We are led 
to these considerations from an exhaustive clinical his¬ 
tory of a case of pseudotabes, published by M. Millo. 


examination alone. The patient, a man of seventy-five 
years of age, had lumbago pains, which were ascribed 
to cold and overwork. He was unsteady on his limbs, 
ataxic in bis gait ; the knee reflex was exaggerated r 
there was no ankle clonus, be had the Arg;Il- 
Bobertson pupil, muscular atrophy of his leg8» 
diminished tactile and other sensibility, with diffi¬ 
culty in micturition. Withal the spinal cord through¬ 
out its whole length was found to be perfectly 
healthy. Tbe lesions found were degeneration of 
the peripheral nerve endings and muscnlar atrophy. 
We may just add that the symptoms came on gra¬ 
dually and became more and more ataxic during tbe 
twelve years the patient suffered. This is just one 
of those exoeptional cases that come to the doctor’s 
study to remind him of the folly of dogmatic writing 
on the subject of diagnosis. In one of our most 
valuable text-books we findIn neuritis causing 
pseudotabes we have a history of rapid onset of the 
symptoms, paralysis and wasting of the muscles, and 
an absence, of vesical symptoms and the Argyll- 
Robertson pupil.” No fault can be found with a 
statement that bolds good in fully 99 per cent, of 
cases. Nevertheless, the exceptional case presente 
itself to remind us of the necessity of keeping in 
mind the great axiom of the immortal Sydenham . 
“ Treat the individual.” It is the recognition of 
this fact, that we prescribe for the patient, that 
differentiates tbe physician from the quack. 


Erroneous Death Certificate. 

An instance of what looks like careless certification 
of death is reported from the Northern Hospital at 
Liverpool where the medical officer issued a death 
certificate on the strength of a simple message that 
an out-patient child had died. It subsequently 
transpired that a mistake bad been made in tbe 
name, the child in question being still living. The 
matter is being investigated, but on tbe face of it the 
fault, if any, lies with the present system of death 
certification rather than with the medical officer, who 
cannot be expected to personally inform himself of 
the hona fidea of death declarations in respect of 
out-patients. 

lotertu Neonatorum. 

The pathology of icterus neonatorum is still in 
many cases very obscure, and it is probable that here, 
as elsewhere, tbe jaundice must be looked on as 
merely a symptom due to many different causes. In 
a paper entitled “Some Interesting Experier.ces in 
Obstetrics,” in the August issue of the American 
Practitioner and News, Dr. W. E. Sleet records a 
very remarkable case illustrating this. In December, 
1894, a patient, aged 18 years, was delivered of her 
first child, who is now a strong and well-developed 
boy. Since that time she has had four pregnanciee 
as follows:—December, 1897; October,1898; January, 
1900 ; and March, 1901. In each of these cases the 
child at birth appeared healthy and perfectly 


'be case had been diagnosed as one of tabes, and 
reated as such during the patient's lifetime, the tme 
ondition being made plain by the post-mortem 


well developed, but within a few days died from 
ictems neonatorum. In the case of the fourth 


Digitized by 


GooqIc 



Nov. 27, 1901. 


NOTES ON OUEBENT TOPICS. 


Ths Midical Pans. 583 


child, a son weighing about eight pounds, death re¬ 
sulted from icterus three days after birth, and the 
post-mortem examination showed that the following 
conditions were present:—The hepatic and (^stic 
ducts appeared normal, while the gall-bladder was 
rudimentary and contained about half a drachm of 
serous fluid. The common bile duct was absent and 
represented merely by a fibrous cord, the liver was of 
normal size, and there was no cirrhosis. There is no 
record of the meconium passed, or of the state of 
the intestines, but the child showed no evidence 
of icterus till some twenty*four hours after birth. 
There appears te have been no post-mortem made in 
any of the three cases. 

The General Medical Council Election. 

In consequence of Dr. Glover’s withdrawal there 
are practically only three candidates before the 
profession as candidates for the two vacancies on 
the General Medical Council as ** direct representa¬ 
tives” for England and Wales—viz., Mr. George 
Brown, the retiring member. Hr. George Jachson, 
and Dr. Woodcock. A study of the addresses 
issued by the various candidates does not materially 
assist one in apportioning their respective merits 
and the differences, such as they are, bear rather 
on the meat s by which the reforms, common to them 
all, are to be obtained. Mr. Brown is radical or 
nothing, and Mr. Jackson appears to have 
“ toed the line.” Dr. Woodcock seems disposed 
to distinguish the practicable from the merely de¬ 
sirable, and this is a commendable quality, since 
practitioners desirous of supporting reforms are 
confronted with the possibly unwelcome fact that the 
Council does not fashion its destinies, these being 
controlled by statute. We cannot help thinking 
that mere clamour against the registration of mid-; 
wives is bad policy. What should be aimed at is to j 
obtain efficient control of the medical education of 
these women before they are admitted to registration. 
The vexed question of Medical Aid Associations is 
naturally one which appeals very strongly to practi¬ 
tioners, but the powers of the Council in the 
direction of preventing unfair competition are 
strictly limited, and such as they are require the 
most thoughtful administration. A Medical Act 
Amendment Bill is, no doubt, extremely desirable, 
but it will probably take more pressure than 
the direct representatives can bring to bear 
to induce the General Medical Council to quit its 
supine attitude and to take up the cudgels for the 
purpose of obtaining additional powers from the 
Legislature. On the whole it would seem that the 
forthcoming election will be decided mainly on per¬ 
sonal lines, though geographical considerations may 
carry weight with some. Into the personal qualifica¬ 
tions of the candidates we do not propose to enter. 
Electors can study the past record of Mr. George 
Brown, whose indefatigable activity has not perhaps 
been attended by results commensiuate with his 
efforts; indeed, he has but too often been the tox 
tHamana in dfserlis. The others, Mr. Jackson and 


Dr. Woodcock, must be judged by their addresses, 
respecting which our readers can form their own 
opinion. 

Mentone Hotel Keepers and Consumptives. 

The action of the syndicate of hotel keepers in 
“warning off” consumptives has led to a lively 
campaign in the Press, on the whole in a tone 
adverse to the proposed boycott. There is reason 
to believe that many of the hotel proprietors are 
“ sorry they spoke,” at any rate, in the way they did. 
No one would contest the desirability of, as far as 
possible, excluding persons in an advanced stage of 
consumption from hotels mainly inhabited by 
travellers in good health—indeed, it is an imperative 
duty. When, however, a resolution is agreed to 
which, if construed literally and applied harshly, 
would close Mentone to oi-dinary invalids and those 
with “ consumptive ” tendencies, it is another matter. 
It must be borne in mind that a very large propor¬ 
tion of those who fly south to avoid the northern 
winter do so for reasons of health, and if refused a 
welcome at Mentone, they will assuredly transfer 
their patronage elsewhere. 

In an action brought by a medical man to recover 
fees for professional services the Judge of the 
Wood Green County Court, in giving judgment for 
the plaintiff, expressed the hope that medical men 
would in future prosecute their claims, their not doing 
so being productive of harm in that their abstention 
engendered the belief in the minds of a section of the 
public that payment of bills was an unnecessary 
formality. One could only wish that County Court 
judges generally displajod more sympathy with the 
hard-worked and unpaid practitioner. 

A VERDICT impugning the carefulness of the 
Health Department of St. Louis, U.S.A, has been 
returned by the Coroner’s jury in respect of the 
anti-diphtheritic serum, the injection of which was 
followed by several fatal cases of tetanus. This is 
an error which is likely to cost the authorities dear. 

An epidemic of whooping-cough is causing great 
ravages among the young population of British New 
Guiana. The high rate of mortality of the disease 
is attributed to the superstitious practices of the 
natives who consult the local sorcerer in preference 
to the doctor. 

FEBSONA.L. 

Da. John Hobnx, of Scarborough, has been placed on 
the Commission of the Peace for the North Bidiag of 
Yorkshire. 

Thh appointment of Dr. Geo. Thornton as Melioal 
Superintendent of the Civil Hospital, Pretoria, has been 
confirmed by his Excellency, Lord Milner. 

Wm hear that there are already a good many appl* 
cants for the poet of Medical Officer to the School Board 
for London. The salary is £800, rising to £1,000. 

Db. Maubicb-Gbobobs Dbbovb, Professor and Agr^ge 

Digitized b> C 



5f4 The Medical Pbbss. 


SCOTLAND. 


Nov. 27. 1901. 


at the Faculty of Medicine of Paris, baa been elected 
Dean of the Faculty, vice Dr. Brouardel, irho reaigned 
after fifteen yeara' tenure of office. 

Mbs. Calveblet Bewicee gave a dramatic recital in 
the Jernaalem Chamber of Weaminater Abbey last week 
in aid of the funds of the Westminster Hospital. A 
Bubatantial sum was realised for this very deserving 
inatitution. 

Dr. Goodhabt ia to deliver the Puzvia Oration before 
the West Kent Medico-Chirnrgical Society, on Friday, 
December 6th, at the Boyal Kent Diapenaary, Oreenwich 
Boad, taking for hie aubject, “General Practice and 
Original Besearob.'* 

Mb. E. F. DbakE'Bbockman, F.B.C.8., of London,has 
presented to the Museum of the Boyal College of Sur- 
geona a complete set of surgical inatrumenta o^ed by 
the Indian “native doctors” in opbtbalmio operationa. 
These wne collected by Mr. Drake-Brockman’s eon 
Major Herbert Drake>Brockman, of the Indian Medical 
Service. 

Mb. T. B. Jeesof, F.B.C.8., ccnanlting surgeon to the 
Leeds Inflimary, will deliver the Bradshaw Lecture at 
the Boyal College of Surgeons, London, on the 11th prox., 
the subject being “Personal experiences in the surgical 
treatment of certain dieeasea.’* The invitation to be 
preaent extends to all members of the profeaeion, and to 
medical students. 

gicoHanb. 

[PBOM OUB OWN COBBESPONDENTS.] 

PEEVENTION OP TUBERCULOSIS. 

An influential public meeting, presided over by the 
Duke of Argyll, was held in Glasgow on the 19th inst. 
Most of the municipal leaders, as well as the most pro* 
minent medical men in Glasgow, were present. Sir 
James Crichton Browne was the principal speaker, and 
explained the objects of the National Association for the 
Prevention of Consumption, under whose auspices the 
meeting took place. Scotland has not kept pace with 
England in the campaign against the disease, its mor* 
tsdity being 17 per 1,000, as against 14 per 1,000 in the 
sister country. The death-rate in Glasgow—20 per 1,000 
—is even higher, though this, of course, contrasts favour¬ 
ably with the death-rate in many Continental cities. The 
Lord Provost, while declining to commit himself as to 
the duty of municipalities in providing sanatoria for con¬ 
sumptives, said that the Corporation was'resolved to do all 
in its power in the line of preventing tuberculosis, whether 
or not it took further steps towards curing it. It ia 
understood that some of the already existing medical 
diarities will benefit largely from the surplus realised 
by .the Exhibition juat closed. Would it not still further 
crown the unprecedented success of that undertaking if 
some part of the funds in the hands of the promoters 
were devoted to the removal of this aconrge of tuber- 
cnlosis.^ At a meeting of the Town Council aubeequent 
to that at which the Lord Provost spoke the sum of 
.£600 was voted to the National Association for the Fre- 

ention of Tuberculosis. 

GLASGOW FBEE FBOM PLAGUE. 

The three patients Buffering from bubonic plague have 
now been discharged from hospital, and as no further 
cases have occurr^, the city, after having been infected 
for about four weeks, is again free from the disease. 
Ten days, counting from midnight of the 18th, must, 
however, elapse before Glasgow is officially recognised 
by foreign authorities to be clear of plague. The Cen¬ 
tral Hotel, to which the outbreak was limited, was re¬ 


opened on the 20th inst. The successful stamping out 
of the plague at so short a time is an interesting object- 
lesson, in view of the paramount importance which Ue 
xecently-iaaned Plague Commission Report ascribes to the 
early recognition of the first cases which occur in a 
district. 

RECTORIAL CELEBRATIONS IN EDINBURGH. 

These took place on a larger scale than usual last 
week. On Wednesday night there was the usual torch¬ 
light procession. On Thursday afternoon the Lord 
Rector, the Marquis of Dufferin and Ava, delivered bis 
address, which was followed by an “ At Home “ in the 
University Union, and by a “ Students’ Night ” in one 
of the theatres, all the seats in which had b^n retained 
by the Students’ Representative Council for the occa¬ 
sion. On Friday the Lord Rector was entertained to 
dinner by the University Conservative Association. The 
proceedings passed off harmoniously. Liberals and Con¬ 
servatives sinking their differences for the nonce, 
although a good deal of adverse comment was ex¬ 
cited by the rowdinees and interruption to which Lord 
Dufferin was exposed during the delivery of his addrers. 
Bis lordship came to Edinburgh at considerable per¬ 
sonal inoonvenienoe and risk to hie health. His speech 
bad all the grace and charm which were to be expected 
from bis career as a diplomatist, and the fact that he 
was unable to make himself audible to the majority of 
bis listeners was surely a reason for sympathy rather 
than an ocesuion for jocular interruption. But, after 
all, the rather severe strictures which have been passed 
on the behaviour of the students are scarcely warranted. 
A comparative study of Rectorial functions discloses the 
fact that while the Lord Rector is always expected to 
deliver an address, he is never by any chance lUtened to 
quietly. Individr^ly, the student is a gentleman; col¬ 
lectively, be has all the attributes of the “roaring 
I human boy,” accomjMDied by a liability to what may be 
I described ss conti^rio^B emotional discharges. At all 
events, it is satisfactory to learn from Lord Dufferin 
I that he was gratified by the kindness and enthusiasm of 
his reception. 

DRINKING CLUBS IN EDINBURGH. 

The police have lately been singularly successful in 
their efforts to suppress what was rapidly becom¬ 
ing a social pest. It has been a matter of noto¬ 
riety for some years that, while public-houses 
are closed on Sunday, there was never the 
slightest difficulty in obtainiog as much whisky 
(and, as subsequent events have shown, worse whisky) 
on the first ^y of the week ns on any other. Under 
guise of “ social clubs ” shebeeoing has been carried on 
with scarcely an attempt at concealment. It was protei 
that in these so-called “clubs ’’ no formality in the way 
of election further than the insmiption of the name in a 
roll book was necessary, no ballot-box existed, while the 
committee were usu^ly self-elected. No means of 
recreation was provided, the club premises consisting 
generally of one or two almost unfurnished rooms, which 
were given up to the sale of drink. A great many of 
these clubs have been raided during the past months, 
and convictions have been secured without difficulty; as 
a result most of those in existence have closed their 
doors—temporarily at least. 


(Dbitunrg. 


SURGEON-GENERAL W. G. N. MANLEY, V.C. 

The death of Surgeon-GeneralWtn. G. N. Hanleytook 
place at his residence at Cheltenham on the 16th inst. 
The deceased had a very active career, baring served 
wi^ the R^al Artillery in the Crimea from June lltb, 
1866, including the siege and fall of Sebastopol (medal 
with clasp and Turkish medal). He was also with the 
Royal Artillery in the New Zealand War of 1864-66, 
volunteered and accompanied the stormieg party at the 
assault of the Gate Pah, near Tanranga, and was 
awarded the Victoria Cross for his condnot daring the 
assault on the Rebel Pah, near Taarauga, New Zealand, 
on April 20tb, 1864, in most nobly risking hU own life. 


Nov. 27. 1891. 


CORRESPONDENCE. 


Thi Mcdical Pbsss. 585 


according to the teatimoBj of Commodore Sir William 
W iseman, in his endeavour to save that of the late Com¬ 
mander Hay, of the Boyal Navy, and othera. Having 
volnnteered to aocompany the atorming party into the 
Pah, he attended on that officer when he waa carried 
avay mortally wounded, and then volunteered to return, 
in order to aee if he could find any more wounded. It is 
stated that he waa one of the last officers to leave the 
Pah. He was thanked in general orders, and promoted 
Staff Surgeon for distinguished and meritorious ser¬ 
vices reud^ered to the sick and wounded during the opera¬ 
tions in New Zealand” (medal). In 1870-71, Surgeon 
General Manley served with the British ambulance in 
the Franco-German War, and was in charge of *'B” 
Division of the Ambulanoe, and attached to the 22ad 
Division of the Prussian Army. He was thanked by 
General von Wittioh, commanding the division, and re¬ 
ceived the Steel War Medal; also, at the request of the 
then Crown Prince, was granted by the German Emperor 
the Second Class of the Iron CroBe‘'on account of hisde- 
voted and excellent conduct in seeking out and caring 
for the wounded of the 22nd Prussian Division in the 
actions of Cheateanneuf and Bretoncelles on the 18th 
and 2l8t November, and the battles of Orleans and 
Cravant on the 2Dd to the 10th December, 1870.” He 
sdso ttceived the Bavarian Order of Merit Surgeon- 
General Manley was also present at the Siege of Paris, 
and, on the declaration of the armistice, prc«eeded into 
the city with supplies for the hospitals. In 1678-9 he 
served in the Afghan War (medal), and in 1882 in the 
E^ptiau War as Principal Medical Officer of the Second 
Division, being present at the Battle of Tel-el-Eebir 

f mentioned in despatches), promoted Surgeon-General 
medal with clasp Third ()1^ of the Oamanieh, and 
Khedive’s Star). 

HENET SUTHEELAND, M.D.. M.E.C.P., Ac. 

Wn regret to have to announce the death of Dr. 
Henry Sutherland, whose death occurred in London 
early last week. He was the second of six sons of the 
late Dr. Alexander John Sutherland, and grandson of 
the late Dr. Alexander Eobert Sntberland, both of 
whom, for many years, held the office of physician to 
St. Luke’s Hospital for the Insane. Dr. Henry 
Sutherland was bom in 1842, and became a member of 
Christ Cbnrob, Oxford, Be proceeded to the d^ree of 
B.A. in 1864, and M.A. and M.B. in 1869. He studied 
medicine also at Addenbrooke's Hospital, Cambrid^ 
and at St. George’s Hospital, London, and began me 
study of mental diseases first at Bethlehem Hospital, and 
subsequently as resident medical officer at me West 
Hiding County Lunatic Asylum. Dr. Sntberland came 
to London in 1870, became a member of the Eoyal Col¬ 
lege of Physicians, and in 1872 took hia M-D. deg^s 
The same year be was elected hotnrer on psychological 
medicine to the Westminster Hospital Medical School, 
a poet he continued to hold nntil 1887. He was 
physician to the St. George’s, Hanover Square. Dispen¬ 
sary, a vice-president of the West London Medical 
Cbim^cal Society, and a Fellow of the Medical, Ob¬ 
stetric^, and the Eoyal Medico-Cbiiurgical Societies, as 
well as of the Medico-Psychological Association and of 
the Pathological and Clinical Societies. He was the 
author of ‘'A Directory of Justices in Lunacy,” of two 
articlea in “Juke’s Dictionary of Psychological Medi¬ 
cine,” and of numerous uaperv on subjects connected 
with insanity contributed to the medical journals. 


(irorr£B])onbntce. 


[We do not hold oorseJvMzevponaible for the opinions of onr 
correspondents.) 

UNTEU8TWOETHT SEEDM. 

To tht Editor of Thx Mkdical Pbxss and Cibculab. 

Sib,— I cannot help wondering what useful purpose 
the writer of the Utter signed “ M.D.” b^d to achieve. 
He does not frankly challenge tbe efficacy of anti- 
diphtberio serum injeotTons, but be indulges in a sneer 
all ronn^ Certainly it must be a matter of regret to 
all that, from carelessness or want of skill, injections of 


this lymph have on two occasions, in two countries far 
apart, given rise to fatal tetanus. That, however, 
reflects on the manufactures of the semtus, and not at 
all on tbe method; indeed tbe fact that, in spite of the 
wide and instant publicity given to such accidents, only 
two instances have been reoordied, tends to prove that 
tbe accident is an avoidable one, and in future no doubt 
uo serum will be issued until it hi^ been appropriately 
tested by direct experiment. 

“ M.D.” is evidently a practitioner with a limited ex¬ 
perience of the use of the serum, either practical or 
theoretical; witness his ignorance of the names of those 
oonoerned in the discovery of the bacillus of diphtheria, 
and 1 would suggest to him that in future communica¬ 
tions on the subject he should deal with it in a scientific 
and logical manner, and not merely sneer at what he 
apparently does not understand. When he commits 
himself to positive statements it will be time enough to 
take up the cudgels in defence of a method of treatment 
which has imp>OBed itself on all civilised communities. 

I am. Sir, yours truly, 

A London M.D. 


DAMAGES FOE PEEMATUEE BUBIAL. 

To the Editor of Thb Mxdical Pbbes and Cibcdlab. 

Sib, —With refereoce to the startling case of prema¬ 
ture interment reported in tbe Mbdical Pbbss ani> 
CiBCULAB of November 20lb, kindly piermit me to aay 
that, in the report 1 read of the terrible occurrence, it 
waa stated that a post-mortem examioation had bMn 
made of the body of the lady, and she was found not to 
have suffered from yellow fever, and that death resulted 
from asphyxia in the coffin. Although “the contrao- 
of the mnecles in rigor tnorti$ ” might account for the 
expulsion of the child in some insHmcee, this was a clear 
case of burial alive. In his monograph on “ Premature 
Burial,” Dr. Franz Hartmann citM a somewhat similar 
horrible incident, taken from tbe Vienna p>ap>er8. 

“ In the year 1898, there died in a small town in Styria 
(Austria) a young pregnant woman, and after waiting 
the onstomary three days she was buried in tbe oburch- 
yaid. Some days after tbe burial a rumour was circu¬ 
lated that she bad been jwieoned by her husband, and 
the grave was opened by order of the autborittes. It 
was then found that she bad but very recently died, and 
the appearance of her body indicated that she had 
undergone a terrible struggle. Moreover, i*he had given 
birth to a child in her coffin. Tbe physician who had 
B'gned her certificate of death wa.s sentenced to a few 
weeks of imprisonment as a punishment for his oare- 
lessnees.” 

Hasty burial is not confined to France, but is fre¬ 
quently practised in this country, and Thb Mbdicad 
pBXBs AND CiBCOLAB dooB great service by calling 
attention to tbe perilous procedure. It is high time 
that legislative ^orms were initiated to remove all 
danger of the piossibility of burial alive bappwoing to 
anyone in tbe United Kingdom. At present no one is 
secure from tbe fearful doom, unless he be killed out¬ 
right by serions accident. 

I am. Sir, yours truly, 

Jas. E. Williamson. 

1, Egbert Street, EegenPs Park, N.W., 

November 22nd, 1901. 


COVEEING A BONE-SETTEE? 

To the Editor of Thb Mxdical Press and Cibcdlab. 

Sib,— Not long ago tbe following extraordinary case 
came under my notice : — 

A young man bad bad a quarrel with another man 
who strnck him on the head with the handle of a bay 
rake, inflicting severe injuries, viz., an extensive de¬ 
pressed fracture of the pMuietal bone on the right side, 
and rendering him unconscious for a considerable pwriod. 

He was carried borne, and one of tbe numerous '* bone- 
setters” (I believe this man was called a “skull 
doctor”) who infest there p»arts was summoned to 
attend him, and the fol'owiugline of treatment wa< 
adopted: f 

First a quantity of hair-oil, a bottle of whichithe 


586 Thi Mbdioal Psisf. 


COttRESPONDBN UJfl. 


Not. 27, J901, 


utUnt had in bis bonae, was ponred into the wound, 
when this was exhausted, melted butter, which, I under- 
stand is a favourite remedy with these “ skull doctors " 
in bead injuries, was used instead. 

Three pounds of bntter were used dnrinf; the five 
weeks the wretched man wasunderthe bone-setter’s ten¬ 
der mercies. Also the patient was not given much 
chance of over-eating himself, as the following very 
restrictive diet will show:—Half a slice of dry toMt and 
three pints of milk and water in the twenty-four hours! 
To quote bis own words, *' I was ravenously hungry all 
the time, and longed for food,” but the dietetic pro¬ 
gramme was rigorously enforced. 

When I saw him he was dying from want of noorish- 
ment and the filthy poisoned wound in his head. The 
suppuration had burrowed extensively under the scalp, 
forming a puffy tumour over and around the fraoturM 
portion of skull, and out of two openings in the scalp the 
foul and foetid pus on pressure ponred in enormous 
quantities. It is an appalling state of things that such 
cases can occur daily as they do without any effort being 
made to put a stop to them. 

But, Sir, the str^gestfact of all in this case was that, 
according to the patient, a medical man, practising in the 
same district and holding a public medical appointment, 
was attending in conjunction with the bone-setter, and 
was present while the hair-oil and melted bntter was 
being used, and, I presume, approved of all the treat¬ 
ment. 

It is therefore scarcely to be wondered at if medical 
men so far forget tbemselves for the sake of a few 
pounds, or perhaps a few shillings, and by this counten¬ 
ance and encourage these bone-setters, that the country 
swarms with such parasites who reap a rich harvest from 
their ignorant dupes. I wish to ask yon. Sir, if this 
medical man baa by his action in this case laid himself 
open to a charge of infamous conduct in a professional 
serue ? Before closing this letter 1 wish to mention that 
the foregoing facte were obtained from the patient 
himself and from enquiries made by the police who are 
looking for the man who inflicted the wound. Hoping 
you wUl in the interests of the public and the medical 
profeesion publish this, 

I am, dear Sir, yours faithfully, 

Giobok Ht, Bussell. 

Cashel, oo. Tipperary, November 18th, 1901. 

[It is difficult to believe that the information onr cor¬ 
respondent has received can be correct. If tiue, how¬ 
ever, it is undoubtedly a case to be brought to the 
notice of the General Medical Council.—E d.] 


" PLAGUE.” 

7*0 /<le Xditor of Thb Mbdxcal Pbbbs and Cibculab. 

Sib,— No one would blame a general injunction to 
authorities to look sell to the ” sanitary ” condition of 
their districts at any time, but it seems reasonable to 
ask whether tbe recommendation contained in the 
article in your issue of November 18th is a complete 
statement of tbe precautionary measures necessary in 
the case of pls^e, or an indication of the actual dic¬ 
tion they should take. 

At the present moment the accumulated knowledge 
as to the behaviour of plague is well represented in 
Eooh’s explicit statement at the Tuberculosis Congress 
which was reported in your columns:— 

“Now we know,” said Koch, *‘tbat eve^ disease 
must be treated according to its own specif indivi¬ 
duality, and that tbe measures to be taken against it 
most Ito most accurately adapted to its special nature— 
to its etiolo({y. The pestilence which is at this moment 
in the foreground of interest, the bubonic plague, may 
be instructive to ns in several respects. 

“ It has l>een discovered that only those plague 
patients that suffer from plague pneumonia—a condition 
that is fortunately infrequent—are centres of infection, 
and that the real transmitters of the plague are rats. 
There is no longer any doubt that, in by far the majority 
of cases in which the plague has been transmitted by 
ocean traffic, the transmission took place by means 
of plague among the ship rats. It has also been 


found that wherever tbe rats were intentionally or 
unintentionally exterminated the plague rapidly disap¬ 
peared, whereas at other places, where too little atten¬ 
tion had been paid to the rat plagfue, the pestiteuce con¬ 
tinued. This connection between the human plague 
the rat plague was totally unknowo before, so that no 
blame attaches to those who devised tbe measures now 
in force against the plague if the said measures had 
proved unavailing. It is high time, however, that this 
enlarged knowledge of the etiology of plague be utilised 
in international as well as in other traffic.” 

Koch is by no means alone in emphasising the urgent 
importance of rat infection : Hanson has eloquently in¬ 
sisted upon it: the experience of Dr. Ashburton Thomp¬ 
son at Hydney in 1900, and more recent excerienoe in 
Calcutta confirms it, the Formosa outbreak of 1896 was 
even known as ” rat-sickness,'’ observer after observer 
notes it: the cultured lay intelligence, as represented by 
tbe Quarterly R view, is so impress^ by the evidence 
adduced as to be ready to admit that tbe belief which 
through recent experience has been slowly crystallising 
in many minds that plague is primarily a rat dis<*aee 
and only secondarily a human diMSse, may be the key 
to the position. 

With this knowlec^ already widely accumulated, 
with tbe fact before u« that at Gla^ow bubonic plague 
amongst people was readily suppressed even with the 
advantage of some start; that at Hull “ pneumonic ” 
plague amongst people was also, though wi^ some diffi¬ 
culty, ultimately suppressed; and with the evidence 
that in outbreak after outbreak the implicatioo of rats 
is, indeed, the uncontrollable factor, it is necessary to 
deal with this disease, following Koch’s advice, aocordiug 
to its special etiology, otherwise we are but bating the 
air. Evidence of the association of the spread of disease 
with '‘insanitary” conditions may readily be fallacious; 
the mere fact that small pox spreads more readily in a 
poor locality than in a rich loouity does not prove that 
” insanitary ” surroundings,” or such oonditions as can 
be remedi^ by soap and water, have anything to do 
with this as a cause, beyond the “ insanitary ” facts in 
regard to small pox that the poor are habitually more 
careless about vacoination, are nndm* less vigilant 
medical supervision, and mix more freely during illness 
than the rich. 

So with pli^foe; if this is indeed a disease in which 
animal infection is a prime factor, as accnmnlating evi¬ 
dence seems to insist, ” scientific sanitation ” must look 
further than to mere dealing with drains and dirt; and, 
while these need never be neglected, advice with regard 
to plague prevention which looks no further is not only 
incomplete, it is misleading. 

I am, Sir, yours truly, 

D. 8. Davibs, H.D., 

Medical Officer of Health, City and Port of Bristol. 

Public Health Department, 40, Prince Street, BristoL 
23rd Nov., 1901. 


THE MEDICAL GUILD CIECULAE. 

To Ike Editor ^ Thb Midioal Pbbss and Ciboulab. 

Sib, —I beg to enclose copy of protest which is being 
signed by members of the Guild Council with respect to 
the irregular action of the chairman of the meeting in 
putting the resolution of which no notice hsd been given 
on the agenda enclosed. 

I have clear evidence that the meeting was “ packed ” 
by the partisans of Dr. Woodcock, showing that it was 
intended to obtain a “ snatch vote,” as I told tbe meet¬ 
ing, and requested the secretary to record that expression 
in tbe minutes. I am. Sir, yours truly, 

G. H. Bboadbbvt. 

8, Ardwick Green, Manchester, Nov. 23rd, 1901. 

[Copy of protest recmved, ” marked several prominent 
members have already signed.”— Ed.] 


A Medical Prand. 

A KAN called Charles Perry, age 45, described as^ an 
American physician, was sentenced to a term of im¬ 
prisonment lut week for a series of frauds .on medical 
men and chemists in London. 


30gl 


Nov. 27, 1901. 


LITERATURE. 


ThB MxDICAL PBXSb 687 


BALL ON DISEASES OF THE NOSE AND 
PHARYNX, (o) 

This admirable handbook has deservedly reached a 
fourth edition. The knowledge of dUeases of the nose, 
especially those of the accessory cavities, and those of 
the pharynx due to mixed infection, is so much wrapped 
up in obscurity, and the treatment is so slow and diffi¬ 
cult that an honest attempt to put the whole subject 
before a practitioner or senior student in a practical and 
intelligible way is no mean task. The fact that inflam¬ 
mation of the antrum of Highmore may give rise to 
severe snpra-orbital neuralgia is not as consoling to the 
diagnostician as it is to the dissector of the trigeminus. 
In the diagnosis of diseases of the accessory einnees, it 
is evident that disease of the antrum must be excluded 
flrat. The author lays stress on the subjective sensation 
of fcetor, some stoppage of the nose, intermittent discharge 
of pus and on transillumination. Puncture of the antrum 
in the manner advocated by Lichtwitz is preferred. 
The troohar, the point of which is guarded by the cannula, 
is introduced in an upward and outward dir^ion beneath 
the inferior turbinated body as far as the middle of the 
meatus. The point having reached the part to be per- 
forated in the upper part of the outer wall of the meatus, 
about an inch and a half distant from the nasal spine, 
the cannula is drawn clear of the point, and the trocbar 
is pushed through the wall. The point of puncture 
selected should always be close to the roof of the meatus. 
This treatment often avoids the sacriflc^of a healthy 
tooth if combined with opening through the alvewlar 
process or canine fossa. In disease of tte frontal sinus 
there is often tenderness at the upper and inner angle 
of the orbit. The utility of transillumination is often 
much diminished by the frequency of asymmetry of the 
sinuses, and the not infrequent absence of one or both 
sinuses. In diag^nosing disease of the ethmoidal cells 
we are told to suspect crusts, pain over lachrymal bone, 
and stoppage of the ncse. Removal of a large portion of 
the middle tnrbioal is often required, but “ it must be ad¬ 
mitted, however, that in certain cases it will be impossible 
to decide if the source of the pus is in the frontal sinus or 
in the ethmoidal labyrinth, or, as is often the case, in both 
these cavities. If pus can be seen by posterior rhinoscopy 
at the vaultof the pharynx close to the cloaca or on the 
posterior extremity of the middle tnrbinal you may 
snspeot empycema of the sphenoidal sinus. Tbe exMt 
diagnosis between this and empysema or suppurating 
post-etbmoidal cells is difficult, and involves endless 
trouble and patience. Tbe author shows a preference 
for old tried remedies, c-g-, in acute tonsillitis instead of 
advocating these new synthetic remedies be prrfers the 
tincture of perchloride of iron, occasionally quinine, and 
sometimes salol. , . , . . 

The treatment of oz®na by cupric electrolysis is not 
spoken very hopefully of. We must confess surprise 
that strong solutions of llq. sod. dilorinat. ate not even 
mentioned under this heMing. Under the head of 
lupus of the nose we find no mention of the FizLsen 
treatmentorby the X-rays, but this is hardly an omission, 
as the treatment by scraping followed by actual or 
galvano-cautery is so successful. For bay fever a pill is 
recommended containing quinine gr. jss, iodide of arsenic 
gr. 1/24, ext. of belladonna gr. 1/12 three times a da^ 
The antbor shows a strong liking for iodine in most 
chronic affections, ey., chronic pha^ngitis he uses i^. 
gr. X, pot. iodid. gr. xx, glycerine 5j > addition to this 
Schlieob recommends the addition of oil of peppermint 
(miij to 5j) for its anesthetic effect on the mucous 
membrane. The type, illustrations, and general get-np 
of Urn book are far above tbe average. 

JELLETT ON MIDWIFERY, (t) 

This compact volume, e mbodying as it does, the 

(a) •• A Handbook o( DiseMes of No» mnd - 

James B. Ball, M.D.Lond., Pbyslcia^est , 

Foartn Edition. With sixty-one Ulnstrations. London. Bailliere, 
Tindall Mid Cox 1901. 7§. €d. „ „ »t ^ t u a 

A Short Practice of Ml^.fery. 

BCh.. B.AO. (Dublin Uniremlty), F.B^.P.L. *c-. Ex 
distant Master, Botunda Hospital; 

^fery and Gynmoolosy, Doblin 5 4c., 4o. Third Edition. iKtndon. 

J and A. ChuiohilL 1901. Price 8o. 6d. 


treatment adopted in the celebrated Dublin School of 
Obstetric®, will be found a very satisf^tory and com¬ 
prehensive guide to the practice of midwifery. It is tme 
that in sundry importut details tbe measnres advo¬ 
cated are at variance with those adopted elsewhere, bat 
the author’s views are securely based on experience 
gained at the Rotunda Hospital, and will command re¬ 
spect if not acceptance. For instance, be deprecates 
the routine employment of the douche, a practice to 
which many eminent obstetricians are wedded, while, 
on the other band, he runs counter to a generally 
accepted canon of the art by advocating plugging the 
vagina in accidental (external) hsmorrhage. Here, 
however, we must defer to the authority of Dr. 
Smyly, who has applied this method with excel¬ 
lent results, and has been enabled to disabuse our 
minds of tbe apprehension, usually inculcated, 
that by so doing an external would he thereby 
converted into an internal bsmorrhage. He prefers 
morphine to chloroform or chloral in the treatment of 
eclampsia, but the discouragement which his advice on 
the treatment of this condition in general tends 
to create is counterbalanced by the knowledge that 
much may he done by intelligently^ applied pro¬ 
phylactic measures to avert tte distressing and 
dangerous manifestations of this morbid state. We 
must confess to some surprise at seeing dteidvoma 
nuxlignum dealt with as a morbid entity. We were 
under the impression that its sarcomatous nature had 
been conclusively demonstrated. The author’s olassifi- 
oation of varieties of extra-uterine pregnancy is a purely 
theoretical conception, and can serve no useful purpose 
outside tbe examination hall. There are chapters on 
infant feeding and infantile diseases, which will be use¬ 
ful to the practitioner, and readers of a statistical ta*n 
of mind may find food for reflection in the report of the 
Rotunda Hospital for the past two years. It would be 
useful if writers on obstetrics would say a few words as 
to the behaviour of the uterus immediately after labour, 
i.e., for tbe twenty-four hours following delivery. It 
undergoes remarkable variations in size during that 
period and they deserve notice, if only to avoid needless 
alarm. We have nothing but praise for the volume as 
a whole, and we can safely recommend it as a gnide to 
practical midwifery. 

CHESTER’S MANUAL OF DETERMINATIVE 
BACTERIOLOGY, (o) 

This work will he simply invaluable to the student 
woiking in the laboratory. Without these tables, which 
serve more for purposes of identification than for classi¬ 
fication, the work of determining unknown bactenn 
without the expenditure of a great amount of work 
would he impractioable. The tables are prw^d by 
chapters on the Morphology of Bacterm, on thei^ul. 
tnral characters and bio-ohemical fnnctiOM, Witt 
the use of the present manual we believe that tte 
teacher can place a given culture in the hands of his 
pupil and expect him to de^miue it, as « done with 
other organic forms. We feel assured then ttat the 
present work wUl serve a useful purpose as a laboratory 
manual. 

THE POCKET GRAY, (i) 

Whxn a book has reached its twentieth thonwd 
there is little need to enter into any detailed notice of its 
merits. Yet this old friend, which hue W 
ediwd by Mr. C. H. Fsgge, M.B., KR.C.8 the Senior 
Demonstrator of Anatomy 

new features which are likely S® 

work The most important addition is that M tte 
description of tte action of each miucle, which c^niy 
renders the account more complete. A boo k of tnis 

(a) A Manual of DetsrminatiT* Bxcteriolw.’’ 

D Chester, Becterioloiist, Delaware CoUefC, Ac., Ac. hew York . 
The MacmUlaa Company. 1901. 

th\ "Tlia Pocket Gray, or Anatomisfe Vade Mecam. 

Edition by C. H. Faw. 

ffi Demo^torof A^tomy, (^y'a WtUl. London: 
BallUere, Tindall and Cox. 190L 3a. 6d. net. 


Co< .gl 





588 Thc Medical PRsee. 


MEDICAL NEWP, 


Nov. 27, 1901 


kind i8 of use ia refreshing the memory of the etndent 
or the practitioner on points that it is not easy to 
retain * in the memory. That it fills a gap 
in the bookshelf of the student has long been attested 
by its steady and unfailing popnlsrity. 6o far 
as we have been enabled to tost ita contents, we are 
pleased to find that Hr. Fa^e has achieved that stan¬ 
dard of accuracy so necessary in a book of this nature. 
Apart from surgery there is a constant necessity for 
reference to the facts of anatomy in purely medical 
work. The physician, for instance, has to keep 
in mind the nerve-supply of muscles and of cutaneous 
areas, and the anatomy of the brain. Indeed, it may be 
said that any practitioner of medicine, no matter what 
bis particular branch, would do well to have a "Pocket 
Grayson bis stndy table for occasional reference. As 
to the student, there is no need to sing to him the praises 
of so old and trusty a friend. We are glad to see that 
neither publisher nor editor has yielded to the tempta* 
tion to increase the size of the book. 

OLIVER ON BLOOD AND BLOOD PRESSURE, (a) 

Dr. Olivsr’s instruments for the examination of the 
blood, for the determination of blood pressure, and the 
calibre of superficial arteries are here described, not, of 
course, for the first time. They have been included 
among the armo scholattica of teachers of physiology 
for some years, and from their first appearance have 
not gone without a welcome from competent and repre¬ 
sentative pbysiologiste. Unlike many of the contriv¬ 
ances invented for the purposes of resesnch in physio- 
logy they are the direct outcome of the desire of a 
physician to apply to his clinical practice new and 
exact methods of investigation. Devised for clinical 
use they have been systematically used now for some 
years by Dr. Oliver, as much as the stethoscope or i 
thermometer have been used by other physicians. This 
book embodies the results he has obtained in this way. 
Scientific research in the course of clinical practice is 
sufficiently rare, mnch too rare, and that, it is safe to 
assert, not because it is discouraged by patients. Dr. 
Oliver’s book is a lesson to clinical physicians in this $ 
but it is not only on this ground that it is remarkable, 
the results at which be has been able to arrive are, 
many of them, of the greatest interest to medical 
men, whether engaged in research or practice. In Dr. 
Oliver’s own branch of medical practice in balneology 
it marks an ep och. __ 

^Caboratorg 

TYPHOID FREE OYSTERS. 

It is high time the Merchandise Marks Act was 
made to apply to oysters, in the sense that it should be 
open to consumers of the delicious bivalve to be in¬ 
formed of the source from which the particular oysters 
they contemplate eating have been obtained. Were 
this generally possible public confidence would promptly 
be rertored in a cheap and once popular article of food. 
The public have it on good authority that oysters grown 
in pure water may be regarded as perfectly safe, but 
this general proposition will not satisfy the fastidious 
or prudent customer in respect of an unidentified brand. 
His only altematlre is to purchase ovsters the 
origin of which he knows at first band, and the 
life history whereof is a matter of public notoriety. 
Our attention was called some time since to the 
Ulifden oyster beds which flourish on the coast of Con¬ 
nemara, CO. Galway, " far from the madding crowd ” 
and all the typhoid possibilities. We have now had an 
opportunity of looking into the matter, and the impres¬ 
sion we have formed is decidedly favourable to the en¬ 
terprise. The beds are situated in the Atlantic, in 
bays chosen on account of their physical advantages in 
respect of oyster culture, and are alimented at every 
tide by water freeh from the ocean. The fisheriee 
are fully fif^ miles from any important aagr^tion of 
human beings, so that contamination by microbes 

(a) "a Contribution to tbe Stu^ of the Blood end Blood 
PreMore." By Gwrge Oliver, M.D., F.B.C.P., Ac. London: 

H. K. Lewis. 1901. 


which are productive of disease in the human being is 
virtually impossible. The oysters themselves, samples 
of which we have microscopically and practic^y 
examined, are uniformly of excellent quality, and as tbe 
beds are only four miles from a railway station rapid 
transit en-sures their delivery in a fresh condition. 
From a dietetic point of view the scientific culture of 
oysters under strictly hygienic conditions, the ' open 
water" treatment of oysters, is an undertaking of 
extreme importance, well worthy of public snpport. 

CA8UMEN. 

Wb have made an analysis of Prideanx’s *' Casamen," 
prepared by Prideaux’s Pare Casein and Life Food Co., 
Ltd., Notcombe, Dorset, and obtained tbe following 
results: — 


Casein. 

... 88-35 

Fat . 

. ... 2-92 

Mineral Salts . . 

... 2-81 

Moisture 

... 5-87 

Sugar . 

nil 

Starch . 

nil 


This preparation of milk casein is a fine floocnlent 
powder, free from taste and odour, and is qnite solnble 
in water. The percentage of solnble casein being 88'35 
per cent., proves beyond question that it is of the highest 
value as a fieeh-forming food, and as it contains no 
starch or sngsr it is eminently suitable for use in cases 
(diabetes, Ac.), in which it is desirable to prescribe a 
diet free from carbohydrates. 

There are a number of everyday foods, which, heiog 
deficient in nitrogenous compounds, are pro tanto 
deficient in alimentaiy value, bat this shortMmins can 
now be easily remedied by the addition of a snitable 
proportion of " Casamen." 

Tbe valne of decidedly soluble albumens to enrich the 
invalid dietary ia now generally recognised and we anti- 
pate that in the near future they will play an importaot 
and increasing part in the alimentation of invalids and 
persons with feeble digestive and assimilative powers. 

c^cbical 

Ths DawUsh Llbsl Case. 

At tbe Devon Assizes, last week, one Clara Cooper was 
tried on a charge of writing and publishing false, 
scandalona, and malicions libels ooncemiog Dr. C. N. 
Lovely, of Dawlisb. Medical evidence was given to the 
effect that the prisoner was insane and irresponsible 
for her actions, bat she was sentenced to six months’ 
imprisonment in tbe second division. Her mental con¬ 
dition will now come under the cognisance of the 
anthoritiee. The proseontion was conducted by the 
London and Counties Medical Protection Society, of 
which Dr. Lovely is a member. 

Asaanlt by a Patient. 

Dr. Adstxn, of Lingfleld, Essex, was the victim of a 
violent assanlt last week at the hands of a patient 
whose mental condition he was investigating. Or. 
Austen received a blow with a chopper, severing the 
tendons of tbe right hand and inflicting other severe 
injaries. 

8mall-pox in London. 

Each day oontinnes to furnish its qnota of recwoits to 
the small-pox hospita^ varying in somber from 30 to 
15. On Monday evening the nnmber of patients under 
treatment was 409. The vaccination retnms for Sep¬ 
tember and October in St. Pancras show that while the 
number of cases on the birth list was 1,0S2, the oertifi- 
cates of vaccination amonnted to 2,060, so that tiie in¬ 
habitants are evidently making np for arrears. The 
total number of scarlatina and diphtheria oases show a 
slight increase, the present nnmber of patients suffering 
from these diseases being 6,120. 

Free Semins. 

The Blackpool Corporation has nndertaken to keep a 
supply of serum for wphtheria aud puerperal fever for 
grataitooB distribution. It is stated that, ultimately. 


tjy 


GoogL 





Not. 27,1901. 


PASS LISTS. 


Thx Midical Pbisb. 


589 


the seiom, “ for ©tery diseasekoowo to 
will thus be rendered available—a rather tali order, and 
somewhat in advance of the times. 

Deaths under Chloroform. 

A MAN age 31, died under chloroform last week wkil® 
having some teeth removed, at Tarporley. near Man¬ 
chester. Another death from the same <»um ooou^ 
at Liverpool, the victim being an infant eight^n 
months of age, who was undergoing m operatoon for 
the remedy of cleft palate. Death m this instance 
was attributed to the passage of blood into the trachea, 
and an exonerating verdict was returned. 

SorlousICharge Against a Medical Kan. 

Th* daily papers of November 19th report that Dr. 
John Flanagan, medical officer of Ballinalw district, 
and two other men, were brought up at Mullm^ and 
remanded, charged with grievously a^ulting Bernard 
Phillips, a groom, by throwing vitnol over the lower 
cart of his body, thereby causing senous injury in the 
abdominal region. It was alleged that the offenwwas 
committed on November 3rd. but the prosecutor did not 
give information until the end of last week. It was then 
found that the acucred had absconded, ^d warrants 
were issued, and the arrests msde m pablin. Philltps 
was Dr Flanagan’s groom, and it is stated that the affair 
took place in the kitchen of the former’s house at Long- 

Presentation to a Medical Han. 

Db. Brbw. of Enoiskerry. has been presented by his 
friends, on the occasion of his marriage, with a 
floently chased silver salver. The s^ver bore the fol¬ 
lowing inscriptionPresented to 
M B. ou the occasion of bis marriage, October 9, I90i, 
in’recognition of his valuable services to the poor and 
public and the kindly and sympathetic manner with 
which he discharged his professional duties since his 
appointment as mOTical officer of this district.” 

A Serious Admission. 

William Ttndalb Watson, Medical Officer of Health 
to the Tottenham District Conncil, pieced guilty l^t 
week to an assault on a little girl, but in view of the 
medical evidence in respect oi the prisoner s health 
sentence was postponed. 

The Poisons Committee. 

This Committee.'appointod by the Lord President of 
the Conncil to inquire into what alterations may be 
expedient in Schedule A of the Pharmacy Act. 1868, sat 
at W hitobaU on Tuesday, Wednesday, and Thursday last 
week. Sir Herbert Maxwell, M.P., in the chair. There were 
also present Mr. A. Cross. M.P., Professor T. B. ^or^. 
Professor W. A. Tilden, Dr. Stevenson, Mr. W. Martm- 
dale, Mr. J. H. Harrison, and Mr. B. B. Masham 
(secretary). 

A Medical Hero. 

Dr. William Smith, of Dungloe, Co. Donegal, has suc¬ 
cumbed to typhus fever, contracted in the discharge of 
his duties as dispemary doctor, he having transported a 
patient suffering from the disease in a boat from the 
Island of Arranmore. By a mournful coinoidenoe his 
predecessor met his death under exactly simil ar ciroum- 
Btancee. 

Boyal Commission on Tuberoolosls. 

Wb have received an official intimation that the Boyal 
Commission on Tuberculosis is now sitting at 1, Chapel 
Place, Delahay Street, Westminster. The experiment^ 
part of its work will be carried out near Btanstod, in 
^Ux, on two farms that have been generously placed 
at the disposal of the Commission by Sir James Blytb. 

Hedlcsd Temperance Association. 

A MBETINO of the British Medical Temperance Asso- 
olatioa was held in the Governor^ ^m of Guy's 
Hospital (by kind permwion of the Visiting Committee) 
on Friday, the 22nd lost, at 4.30 p.m. Prof. Charters 
Bymonds presided and the discussion, which was on the 


“ Advantages of Total Abstinence,” was ably opened by 
Dr. Claude Taylor. Several students and others took 
part in what proved a most interesting and instructive 
disouBsiou. Tea and coffee (provided by the kindness of 
the hospital authorities) were served during the half- 
hour preceding the meeting. 

Further Medical Detachments. 

Obdbbb have been issued for another 100 men of the 
Boyal Army Medical Corps to leave Aldershot for South 
Africaon the 6th prox.,and three more detachments of 100 
each by the beginning of January. This will make a 
total of over 700 in two months, the lai^est reinforce¬ 
ment in BO short a period since the beginning of the war. 


University of London. 

The following is an official list of candidates who have 
passed the M.B. Examination 

First Division.—John Atkins, Hermann Baleao, Janet 
Mary Campbell, Frank Challaos, Carey Franklin 
Coombs, Alfred Ernest Jones, Henry Crewe Keates, 
Robert Kalsall, Robert Archer Lloyd, John Ford North- 
cott, Richard Horace Paramore, Arthur Ricketts, 
Charles Archibald Scott Ridont, William Morton 
Robsou, Ellen Mary Sharp, John Henry Sheldon, James 
Ernest Stratton, Albert E. Thomas, Charles J. Thomas, 
B.Sc., Kenneth Vincent Trobshaw, John Frederick 
Walker, William H. Wynn. B.So., Ernest Eric Young. 

Second Division.—Kenneth Bush Alexander, Alfred 
Eaton Baker, Bobert Balderston, Ernest Gilbert Bark, 
Harold Shuttleworth Barwell, Anthony Birch, William 
Henry Bowen, Sidney Bree, John Charlton Briscoe, 
Henrr Martyn Brown, Herbert William Brown, 
Katherine Chamberlain, Olive Claydon, Myer Coplans, 
Louis Edington Dickson, Arthur Edmunds, B.So., 
Benjamin Gr^ory Fiddian, Herbert Hallilay, Helen 
Beatrice Hanson, T. Ayscough Hawkesworth, Helena 
Gertrude Jones. Ernest William Julias Ladell, Ernest 
Lewis Lilley, Edward Vaughan Lindsey, Thomas Lister 
Llewellyn, Kenneth Fraser Lund, Zebulon Mennell, 
Edwin Morgan, Bertram Wilmore Moss, Frank Herbert 
Noke, William Gibson Parker, William Edward Peck, 
Joseph Arthur Perdrau, Howard Welles Bsynolds. 
Robert Ellis Roberts, B.Sc., Florence Robinson, Agnes 
Catharine Scott, Walter Bernard Secretan, Charles 
Gabriel Seligmann, Cuthbert Fennessy Selous, Harold 
Farley Seymour, Harold Weightman Sinclair, Anna 
Maude Smith, Douglas Wilberforoe Smith, Alfred 
Richard Spencer, Louis E. Stamm, B.A , B.So., William 
Lnmsden Stuart, John Herbext Sykes, Claude Tessier, 
Robert Cyril Turnbull, George William Watson, George 
Ernest Wangh, AugastuB Joseph Wernet, Prank 
Cordenx Wetherell, Clarence Barns Whitehead, John 
Thomas Williams, Arthur Gordon Wilson, Edith 
Louisa Young. 

Society of Apothecaries of London. 

Thb following candidates have passed the undermen¬ 
tioned examinations in 

Surgery.—J. E. Bolton (Seotions 1. and II.). E. N. 
de V. Dawson (Section L), B. Gauld (Section I.), W. 
St A. P. Hubbard (Section I0» B. 8. 0. Mannsell (Seo¬ 
tions I. and II.), H. S. MoLellan (Section L), D. V. 
Muller (Section I.), B. Rees (Sections I. and II.), C. M. 
Woods (Seotioiis I. and II.). 

Medicine.—C. H. Allan (Sections I. and II.), P. C. 
Borsess (Section II.), A. Dewar, P. 8. Hopkins (Section 
I.) H. S. McLellan (Section I), D. V. Muller (Section 
I.)| B. E. Sansom (Seotions I. and II.), F. I. Trimmer 
(Sections I. and II.). ^ ^ 

Forensic Medicine.—C. H. Allan, J. H. Beasley, S. F. 
Cheesman, A. Dewar, P. 8. Hopkins, C. B. A. Huddart 
H. S. MoLellan, B. B. Sansom, F. I. Trimmer. 

Midwifery.-R. Gauld, H. 8. McLellan, F. H. Rother¬ 
ham. 

The diploma of L.S.A. was granted to the following 
candidates C. H. Allan, J. H. Beasley. P. C. Burgees 
B. 8. 0. Msunw ell, B. £. Sansom, F. I. Trimmer. 


Coogk 



NOTICES TO COBRESPONDBNTS. 


<jfl0tiCC0 to 

<irotteo)>onbmtjB, $hort %tiUts, ict, 

Co*iiirom>TS raqniriag & reply in thii column nra per* 
ticnlarly reqneeted to make oae of a diitinctiv* iignatwn or 
ia<Ma{«, and aroid the practice of aigning tbemaelrea '* Beaderi” 
“ Sobscriber," “Old Snbacrlber,” Ac. Vnob confnalon will be 
Bpared by attention to tbia role. 

Da. Maituhd Bakbat's paper ie marked for an early number. 

Da. J. PraciUAL Baowir (Uancbester).—We cannot lend onr 
colon na for the puipoee of criticising the conduct of another 
tntdical journal, bowerer veil founded }onr criticism may be. 

Caichab,— 1. The middle period of life is that in which locO' 
motor ataxy uanaJly comtn'ncea. No lees tbnn hatf the caaes 
begin between thirty and forty, one quarter between forty and 
fifty, and ratbi r leas than a quarter between twenty and thirty. It 
larrly begins after fifty, and still more rarely before twenty. 2. 
Malea snffer far more frequently than females, the proportion 
being about ten to one, and thia implies some proclivity fnberent in 
tbe male Bex. 3. One of the canaee wbirb can eometimes be clearly 
traced is injury, which inrolres concusBion of the spine. 4. The 
symptoms appear to develop gradually some weeks or montba 
after tbe injniw. 5. One of the best modem text-booka on tbe 
practice of medicine ia Oaler's “Principles and Practice of Medi¬ 
cine “ ; on Midwifery, Jewett or Qalabin. 

N. T. C.—The late Mr. B. B. Anderson left a wife and family in 
Tobago almost entirely, we believe, unprovided for. A Fund bae 
been started by Lord Stamford, Mr. Timothy Holmes, and others, 
with a view to rendering them some assistance, but we regret to say 
that thia effort has not met with much resMnse. It will 1 m re- 
memlMred that Mr. Anderson was awarded AaOO damages against a 
judge in Totego, bnt this verdict was set aside at the High Court 
by tbe late Chief Justice Coleridge, and it was in pursuit of tbe j 
endeavour to obtain redress for this injustice that ur. Anderson j 
came 10 much under public notice during the few yean preceding j 
bis death. I 

Lomax.—I n modem times, perhaps, tbe most striking atatis* | 
tics of the beneficence of vaccination are furnished the leMrta 
relating to the prevalence of small-pox in the Franoo-Oerman War. 
Tbe mortality among the French was 23,500. and among tbe 
Germans, who bad all been vaccinated, 268. These figures have 
never been disputed, and they can always be quoted in refutaiion 
of the misrepresentations of the anti-vaccinatioDists. 

Dn. M. W. Toxic symptoms asthe result of absorption of bella¬ 
donna from plaateraare by no means unknown, IndeM, they would 
probably be discovered, if looked for. In most instances of the appli- , 
cation of such plasters if they exceed, say 20 square inches. Nstn- ' 
rally tbe dearee of absorption will depend upon the thickness or 
otherwise of the skin. Asamle, but slight inconvenience is caused 
uuless there happen to be, or to form, a solution of cutaneous con- 
tinoity. • 

^ftectings of the §odctie 0 . 

LONDON. 

Wkpxespat, Nov. 27th. 

DBRMATOLOOICAL dOClKTT OF OuEAT BrITAIX ARP IrELARD (20 
Hanover Square. W.).—5 p.m. Meeting. 

UvRTERiAK HociETT.—(London Institution,Finsbury Circus,E,C.). 
>- 8.30 p.m. Patbolo^cal Evening. I 

Thvrspat, Dec. 5te. j 

Hartriar Socibtt of Lordor (Stafford Booms, Titchbome , 

Street, Edgwure Bead, W.),—830 p.m. Mr, C. W, Mansell 
MouUin: Some Unusual Effects of Moveable Kidney. 

Fridat, Dec. 6th. 

West Lordor Medico CBiRrRoiCAL Socibtt.— Clinical Meeting 
at tbe West London Hospital, when Mr. Keetley, Dr. Seymour 
Taylor, Dr. Saunders, and others, will show cases. i 

DUBLIN. 

WUDRBSDAT, Nov. 27TH. ' 

Dublin University.—Final Medical Examinations. Sections A ' 
and C, continued. 

Fbidat, Nov. 2PrB. 

Boyal Academy of Medicine in Ireland. Section of Pathology.— 
ExbilitsandCommunicatiom—1. Dr. Parsonai (a) Note onacase 
of Oastroectasls, (b) Anenmsm of Aorta. 2. Prof. O’Sullivan; 
Blood from case of Tropical Malaria showing Crescents 3. Mr. J. 
B. Story: Zonular ^Uract. 4. Mr, B. O. Croly; Sarcoma of 
Knee. S. The President: (a) Bemarks on the Causation of Vac¬ 
cinia (with lantern demonstration), (b) Tbe Bacteriology of a case 
of Snppnrative Pelopblebitia aecondary te a case of Appendicitis, 
(c) Hue Supra-reral Cyst. 

Boyu College of Surgeons. 830 p.m. 




Aird, I., M.B., B.S.Edln., Certifying Surgeon under the Factory 
Acts for ttie Bangor District of County Down. 

Bartor, G. a. H., U.D.Brax., M.B.C.S., L.S.A., an Honorary 
Assistant Anssthetiat to the City Orthopedic Hospital, 
London. 

Irole, C. D., M.B.C.S., F.B.C.F., Certifying Surgeon under the 


I Factory Acta for the Somerton District of the County ot 
■ Somerset. 

I Parbt, Lborarp a., F.B.C.S.£Dg., B.S.. M.D.Lond., Aavistant 
I Surgeon to the Sussex Era Hospital, Brighton. ^ 

Patxrsoh M. S.,M.B.. B.S.Durh.. M.R.G.S., L.B.C.P., Bcmdent 
Medical Oflicer to the Hospital forCooBumpti 'n. Brompton. 

BocHE, Redmord, A.B.. M.&C.S., L.B.C.P.. L.M., AUmding 
M^ical Officer, Westninater IMarensarT. Westminster. 

BELxiaE, J. Febdeeicx, M.S., Ch.6.Edin., House Surgeon to tbe 
ChicheBter Infirmarr. 

latandes. 

Couaty Asylum, Hickleover, Derby —Senior Assistant Medical 
Officer. Salary commencing at £150; also Junior Asnstsnt 
Medical Officer. Salary commencing at £120; both with 
apartments, besrd. washing,and attendinee. Application* to 
the Medical Superintendent 

Devookhire Hospitu, Buxton, Derbyshire.- House Surgeon and 
Assistant House Surgeon. Salary, Rouse Surgeon £100 per 
annum. Assistant £50 per snnum, with apirtments, board, and 
lodging. Applications to the Seoietarr. 

Dr. Bteerens’ Hospital, Dubliu.—House Surgeon. Salary £l<i0 per 
annum, with apartments, fire, and light. A jiplications with 
copies of testimonials, to be addressed to the Ooremors not 
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Zoology, Practioe of Medicine and Surgery. Particulars as to 
dates emoli<ments. Ac., on reference to our advertising ooiumns. 

Manchester Hospital for Consumption and Dis'iasea of the Throat 
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North Staffor^hire luflrmary and Eye Hospital, Hartsbil].- 
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Owens (College. Manch*8‘or.—Assistant Lecturer in Patholc^. 
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Boyal Hospital for Incurables, Donnybrook. Dublin.—Vesideat 
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#irth0. 


Drabble. - On Oct. 22nd, at the Manor House, Walton-on-Tbamee, 
the wife of Uro. W. Drabble, M 8.. M.Ch.. of a djaughtar. 
Fxrrarves. • On Nov. 20th, at Aokwi^rth, Yot kshire, the wife of B. 

W. L. Femandee. M B , C.M , of s daughter. 

BoGER-SiirrH. - On Nov. 21st, at 1, College Terrace, Hampstead, 
the wife of Hugh B<^r-8mitb, M.D., of a son. 




Coox— Claxtor. - On Nov. 23rt, at All Souls’ Church. Langham 
Place, Lo^on, W.. Joseph B. Cook, L.B.C P.. M.R.C.S., of 
Ps<d^gton Street Islington, to Malvioa (Millie), only dangbter 
of the late Jeese ()laxu>n. Esq., solicitor, of Ely, Csmbe. 

Btall- Collier.— On Nov. 2Srd, at St. George’s Church, Hanover 
Square, London Charles By^, F.B.C.S., youngest eon of the 
late Ed. C. Byall, Surgeon to tbe l8th Royal Irish Regiment, to 
Frances Mary, dan^ter of the late Thos. Collier, J.P., of 
Alderley Edge, Cheenire. 


SeathB. 


Clivt.—O n Nov. 23rd. at Kno'e Lodge, Trestillian Boad, Brockley, 
S. £ , Samuel Clift. Deputy Inspector-General, B.N (retired), 
H.B.C.8.. aged 78 years. 

Doric. —On Nov. 83rd, at Townfleld Honae, Keighley, Yorks, Wm. 
Doble, M.D., J P., aged 67 years. 

HORROCEB.-On Nov 16th, at Shorebam, Great Croeby, Lancs., 
Wm. Hy. Uorrocks, M.B.C.S.. L 8.A., aged 86. 

Llotd.—O n Nov. I5th. at Ammanford, Catunarthen, Evan Lloyd 
M.B C.S., L.aA. 

Marlet.— On Nuv. ]6th, at Cheltenham, S Argeon-Oeneral William 
O. N. Manlev, C.B., V.C., M.B.C.S.Eng., Army Medical Stall 
(retired), in hia 70th year. 

Mitchell. On Nov. I3ib, at Kinnehy. King’s County, Adam O. 
Mitchell, L.B.C.P., L.B.C.8. Ed.. agM 45. 

Sturors. On Nov. 16th, at (Hrtn, Baird's Hill, Broadstain, 
Montague James Sturges, M.D.Bdln, aged 66. 

Svtherlahd.-Od Nov. )9tb, at21, NewCivendish Stroet,London. 
W., Henry Sutherland, M.A., M.U.Oxon., M.B.C.P., secona 
eon of the late A. J. Sutherland, M.D., F.R.C.P., ¥.&&, 
aged 56. 


Googif 



He ^edieal ^ress Cieeute. 

“SALUS POPULI 8UPBEMA LEX." 


VoL. CXXIII. WEDNESDAY, DECEMBER 4, 1901. No. 23. 

(Driginal (Eontmunicattonst. 

NOTES ON A CASE OF 


SUPPURATING OVARIAN CYST, 

COMPLICATED WITH A LARGE 

INTRAPERirONEAL ABSCESS, (a) 

By HENRY JELLETT, M.D., F.B.O.P.L. 

Ex-Auistant Sfaster, Botnsda Hospital. 

The following case is, I tbiuk, worthy of being 
brought to the notice of tlie Academy. It furnishes 
an example of a happily not rery common complica¬ 
tion of an ovarian cyst, and is for this and perhaps 
for other reasons of interest. Before proceeding to 
rdate it I must mention that I am not alone respon¬ 
sible for the good results with which its treatment 
was attended, but that it was a case the major credit 
for which belongs to our late President, Dr. A Y. 
Macan, who was the first person to operate upon the 
patient. 

Case. —Mrs. K. D., at. 38, was admitted to Sir P, 
Dun s Hospital, under the care of Dr. Macau, on July 
27th last. The patient at the time of admission was 
in an extremely critical condition. She suffered from 
great pain over the abdomen, loss of appetite, thirst, 
vomitmg, extreme constipation, and debility. These 
symptoms bad been present to a marked degree for 
the previous five weeks, but prior to that Ume she 
stated that her health bad been fairly good. Her 
temperature on admission was 101® F., and her pulse 
varied from 100 to 120. On examination, her abdo¬ 
men was found to be distended, owing to the presence 
in the lower part of a larw and tense tumour, in the 
upper part of distended intestines. By vaginal ex¬ 
amination, a tumour could also be found filling 
Douglas’ pouch. The patient was kept under obser¬ 
vation for a few days, and attempts made to secure 
an evacuation of the bowels. As, however, there was 
no improvement, but rather a deterioration in 
her condition, Dr. Macan determined to open the 
abdomen. On July Slst, he accordingly operated 
upon the patient, a proceeding at which he kindly 
mvited me to assist. On opening the peritoneal 
cavity, it was found that the tumour was formed by 
a very large and very fcetid collection of pus among 
the^testines. The collection extended upwards to 
slightly above the umbilicus, and downwards to the 
bladder, and the upper portion of Douglas’ pouch. 
There were, as is usual, several loculi in which further 
Md equally foetid collections of pus were found. 
With considerable difficulty all the contents of 
the abscess were evacuated, and the cavity was 
washed out and plugged from above with iodoform 
gauze. The abdominal wound was then closed 


(fl) A Paper read before the Obetetrioal Section, Boyal Academy 
of Medicine, Ireland, Kovember 22nd, 1901. 


save for a portion of the lower end, through which 
the gauze emerged. I may mention that towards 
the end of the operation the advisability of draining 
from the vagina was discussed, and with a view to 
making the necessaiy opening. Dr. Macan asked me 
to pass my fingers into the vagina in order to deter¬ 
mine the direction in which an incision should be 
made. However, when I had done this, we found 
that the collection of pus had not extended to the 
bottom of Douglas’ pouch, inasmuch as the latter 
was occupied by a swelling the size of an orange, 
anteposed to which was the uterus. The condition 
of the patient at this time was so bad that it was 
determined not to remove this mass, but to trust 
to drainage from above. This decision I consider to 
have been very wise, as the further manipulations 
which its removal would have entailed would quite 
possibly have been sufficient to turn the scale against 
the patient. 

The condition of the patient after the operation 
was very critical. She suffered much from vomiting, 
her pulse was weak, and her temperature sub-normm. 
She, however, was able to take small amounts of 
liquid nourishment, and on the second day after the 
operation her bowels acted. On August 3rd Dr. 
Macan went for bis holidays, and the patient came 
under my care. She was then, to my mind, in an ex¬ 
tremely bad condition, as a consequence of toxic 
absorption from the abscess. Her pulse was very 
feeble, and her temperature varied from sub-normal 
to 101® F. Her skin was jaundiced, her eyes sunk in 
her head, and her mind wandering. Further, it was 
difficult to iudnce her to take nourishment. The 
wound had been dressed twice dmly since the opera¬ 
tion, and the cavity douched out and plugged lightly 
with iodoform gauze. In spite of this, the smell of the 
discharge was still most offensive. As the solution 
with which the cavity was douched did not seem to 
produce any good effects—1 believe that lysol bad 
been used, I desired the nurse to inject instead a 
25 per cent, solution of sanitas in warm water, and to 
wash out the cavity still more frequentlv than she had 
been doing. I had^, however, very little hope of effect¬ 
ing a go:^ result. The next day the patient was 
sligbtlj better. The day after her condition was 
again improved, and the discharge was losing its ex¬ 
treme fmtor. This gradual improvement continued, 
until, by August 8th, the temperature had fallen to 
almost normaL At the same time the abscess cavity 
was becoming notably smaller, and in a few days more 
it was possible to dispense with all plugging. 

I may mention, incidentally, that in consequence of 
the infection of the abdomimd wound by the contents 
of the abscess, all the sutures had cut out, and the 
entire wound, save for what was apparently a peri¬ 
toneal floor, bad reopened. As a result of the dis¬ 
tended condition of the intestines, to which I will 
presently refer, this raping became ver^ marked, and 
must have measurea as much as two inches across. 

cog e 


Di'- ‘ .:ed i 







592 Thi Mkdioal Pebss. ORIGIJ^AL COMMUNICATIONS. Dec. 4. 1901 


According]]^ as the condition of the patient was daily 
improving, I determined to bring together the edges 
with sutures. This I tried to do on August 19th, 
the sutures being passed subsequently to endermal 
injections of cocaine. In consequence, however, of 
the extreme thinness of the walls, and of the Sac- 
cidity of the skin, it was impossible to obtain a firm 
suture-hold of anything save the skin, and even then 
the main result of the sutures appeared to produce 
an inversion of the latter. However, the results of 
the re-suturing were not so bad as they appeared, 
the wound was immediately diminished by about 
half its width, and this was subsequently again 
further diminished by straps of adhesive plaster 
pulling over little rolls of cotton wool placed in the 
wound to keep the skin from inversion. 

Unfortunately, the great improvement which bad 
taken place in the patient’s condition proved to be 
only temporary, ana about September Ist she showed 
signs of returning to her former state. Her tem¬ 
perature again rose, reaching a height in the evening 
of 101® F.,her appetite was lost, the abdomen became 
very tympanitic, and it was almost impossible to get 
the bowels to move. I then examined the abdominal 
wound very carefully, but could find no sign of any 
accumulation of pus in its neighbourhood. The 
small sinus which a few days previously had lead 
to the former site of the abscess cavity, was almost 
completely closed. It appeared to be in every way 
healthy, and there was no evidence of any accumula¬ 
tion of pus around or below it. Accordingly, I made 
a vaginal and rectal examination, and was then easily 
able to determine the pi'esence of a swelling com¬ 
pletely filling Douglas' pouch, pressing upon the 
rectum, and obviously containing fluid. It was ap¬ 
parently larger than at the time of the operation. 

As this swelling was obviously the cause of the 
patient’s condition, I determined to remove it with 
as little delay as possible. Accordingly, on Sep¬ 
tember 5th, five weeks after the first operation, with 
the assistance of Dr. Kennan, I opened the posterior 
vaginal fornix in the usual manner. On reaching 
Douglas' pouch, I found that my fin^r came into 
contact with a well-defined tumour, adherent to the 
neighbouring structures and containing fluid. The 
adhesions to the floor of Douglas’ pouch could be 
easily broken down, but, when the finger came to 
the upper portion of the tumour, they were found to 
be very dense. Whilst breaking these down, a portion 
of the tumour was tom and a quantity of very foetid 
pus escaped. With some little difficulty the entire 
tumour was separated from its upper attachments, 
and remained alone attached by what was apparently 
a pedicle connecting it with the right cornu of the 
uterus. There was no truce of any structure resem¬ 
bling the pelvic-infundibulo ligament. As there was 
a considerable amount of hsemorrhage from the 
broken down adhesions and possibly from the re¬ 
mains of this ligament, I applied a clamp to the 
pedicle, divided the latter, and removed the tumour. 
Then, as there was no bleeding point to be seen, but 
a quantity of general oozing, 1 plugged the pelvis 
with gauze sponges wrung out of water at a tempera¬ 
ture of about 115® F., taking care not to disturb the 
clamp. The following day I removed the sponges, 
a process which necessitated tb^ administration of 
nitrous oxide gas. 1 had not intended to remove 
the clamp until the following day, but it came off 
in the process of re-plugging the pelvis, the reason 
for which was subsequently made very obvious. 
There was, however, no hemorrhage. There is little 
more necessary to add. I ro-plugged the pelvis each 
day through a glass speculum, inserted through the 
opening in the vaginal fomix. For the first few 
days, it was necessary to administer an amss- 
thetic, as the patient could not bear the pain 
which the proceeding caused. Each day the 


cavity became a little smaller, the patient’s 
temperature gradually fell to, and then re¬ 
mained at, normal, and her condition materially 
improved. About the middle of September Dr. Hacan 
returned, and I resigned her to bis care. She con¬ 
tinued to improve steadily from day to day, and on 
November 10th she left the hospital. 

The history of the clamp, which fell off, is not xm- 
interesting. It was given to the nurse to wash, and as 
soon as it was placed in warm water one blade fell off. 
It had apparently cracked half across at the lock 
during the application, and then completely across 
whilst it was in eitu. The dried blood with which it 
was covered had, however, proved sufficient to hold it 
together. The clamp had been made in Germany. 
The moral is obvious. 

Theie is one point which this case shows very 
clexrly, and that is the amount of foetid pus which 
can be present in a patient without interfering with 
the temperature, when once she has become so to 
speak inocculated against such pus. In this case, 
after the patient had recovered from the first opera¬ 
tion, her temperature fell to normal, and remained 
BO for seventeen days. Yet all the while, there was 
an accumulation of most feetid pus in the pelvis. 

The action of sponges wrung out of very hot water 
in checking what was a considerable amount of 
hemorrhage, was most satisfactory. Their temporary 
use had Mea suggested to me by Dr. Glenn in a 
previous case, where they had also succeeded admir¬ 
ably. In this case they were allowed to remain 
as a substitute for iodoform gauze, and were removed 
without difficulty on the following day. 

The cause of the large abscess wnich Dr. Macau 
opened, seemed to be very obscure at the time of bis 
operation. There was a collection of pus among the 
intestines, apparently unconnected with any tanmble 
source of infection. The discovery subsequently of 
the suppurating ovarian cyst will, however, I think 
explain ite origin. To my mind, the case was ori¬ 
ginally one of an ovarian cyst, the pedicle of which 
became twisted. The contents of the cyst were then 
infected from the rectum, and this infection extended 
in turn through the walla of the cyst into the peri¬ 
toneal cavity setting up a localised peritonitis, and 
ultimately leading to the formation of a large 
abscess. 

5^tnch (Eliitical %ccturc. 

treatmen'Fof diabetes. 

By Dr. LEPINE, 

Professor kgrf'gi at the Toculty of Uediciae of Lyons. 

First of all, and before dealing with the treatment, 
it is necessary to question the patient closely on his 
mode of living. Men are frequently bad observers of 
themselves, and it is necessary to verify their asser¬ 
tions by appealing to those who live with them, 
especially their wives. In this way certmn important 
particulars, harmful habits and the like, may be dis¬ 
covered. Last year I was consulted by a diabetic 
patient, set. 50. He was free from every hereditary 
taint', and led a vei 7 sober life. After long question¬ 
ing I found out that he had been lix ing at one time 
three miles from his place of business, and had 
walked the distance four times daily, doing thus 
regularly twelve miles. A few months oefore coming 
to consult me he came to live at his place of business, 
and consequently was deprived of his hygienic 
promenade. I prescribed two hours’ walk a day, and 
naturally ordered some restrictions in his diet, and 
the glycosuria disappeared. 

Aitw correcting hygienic defects of the patient the 
medical examination commences—hereditary and 
personal antecedents, actual condition. &c. After 


C 


4. 1901. _OBIGINAL COMMUNICATIONS. Th. M.dical Pbiss. 693 


these investiRations we pass on to the state of the 
arine, how much sugar ? What kind of sugar P Are 
there other anomalies of the urine, notably albumi¬ 
nuria, renal casta P Does the urine give the reaction 
of Gerhardt (port wine colour when perchloride of 
iron is added). 

The determination of the quantity of sugar ex¬ 
creted in the twenty-four hours is of value only when 
it is exact. The sample of urine to be test^ should 
not be taken at any hour of the day but from the 
total quantity of urine emitted in the twenty-four 
hours; further, it is well to put the patient for two 
or three days on his ordinary diet The quan¬ 
titative analysis of sugar should be made both by 
the polarimeter and by the aid of Fehling’s solution, 
the one controlling the other. After estimation of 
the sugar we next ascertain the proportion of urea, sis 
it is necessa^ to know the deg^ of disassimilation 
of albuminoid foods. In this respect it is too fre¬ 
quently forgotten that all men are not equal; there 
are big and small, fat and thin, old and young. To 
compare the urea with the body weight, as is some¬ 
times done, is good as far as it goes, but it is not 
sufficient; if a precise estimate is to be made it is 
indispensable to compare it with the quantity of 
fixed albumin contained in the body of the subject. 

The proporiion of sugar to urea is not without 
interest. Let us take a patient with diabetes—that 
is to say, one who fails to bum up the sugar which 
he forms at the expense of the albuminoid elements, 
and who states that he is following a strict anti¬ 
diabetic regime. If the proportion of sugar to the 
urea is five or six of sugar to one of nitrate of urea, 
then either the patient does not observe strictly his 
regime or the diabetes is very grave. 

Albuminuria is very common in diabetic patients. 
This fact, insisted upon by M. Stokvis (18^) is too 
little known by physicians, because they generally 
consider a little albumen as of no importance. But the 
outcome of investigations made by Ktilz and Ton 
Koorden tends to prove that in two-thirds at least of 
the cases albumen was present, and in a large number 
of these cases (60 p^r cent.) renal casts were aW 
seen, revealing the existence of renal irritation. This 
latter symptom is important in the treatment of 
diabetes, because where a large number of casts is 
present any remedy capable of irritating the kidney 
should be avoided, nephritis, however slight, being 
one of the most favourable conditions to the develop¬ 
ment of premonitory intoxication of coma. 

The urine of healthy individuals may contain 
traces and sometimes a rather lai^r proportion of 
aeet^, consequently it is not acetonuim but diace- 
iuria that must be looked for in diabetic patients, 
because it affords the surest indication of the condi¬ 
tion of the patient. Nothing, on the other hand, is 
easier than the detection of diaceturia; it is sufficient 
to add a little perchloride of iron to the urine. If 
the mixture turns the colour of port wine, the urine 
contains diacetio acid. This is the reaction of 
Gerhardt. 

The presence or otherwise of this acid is of the 
utmost importance in regard to the proraosis of the 
malady. As long as there is no acid the treatment 
may be limited to suppressing the glycosuria by a 
strict regimen and appropriate medical treatment, 
but if diacetic acid be present the glycosuria passes 
into the back ground, and all our efforts should be 
concentrated on the removal of the acid. 

Treatment of diabetee where diacetic acid ia aheent. 
—(a) Diabetes in which the glycosuria diappeared 
even under the influence of a prescribed regime. 
The first thing to do is to submit the patient during 
three days at ^aat to a regime consisting of albu¬ 
minoid and fatty substances, meat, fish, cheese, 
cream, eggs, walnuts, Ac. But in order that the ex¬ 
periment should be of any value, it is necessary to 


take into account the qtuintity of food daily ingested. 
It is _ also absolutely necessary that the regime be 
sufficient to maintain the nitrogenous equUibrium of 
the patient, for though a starvation diet is very effec¬ 
tual against the sugar, it is not very practical, because 
m suppressing the glycosuria it may kill the patient. 
On the other band, an excess of albumen would be 
veiy injurious, consequently the nourishment should 
hejuat aufficient, taking into account the weight of 
the patient, whether stout or thin, Ac. If, thanks to 
this regime, the sugar disappears, the patient may 
be considered to have a mild form of diabetee 
and should no complication arise the malady may be 
regarded as benign. 

(6) Diabetes in which the glycosuria is merely 
diminished by the regime. 

Here the treatment is more difficult, since even 
with a strict diet the sugar is merely diminished in 
quantity, and not got rid of altogether. In such 
cases the strict meat diet has been highly recom¬ 
mended, but in spite of Cantini’s authority, 1 do not 
hesitate to affirm that this practice is dangerous, as 
it has a tendency to irritate the kidney and to in¬ 
crease the albuminuria, and in some cases it increases 
the glycosuria by rendering the kidney more per¬ 
meable to sugar. The reality of rencu diabeiea is, 
however, not generally admitted as yet, but it is 
beyond doubt that we must even now accept the 
existence of a rmal element in diabetes. In other 
words, of two patients with the same degree of byper- 
glycffimia will excrete urine containing but little 
sugar, and the other a great deal bemuse their 
kidneys are unequally permeable; a fact, which 
clinic^ experience shows us every day. 

Treatment of Diabetee with Diacetic Acid in the 
Urine. —It is hardly necessary for me to recall the 
fact that diabetic patients whose urine contains 
diacetic acid also excrete acetone. We meet, how¬ 
ever, with many persons who excrete a email quan¬ 
tity of acetone without any appreciable diaceturia, 
but there does not exist, to my nowledge, diaceturia 
without acetone. More frequently, if not always, 
these patients have also oxybutync /3-acid in the 
urine. 

As to the origin of these substances, there is still 
a great deal of uncertainty. Some years ago it was 
thought that the albuminoids were the exclusive 
source, but the researches of Geelmuryden seem to 
prove that fatty matters are a very important source 
of oxybutyric acid and its derivatives, diacetio acid 
and acetone, hence the indication for diminishing 
the ingestion of fatty substances. 

Although in certain diabetic patients diaceturia 
may persist for montha without any apparent incon¬ 
venience ; the indication is absolute, viz., to arrest 
this grave complication. Everything should be 
brought to bear on this important point. The 
means at our disposal are by diet and suitable 
medication. 

Free ingestion of carbo-hydrates ia frMuentl^ fol¬ 
lowed by a decrease of diaceturia. That is an 
important fact, but it cannot entirely satisfy us, 
bemuse, on the other hand, the glycosuria is in¬ 
creased. Consequently, it is necessary to find some 
other substance. Schultzen, a long time ago, 
thought that he had found this substance in 
glycerine, his belief being based on the theory that 
the sugar by absorbing an equivalent of water was 
converted into glycenc aldehyde and glycerine. 
Unfortunately experience did not bear out this seduc¬ 
tive theory. 

According to If. Schwartz, a derivative of glucose, 
gluconic acid, that is to sav, glucose already in wrt 
oxydised, would diminish the diaceturia better than 
the glucose, and. in fact, the case published by M. 
Shwartz is worthy ofJ attention. It was that of a 

OOglt 



594 Tei Medical Pbsbb. ORIGINAL COMMUNICATIONS. 


Dbc. 4, 1901. 


jomig man suffering from grave diabetes with pol- 
monarj phthisis. During the six weeks of his 
sojourn in the hospital of Pra^' e the patient fell 
three times into a comatose condition, witn increase 
of excretion of acetone. The first time, and while he 
had been already unconscious, he was ^ven, in a pint 
of water, 70 grammes of gluconic acid, neutralised 
by 140 grammes (five ounces) of bicarbonate of soda 
of this last Bubstwce being given by the month and 
by the rectum. Although the acidity of tbe urine 

S ersisted, the patient recovered consciousness; the 
yspncea, which was very marked, disappeared, and 
the condition of tbe patient remained satisfactory for 
three weeks; but tne increase of fatty food, aug¬ 
mented again the acetone, and a second attack of 
coma was the result; similar treatment was ordered, 
and for fifteen days all went welL He bad, however, 
a third attack, and this time he was treated exclu¬ 
sively by bicarbonate of soda, gluconic acid being 
unobtainable, but he succumbed tbe third day of the 
coma. 

It is evident that in this remarkable case gluconic 
acid saved the patient twice. It seemed to have 
acted ss a genuine curative agent. However, it is 
impossible to base any conclusion on an isolated 
case, and it is to be hoped that we shall soon have a 
sufficient quantity of gluconic acid to experiment 
with, not only in coma out also in the acid dyscrasia, 
before the appearance of the typical dyspncea. 

Until that time, however, we must always have 
recourse to bicarbonate of soda in very lai^ doses; 
is in any case a very useful medication, and has 
saved many patients. 


A NOTE ON THE 

MODERN TECHNiyUE 

OP 

POSTERIOR VAGINAL 
CCELIOTOMY. {a) 

By E. HASTINGS TWEEDY, r.R.0.P.I., 

Ex-AwiatABt Mut«r, Botonds Hoapital. 

The specimen I have tbe honour of presenting to 
your consideration this evening consists of the right 
Fallopian tube and a parovarian cyst removed from a 
very stout patient of mine in Steevens, Hospital, by the 
operation known as Prior’s posterior vaginal coelio- 
tomy. Prior's operation does not appear to have re¬ 
ceived the attention it deserves either in this country 
or yet in En|;land, and it is for the purpose of 
eliciting the views of members here to-night con¬ 
cerning it that I now present this very common-place 
specimen. With a few exceptions Irish surgeons 
seem to have made incision into tbe anterior fornix 
their operation of election when performing col- 
potomy, and there does not appear any indication 
that the operation is advancing in popular favour, or 
even holding its own. 

The objections ur^d against it are, that tbe 
limited opening into the abdominal cavity does not 
permit of the various steps of tbe operation being 
seen, consequently irreparable barm may be infiicted 
on important structures, which neither the sense of 
touch, nor a previous knowledge of anatomy can 
safeguard. 

I ^lieve we possess in Prior’s opteration a means 
of overcoming these, and other objections, to a con¬ 
siderable extent, provided conditions be favourable; 
or, in other words, provided a woman has borne a 
full-term child, and the vagina be not inflamed or 
abnormal. 


(a) A Paper read before tbe Obitetrical Section of tbe Beyal 
Aeademr of Medicine in Ireland, on Nor. 22nd, 1901. 


In the removal of this tumour I followed bis pro¬ 
cedure, which I shall now describe in detail. The 
patient, a very stout woman, with a roomr va^a, 
was prepared as for an ordinary abdominal section, 
ansBstbetised, and then placed on Bumdt’e operating 
table, in the usual dorsal position. The shaved vulva 
and the vagina were now for the second time 
scrubbed thoroughly with soap and water (green s cap 
is to be preferred), then douched out with creolin 
solution, and finally bathed in an alcoholic solution of 
blniodide of mercury (1 in 1,000). This latter anti¬ 
septic is the one now most relied on in Steevens’ 
Hospital for tbe final stages of skin disinfection. It 
has not alone the merit of great penetrability, but 
likewise hardens and comifies epithelium, so hinder¬ 
ing maceration and its removal daring the operation. 
Abullet forceps was then attached to the posterior 
cervical lip, and the fornix exposed by means of a 
Martin's speculum. On moving the cervix up aod 
down, the crescentic fold, which indicates the reflection 
of the v^ina on to the cervix was clearly made ouL 
This I picked up by a forceps, and incised the 
vaginal mucous membrane to tbe extent of about an 
in^, in the transverse direction, b^ means of sharp 
pointed scissors. This incision did not go deeper 
than tbe mucous membrane. A catch forceps was 
then fixed on the posterior flap, and my assistant 
was directed to make firm traction on this, as well 
as on the forceps attached to tbe cervix. My index 
fingers were now inserted into the wound, and tore 
wi^ ease through tbe peritoneum, close to its 
uterine reflection. Before withdrawing the fingers 
the wound was enlarged by lateral tearing. This 
procedure is easily carried out, and does not involve 
fear of inju^ to the ureters, nor to the uterine 
vessels, provided undue foi'co be not employed. The 
fingers having been withdrawn, a gauze wipe wrung 
out in saline solution, and to which a piece of silk is 
attached for ease in its removal, was now placed 
in the abdominal cavity to collect blood or o^er 
discharge, and to partially shut ofE the intestines 
from dust infection. 

Tbe next step of the operation consisted in the 
passing of two long vaginal retractors into tbe 
wound, and the removal of all other instruments 
from the vagina. The table was now lowered, so 
that the patient with her knees still in tbe gyneco¬ 
logical crutches, assumed the “head downward’’ or 
Trendelenberg position. On now widely separating 
tbe retractors the intestines could clearly be observed 
as they slowly receded from the field of operation, 
and an excellent view of the cyst^in size about 
that of a billiard ball—was obtained. The anterior 
blade was now removed, and tbe tumour seized by a 
couple of fingers presented no difficulties in its re¬ 
moval. The patient, raised again to the horizontal 
position, had tbe temporary pad removed, a strip of 
moist iodoform gauze was inserted just within the 
lips of tbe wound, and the vagi^ well packed around 
the fomices with similar material. This packing was 
taken out on the third day, the patient being under 
the influence of chloroform, and lying in the Sim’s 
position. A new one was inserted, but not through 
the wound, this being a departure from the original 
operation, which provides for a draina;^ for seven 
days, an unnecessary precaution to my mind. 

Dilatation of the sphincter, and the passa^ of a 
catheter every four hours are further suggestions tbe 
soundness of which will not be called in question. 

Tbe operation as thus described is a simple and 
rapid procedure, and remarkably free from compli¬ 
cations. It is obvious that it possesses a wide range 
of usefulness, but as the indications for its employ¬ 
ment are now sufficiently well known I need not 
dwell on them. As a means of gaining acc^s to, 
and a greater knowledge of, the structures on while 

: CoogL 


I 


Dec. 4, 1901. 


OHIQlNAIi GOMMUNICAX'IONS. Tbi Midioal Pbsss. 595 


we intend to operate, I belieTe it to be far superior 
to tbe older operations. With it injuries to the 
rectum should be avoided, while adhesions can be 
attacked, and separated with as much ease, and with 
far less dan^r, than if dealt with br means of a 
supra-pubic incision. Moreover, should the bowel 
give) waj while endeavouring to combat adhesions, 
the accident is not likely to prove of a very formid* 
able character. The generu peritoneal cavity is 
almost certainly shut off from infection, and tbe 
rupture, even though unclosed at the time of opera- 
tioo, will heal spontaneously in the majority of io* 
stances. I hold that all recent cases of pyosalpinx, 
which call for operative interference, should, when 
possible, be approached through the vagina. Mul¬ 
tiple incisions into the abscess cavities, with subse* 
quent drainage; the whole procedure, guided by 
sight and touch, eveu though it fail to effect a per¬ 
manent cure, will at least render any more radical 
operation afterwards undertaken comparatively safe. 

I trust I shall not be understood as saying that 
the operation just described marks any radical 
departure in vaginal coeliotomy. I am aware that 
posterior colpotomy has been performed very fre¬ 
quently by different surgeons in this city who can 
^tify to the easy manner in which tubes and ovaries, 
even though normally situate, can be palpated and 
directly examined by its means. Miy contention 
merely is that Priore operation makes a step for¬ 
ward in its technique, and somewhat enlarges its 
scope. Furthermore, it is obvious that anterior 
colpotomy must of necessity remain the proper 
operation under certain conditions. Finally, 1 should 
llxe to point out the great advantage afforded by 
modem operating tables, giving as they do a good 
TrendelenMrg position, without which Prior’s opera¬ 
tion becomes impossible of execution. And of 
scarcely less importance is a sufficiency of light 
hardly procurable in any but tbe recently built 
operating theatre, of which we possess a very good 
example in Steevens’ Hospital. 


%hz 1901 . 


TWENTY-FIVE YEARS' EXPERIENCE 

OF 

URINARY SURGERY IN ENGLAND. 
Dxzjvbrbd befobb thb Habtbiak Society of 
London, Noybubbb 21st, 1901. 

By G. BUCKSTON BROWNE, M.R.C.S.Eng. 

Abstract of Lbctubb III. 

The most important of tbe complaints which par- 
ricolarly concern the male urethra is certainly 
urethr^ stricture, especially when we consider tbe 
really fearful methods of tr^tment in vogue during 
the early part of the last century, and the dangerous 
operations to which patients were subjected, and 
which even now linger among ns. The t^tment of 
certain disorders of tbe nrethra have been so modified 
and chang^ that urethral strictures are undoubtedly 
less severe than they were, and less frequently met 
wito, and when met with are so mneh better treated 
that the modem stricture patient, if he is willing to 
submit to a very mild and gentle discipline, may 
usually view ^ future with perfect calm and 
equanimity. Strictures of tbe urethra may clinically 
be divided into two great classes—those which 
readily yield to dilatation and which can be kept 
open by toe easy and periodical introduction of a 
bougie, and those which cannot. It is this 
latter class of stricture which 1 propose to con¬ 
sider to-night—that is, those which do not yield 


to dilatation. It may be asked why should anything 
more be done if a patient can manage to make his 
water, and if his stneture will admit a small bougie P 
Apart from the constant danger of complete reten¬ 
tion of urine, there is always the possibHity at any 
moment of a urethral abscess, which is probably at 
first a peri-urethral abscess, with all the subsequent 
dangers and troubles of urethral fistuls, w-nd even if 
no abscess forms, it is certain that in time serious 
v^ical trouble will arise, the bladder may as it were 
give up tbe straggle and become atonied, or it may 
become inflamed, contracted, and intensely irritable, 
tbe kidneys will become pyelitic, and finally there 
will be interstitial nephritis, suppuration, and death. 
If. in a case of stricture, a bourie as large as No. 8 or 9 
(Euglisb scale) cannot regularly passed, and passed 
with ease and comfort, something more radical must 
be attempted, and this more radic^ treatment has very 
much occupied the minds of surgeons for the last fifty 
yeaiB. 

The history of the exact inception of internal ure¬ 
throtomy is a little obscure, but it is certain that in 
1827 an English sur^on, Mr. Stafford, of London, 
first brought forward his urethrotomes, which are 
undoubtedly the prototypes of all later instruments. 
About 1865 the forcible rapture of stricture, gener¬ 
ally called Holt's operation, attracted a go^ deal 
of notice, tbe operation consisted in passing tbrough 
tbe stricture a small railway, along which a metalSo 
wedge was suddenly pushed in with considerable 
violence, and tbe fibres of toe stricture ruptured. I 
often saw this done in my early days. It was an 
operation founded upon thoroughly unsurgical prin¬ 
ciples, and practised by those who would nave bad 
no sympathy with the views of the real nature of 
urinary fever, which I enunciated in my first lecture. 
I hope and believe that the operation is now dead, 
and thoroughly forgotten. Then in the late seven¬ 
ties came the treatment of stricture by electrolysis, 
it was introduced with great eelat at one of our 
London societies. I think some fifty cases at first were 
published, andeveiy ooe was said to be perfectly sue- 
cessful, there was not a single failure among them aR 
I pointed this out at the meeting as a saspicioas 
sigD, but the treatment was taken up vig^rouslyi RRd 
papers and books, full of successes, were published 
by snrgeoos of position. Where is tbe treatment 
now P Of all these treatments internal nrethrotomy 
is the operation which I believe has come to stay. 
It is in my opinion the one treatment for all stric¬ 
tures which will not yield to dilatation. I will briefly 
state wbat I mean by internal urethrotomy. I mean 
the free division—no scarifications, no nicks, no 
multiple incisions—but one bold free stroke of tbe 
knife through all the fibres of the stricture in the 
floor of toe urethra, since almost invariably the in¬ 
duration is most marked there. I maiotain that this 
can only be done by an instrument which becomes 
practically a long kwe in tbe operator’s band, anH 
which is entirely under the control of that hand, 
subject to no mechanical restraint whatever, and 
entUng, much or little, when and where, just as the 
surgeon’s tactile sense informs him is necessary. 

I prefer to cut from behind forwards, or from left 
to right, and the instrument which permits of this, 
and at the same time is simply a knife 
and nothing more, is the urethrotome usually 
credited to Civiale, and always recommended 
and used by Sir Henry Thompson. The blade 
is protruded beyond the smeture, and then 
drawn forwards, the stricture divided, the blade then 
sheatoed, and toe instrument witbdravm. It is 
difficult for me to express in sufficiently moderate 
words my disapproval of such an instrument as 
Maisonnenve’s, which still figures in our text-books, 
and may be taken as the type of instrument pre* 

, /L.OOglc 


596 Thb Midical Pbibb. ORIGINAL COMMUNICATIONS. Drc. 4, 1901. 

ferred by tboee who would make surgery aoytbmg groping and trusting to good fortune, whereaaltbe 
but wbat it ought to be, namely, a handicraft, sui^on should rely upon nimself—that is, upon bis 
l^fore, boweyer, a Civiale’s urethrotome can be sense of touch. Filiform bougies are really 
introduced the stricture must be dilated up to at dangerous. When actually in the bladder they 
least a No. 6, and 1 have found in practice that it is ma^ break and lead to yery unpleasant consequences, 
always possible, after haying passed a No. 1, to do so. Filiform bounes are misleading also; no one can be 
indeed I can only recall one case where this was sure where they really are, they may double up and 
difficult, it is, however, “ le premier pas qui coute,” really penetrate no distance, or they m^ pass into 
and this leads me to the question of the fistu^ or false passages. I regret to find that they 
treatment of different strictures, strictures which do are still recommended in the latest works on surgery, 
not come to the surgeon until instrumentation is, if In the passage and dilatation of really difficult 
not apparently impossible, at least very difficult, strictures 1 have no confidence in any instrument 
In ormnary practice, if a patient in such a condition except steel ones. No silver catheters are strong 
have complete retention of urine, the aspirator will enough, and 1 have even given up using the probe* 
probably oe used, and it may be used several times, pointed silver catheter of Syme, which for a long time 
and stiQ the stricture be found impassable by in- was a favourite of mine. I prefer finely-polished 
stmments. Symes said, and I entirely agree with rigid steel instruments, instruments which will not 
him, that puncture of the bladder for retention of bend or yield under any proper force, and therefore 
urine Is fully warranted in military, naval, and allow of the most exact and accurate manipulation, 
country practice, but “ when hospital surgeons con- I employ a set of sixteen sounds, eich one is two sizes 
fess that they freouently find it necessary to nunc* larger in the shaft than at the point, the smallest 
ture the bladder, the standard of professional skill being No. 2 in the shaft and less than No. 1 at the 
is lowered to a degree which may prove injurious to point (marked 0-2), the next being 3 in the shaft and 
the interests of the public.” After aspiration of the I at the point (marked 1-3), and so on up to the 
bladder contents and continued failure to pass a laraest No. 17 (marked 15-17). 

catheter, per vios naturales, the modem surgeon will The treatment I have devised for all cases of 
usually perform a perineal section, usumly after difficulty or so-called impassable stricture is as fol- 
Mr. Wheelhouse’s method, bv this operation he lows, and I would first of all advise that the surgeon 
exposes the anterior face of the stricture by a should arrange for a convenient time, when he is as 
free perineal incision, and hopes to find the free os poscdble from harassing calls and messages, 
orifice of the stricture with his probe. If he finds It is no use, indeed it is dangerous, to attempt a bad 
the orifice, a director is introduced, and the stricture case of stricture in a hurry. The instruments re* 
is divided bv a knife and a catheter tied in. But quired are the sounds just mentioned, a Civiale’a 
the orifice of the stricture cannot always be found; urethrotome (I always can^ two in case of break- 
the most consummate craftsmen have failed. If the down), some blnnt-ended English gum bougies, vary- 
strioture orifice cannot be found the oneratormakes ing in size from No. 3 to No. 10, a foot rule marked 
a hit-or-miss incision, hoping to find the urethra in inches, and a No. 11 or No. 12 soft gnm catheter 
behind the stricture. Is it surprising that incisions mounted on a stylet for tying in at the close of the 
made in this way sometimes refuse to heal P I have operation. The patient (except in a case of acute 
gradually become imbued with the belief that in retention) has b^n carefully prepared, aperients 
cases of difficult stricture the perineum must on no administered, a bath taken, ana the rectum cl^red 
account be interfered with. Tnis has led me slowly bv a good enema. If an operating table ^ not avail- 
to discover for myself that there are no caeee of etric- aole, the bed should be made firm and level by 
ture, however eevtre, through which it ie impossible to placing the leaf of a table or a board under tbo 
pass an instrument. This is going further, then, than mattress. Each leg of tbo patient is wrapt in 
the dictum of Syme, who said that where water a blwket, and a third blanket is placed across the- 
came out an instrument ought to go in. In making body; the perineum and pubes are thus left exposed., 
this statement that all strictures are passable by The patieut is then completely ansesthetised. for the 
instruments, whether water comes through or not, I urethral reflexes are the last to be ansesthetically 
desire to speak with great care and deliberation, for abolished, and success depends upon the patient 
I believe that the prevention and the mitigation of being periectly quiet. A blnnt-enaed soft bougie is- 
much human suffering depends upon belief in this now introduced into the urethra, and the exact dis- 
doctrine. Of course, I must exclude from considera- tance of the stricture, or in case of multiple stricture 
tion all cases where the urethra has ceased to exist, of the anterior stricture, from the external meatus 
the result of mechanical or pathological injury, and 1 is accurately ascertained and measured. In very 
know well that 1 am not in accord with many well difficult cases the right-handed surgeon will have to- 
knovm authorities. stand on bis patient’s left, and with bis left finger in 

Believing that an inf trument, with care and the rectnm he will steady and secure the point of the 
patience, can always be passed through a strictured well-warmed and vaselined steel sound as, bolding 
urethra, I next assert that when once an instrument it in bis right hand, be attempts to pass it. The 
has been fairly passed into the bladder, it can boldly finger in the rectnm will be at once informed if tbe 
be withdrawn and replaced by oue a size larger if tbe point of the instrument leave the middle line. No 
surgeon have confidence in himself, and, thirdly, I force mast be used, but a steady search made for tbe 
have never yet met with a stricture which in this orifice of the stricture, and firm but gentle pressure 
way could not be dilated up to No. 6 or 7 English, exerted when found. Tbe surgeon mnst steal in 
A Civiale's urethrotome can then be introduced and little by little, as Ambroise Pare says, referring to 
the striotnre divided. This is wbat I term my method anotbsr subject. The operator will find jJter- 
of internal urethrotomy tout d’un coup, at one opera- a while that tbe stricture yields under bis band, 
tion. The worst case of stricture may be auEestbe- the instrument advances a little, and soon be is- 
iised, dilated up to No. 6, tbe urethrotome intro- gratified by feeling tbe end of the sound fairly 
duced and the stricture cut to full size, and left with grasped by the stricture. At this moment no 
a full-sized catheter tied in, all at one sitting. Let attempt should be made to pass the instrument,, 
us now consider tbe exact manipulation, we will not which is probably the 1-3, or next to tbe smallest, 
say of an impassable stricture, but of a very difficult on into the bladder, at any rate not unless it passes 
one. In dealing with a difficult case of stneture, I forward quite easily, but it should be withdravm and’ 
have long ago given np tbe use of filiform boogies; the next largest one, tbe 2-4, applied, and tbra the- 
their use is not true surgery; it is simply blind 3*5, by so doing the orifice of the stricture will be> 


Dsc. 4, 1901. 


original communications. 


I'nB Mbdioal Pabbs. 597 


dilated, and will not fi^ip and retain tfae point of the 
1>3, which may be taken up again, and will now pro¬ 
bably pass on into the bladder. Then the 2-3, tben 
3-4, tbe 4.5 and the 5*6 should be successiTely passed 
in. Tbe sounds are known to be in the bidder by 
their shafts being felt to be accurately in tbe middle 
line, and their points free in the bladder. When 
once the No. 6 or 7 sound has been fairly passed 
into tbe bladder, it should be allowed to remain 
in place, while tbe surgeon changes sides. He 
now stands on his patient’s right, draws ont tbe 
sound and slips in the urethrotome. If difficulty 
be found in introducing the urethrotome, the 
sound must again be passed. Sometimes tbe 
urethrotome can best be lightly and gently shaken 
in, as it were, rather than actually directed and 
passed in. When the bulb of the urethrotome is 
fairly in tbe bladder, there is a sensation of looseness 
and freedom quite characteristic, and the suraeon 
may feel sure that all is right. Nothing should be 
attempted until the surgeon is satisfied that tbe 
urethrotome is really in the bladder. When in 
proper position the instrument is carefully withdrawn 
until the bulb is an inch beyond where the stricture 
is known to begin, tbe anssstbetist is warned that 
the ratient must be perfectly still for a moment, the 
bla^ is tben protruded, and a free incision is made 
from behind forwards for a good inch along tbe 
floor of the urethra, and about half of an inch deep. 
The blade is tben sheathed and the instrument 
withdrawn. A full-sized sound is now passed, a No. 
12 or 13, and if, as is practically always the case, it 
passes easUy, then the lai^r ones, 14,15,16,17, may 
be passed in sucoession, and then the soft catheter 
mounted on a stylet, curved so asezactly to correspond 
with tbe curve of tbe sounds, is passed in, the stylet 
removed, and the catheter tied in. The urine which 
is in the bladder will issue by the caHieter, and so 
show that sU is right. Should there be a doubt aiK>ut 
the catheter being in tbe bladder, it should be with- 
drawn and again passed in, and on no account should 
any water be injected through it until there is no 
doubt that it is in the bladder. When the catheter, 
usually No. 10 or 11 (English scale), is secured in the 
bladder tbe operation is over. Usually tbe inlying 
catheter is well borne, and is removed in three days, 
in a very few cases there is irritation set up, and the 
instrument has to be removed. I always do all 1 can 
to persuade the patient to bear with tbe catheter for 
at least two days, as I am convinced that by its use 
the chances of hsemorrbage are much reduced, and tbe 
pain and sometimes the difficulty of natural micturi¬ 
tion are avoided. The patient sits op about the eighth 
day, and with the periodical passage of two or three 
well-warmed, well-oiled steel sounds, tfae largest 
usually No. 14 (English) the case is finished. The 
patient learns to pass tbese sounds for himself. By 
this method of mine tbe patient is not subjected 
before operation to painful, difficult, and often tedious 
instrumentation, and he is spared the old plan of 
dilating up the stricture by tymg in a series of small 
catheters, each lat^r than the one preceding, which 
is certainly not the best preparation for a p^ which 
it is intended finally to incise, and, above all, the 
patient is spared a perineal incision with all the slow 
recovery which necessarily follows such an operation. 
There is rarely any important hemorrhage, and there 
is no risk of the possibility, by no means to be over¬ 
looked, of one of the most trying and disagreeable 
misfortunes, namely, a perineal urinary fistula. 1 
have now an experience of the operation of internal 
urethrotomy for twenty-seven years, and I am happy 
to say I have never lost a patient from it. I have 
only two or three times had anp trouble from extra¬ 
vasation of urine, and when this has occurred it has 
always resulted ^m an incision in the anterior por¬ 
tion of the urethra, where the extravasation has been 


euily and safely dealt with. The avoidance of pre¬ 
liminary instrumentation is important, for it is the 
distnrbwce of a difficult stricture by small instru¬ 
ments when tbe patient is not amesthetised that is 
so often followed by urinary fever. Tbe operationat 
one sitting is usuculy followed by no constitutional 
disturbance whatever. Internal urethrotomy is an 
excellent operation, as I have just suggested, in many 
cases where there is no real difficulty in traversing tbe 
stricture with an instrument. These cases may be 
grouped as follows under eight heads:— 

1. When time is an object. *1^6 patient is per¬ 
haps ordered on foreign service, or, perhaps, on 
the eve of marriage, finds that he is the subject of 
stricture. These instances might easily be multi¬ 
plied, where it is justifiable to run a little more risk 
than ordinary dilatation entails in order to get the 
best and most permanent result possible in tbe 
shortest space of time. 

2. When the stricture is at the urethral orifice, or 
in the penile urethra, it will not yield permanently 
to either continuous or interrupted duatation, but 
must be divided. 

3. In cases of stricture where the gentlest instru¬ 
mental interference is followed by rigor and great 

S rostration, if the fibres of the stricture are freely 
ivided, the use of a bougie will cease to be foUowM 
by rigor. If after internal urethrotomy, the use of 
a bougie is still followed by rigor, it wiU be because 
tbe operation has been incomplete, and it must be 
repeated more thoroughly. Men are often met with 
from malarious countries who continue to have 
agueish attacks when resident again at home. I 
have not infrequently found this lever to be asso¬ 
ciated with urethral stricture, and have found that 
the attacks disappear altogetW when the stricture 
is divided. 

4. Internal urethrotomy is required when a stric¬ 
ture rapidly recontiacts wer dilatation. Such stric¬ 
tures are (^ed resilient. 

5. Also when tbe deposit round a stricture is 
obviously large and dense, dilatation is useless, ud 
tbe stricture must be cut, and sometimes requires 
more than one cutting operation before a satisfactory 
result is obtained. 

6. When renal or other calculus is impacted 
behind a stricture, the stricture had better be divided 
internally, and, if possible, tbe calculus extracted 
per vias naturaiet; snould this prove impossible, the 
calculus may be cut down upon, and the diri- 
sion of the stricture and subsequent treatment will 
prevent the opening made becoming fistulous. 

7. No urethral fistula will ever heal as long as the 
urethra is contracted in front of the fistulous urethral 
orifice. Divide the stricture and keep it open by 
periodical instrumentation, and usually the fistula 
will close. 

8. As age advances it is not unusual, although the 
contrary has been stated, for a strirture patient’s 
troubles to be complicated by prostatic hypertrophy, 
making it necessary for him to pass a part, or the 
whole, of his urine by catheter. To do so he must 
have a patent and easy urethra; and as stricture 
tends to tighten up in elderly people many of these 
patients find increasing difficulty in passing a 
catheter of reasonable size. Here intemm urethro¬ 
tomy comes to our aid, for the stricture is too hard 
and inelastic to yield to dilatation. 

Much as I dislike incising the perineum there are 
four conditions where it has to be done. 

1. When there is extravasation of urine. 2. When 
pus requires an exit. 3. In some cases of prostatic 
calculi, and 4, in certain rare cases of urethral cal¬ 
culus. In the two latter instances, and in one form 
of prostatic abscess, the urethra must be incised m 
weU. In all cases of periprostatic abscess and 
perineal abscess a &ee perineal incision must be 



598 Ths Mbdical Fbxsb. 


TEANSACTI0N8 OF SOCIETIES. 


Dzc. 4. 1901. 


made at once. The misofaief which maj resnlt from 
delay ie astonishing. In prostatic ahsoess I have 
known pns burrow into the buttocks, and even into 
the groins, presenting there like a bubo, before in* 
cision has b^n made, and of courte the abscess may 
open into the rectum, causing a rectal urinary fistula, 
woich may need months of careful treatment, 
and may even embitter the whole of the remain¬ 
ing life time. The ordinary prostate abscess 
should be opened from the perineum, but the 
urethra, in my judgment, should be severely 
left alone. There is, however, one form of prostatic 
abscess which I have not seen described, and which 
needs special treatment. Two forms of prostatic 
abscess are usually mentioned—the peri-prostatic 
abscess and the follicular abscess. But I have occa¬ 
sionally been consulted by elderly men exhausted by 
a profuse and continuous discharge of pus from the 
urethra, and upon rectal examination have found one 
or other prostatic lobe simply a bag of pus, draining 
imperfectly and slowly into the urethra. There has 
been no periprostatic collection of pus. It is unwise 
to attempt to go straight into this prostatic bag of 
us from the perineum for obvious reasons. I have 
ad great success by opening the urethra behind the 
bulb from the perineum; I then pass the forefinger 
of the left hand ^ntly into the prostratio urethra, 
along this fingerlpassa probe-pointed director and, 
guided by the end of the forefinger, the probe is made 
to pierce the wall of the prostatic urethra from the 
urethra. Then a pair of polypus forceps is passed 
in and opened so as to dilate the wound in the pros- 
tatio urethral wall. I have found that, so treated, the 
abscess drains freely and recovery takes place in 
cases which under other treatment do not do well. 

Then with reference to perineal abscess, a patient 
afflicted with a tight stncture sometimes, without' 
any very definite cause, finds himself unwell. His ' 
perineum is hard, tender, and throbbing, and he 
may, or may not, have a rigor. We all know that a 
perineal abscess is in process of formation. All sur¬ 
geons open such an abscess at once, giving vent 
usually to a large quantity of matter; in a few days 
urine is passed by the wound, and, unless the stricture 
is attenaed to, a permanent urethral fistula remains; 
often the stricture is leisurely attended to by dilata¬ 
tion, and even then the fistula is generally oostinate, 
and a source of annoyance to the patient for years. 
A real extravasation abscess is not veiw common; 
it begins by minute extravasation behind the stric- 
’ture, but the formation is tedious, and is preceded 
by a slow growing cord-like process, which is unmis¬ 
takable to the touch of the practical surgeon. Now 
my point is this, if the surgeon is prompt in dividing 
the urethral stricture,a true perinem abscessneverwiU 
-communicate with the urethra, and the patient will be 
saved all the trouble of a urinary fistula. I freely 
divide the stricture from inside the urethra, pass a 
15 or 16 (Eng.) steel sound, and tie into the bladder 
a No. 12 gum catheter per j>enem. I then put the 
patient into the lateral Utbotomy position, and, with 
my left forefinger in the bowel I introduce a sharp 
narrow knife into the perineum, half an inch above 
the anas, I go straight in until pus issues, and then 
withdraw, and in withdrawing divide the skin up¬ 
wards alittle, so that the finger can follow the knife; 
the finger dilates the opening, and finds a lai^ 
cavity full of pus, with the urethra filled by the 
catheter lying above, almost, as it were, dissected 
away from the surrounding tissues. As a rule this 
one opening will suffice to drain the abscess, but I 
have bad to make a more dependent opening in the 
buttock. The catheter should remain in about three 
daya Patients treated in this way, I find, make 
easy and rapid recoveries. 

in concluding this lecture on the urethra I would 
submit that while it is very easy to cut into a urethra 


it is sometimes very difficult to heal up the incision, 
and that a urethro-perineal fistula is a lamentable 
complaint. The urethra should never be opened in 
any case of vesical calculus, urethral stricture, peri¬ 
neal abscess or extravasatiun, or for vesical explora¬ 
tion or drainage, or for any prostatic operation. I 
would look upon urethral incision in these cases as 
a sni^cal trespass. 


®;linual ?K,ccorl)B. 

NOTES OP A CASE OP A HALFPENNY 
IMPACTED IN THE (ESOPHAGUS. 

By Dknnib Exnmidt, F.B.C.S.I. 

A CHILD, set. 6, was sent to me from Athlone with a 
history of having swallowed a halfpenny six weeks pre¬ 
viously. She was very emaciated, complained of a 
good deal of pain about the chest, and could not swallow 
asy solid food, but fluids went down freely. I got the 
child photographed by X-rays, and the photograph 
showed the halfpenny standing vertically iu the osao- 
phagns, opposite the second dorsal vertebra. 

On the following day, an anesthetic was administered, 
and 1 extracted the coin through the mouth. I used a 
forcepe with a curve almost at aright angle,after a pat¬ 
tern recently shown by Mr. MoArdle. So tightly was 
the halfpenny impaoted that the forceps slippA off of it 
repeatedly, and I had to dislodge it by a to and fro 
movement before I could bring it away. The child ex¬ 
pectorated a good deal of mucus tinged with blood after 
the operation, and made an uninterrupted recovery. 


‘^ranBactioiiB trf gocictifs. 

EOTAL ACADEMY OP MEDICINE, IRELAND. 
Section or Obbtxtbics. 

Mxbtino held Fbidat, Nov. 22nd, 1901. 

The President, Dr. W. J. Sittlt, in the chair. 


The following specimens were shown ;— 

The President : Two specimens of fibromyomata. 

Dr. Alfbed Smith : Three interesting fibromyomata. 

Dr. Jbllbtt : Uterus and appendages removed for 
chronic salpingo-oophoritia. 

Dr. PuRBrOT: (a) Three distinct ovarian tnmonn re¬ 
moved in one laparotomy: (b) tnbe containing tubal 
mole, wbich lay in front of utoms; (o) ruptnr^ tnbe 
and ovnm belonging thereto; (d) demdna passed by 
same patient four days after rupture; (e) ovarian oyrt 
and hydrosalpinx; (f) donble bsmato^pinx. 

Dr. Wm. Shtlt, on taking the chair, thanked the 
members of the Obatetricsd Section of the Academy 
for the honour they had conferred on him by twice 
electing him President of the Section. He remem¬ 
ber^ the old OlMtetrical Society of Dublin, which 
originated in the Botnnda Hospit^. and was the first 
obstetrical society founded in the United Kingdom. 

Dr. JiLLiTT read a paper entitled 
notes on a case or buffuratino ovarian ctbt, 

COMPLICATED WITH A LARGE INTEA-FEBITONBAL 

ABBOBSB. 

which vrill be found in another oolnmn. In the discus¬ 
sion that followed, 

Dr. Macan remarked that the womsm whoee history 
they bad just heard was the worst case he ever had in 
hoepital. He determined on laparotomy on her admia- 
sion, if anything could be done it should be done 
quickly. The cause of her condition was found to be a 
feetid abscess. Tbe fact that for seventeen days after 
the temperature became normal, that it remain^ so he 
considered to be well worthy their thonght; it showed 
how there may be pns without a rise of temperature. 
He now thinks that he should have drained the abdo¬ 
men through the vagina, bnt he found s firm mass in 
Douglas’s pouch, and the patient was not young enough 
or well enough for a voyage of discovery. The foiom 
that broke was made in Germany,'* but if you take 

oog 




Dbc. 4. 1901. 


TBANSAOTIOUS OP 800IBTIES. Tbb Mbdical Pubbs. 599 


too weak a forceps, aay an intestinal one. to olamp am 
ovarian pedicle yon can break it, even if made ..in 
England. 

Dr. Albbbt Smith said one oonld not eetimate the 
character of the pas from its stench—pns ooUections in 
the neighbonrhc^ of the rectum are notorionsly bad 
Bmelling. The relief of pain felt after opening an 
abscess, he thonght, is due to the dimiantion of tension 
of the abscess sac. Emptying the first abeoess relieved 
tension, pain ceased, and temperature felL Then the 
second abscess ripened, became tense, and temperatnre 
rose. His faronrite antiseptic wash was peroxide of 
hydrogen, with which he washed the sac until the fluid 
comes ba«3k free from air bubbles. 

Dr. PuBBFOT, Master of the Botunda Hospital, was of 
opinion that Dr. Jellett’s paper offered several practical 
points for consideration—there was oozing of blood, 
which, in such cases, was not withont danger. And he 
could not but think that both the operators. Dr. Jellett 
and Dr. Uacsn lacked courage in not opening into 
Douglas' pouch from the vagina and emptying the 
pocket of pus which afterwards gave so much trouble, 
necessitating a second operation. Dr. Jellett's report 
was not consistent; the mass in Donglaa' space ia in 
one place referred to as a hard mass, and again spoken 
of as a ooUeotion of pns. 

Dr. Maoak rose to give a personal explanation. 
Seventeen days after operation if a normal temperatnre 
followed by a rise shows that something must have 
happened. 

Dr. Jbi,lxtt in reply said, the improvement in the 
patient after Dr. Macan's operation was only relative. 
Her temperature fell, her pain ceased for a time; but 
she could not be got to take food. The mass in Douglas’ 
space had considerably increased between the operations 
—it was an increase in pns, not a fresh formation. The 
explanation of Dr. A. Smith of the psin from tension of 
the fac is probably right. 

Dr. Hastinos Twbbdt read a paper advocating 

POSTBBXOB VAGINAL C<ELIOTOMT IN OTN.SCOLOOT 

as the operation of election rather than that by the 
anterior fornix. The paper will be found on page 694. 
In &e disoasBion that followed. 

Dr. Macan remarked that he was old enough to oon> 
fesB he did not know Prior’s operation, and was 
not much enlightened by the paper. Operators had 
long used both anterior and posterior oolpotomy, and 
Prior did nothing in bis opinion except the po^rior 
operation with the use of the Trendelenberg position. He 
did not think the position in such an operation brings 
the parts well into view—better without it. Nor oonld 
he understand how the nreters or vessels oonld come 
into the way of the operator in posterior oolpotomy. 
He looked npon removal of plugs as almost always pain¬ 
ful unless you wait for the presence of some moisture, 
which he recommends, always sapposing there is no rise 
of temperatnre. In all such cases the question natorally 
arises, What rente will the surgeon pursue: vaginal or 
abdominal ? In unilateral diseases be preferred the 
superior operation, as one gets a better view of the con¬ 
dition of the parts. In cases of abscess the vaginal route 
is as a rule the preferable, and when tumour is located in 
Douglas' pouch posterior oolpotomy is to be preferred. 

Dr. Pdbbfot did not think that posterior oolpotomy 
is BO free from all risks as the paper might lead hearers 
to think. In two recent cases he had had secondary 
bleeding. One case occasioned him some anxiety as 
bleeding came on during the eight, and he found on his 
arrival a vessel spoutiog at the angle of the wounds, 
on which he had to apply a oatch forceps. 

Dr. Albbbt Smith was of opinion that with the use of 
antiseptics opening the peritoneum has been robbed of 
its terrors, and he uses the abdominal route in all cases, 
as giving the best view of the parts, and is no more liable 
to shock than the vaginal. The painful process of re¬ 
moving plug^ng might be avoided if a bag were need, 
and this ba^ filled with tampons of small plugs, which 
could be rmdily removed withont causing pain. He 
bad found the early removal of plugs comparatively 
painless, and had no bad results from doing so. 


Dr. Jbllbtt said the Section had wandered from the 
sn^eot of Dr. Tweedy’s paper, which was a description 
of Prior’s operation. It is obvious, be remarked, that 
if adhesions were present no tissues fall down, and 
there is no increased area o{ view. 

Dr. William Smtlt oonld not understand Dr. 
Jellett's objection. How can we disonss the operation 
other than by comparing it with the methods of other 
operators ? An operation very similar to this of Prior's 
is recommended in cases of hysterectomy for cancer. 
The Trendelenberg position has the great advantage of 
allowing of plugging the wound. It may be necessary 
to allow plugs to remain in a long time. As a whole, he 
prefers the abdominal route, yet he confessed there are 
oooaaions when the vaginal is the preferable. Oar 
views are modified by time. We are not now so anxious 
to excise everything. The tendency is to look at 
patients years after operation, and on their then condi¬ 
tion to decide on the benefita or otherwise of the pro¬ 
cedure. Tears ago he removed a unilateral pyosalpinx 
and did it by the abdominal rente; he was now able to 
teoord that the patient, who went to the oonntry, has 
been for years quite well, and the mother of a healthy 
child. In one case he removed the ovaries by the 
v^inal route, leaving a little of the tubes. Tears after¬ 
wards the pstient h^ to be again operated on, the re¬ 
maining portions of the tabes were removed, and the 
patient is now quite well. Had he selected the 
addominal route the second operation would not have 
been necessary. 

Dr. A. Tweedy thanked them for the friendly criti¬ 
cism his paper had called forth. He brought Prior’s 
operation under notice beoaose it was little known and 
in certain conditions would be found useful. 

The meeting then terminated. 

LIVERPOOL MEDICAL INSTITUTION. 

Hbeting held Nov. 7tr, 1901. 

The President, Mr. Eixiab A. Brownb, in the Chair. 

THB FINBBN TBBATMBNT OF LUPUS. 

Db. O. Stopfobd Tatlob showed a new lamp for the 
treatment of Inpns, diagrams of which have already 
appeared in the journal. After entering with an ex¬ 
piration of its construction and management, he said 
that snooess was only to be obtained by practice. 

Dr. Leslie Bobebts said that he was using Mr. 
John Hnateris arc lamp in the treatment of lupus. If 
the new lamp was theoretically as active as the original 
Fiosen apparatus he thought it would not be long 
before it would become obsolete. His experience was 
too recent to speak as to results, but he desired to warn 
members against being too optimistic. In properly se¬ 
lected cases he had seen the light treatment give 
wonderful cosmetic results, but the cure was slow and 
tedious. He thonght that we should not rely solely on 
any one measure in the treatment of Inpns, There were 
many oases in which it would be better to begin with 
the oantery, and to complete ^e case with the arc lamp. 
Time alone oonld fix the real worth of the lamp treat¬ 
ment. 

Dr. Gbunbaum described Bang’s new lamp, which he 
had seen working in Hambnrg. Its chief features were 
great portability and cheapness. It had cooled iron 
electrodes, whioh gave many more nltra violet rays than 
carbon. 

Dr. Tatlob replied that the idea of metal carbons was 
impracticable, because the intense heat of the “ arc ” 
would convert them into a liquid state. He had not 
yet met a case of lupus to whioh he had not been able 
to apply the lamp satisfactorily. 

Mr. B. W. Mubbat related 

A COMFLICATBD CASE OF UALABIAL POISONING. 

The patient, a man, set. 20, contracted malaria two 
and a*half years during a voyage up the Amazon. 
He was treated in a New Tork hospital on account of 
high fever and blood in the urine, and during bis stay 
of ten months in this hospital had the right kidney, the 
vermiform appendix, and general peritimeal cavity ex- 


CoogI( 


600 Tb« Mbdicil Pbbm. TBAKPACTIONS OF SOCIETIES. 


Pic. 4 , 1901. 


plored, and the bladder drained from the perineum. He 
returned to Liverpool, and remained in good health 
until August, 1900, when he was admitted to the 
Northern Hospital suffering from high ferer and blood 
in the mine, from which hospital he was discharged at 
his own request at the end of five days, although his 
temperature was 104^. The urine confined a large 
quantity of blood, and the malarial parasite was present 
in the blood. He was re-admitted in January, IMl, and 
has remained in hospital erer since. During this time 
the temperature has averaged 102^, rarely falling to 
normal, and occasionally rising to 106^. Eepeated 
examinations of the blo^ have failed to again rereal 
the malarial parasite. A cystoscopio examination of 
the bladder was made, and an ulcer seen close to the 
right ureter; the bladder was opened and the ulcer 
treated with nitrate of silver. The haematuria then 
cessed for some time, but returned later and was 
accompanied by great abdominal pain, referred 
to the right side, and with violent attacks 
of vomiting. As the esse could not now be 
considered one of malaria in September, the right kidney 
was exposed and found to be apparently healthy. During 
the last month the patient has improved though the 
temperature remains high, and there is blood in the 
urine. Numerous drugs, including tannin, arsenic, 
iron and opium have been tried without any apparent 
benefit. 

Major S. Boss said that the detailed temperature 
chart was not that of a case in which malaria was the 
only cause of the fever. The chart showed a continuous 
fever. He bad no doubt that malarial parasites were 
present, but thought some other cause was producing 
the long continued elevation of temperature. The blood 
in the urine was not due to hecmoglobinuria. The spleen 
was not enlarged. 

Mr. D. Thblwxll Thomas showed a patient upon 
whom he had performed 

BXTXBNAL PBABTNOO-tSSOPEAQOTOMT TOB TBAUHATIC 
STBXCTtTBB 

in the upper end of the cesophsgus, caused by accident¬ 
ally Bwallovring fuming nitric acid. Some months after 
the accident it was impossible to pass bougies. On ex¬ 
posing the striotTure by eiternal incision it was found so 
small as only to admit a fine probe. The cicatricial 
tissue was divided on a fine probe director. Excision 
was impossible, and transverse suture not feasible, so 
suturing was resorted to over am cesophageal tube passed 
through the month, continnons through the mucous 
membrane, puckering it up over the stricture and Cush 
mg’s suture of the muscular coats of the cesophagus. 
The young man eventually made a good recovery, and 
now (seven months after operation) can swallow solid 
food, and a full-sized bougie can be easily passed. 

Mr. F. T. Paul said traumatic strictures of the oxso- 
phagxu were uncommon, and rarely so favourably 
situated for operation as in Mr. Thomas’s patient. He 
recognisAd the difficulties of a plastic operation owing 
to the fixation of the tube at this point; but evidently 
enough had been done to render subsequent complete 
dilatation an easy matter. 

Dr. D. M. Button read a paper on 

UTCOSIB, 

dealing with the not onoommon occurrence of mycosis 
in this country, and the singular paucity of English 
literature on the subject as compared with that written 
by Continental authors. Mycosis was defined as the 
accidental parasitism of dipterous larve, t.t., maggots of 
flies, and was classified according to the distribution of 
the m^gots on the gastro-intestinal tract, the skin, in 
wounds, and in the nose and ear. Five typical cases of 
intestinal mycosis were related, two occurring in Dr. 
Hutton’s own practice. Speaking of the aetiology, the 
opportunities for invasion by the ingestion of the eggs 
of flies in uncooked vegetables, tainted meat, Ac., were 
dwelt upon, and the wonderful resisting powers of 
maggots to toxic agente and unfavourable conditions of 
life generally commented upon. Evidence was given 
that the eggs or larvse for the most part perish in the 
alimentary tract, and that the reason of their survival 
in the known caeee is as yet unsolved. The remainder ' 


of the paper was devoted to the symptems and treat¬ 
ment of the condition, and with the better known 
cutaneous mycc^is, viz., mycosis vulnemm and nariutn. 

Major E. Eoss related some cases of mycosis of 
wounds which he had seen in India. He thought that 
the nervous effects so distinctly produced in some of 
the intestinal cases were instructive in reference to the 
similar effect of intestinal worms. 

Dr. Hubbbt Abmstbono mentioned a case of intea- 
tinal mycosis due to a maggot about one inch in length 
(name unknown) A purge failed to reveal any further 
specimens, and there had been practically no symptoms. 

Dr. H. John Bat asked if the symptoms produced 
were due to mechanical irritation or to toxic absorption 
of poisons produced by the larvee in the intestine ? In 
heleminthiasis definite blood chanfzes have been d^ 
Bfuibsd, showing that there was probably a toxic agent 
in addition to the mechanical irritation. 

Drs. Eellett, Smith, and Sumner also spoke, and 
Dr. Hutton replied. 


SHEFFIELD MEDICO-CHIETJEGICAL SOCIETY. 
Mbktino HiLn Nov. SlST, 1901. 

The President, Dr. C. H. Willst, in the Chair. 


Casbs. 

Db. Gwtnnb showed a girl, set. 5, suffering from con* 
genital dislocation of the hip, where he had tried blood¬ 
less reposition of the head of the femuraa recommended 
by Lorenz. From the difficulty found in retaining the 
head in the cup of the acetabulum he t hought that 
most probably a portion of the capsule had been in¬ 
cluded in the reduction. He did not anticipate a suc¬ 
cessful result from this method, and after a further 
trial, proTOsed to open into the capsule and replace the 
head of the femur by the method ^opted with so much 
success by Lorenz. 

Mr. Snxll introduced the following patients:— (1) A 
young woman, from whom an encapeuled tumour (endo¬ 
thelioma) had been removed from the orbit. The 
growth reached to the back of the orbit, along the 
lower floor, and was loosely connected with the eyeball 
and optic nerve. The globe was preserved and vision 
was normal. (2) A woman, from whom a sarcoma h^ 
been removed from the lower wall of orbit. (3) A man, 
injured by bum from piece of hot steel. Four rectifying 
operations had been peiformed. (a) For ectropion of 
lower lid; (b) for obliteration of canaliculus (epiphora); 
(c) for extensive symblepharon ; (d) for ingrowing eye- 
laches of upper eyelid. 

Mr. Skill also showed a large clear cyst (size of a 
pigeon’s egg) removed from the upper and inner angle 
of orbit. 'The patient was a young man, eet. 19, and the 
cyst had exist^ for many years, but bad increased in 
size, especially recently. 

HBADACHEB DXPXNDBNT on STB CONDITIONB. 

Mr. Snell related a case of headache relieved by 
correction of refraction error, and remarked upon the 
effect of cycling in some instances. The patient was a 
missionary, a)t. 32. Xbe headaches were severe, affect¬ 
ing chiefly the left side, upper part, and back of head. 
They commenced in February, 1899. A doctor declared 
the eyes were normal, and ordered six months’ change 
of scene, Ac., with less work. The patient returned to 
work, somewhat improved, in the autumn. Be managed, 
though cuffering at times considerably, to run on until 
February of this year, when he completely broke down 
and was invalided to England. The Medical Board 
ordered six months’ rest. At the expiration of this time 
he was still unfit for work, and he was reconunended to 
consult an oculist. Be accordingly saw Mr. Fnell in 
October last. Y=6/6each eye; aft^ homatropine and 
cocaine, y=6/6, or, + 5D cyl., axis horizontal, V=6,5 each 
eye. Muscle balance was normal. Cylinders were ordered 
for general use. Belief was speedy and complete. After 
three weeks he desired to return to work, and on Novem¬ 
ber 23rd took up the duties of a curacy. Mr. Snell re¬ 
marked on the frequency with which he^achee depended 
on eye conditions, and that knowledge of this relation- 



Die. 4, 1901. 


GENERAL MEDICAL COUNCIL. Th* M.dical Pb*8b. 601 


«hip was beooming more widely recognised. The instance 
related was a go^ Ulostration of the relief following 
the correction of error of refraction. The defect was 
low degree, as is often the case, bat the axis of the 
astigmatism was contrary to the mlo. The mnscle 
balance onght always to be tested. Another point in 
this case was the increased headache and discomfort 
which sometimes followed cycling. Mr. Snell alluded 
to this as occasioned, in this and other instances he had 
met with, by the rider stooping over the handle bars and 
thereby necessitating, when looking forwards, the gaze 
being directed above the horizontal line, thas indacing 
weariness of the elevator mnsdes. 

Dr. GoDrBET Cabtkb narrated two cases of labour 
ooenrring daring the coarse of acute croupous pnen- 
monia. Both patients were multipart, and contracted 
'the pneamonia as a sequel of epidemic inflaenza. Both 
were tet. about 30. The first was a delicate lady (6t 
months advanced in pregnancy), and the pneamonia was 
of a severe type. There was high temperature from the 
first. On the sixth day. when there was very rapid 
pulse, great dyspncea and slight lividity, abortion tmk 
place. The child was easily bom, and there were no 
complications. The patiect did not seem much worse 
till the next day. But death ensudd forty-eight hours 
after delivery. The second was a strong, healthy woman. 
Full-term labour occurred on the second day of the 
pneamonia. Delivery was easy, but there was an adhe¬ 
rent placenta. Chloroform was well borne, but ten 
minutes was occupied in detaching every portion of the 
afterbirth, and free haemorrhage occurred. The crisis of 
the pneumonia was reached on the eighth day, and a 
{'ood conv^esoence ensued. Dr. Carter coosidered that 
the bsemorrhage in the second case was probably bene¬ 
ficial by relieving the right side of the heart. He said 
that labour occurring early during the coarse of pneu¬ 
monia, in a healthy subject, and while the powers were 
still good, was not probably a very dangerous complica¬ 
tion ; but when it occurred late in the disease it was of 
.grave omen, being, so to speak, a last effort to lighten 
the ship before going down. 

Mr. Favbll related the following cases: — (1) 
Bemoval of unmptured tubal gestation of one side 
with hydrosalpinx of the other tube; (2) Dermoid 
^mour of ovary removed by v^inal cceliotomy. 

Dr. Husbabd read notes of a case of 

HIDATIDIFOBM DBOIMBBATION OF CHOBION, 
and showed specimen. 

Mrs. A. C., eet. 33. Multipara, having borne one child, 
four years, and another two years ago, considered her¬ 
self again pregnant. Menses had stopped one month, 
and she hM bad vomiting and indefinite pains in the 
lower abdomen. Vaginal examination showed very slight 
•enlargement of uterus, with some tenderness in left for¬ 
nix. The vomiting was treated with only moderate 
success for three to four weeks, when heemorrhage set in 
which continued for three days. Very soon vomiting 
returced, and a second vaginal examination was made. 
Although only twenty-six dajrs siooe last examination, 
the ntems was much larger, and of an irregular 
shape, being bulged out towards the left side, the 
whole mass about the size of a cricket ball. 
There was also much tenderness, specially on 
the left. The os was closed, and there was on 
■examination no hsemorrhage. Vomiting was still 
severe, and resisted all treatment. Ergot was ad¬ 
ministered, and was followed in the night by severe 
hsemorrhage, with some jelly-like dischai^e and a small 
■cluster of vesicles. The uterus was then emptied by 
means of finmrs and douche. One large cluster attached 
-to a piece of decidua and several smaller clusters of 
vesicular degeneration were obtained (the specimen as 
shown). There was slight hsmorrh^e, which shortly 
stopped under hot douche and ergotin, and vomiting 
entirely ceased. The evening of the same day tem¬ 
perature was lOO'S and pnlra 100, the patient en¬ 
joyed food, and has so far made a gora recovery. 
The noteworthy points in this case are:—1. That con¬ 
trary to the usual symptom—^besmorrhi^e—the chief 
trouble was the intense vomiting leading to the suppo¬ 
sition of hyperemesis gravidarum; 2, The rapid increase 


in size of uterus between the first and second examina¬ 
tions, with the irregularity of shape and tenderness; 
3, The early period at which evacuation took place. 
Tbe length of the pregnancy, so far as could be made 
out, not being more than ton weeks. Most persist to 
four or more months so far as I have been able to ascer¬ 
tain from recorded cases ; 4, Tbe small amount of tbe 
vesicular mass, with the amount of decidual membrane, 
the result of early evacuation. Tbe serotinal part 
(probably) of the latter was moulded somewhat into a 
conical shape, and gave attachment to the chief bunch 
of vesicles. The entire mass measured about half a 
pint. 


THE GENERAL MEDICAL COUNCIL 

OP 

EDUCATION AND REGISTRATION. 


Sir WiLLiAu Tdbmek, E.C.B, President, in the Chair. 


FIRST DAT— Tuesdat, Novembeb 26th, 1901. 

The 72nd Session of the Conncil was opened on Tues¬ 
day, November 26^, with the ususd Presidential 
Address. In dealing with tbe steps necessitated by the 
expiration of tbe tenure of office of two of the direct 
representatives for England and one for Scotland, the 
Fbesident expressed regret at the oanse of Dr. Glover’s 
not presenting himself for re-election, adding that 
daring the fifteen years during which be and Dr. 
Glover had sat on the Council together he had always re¬ 
ceived from him unfailing courtesy and consideration. 

In reference to the recognition of medical degrees 
granted by the TTniversify of Malta, he stated that the 
clause in the schedule of University r^uiremento in¬ 
sisting on one year’s probationary practice in Malta on 
the part of foreign graduates h^ been stmok out. 
An Order in Counoil, dated September 26th, applies 
Part II. of the Medical Act to the inland of Malta, and 
two applications for admission to the " Register " from 
Maltose gradnatos bare already been received. 

The intormation asked for in respeot of the require- 
ments of the various Italian universities had been 
received smd referred to the ExeoutiTe Committee, and 
five applications for registration bad been received from 
Italian practitioners. 

He mentioned that the Bill for the Increase of the 
Penal and Disciplinary Powers of the ConnoU smd of 
Medical Authorities in tbe United Kingdom, prepared 
under the instructions of the Council, bad been intre^ 
duoed into tbe House of Commons by Sir Richard 
Jebb in June last, and bad been read a first time. 

The inspection of final examinations at tbe Univer¬ 
sity of Dublin, at the Royal University of Ireland, and 
at tbe conjoint examinations of tbe three medical and 
surgical corporations in Scotland had, he said, been com¬ 
pleted, and &e reports had been forwarded to tbe reapeo- 
tive b^es for their observations and remarks, bat tbe 
replies had not as yet been received, with the exception 
of one which only arrived that morning. He raised the 
question whether it would be necessary for Dr. Herring- 
ham, the Councirs inspector, to attend the final exami¬ 
nations of the Apothecaries Hall of Dublin next year in 
view of tbe fact that the medical and surgical corpo¬ 
rations in Ireland would have their final examinations 
inspected next year by the general inspector and the 
Council's visitor. 

He referred to the penal cases upon which the Council 
would be requii^ to aid j udicate, most of the practitioners 
summoned to appear being charged with habitually em¬ 
ploying, for the sale of sohednled poisons, persons not 
qualified to act as chemists or pharmaoeutioal assistants. 
He snggeetod that possibly the time had come for tbe 
Council to issue a definite declaration on this subject 
for the information of the profession generally. One 
penal case bore on the question of the employment of a 
registered medical practitioner by a medic^ aid associa¬ 
tion, which, it was alleged, systematically practised can¬ 
vassing for the purpose of procuring patients. 

Among other topios he said they might look for a 
report on the stops which had been taken in order to 
carry out the recommendation of the Council that the 



602 th» M*dical Pbi89. GENERAL MEDICAL COUNCIL. 


standard of preliminary ezamiaation required by some 
of the examining aatboritiee ebonld be raised. Certain 
questions would, be said, come np for debate in connec* 
tion with motions proposed in June last by Br. Bruce 
and Hr. Ball sugi^ting tbat, in addition to the ezamina* 
tion on the subjects of general education, a second or 
scientific reg^tration of students should be established 
by the ^uncil, and that the period of medical study 
should be four years after the second registration. In 
discussing this new question he expressed the hope that 
the Council would bear in mind the paramount import* 
ance of their not losing their bold on the standard of 
general education to be required from students of 
medicine. He went on to say tbat the recommendation 
that all intending students of medicine should pass an 
examination on subjects of general educaUon, and the 
consequent establishment of a students' register, formed 
an important epoch in the history of the Council, and 
in the educational progress of the profession. Although 
no special statutory powers had been conferred on the 
Council to require the registration of students, all the 
examining authorities were consenting parties, and 
a^eed not to admit candidates for professional examina¬ 
tions unless their names had been previously placed on 
the students' register. Acting along with the qualify¬ 
ing bodies the Council bad been able to require a 
standard of general education from entrants to our pro¬ 
fession, which, in so far as can be provided by an 
examination trat, secured tbat they possess a school 
education sufficient to enable them with intelligence to 
engage in professional study. The period of professional 
education had also been extended to five years, and an 
influence for good has been exercised on the training of 
the younger generation of practitioners. He regarded 
with apprehension a movement which, by the with¬ 
drawal of one or more of the qualifying bodies from an 
ag^ment in which all are concurr^, would destroy 
unity of action in the matter of students' registration, 
and would nuUify the influence of the Council. 

In conclusion the President announced bis intention 
of placing his resignation in the hands of the Council at 
the present meeting, so that they might forthwith pro¬ 
ceed to the election of his successor. 

After the usual vote of thanks to the President for hie 
address, the table showing results of the competitive 
examination held on August 6th for commissions on the 
medical staff of the Navy was received, and tiianks re¬ 
turned to the department for the same. It was men¬ 
tioned tbat there had been no examination for oommis- 
tions on the medical staff of the Army though one was 
stated to have been held for the Indian service. As the 
latter table had not been received the Segistiar was 
directed to write to the India Office to know if the 
examination had really been held. 

Axxndiiimt of STANDiya Obdbbs. 

The Council next discussed a report from the Eiecu- 
tive Committee in reference to certain amendments in 
the Standing Orders governing the judicial procedure 
smd decisions of the Council. The Pbxbidbnt put it to 
the Council whether the discussion should or should not 
take place <n camera, a course against which Mr. 
Horsley and Mr. O. Brown protested, and on being put 
to the vote Br. Atthill’s motion tbat it take place »» 
camera was negatived. 

The Pbisidbnt observed that the Penal Cases Com¬ 
mittee, which only referred to the Council complaints 
in which a prima facie case had been made out, really 
acted as a grand jury, and he ineisted on the import 
anoe of preserving the distinction between the criminal 
and the professional cases. The first amendment pro¬ 
posed was that Order XIY. 14, (2), (b), should read ae 
follows: "tbat the facts alleged against ... in 
the notice of inquiry have been proved to the satisfac¬ 
tion of the Council,” and further, "that fxurtber con¬ 
siderations of the facts proved against ... be 
adjourned until tbe next session,*' or other specified 
date. This was discusred tn camera and agreed to. 

Tbe Council then adjourned. 

8ECONB BAY.— Wbdnbsdat, Novxubbb 27th. 

The President, Sib William Tdbnbb, in the Chair, 
Mr. Muir Mackenzie, the legal assessor to the Council, 


Bxc. 4, 1901 

was present, amd a letter from him was read in^camera. 
The Council next proceeded to take into oonridention 
the oasee of Alexander Stewart, of Uphall, registered as 
Lie. Fac. Phys. Sui^. Glasg., 1878, M.B., Mast. 8ni^., 
1880, Univ. Clasg.; Simon ]^nce Clark, of 69, Bixon 
Avenue, Crossbill, Glasgow, registered as Lie. Soc. Apoth. 
Lond., 1884, Lie. B. Coll. Phys. Edin.. 1885, Lio. Fao. 
Phys. Snrg. Glasg., 1885; Alexander Whyte Mason, of 
686, Springbum Boad, Glasgow, register^ as holding 
Triple Qualification of Scotland, 1863; William Alliaou 
McLachlan, of Bumbarton, registered as M.B., Mast. 
Snrg., 1874. M.B., 1877, Univ. Glasg.; James Wilson, of 
Bumbarton, registered as Lie. Fac. Phys., Sorg. Glasg., 
1882; Bicbard Allan, of Dumbarton, registered as Lie. 
B. Toll. Phys. Edin., 1872, Lio. Fac. Pbys. Surg. Gla^., 
1872; and John Steele Smith, of 480, Springbum Boad. 
Glasgow, registered as M.B., Bao. Surg., 1900, Univ. 
Glasg., who had been severely summoned to appear 
b^ore the Connoil to answer tbe following charge 
as formulated by the Council's solicitorTbat you 
have been guilty of infamone conduct in a professional 
respect, particulars of which are tbat yon, being a regis¬ 
tered medical practitioner, habitually employ as assis^b 
for tbe sale of scheduled poisons a person not qualified 
to act as a chemist or pharmaceutical assistant, and 
thereby cause such person to commit breaches of the 
' Pharmacy Act. In the cases of Br. Clark and Br. Wilson 
the charge was that of employing more than one un¬ 
qualified assistant. The complainants, for whom Mr. 
Peter Morisou, 8.S.C., appeared, were the Pharmaoen- 
tdcal Sociely of Great Britain. 

Mr. Winterbotham, solicitor, formulated the charge as 
given above,and^all the gentlemen accused signified their 
desire to be dealt with together. They were represented 
collectively by Mr. A. B. Ferguson, solicitor. 

Mr. Peter Morison, junior, solicitor, on behalf 
tbe Pharmacentical Society, dealt with each caaes 
teriatim, and urged that it was imperative in 
the interests of tbe public tbat tbe acta com¬ 
plained of should be adequately dealt with. In some 
of tbe cases there was an aggravation of the offence, as 
when, in addition, the name of the person to whom the 
poison was sold was not duly recorded. He referred to 
certain statements which had been made that when 
chemists offended they were not proceeded against and 
that the present proceedings were vindictive, an allega¬ 
tion which he strongly repudiated. 

The Pbbsidxmt Uien called on tbe respondents in¬ 
dividually to read tbe letters which they had sent in 
re^y to the charges made against them. 

The letters were then read. The respondents 
admitted the charge, but among other attenuating cir¬ 
cumstances urgedthattheir assistants acted oontraiy to 
their express orders and warnings. They concluded by 
expressing their regret, smd poin^ out that their offend¬ 
ing aseiatMts had ^en prosecuted, 

Mr. Fxboubon, for the accused, denied tbat he had 
made a chai^ of vindictive conduct on the part of that 
Council, and be protested against the use of such an 
expression as “ infamous conduct ” in formulating the 
charge. 

The Pbbsidxnt said the Conocil were merely acting 
in accordance with the Statute. He understood that th» 
charge of vindictive conduct was made against the 
Council of the Pharmaceutical Society, not against the 
General Medical Council. He said he understood that 
all of them, or all but one, were ready to undertake that 
in future they would not employ or keep unqualified 
assistants, to which the accused signified their assent. 

Mr. Mobison thought Br. McLachlan had not given 
the undertaking. 

The Connoil then considered their decision in camera, 
and, when strangers were le-admitted, 

The President said: The Council, having carefully 
deliberated on the evidence contained in tbe documents 
before us and tbe statements which yon, gentlemen,, 
have made, they have instructed me to read to you the 
decision at whi^ they have arrived, and, although I am 
only going to read it once, yet you must understand 
that this decision applies to each one of yon, and tbe 
decision is as follows—that each of you, having expressed 
to the Connoil your regret for the commission of a pro- 

L-ooi-le 


Dec. 4, igoi. 


GENERAL MEDICAL COUNCIL. 


The MsDiCix Pbbsb 603 


feesional offence, which the Ck>nnoil has declared to be 
grare and fiaaght with danger to the public, and bav* 
ing pledg^ yonreelTes to abstain from any conduct 
affording similar groiind of complaint in the futnie, the 
Connell resolve to proceed no further in reference to the 
facts proved against you. 

The Ezeentive Committee brought up a report for the 
consideration of the Council containing a revised list 
of eoientifio institutiona at which the course of medical 
stndy may be commenced by application for registration 
in the StudenU Reguier, and tbe subject being under 
consideration when the Coxmcil adjourned, fur&er dis* 
cussion was postponed until the Education Committee's 
report bad been received. 


THIRD DAT.— Thuesdat, NovEMBEa 28 th. 

A Medical Aid Association Case. 

The whole sitting was taken up with the case of Dr. 
Robert Rendall, of Great Yarmouth, who appeared 
before the Council to answer a charge That he had 
accepted and continued to bold the appointment of 
medical officer to the Liverpool Victoria'^gal Friendly 
Society, a society which systematically practised can* 
vassing for tbe purpose of procuring patients, and that 
he had approved of, or acquiesced in, such canvassing.” 

The case was brought before the Council by the 
Medical Defence Union, as complainants, on behalf of 
the Great Yarmouth District Committee of tbe Incor¬ 
porated Medical Practitioners Association. Tbe re¬ 
spondent was represented by Mr. Lawson Walton, E.C., 
M.P., and Mr. C. Mathews. 

Dr. Batbhan, in laying tbe case before the Council, 
pointed out that it raised a question of the greatest 
importance not only to tbe profession but to tbe public. 
He referred to the resolution of the Council pass^ in 
June, 1899, strongly disapproving of medical men asso- 
ciating themselves with medical aid associations which 

S stematically practised canvassing and advertising for 
e purpose of securing patients. Tbe society existed 
for the purpose of providing medical advice for Mrsons 
then in good health, who paid a small entrance f^ and 
members were canvassed for by agents from door to 
door quite irrespective of their ability to pay for medi¬ 
cal attendance or wheteer they had medic^ advisers of 
their own. This had led to much friction between the 
society and the profession. He pointed out that it 
might be said that Dr. Rendall himself did not canvass, 
but it would be shown that the people canvassed were 
asked to join the doctors' club, and Rendall’s name 
was systematically mentioned by the canvassers. 

Mr. W. E. Wyllye, of Yarmouth, was the first witness, 
and he described the mode in which the canvassers went 
to work, in support of which be produced a number of 
documents. He admitted that Dr. Rendall bad written 
to him asking for the names of tbe persons whom it was 
alleged be h^ canvassed, a request with which he had 
not thought fit to oomp'y, tbe facts being common 
knowledge. Similar evidence was given by Mr. A. H. 
Moxon. 

Dr. Batsman put in a large number of sta'utory de¬ 
clarations of local medical men and persons who bad 
been canvafsed. To the latter had been handed burial 
cards and also Dr. Rendall's cards. 

Mr. Lawson Walton, speaking on behalf of Dr. 
Rendall, pointed out that the Council had to consider 
two distinct questions, (1) whether the allegations 
against Dr. Rendall, if proved, would bring him within 
the scope of the June resolution, and (2) whether upon 
the facto it could reasonably be held that there had 
been professional misconduct. He urged that, as it 
could not be intended to proscribe tbe numerous small 
societies which catered to the medical wants of the very 
poor who would not have a medical man of their own, 
therefore the allegation of canvassing to procure patients 
could not be held to apply to theee. He denied that 
there had been any systema^o canvassing by the medical 
lud society of which Dr. Rendall was the medical officer, 
whatever canvassing there was having been to promote 
tbe insurance business and not to procure patients. He 
mentioned th«t only 160,000 of the twenty-two and 
a milli on members of friendly societies availed' 


themselves of the medical aid society. The managers of 
the society, and tbe men themselves, denied £aving 
canvassed for the medical society, and he said he should 
produce statements contradicting the specific allegations 
made in the statutory declaratioDB, and he sbo^d call 
Dr. Rendall and the principal officials to prove what 
their attitude had been. In conclusion, he pointed out 
that upwards of 2,000 medical men connected with 
similar societies would be affected by the decision 
arrived at. 

After further evidence had been given by managers of 
the Liverpool and Medical Aid Societies tending to re¬ 
fute the allegations of systematic canvassing for the 
latter— 

Dr. Rendall was called forward once more. Qnestione I 
by his counsel he said be saw many persons connected both 
with the Friendly Society and the Medical Aid Society. 
They were very poor. They could not afford medical assi^ 
anoe, be thought, except in this way. When complaint 
was made, be ma^de inquiries, and so far as he could 
find out, there was no canvassing. He asked his 
patients how they came to know of tbe Medical Aid 
Society and they said through their friends. He h^ no 
idea that canvassing was being carried on for tbe 
Medical Aid Society. He had not canvassed nor bad he 
been a party to canvassing for patients. In cross- 
examination, be denied all knowled^ about the cards 
which had b^n produced, and could not explain how they 
had reskchrd the persons. 

The further consideration of the case was postponed 
until the following day. 


FOURTH DAT.— Fbidat, Novbmbeb 29th. 

Tbe first item on the programme was the considera¬ 
tion of the case of a dentist who was found guilty last 
session of having unjustifiably made use of letters after 
bis name, calculated to convey the impression that he 
was a licentiate in dental surgery of the Royal College 
of Surgeons of England, which was not the case, he 
having been registered in virtue of having been in prac¬ 
tice b^ore 1878. As he stated that he had erred in 
ignoramce, and promised to sin no more in this partianlar 
way, he was let off with a caution. 

Italian Medical Deobees. 

Tbe report of the Executive Committee bearing on the 
value of Italian qualifications was brought up. They 
hii/i satisfied themselves that the regulations of the 
Italian Universities provide a sufficient standard of 
profeeeional knowledge, consequently the degrees in 
medicine and suersiT such Universities are recom¬ 
mended for admission to registration in this country, 
applicants to he required to afford suitable evidence of 
identity, Ac. A motion to refer the report back to the 
committee having been negatived the report was re¬ 
ceived and adopts. 

Repost or Education Committee. 

Some desultory discussion took place on a very 
elaborate report prepared by the Education Committee 
on the 6tep« taken with tbe object of securing improve¬ 
ment in the standard of preluninary examinations. 

Sir John Battt Tuee, in introducing the report, 
sa'd that tbe oldest of their Universities had met the 
committee on common ground in working for tbe 
common good, and he hoped that the Government 
would shortiy bring in an adequate Education Bill. 

Dr. Nobman Moobe criticised the wording in respect 
of the matriculation examination of the University of 
London and suggested an alteration. Ultimately the 
discussion was Mjoumed. 

The Medical Aid Association Case. 

The consideration of the case of Dr. Rendall was then 
resumed, ^me discussion took place on the <me8tion 
of the confirmation of the minutes, and then Dr. ^ndall 
was recalled. In reply to his counsel, he send that, as 
far as he had ascertained, there were no canvassers for 
the Medical Aid Society, and he said the statements 
made as to his having personally canvassed were untrue. 
A collector for the friendly society was called, and stated 
that be had received instructions on no account to canvass 


zed by' 


Google 


604 Th» MsDICAL 


GERMANY. 


forthe Medical Aid Societjr, and he added that the state¬ 
ments made conoeming him were deliberate falsehoods. 
A second canvasser gave evidence to the same effect. 
After some further corroborative evidence had been 
given, Mr. Lawson Walton, having been authorised by 
the Council to make any further remarks, urged that 
Recharge had not been established and that the evi¬ 
dence based on the statutory declarations was absolutely 
Alluding to the suggestion that all 
difficulties would be avoided if there were a separation 
in the staff of the Liverpool Society and the Medical 
Aid Society, he said it would not be worth the while of 
the Medi(^ Aid Society to organise a staff of its own, 
and that it would be better to let it die. 

Dr. Batbman, in conclnsion, contended that the charge 
had l^en proved up to the hilt j the canvassers went not 
only into the houses of the poor, but also to the'residenoes 
of the well-to-do, so that it could not be said that the 
institution was for the benefit of the poor. He added 
that what was objected to was the canvassing and that 
alono. 

The Conncil then deliberated for a long time in eamtra, 
and on strangers being readmitted the Pbbsident, 
Mdressing himself to Dr. Eendall, stated that the 
Conncil regarded the charges as satisfactorily proved. 
He insistod on the gravity of the offence of which he 
(Dr. Hendall) had been found guilty, and said that in 
order to give him an opportunity to reconsider his posi¬ 
tion the farther consideration of the case had omn 
adjourned until the next session. The Council then 
adjourned. 


FIFTH DAT.— Satdbdat, Notbhbeb 30th. 

Sir W. TtTBNBE, President, in the chair. 

A Question or Privileoe. 

The Pbbsidbnt said his attention had been called to a 
letter in which hie action in the chair had been chal¬ 
lenged, and it was practically alleged that he had acted 
in a way that he should not have done. This, be observed, 
was a matter of importance, as affecting three persons— 
namely, the member of the Council whole alleged to have 
made the statement, the President, and another member 
of the Council, regarding whom it is alleged the Presi- 
^nt had acted in a way that he should not have acted. 
That must be regarded as a question of privilege. It 
affected several members of the Council, and what he 
proposed was that the letter should go on the pro- 
gmmme of businm for Monday. Members of the 
^unoil would then have the opportunity of seeing what 
bad been stated, and also an opportunity would be given 
to himself to formulate an answer. 

Report of Education Committbb. 

The Council then resumed the consideration of the ' 
second report of the Education Committee on the steps 
taken for the improvement of preliminary examina¬ 
tions. 

Dr. Moobb, referring to the amendment suggested by 
him on the previous day, said that his proposal would 
remove a practical difficulty, but under the oiroumstances 
he would withdraw bis amendment. 

On the original motion. Professor Windle contended 
that it was quite impossible for the Council or any other 
body to suddenly raise the standard of preliminary ex¬ 
aminations without producing a dangerous dislocation 
in the educational affairs of the country. He believed 
such action would have a dangerously depressing effect 
on the number of medical students entering the pro¬ 
fession. 

Sir C. E'ixon said if the Council was not prepared to 
deal with these matters in a uniform way he should he 
obliged to advise those whom he could infiuence that it 
wav not absolutely necessary to assent to or follow the 
Council’s recommendations. He strongly protested 
against distinctions being made, reminding his col¬ 
leagues that they in Irelud had charters as long as 
any in England. 

Mr. Bbtant expressed his surprise at its being said 
that some of them were trying to go against the wishes 
of the Council. They were loyal to the Council, and 
should continue to be so in the future unless the Council 
gave them some good reason for their acting otherwise. 


Dec. 4, 1901. 

Dr. NobwAN Moore declined to be led into disoassing; 
the question of the length of charters on or the 
other side of the Channel, or the question whether 
William III. or Henry VIII., who lived a little earlier, 
had done more mischief to the human race. 

Dr. PaTTioBEw hoped they should not have, as he 
feared they might have, one law for England and 
another for Ireland in this matter. 

Dr. Glover thought a great responsibility rested on 
the Royal College of Surgeons in Ireland, whose repre¬ 
sentative bad introduced a subject which led to so much 
debate. He believed if they were to go to the Privy 
Conncil to adjudicate between the Council and the 
Colleges they would come to grief. 

Sir J. B. Tuke having replied, the closure was moved 
and carried unanimously, and the report, of whi<di high 
approval generally had been expressed, was adopted. 

Report of Pebbomation Committee. 

Mr. Horblet then brought up the report of the Per¬ 
sonation Committee. The report set out with much 
minuteness provisional regulations to guard against 
personation abuses, some of which were very gross 
indeed, instances have been mentioned in which a 
“ coach ” had passed an examination personating his 
pupil. The regulations applied to practitioners as well 
as to students. The report was under discussion when 
the Council adjourned. 


Germans. 

[from our own corbespondent.] 

Bsrliv, Not. 30th, 190L 
The Devtach. Med. Woch., 30/01, has an article on the 
Treatment of Dtsbntebt 

by Dr. Flehn. Whenever dysentery is diagnosed or 
even suspected, the patient has two tablespoon- 
fnlB of castor oil given. Examination of the follow¬ 
ing stools clear the diagnosis in doubtful cases, 
and allows an opinion to be formed as to the 
extent and degree of the intestinal changes that 
have taken place. But above all the laxative removes 
a large quantity of infectious material from the canal^ 
When the immediate action of the oil him subsided the 
calomel treatment ia begun. A tablet containing 0^ 
gm. is given every hour until twelve have been 
taken. The course is repeated the next few days, none 
being given daring the night. It is important that the 
calomel be given in the tablet or tabloid form, as no par¬ 
ticles of the calomel are then liable to be left.in the month 
and setting up stomatitis. Moreover, the patient must 
wash out his mouth with great care every time he baa 
taken his tablet with a solution of tincture of rhubarb 
in water, or with a solution of salicylic acid. If any sns* 
picion of stomatitis arise the gums must be scrubbed 
with a mop of cotton soaked in one of the solutions named. 
An interruption of the oslomel treatment is not necessary, 
but it is necessary to continue the care and treatment 
of the month for at least three days after stopping 
the calomel. After the calomel tablets have been given 
for three days, twelve tablets of bismuth subnitrate 
of 0 5 gro. each should be given hourly, the mouth 
being looked after and treated for three or four days. 
Six grammes of bismuth per day are given until the 
stools are formed, and until nothing pathological has 
appeared in the stools for some days. Then t^e patient 
takes three grammes per day in doses of half a gramme. 
With tendency to constipations in the later stages or 
with post-dysenteric intestinal catarrh a qnarter to half 
a litre of artificial Carlsbad water is given. This may 
be taken for some weeks with the best results after the 

Googie 



A.U STRIA 


Thi Msdical Pbisb. 605 


_D*c. 4, IWl. 
drag treatmeot has bean flniehed with. If irritabilitj 
of the mucoug membrane of the inteetinal canal con* 
tinneg, KUsingen water may be given ingtead. The 
diet is of prime importance; a milk diet is imprac¬ 
ticable. During the first few weeks, and nntil the 
stools are reduced to one or two a day, and nntil tbey 
are distinctly formed, a mixed, but exclusively liquid 
diet is given, the basis of which is rice cooked 
and strained, bonillon, eggs beaten up, gruel, cocoa, 
and, as far as possible, milk. A good Bordeaux is also 
given. When the stools have become free from mucus 
and traces of blood for some days, and when patients 
have often acquired a shatp appetite, an addition may 
be made of mashed potato, porridge, egg, with a light 
bisonit and perhaps a fruit jelly, Tropon may also be 
given, best with water as a medicine, and in it two 
tablespoonfuls mixed with water to a thick consistence 
and eaten with a spoon without aoy addition. Only 
twelve to sixteen days after all symptoms have dis¬ 
appeared should meat be given, and then that of the 
lightest with vegetables. A commencement sbonld be 
made with scraped ham and minced fowl, and later on 
the more usual kinds. 

Thb Quininb Tbbatmebt of Ttphoid Fkvib. 

Professor Goldscheider has some observations on this 
in the Therap. d. Qegenvsart, 7/01. In the high continued 
fever the effect is unsatisfactory in the majority of 
cases, especially in the first half of the stage. In the 
very early days, and in the latter half, on the other 
hand, the effect is better. If a dose of quinine acts only 
on the duration of the exacerbation, it is advisable to 
give another dose twenty-four hours later—perhaps a 
larger dose; but if the evening temperature is materially 
infiuenced it is well to pause for a day as the effects 
become less. In the eonUnua eontineru large doses must 
always be given 1'5 to 2 gms. Its actionmay throw light 
on a doubtful case. Its efficacy in short-lasting con¬ 
tinued at a time when it cannot be distinsuished from a 
severe case is a favourable prc^ostic, whilst a maxi, 
mum effect in medium length of curve not unfrequently 
indicate severe infection. A good effect may indeed be 
seen in oases that end fatally, but the fatal result is 
often due to complications and not to the fever itself. 
In regard to the question whether a morning or evening 
dose is better, the author has arrived at the oonolnsion 
that the evening administration is the more rational. 
Generally speaking, it is best to give the quinine about 
eight o’clock in the evening. 

Jlustrta. 

[raoM ona own cobbxbpondxnt.^ 

ViEiUTA, Nov. 30th, 1901. 

Subobbt of Stohach. 

At the Gesellschaft der Aerzte Uilmann showed a 
patient, set. 44, who became ill seven years ago with 
loss of appetite, general malaise, and vomiting. On 
two occasions the vomit was bloody, while the stools 
were also much blood-stained. The diagnosis at the 
time was ulcer of stomach. In November, 1900, an 
elongated growth began to show itself in the left hypo¬ 
gastric region, very painful on pressure, while vomitins 
was severe. From these signs it was concluded that 
this was either carcinoma or perigastritis ulcerosa. 

Operation revealed a large round ulcer which had 


become attsohed to the wall of the abdomen, through 
which it had almost penetrated. 

The second case had a similar history, which softer 
operating was found to be an hour-glass stomach with a 
hard cicatrix at the stricture, through which the finger 
had difficulty to pass. The origin had been a deep ulcer 
of the stomach. Gastrostomy was performed with the 
best results, and both patients perfectly recovered. 

Wbitbrs’ and Pianists’ Cbamp. 

At the “ Doctoren Collegium ” Bum propounded the 
pathology and rational therapy of writers’ cramp as 
well as to that of pianists’, who were most frequently 
attacked with this malady, although others who were 
confined to protracted restraint were also subject to the 
disease. Happily, this co-ordinative professional neurosis 
was not so common as might be expected. The very 
rarity of the disease has created a sort of scepticism in 
the profession that has not infrequently driven the 
patient to take refuge in the counsel of charlatans 
cbirographers, &c. After analysing the graphospasui, 
its stages, and varieties, which depend largely on the 
constitutional vigour. Bum considered the disease 
parallel with the theories of Erb and Benedikt in their 
demonstration of neuropathology. All these profes¬ 
sional defects may be relegated to the droulus vitiosus, 
which primarily commences with a disturbance in the 
peripheral nerves through muscle or nerve exhaustion 
which soon affects the co-ordination centre, culminating 
in loss of energy, inanition, and loss of power in la^ 
groups of muscles. The estiology or more remote origin 
may often be traced to alcohol, over^exertion, false 
technique, unsuitable writing wmfAvtulg and table, or it 
may be due to the uratic diathesis, or injury. 

Zabludowski has shown ,that traumatic arthritis, 
through compressed or constricted playing of the piano, 
In young children are often the initial point that act on 
the centripetal nerves, resulting, as Bucheim has ably 
demonstrated, in a neurosis of the peripheral nerves also. 
Probably the exhaustion in this complicated exercise 
may set up a functional disturbance that may lead to 
the same result. 

The first part of the treatment must be total abstinence 
from everything that induced the cramps, vis., play¬ 
ing, writing, or working. Locally, warm bathing, mas- 
s^e, passive movement, and some other gymnastic 
exercise. Various devices and apparatus are before the 
public to facilitate writing which may be taken advan¬ 
tage of when entire abstinence cannot be submitted to; 
this partial treatment is never satisfactory. 

Of all the forms of this cramp the spasmodic is the 
most amenable to treatment. Bam said he bad had 
thirty-five oases (writers) of this class: eighteen were 
cured or improved; seventeen pianists, of whom eleven 
were cured. These are exclusive of violinists, dancers, 
cyclists, masseurs, tennis players, &o., &o. 

Nxw Nabcotisino Apparatus. 

Braun showed an instrument for giving chloroform in 
combination with ether, or singly, simply by turning a 
tap on the instrument for ether or chloroform or both at 
the same time. 


Pbofxssob W. J. Simpson has been appointed, as an 
expert on plague, to advise the Government of Hong 
Eong as to the means to be adopted to check the con¬ 
tinued prevalence of the disease. 


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606 Tbs Midical I'srss. 


THE OPERATING TBEATBE8. 


Tic. 4. 1901. 


SunflarB- 

[FBOX OUB OWK COBBB8PONDINT.] 

Budipxst, Not. SOth, 1901. 

At the recent meeting of the Boyal Hungarian Medi* 
cal Society, Professor Elischer, of Budapest, read a 
paper on 

Thb Enplotxxnt of Hiboin in Gtnjecologt. 
According to the statistics of the last three years, 376 
patients out of 10,101 (3*67 per cent.), in the out¬ 
patient department, suffered from carcinoma. Among 
these only 105 (11 per cent.) were considered suitable 
for operation of any kind, and in only seTonteen oases 
was total removal indicated. The other patients, 
who wander from one hoipital to another, consult the 
surgeon chiefly in order to obtain alleviation of their 
painful symptoms. 

The pain associated with cancerous affections of the 
womb soon defies the drugs in general use, and, therefore, 

1 decided to administer heroinum hydroohlorium recom¬ 
mended by Breser, Gerhardt, and others. 

Compresses soaked in a 1 per cent, glycerine solu¬ 
tion of heroin were used in twenty hospital oases. In 
half the cases the pain was due to peritoneal irritation; in 
the other half to inoperable uterine cancer. 

In cases of ascending g^norrhceal perimetritis, as well 
as in cases of diseases of the adnexa, I succeeded in 
diminishing the pain. In one case of inoperable cancer 
I obtained a remarkably satisfactory result. Heroin 
proved useless in cases in which the cancerous degenera¬ 
tion involved the pelvic connective tissue and the 
glands. 

In cases of nervous restlessness and sleeplessness, and 
in hysterical wcmen the administration of heroin gave 
little 01 no relief. 

Professor Havas exhibited a case of 

Examthxha Univxbbalb Tubibosdn bt Planum, 
of seven years’ standing, in a g^l, let. 8. He had 
shown the girl four yeavs sgo, and his object now 
is to demonstrate the subsequent course. The dis¬ 
ease started originally in the skin of the forehead. 
As to the treatment, he sud that in all such cases 
the only radical cure is the operative excisiou of the 
xanthoma, but this can be performed only in cases in 
which the affection is not universal, as in the present 
case. ElectrolysiB is sometimes followed by satisfactory 
recovery, even in certain cases where one would hardly 
expect it. Its only disadvantage is that recurrence of 
the xanthoma is common after its use. The patients 
exhibited by him in whom by reason of the generalised 
nature of the affection neither of the above-mentioned ' 
methods was applicable, is taking phosphorus and tur¬ 
pentine inlemally, as recommended by Beenier. 

Dr. Hudovering read a paper on the 

Tabbs of Mabbibd Couplxb. 

Up to the present twenty-seven cases of tabes 
conjugalis are recorded in the literature of the 
subject, Hndovering now placed on record three 
further cases of the kind. It must be premised that 
in all the three couples the tabes was subsequent to 
syphilis, a relationship which existed in the recorded 
cases, in fact in twenty couples out of twenty-four, 
syphilitic infection was distinguished with certainty, 
in three conples there was reason to suspect it, and only 
one couple proved to be really free from syphilis. It 


follows that in 06 3 per cent, of the conjugal tabes oases 
there was antecedent syphilitic infection. The theory 
first brought forward by Lougres that tabes and general 
paralysis are produced by a special form of syphilis, i.»., 
a virus tiervtve, which, in bis view, possesses a special 
affinity for the central nervous system, Hudovering de¬ 
clined to accept this view until placed in posses¬ 
sion of real proofs. He holds, therefore, that thereason 
why so many syphlilics develop tabes or general para¬ 
lysis while the remainder are free from any sequels of 
the kind, is not to be sought in the above-named 
affinity of the syphilitic virus for the central nervona 
system, but that this special predisposition is to be 
sought for in another direction, perhaps in the con¬ 
genital or acquired particular disposition of the nervous 
system. 


©ptrating 


TOTTENHAM HOSPITAL. 

Ofbration fob Extba - utbbini PaxaNANCT. —Dr. 
Abtbub Giles operated on a woman, set. 34, who had 
suffered first for two months from amenorrhoea, this 
being followed a fortnight later by a second more (erions 
period. There had been considerable hsemorrhagic 
dribbling, followed by pain in the right side, which 
gradually increased. On admission she was very col¬ 
lapsed. A diagnosis of extra-uterine pregnancy having 
been arrived at, operation was performed the following 
morning sdterthe patient's admission. A tumour was 
found the size of the fist, which was removed, together 
with the right appendages; an nnruptured tnbsd gesta¬ 
tion being found in the proximal half of the right tube. 
The mass was very closely adherent to the right comer 
of the uterus, and it involved half the tube, the remain¬ 
ing half being almost ^unaltered. Owing to the patient 
having lost so much blood previous to operation and to 
admission, transfusion of normal saline solution was done 
before the woman was removed from the tabU at the end 
of tile operation. On cutting open the specimen a foetus 
of about seven or eight weeks was found in a small 
amniotic cavity which projected so far on the surface as 
to give the impression that rupture was imminent. Dr. 
Giles said that the points of comment in this case were: 
(1) the importance of collapse as a means of diagnosis in 
conjunction with pain and slight hemorrhage; (2) the 
relative rarity of these proximal pregnancies without 
rupture; (8) the value of transfusion as a restorative 
measure without waiting for very serious symptonu at 
the end of the operation. 

The patient made am uninterrupted recovery. 


A Sale of Practice Action. 

In an action tried in the King’s Bench Division last 
week Hr. F. B. Thompson, of Maida Vale, claimed 
damages from Mr. D. H. Beegling for alleged misrepre¬ 
sentation in regard to the sale of a practice which, ac¬ 
cording to the books, brought in between £400 and £600 
a year to the vendor and nothing at all to the purchaser. 
The vendor had himEelf purchase the practice in 1897 
for £620. There was the usual conflict of evidence, one 
question being whether the Maida Vale practice alone 
was sold or whether it included that part of Mr. Beeg- 
ley's practice in West-End hotels. Ultimately the 
jury was discharged without having agreed upon a 
velvet. 


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" SALUS POPDLI SUPBBMA LEX.” 


WEDNESDAY, DECEMBER 4, 1901. 


THE GENERAL MEDICAL COUNCIL. 

The session which was inaugurated last week, 
though it has not witnessed any very exciting 
debate of the kind to which we have of late years 
become accustomed, will be remembered for several 
reasons. In tbe first place, it witnessed tbe first 
practical application of tbe principle of reciprocity 
of medical practice. Tbe Executive Committee, 
having satisfied themselves that the regulations and 
I'eqnirements of the Italian Universities provided an 
adequate standard of professional knowledge have 
recommended the Council to admit Italian graduates 
to registration in this country on satisfactory evi* 
dence of identity, &c. Similar reciprocity will in 
future be extended to graduates of the University of 
Malta thongfa, as this is a British possession, the con¬ 
cession is not quite on the same footing. Thus is 
inaugurated a new era, and protectionism has been 
oust^ from one of its least defensible strongbolda. 
It may be anticipated that in the near future this 
principle will undergo considerable development, a 
development which must he jealously watched in 
order that it shall only establish equality inter parts. 

The prosecution of a batch of “open surgery” 
practitioners in .Scotland will, no doubt, bring home 
to those who are still in tbe position of violating 
tbe law regulating the sale of poisons the propriety 
of mending their ways. The principle having thus 
been formally established, future offenders cannot 
reckon on receiving the indulgent treatment which 
has been extended to these, tbe pioneers. If the 
difficulties which this pronouncement will introduce 
into the carrying on of a retail drug trade by regis¬ 
tered practitioners should have for effect to dis¬ 
courage this conjunction of trade with the practice 
of medicine the profession will be tbe gainers. 
The most important event of the session is probably 
the consideration of the case of Dr. Bendall, of 
Great Yarmouth, who was charged with being asso- 


Ab'riOLES. _ Ths Medical Paies. 607 

dated with a medical aid society wbicb system¬ 
atically canvassed and touted for patients. Tbe 
, case was gone into at great length, and the re¬ 
spondent bad the assistance of eminent counsel, but 
tbe evidence .was overwhelming, and tbe ingenuity 
of tbe defence was mainly directed to tbe discovery 
j of technical loopholes, a device which might con- 
' ceivably have proved successful in a court of law, 
but invariably falls short of its object before tbe 
Council, where tbe rules of evidence are somewhat 
more elastic. It was stated that upwards of two 
thousand practitioners await with interest, possibly 
with anxiety, the decision of the Council, a number 
which shows how widespi'ead the system has become. 
It was pointed out that the difficulty would disap¬ 
pear if tbe administration of the friendly society were 
separated from that of the medical aid society, but 
respondent’s counsel said he bad been informed that 
this would not be practicable, and that they would 
probably prefer to let the medical aid society die 
out. That, perhaps, is tbe best thing that can 
happen, although it was by no means tbe object 
aimed at, which was merely to prevent a society 
doing for a practitioner what that practitioner would 
not dare to do for himself. After a most patient 
hearing the Council arrived at the conclusion that 
the chaises had been proved, and as this was a test 
case they postponed the further consideration of the 
matter in order that Dr. Bendall may put his house 
in order before tbe next session, when he will have to 
appear and prove that be has taken the lesson to 
heart. 

AN OBJECT-LESSON IN VACCINATION. 

Tberb are obvious objections to tbe publication of 
statistics in tbe course of a prevailing epidemic, 
but, since the errors are known beforehand and can 
be allowed for, the advantages attending a clear 
statement of results as far as they go far outweigh 
the drawbacks. We welcome, therefore, tbe publi¬ 
cation in tbe Times for last Saturday of the salient 
features of the returns of tbe present epidemic of 
small-pox in tbe metropolis. The number of oases, 
it is true, is rather small for statistical purposes, and 
as tbe fatal cases are always in advance of tbe re¬ 
coveries, tbe mortality at any given period mast 
necessarily appear higher than it really is. Although 
it is necessary to point this out in order to avoid 
misconception, the error applies all round and does 
not invalidate a comparison between different classes 
of oases. The first point to attract attention is the 
very wide distribution of the epidemic, no part of 
Loudon having escaped. Cases have occurred in 
many districts which rejoice in an unholy notoriety 
for dirt and overcrowding, yet by far tbe greater 
number of oases occurred in tbe district of 8t. Fancras, 
a district which is less poor and overcrowded than 
several others. Tbe only light, says the writer of the 
article, which the returns throw upon the question is 
the fact that the proportions of deaths and unvacoi- 
nated from St Fancras were both excessive. Of 349 
patients, 181 were males and 168 females. The age 


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LEADING ARTICLES. 


Die. 4. 1901. 


608 Th* Midical Pbkss. 


of maximum amenabilitj to infection eeema to be 
between twenty axd thirty, and after fifty the liability 
to amall-pox appears to be slight, though when per* 
sons over forty do contract the disease the rate of 
mortality is extremely high. Of the 349 cases 116 
ended fatally, representing an apparent case mortality 
of 33 per cent, an estimate which, as wo have already 
explained, is in excess of the truth. The author divide s 
the cases into three groups, vaccinated, unvaccinated, 
and " doubtful,” and it is hai'dly necessary to pointout 
that “ doubtful ” is almost an exchangeable term for 
unvaccinated. The vaccinated cases numbered 233, 
and showed a mortality of 20 per cent. The mor¬ 
tality among the unvaccinated and doubtful was 60 
and 57 per cent, respectively, so that the rate of 
mortality among the unvaccinated was thrice as 
great as among the vaccinated. When all the non- 
fatal cases belonging to the same period are added 
the rates will,of course, be lowered, but the difference 
of mcaiality between the vaccinated and the nnvac- 
cinated will probably be increased because the great 
majority of the favourable cases are among the vac¬ 
cinated, Analysing the figures, we find that all the 
cases of small-pox under five years of age were un- 
vaccinated, and of these nineteen out of twenty-three 
died. Under ten all were unvaccinated except one, 
and of forty-two there were twenty-nine deaths, 
all among the unvaccinated. Out of a total of 
eighty-one children under fifteen, fifty-seven were 
unvaccinated, and of these thirty-eight died, while 
of twenty-four vaccinated children twenty-three 
recovered. The figures show that the protective in¬ 
fluence of vaccination diminishes pn^^sively after 
childhood, but at every age the unvaccinated oases 
show a vastly higher mortality than the vaccinated 
Tiro deaths occurred among revaccinated persons, 
revaccination having been performed, in one six, and 
in the other seven, years ago. It is a significant fact 
that no instance has occurred of the occurrence of 
small-pox among the immense numbers of those who 
have recently been revaccinated at a time when they 
may be assumed to have been free from infection. 
With regard to the relative severity of the attacks 
it is mentioned that the confluent and hsemorrhagio 
forms occurred in 22 per cent, of the vaccinated 
and in 73 per cent, of the unvaccinated, and, 
as in all other epidemics, the measure of protec¬ 
tion appeared to be in direct proportion to the 
number and area of the scars. We welcome this 
brief synopsis because it comes opportunely as a 
set-off to the wearisome juggling with figures with 
which the Press has of late been inundated. The 
figures afford irrefragable proof of the protective 
value of vaccination, a protection which, though it 
be not as permanent and as absolute as was at one 
time hoped, is nevertheless striking enough to con¬ 
vince the most sceptical We note in this connection 
that at a recent meeting of the Association of Public 
Yaccinatore a resolution was passed in favour of 
transferring the whole administration of vaccination 
from the control of local bodies to the Local Govern¬ 
ment Board, or some other central body. In view of 


the obstructive tactics of many boards of guardians 
at the present time this expression of opinion 
deserves serious consideration. 

THE PURSUIT OF HEALTH. 

The pursuit of health is with some persons almost 
as absorbing a task as the pursuit of pleasxu'e by 
others. In both cases the intellectual phase is 
capable of much philosophic sifting whether con¬ 
sidered in the purely individual aspect or on the wider 
basis when the attention of a community is involved. 
There can |be no doubt that in many instances the 
search for health is simply a valetudinarian expres¬ 
sion of lack of proper mental and bodily occupation, 
but the hypochondriac may be found in all ranks <ff 
society, from the duchess who fosters bone- 
setters and quack medicines, to the club patient 
or the workhouse inmate who swallow physio 
literally by the hogshead in the course of 
the year? As to ,the average working man, it 
may be said that he has no time to be ill, and if he 
sicken and fall out of the ranks the only course open 
to him is to die. In fulfilling that destiny he is 
simply obeying the remorseless laws of the struggle 
for existence by which Nature has ordained that tnaw 
shall work out the salvation of his race. Some day 
it is not improbable that the more equal distribution 
of property which is likely to take place in a far 
future will result in the health of the producers 
being carefully guarded by the State. Meanwhile 
the progress of civilisation has been mainly in the 
direction of the fostering of weakly individuals by 
enabling them to hold property in safety. The wealthy 
invalid is able to secure for himself every possible 
condition of environment favourable to the prolonga¬ 
tion of life and the arrest or cure of his complaint. 
The sick man who is not wealthy, moreover, com¬ 
mands a vast deal of attention under latter day 
social organisations. The great modem system of 
medical service, both State supported and voluntary 
Is to a great extent directly concerned in bolstering 
up the weak and the sick and those defective in 
mind and body, who would perish if left to their 
own resources. In this way the humanity of 
mankind thwarts in practice the precepts that have 
long ago been framed by philosophers with a view 
to the construction of ideal Utopias from which 
the unfit shall have been ruthlessly exterminated. 
Philosophers, however, have always to reckon with 
the emotional side of human nature in their en¬ 
deavour to govern mankind by the force of pure 
reason. The existence of that moral protest, for 
instance, n^atives for once and for all time the 
proposal to encourage marriages on grounds of arti¬ 
ficial selection so as to breed a race of men on lines 
that have been reduced to a science by cattle breeders. 
While humanity is humane its methods are not likely 
to alter much in principle. The care of the sick in 
civilised communities is certain to continue a prime 
object of solicitude, although signs are not wanting 
that some day the State may assume the burden 
that has hitherto been borne mainly by the shoulders 

D!c:'''ze'^ CjOO^ 10 


Die. 4, 1901. 


NOTES ON CURRENT TOPICS. 


ThI tfaOIOAL PKJtSS. 609 


of the philanthropic citizen. The endless pursuit of 
health, whether by the hypochondriac or by the 
weak, is in some way or other a standing reproach 
to our imperfect condition of derelopment. In some 
cases the environment of the individual is at fault, 
and he is the mentally enfeebled product of a defec* 
tive system of up-bringing which has failed in his 
physical or his intellectual education, and has turned 
him out into the world with no definite object 
in life. In other instances he has been the victim 
of insanitary surrounding in home or in factory, or 
of preventible disease in one of its myriad forme. 
It is with these two last mentioned factors that 
scientific medicine is concerned, and may be said to 
be itself engaged hotly in the pursuit of healtii. 
Preventive medicine by reducing the incidence of 
some infectious diseases and by exterminating others, 
has achieved and is achieving prizes of incalculable 
value in this absorbing chase. Thanks to the medical 
profession, plague and cholera have been banished 
from the shores of the United Kingdom, typhus 
fever and small pox have received their death blow, 
and various other deadly mfectious diseases show 
signs of the defeat that sooner or later awaits 
them in the warfare that is being waged 
against them by modem sanitary science. In 
spite of the fields that have been won, however, 
much is left to be conquered. A great unknown 
wilderness remains to be explored before medicine 
can be reduced to the position of an exact science. 
That terra incogniia is the happy hunting ground of 
the quacks who prey on unwary persons wandering 
thitherwards in the pursuit of health. It is to be 
hoped that the attainment of the day of fuller know¬ 
ledge will enable legitimate medical practitioners to 
rescue all who are in search of health from the 
clutches of the patent medicine vendor and the 
charlatan. 

JCotfB on (Eurunt ^ojiico. 

The Resignation of Sir W^illiam Turner. 

The announcement made by Sir William Turner, 
the President of the General Medical Council, at the 
close of the address with which he opened the recent 
session of that body, in reference to bis intention 
to place his resignation in their hands, comes upon 
us as a surprise. Since Sir William took up the 
sceptre which bad fallen from the hands of the late 
Sir Richard Quain, he has proved in many respects 
an admirable president, whose rulings have almost 
always been deferred to with respect. His tong 
experience of Council business and his own decision 
of character enabled him to control the debates and 
to guide them to practical oonolusions. Cert^ 
incidents, to which we need not now refer, showed 
that he was not altogether in touch with the 
new spirit which has been imported into 
medical politics, and on more than one occasion 
he went out of his way to place obstacles 
in the path of those who recognised the imperative 
neoessity of reform in certain departments of the 


administrative work of the Council. Errare 
humanum e»i, a failing from which even the most 
distinguished are not exempt. The Council will 
remember Sir William as a conscientious, hard¬ 
working president, as a man of sound jodgmenb 
and good counsel, who endeavoured, generally 
with success, to be impartial. Those who know 
the amount of labour and the responsibility which 
appertain to the post of president of Council will 
readily understand and sympathise with Sir 
William's desire to be relieved of the burden. His 
services to the medical profession in many important 
capacities over a very long period of years entitle 
him to a well-earned repose which, we trust, he may 
long live to enjoy. 

Medical Advice in the Lay Press. 

Foe many years it has been the custom of cer¬ 
tain lay papers to give medical advice in their 
columns. In one well-known Sunday paper several 
columns are given by a " physician whose qualifica¬ 
tions for the work are of the highest.*' This person 

is, of course, anonymoru, or the Medical Council 
would promptly take cognizance of his existence, if^ 
indeed, he be a medical man at alL Not long since, 
however, an advertisement appeared in a daily paper 
for a medical man to undertake the medical columna 
of a weekly journal, presumably the journal in 
question. For any medical man to prescribe for 
hundreds of patients he has never seen on the 
sole evidence of their necessarily imperfect 
description of their own symptoms is not 
only absurd but constitutes a positive danger to 
the public, to say nothing of a disgrace to the prac¬ 
tice of medicine. It is a pity that a paper edited by 
a brilliant journalist should descend to commerce 
of this kind. Even worse than this are the adver¬ 
tisements of so-called skin specialists and others 
who mostly have rooms in Bond Street. These 
people advertise in the periodicals which appeal 
mainly to lady readers. We read that Madame X. 
will remove superfluous hairs and perform many 
other operations which are the province of the derma¬ 
tologist. That such people should be allowed to carry 
on these practices with impunity is regrettable, but 
the Medical Council have apparently no power to stop 

it. It is possible that some of these advertisements 
are merely a cover for places of assignation or worse, 
as in the case of the notorious “ massage ’’ establish¬ 
ments. 

The First American Practitioner. 

Amono “ the names of those which came over first, 
in ye year 1620, and were by the blessing of God the 
first beginers and (in a sort) the foundation of all 
the Plantations and Colonies in New England ; and 
their families,” we read the name of ” Mr. Ssmuell 
Fuller, and a servant caled William Button.” Ac¬ 
cording to Dr. Packard, who has recently published 
a work entitled “A History of Medicine in the 
United States,” there is little doubt that the earliest 
practitioner of medicine in Massachusetts was 
gamuel Fuller, who was among the passengers on 

cog e 


Di'- ‘ zed t. 


610 Tn» M»i.ic4l Pbms. NOTES ON CTJERENT TOPICS. 


Dbc. 4, 1901. 


the * Mayflower ’ in 1620. Apparently Fuller 
held no diploma or official recognition, but 
still he was cooaidered to be the physician of 
the pilgrim colony, and was even called in this 
capacity to the infant colony of Massachusetts Bay. 
The first record of his professional work occurs in 
August, 1621, when in a scrimmage with the Indians 
ther was 3. sore wounded; these they brought 
home with them,” i e., to Plymouth, “& had their 
wounds drest & cored and sente home.” This act of 
kindness had an excellent effect in theway of winning 
the friendship of their savage neighbours. In June 
or July, 1622, ca^ne the Charity and Svmn, two ships 
sent by “ Master Thomas Weston "—from whom the 
pilgrims suffered so much ill-usage—having in them 
some fifty or sixty men. During their unwelcome 
sojourn at Plymouth several of their number became 
sick and lame,” and these they left at Plymouth 
under Dr. Fuller’s care, “ although they had a sur¬ 
geon of their own,” Mr. Salisbury. In the winter of 
1628 an epidemic appeared among the newly arrived 
colonists at “Naumkeag” (now Salem), in Massa¬ 
chusetts Bay, caused “by infection that grue 
amonge ye passengers at sea.” Accordingly, Dr. 
Fuller was sent to the Bay colony, where he 
attended to the bodily ailments of the settlers. 
In the summer of 1630 Dr. Fuller was again 
called to Massachusetts Bay on account of the 
great prevalence of sickness, occasioned, says Oov. 
Winthrop, by “ ill diet at sea.” Therefore, on July 
8 th, he went to Matappan (now Dorchester), “and 
let some 20 of these people blood.” On August 
4th he was at Salem, and a little later at Charles¬ 
town, probably still “ letting blood,” and discussing 
theology, for he was quite as well versed in the 
theology of the day as he was in medicine. Soon 
after he wrote that “ the sadd news here is that many 
are sick and many are dead. I here but lose time, 
and long to be at home. I can do them no good, 
for 1 want drugs and things fitting to work with.” 
Further referenced to Dr. Fuller’s medical work are 
few, and wherever he is subsequently mentioned he 
appears in the light of a theologian. In 1633 the 
colony was visited by an “ infectious fevoure,’' of . 
which, “after he had much helped others” died 
Samuell^ Fuller, who was their suigeon and phisi- 
-tion.” 

Unneoessary Operations. 

It cannot be denied that at the present time there 
is a tendency to perform operations upon cases 
where, to say the least of it, operative interference 
is unnecessary. In this way a veritable (xusoethe$ 
f/perandi grows apace. In no department of surgery 
Is this so prevelent as in that of the nose and 
throat A distinguished laryngologist has lately 
4rawn attention to the subject in a lecture on 
the principles of local treatment in diseases of 
the upper air passages. He points out that the 
craze for operation is conspicuous in the case 
of adenoid vegetations, which came before tiie 
notice of the profession only about twenty years 
ago. Suddenly operation for adenoids became 


the rage, and every lymphatic nodule in the pharynx 
was promptly removed. It must be admitted that in 
a severe case causing obstruction to nattal respirataon, 
operation is not only justifiable but distinctly indi* 
cated; but many non-obstructive cases do not 
necessitate operation, and the adenoids often dis¬ 
appear spontaneously. In the case of adenoids the 
fault lies pmrtly with the public, for parents ask each 
other if their children have been “ done,” as if it were 
a matter as necessary as vaccination. With regard 
to the danger of this excessive operating, in 1896 
statistics were published showing that in two years 
and a quarter eleven deaths were reported after 
operation for adenoids, most of which were con¬ 
sequent upon the practice of obliging the snssthetist 
to perform his duties with the patient in the sitting 
posture. Next to adenoids, perhaps operations on 
the nose come into the question. No one can object 
to a nasal spur, or other material obstacle which 
causes serious obstruction to breathing being 
removed, but every slight deviation or spur of the 
nasal septum does not require the saw, nor every 
puffinesB of the turbinate bones the cautery. 

Medical Fees in Legal Proceedings. 

In another column, we report a case of much 
interest to the medical profession, involving the 
question of the fees to which medical witnesses are 
entitled. As it is probable the case will be brought 
before the Court of Appeal, we refrain from com¬ 
menting upon it. We should like, however, to correct 
a mistake, which was made by Mr. Justice Wright in 
delivering judgment. He said that he had asked 
the question why one of the witnesses should receive 
anything beyond the ordinary fee, and the reply be 
bad received was that it was because the witness 
was a gentleman of great eminence. Mr. Justice 
Wright, however considered, that to express it collo¬ 
quially, “ the witness received higher fees because 
he drove a brougham and lived in Merrion Square.” 
Mr. Justice Wright will, we hope, pardon us if we 
correct him. A witness of eminence reemves, and is 
entitled to receive, fees beyond the ordinary scale, 
not because be drives a pair, but, again to express it 
colloquially, because bis market value entitles him to 
demand such fees. Mr. Justice Barton’s remarks 
are more to the point:—“ There was great force in 
the argument that one guinea a day was not areason- 
able fee for a doctor, between party and party, for 
attendance in court.” We trust that the matter will 
be submitted to the Court of AppeaL 

Izunates Inebriate Beforznatories. 

A CONFSEXNCX was held last week at tiie Home 
Office with the object of devising some scheme of 
voluntary assistance to inmates released from 
inebriate reformatories, under the presidency of Sir 
Eenelm Digby, the Permanent Under-Secretary of 
State. The conference was attended by representa¬ 
tives of the Bench, Church, County Council, various 
missions, and similar bodies. The conference was 
not concerned with either the establishment or 
maintenance of inebriates’ reformatories, bnt with 

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the treatment of the inmates at avery critical period 
~ namely, when they had undergone a period of 
detention in a reformatory and were set free pro* 
visionally for a time under a system of licensing. 
Experience teaches that when an inebriate is released 
after apparently Tery considerable progress has been 
towards reclaiming and reforming him, if he goes 
back at once to his original surroundings he is in 
grave danger of relapse. What is urgently required 
is some organised method of protecting the inebriate 
during this dangerous interval, and unless such a 
want is supplied there is considerable danger of the 
object of the Inebriates’ Act being lost altogether. 
This reform is one which might easily be specially 
met by the representatives of the various philan¬ 
thropic and religious associations. Homes already 
exist which might well he adapted for the 
purpose, and it earnestly to be hoped that the 
conference will succeed in arranging some method by 
which these homes might be brought in contact with 
the reformatories in order to continue and complete 
the good work begun in the former. The proceed¬ 
ings of the conference were almost entirely informal, 
and the various representatives present expressed 
their views in a conversational way, with the result 
that it is possible that much good will come of the 
interchange of opinions which took place. 

Another Sui^eon “Back from the War.” 

It is somewhat of a mystery why every medical 
man who has held any prominent position in the 
South African campaign should consider it his 
bounden duty to give a blank cheque of absolute 
confidence in the Government immediately on his 
return home. The thing has happened so often that 
it is now accepted as a matter of course. The base 
insinnarion of some of the baser yellow journals, that 
these civilian utterances are influenced by the pro* 
spect of official honours and rewards, may be at once 
dismissed with contempt. For all that, it would be 
as well for these martial civilians back from the 
war” to exercise in their speech a little more of the 
caution that they attach to their scientific state¬ 
ments. Not long ago Hajor Stonham, in the 
course of a public lecture at Haidstone, is 
reported to have said that " it made his 
blood boil to hear it alleged that Boer women and 
children were not well treated.” Individual bad 
treatment of women and children by our soldiers 
has never been alleged. The policy of the concen¬ 
tration camps has been criticised, and their insani¬ 
tary and defective organisation, that have led to 
a disproportionate mortality. Does that latter fact 
rouse Major Stonham’s anger P If so, just at present 
abundant opportunities exist for airing his views in 
public. The facte advanced by the Government, 
that the Boers have insanitary habits, and are so 
ignorantly foolish and superstitious as regards 
medical matters that their usual death-rate is abnor¬ 
mally high, should have weighed'against the policy 
of bringing them together in large numbers under 
unfavourable conditions of surveillance. 


College Representation on the C.M.C. 

The annual meeting of the English Royal College 
of Surgeons is chiefly remarkable for the registration 
of pious opinions. The tall of the Council wags the 
body of the members, and the protests of the latter 
are listened to, usually, with gravity and politeness, 
and then the matter ends. Were the I'esolutions 
duly carried at former meetings to be carried out by 
the Governing Council of the College, the most 
exacting reformer would find his vocation gone as 
regards a score of standing grievances. It is of 
little use attempting to bring this ancient and auto¬ 
cratic body into touch with the times, however, 
until a radical alteration in its constitution 
has been made by conferring a right of elec¬ 
toral representation upon its members. In the 
absence of that form of control the resolutions 
passed at the annual meetings can have nothing 
beyond an abstract and academic interest. At the 
meeting held in Lincoln's Inn Fields a fortnight agor 
a resolution was passed “ that the representative of 
the College on the General Medical Council should be 
elected jointly by the fellows and members of ten 
years’ standing,” Were that principle to be adopted 
it would register one of the most practical of medical 
reforms that could well be imagined. Such a step 
would at once reduce the preponderance of the purely 
educational element in the College nominations to 
one more widely representative of the interests of 
the main mass of the members of the College. It is 
this subordination of general to particular forms 
of government that has led to the present defence* 
less position of the profession as a whole. A pore 
democracy may one day supplant the autocracy 
that now holds the Colleges and the General Medical 
Council in an iron grip. That appears to be the 
unacknowledged goal of the most active medical 
reformers. 

The Alleged Cure of Cancer by X-Rays. 

The news of an alleged cure of cancer by an 
American medical man has, within the last few days, 
been busily bruited among the public newspapers on 
this side of the Atlantic. The particular method 
thus announced is by exposure to the X-rays, or 
rather to the tube that produces the rays, which in 
themselves probably possess no healing virtue of any 
kind whatever. There is nothing new in the treat¬ 
ment of cancer by the focus tube, for the plan has been 
upon its trial by English surgeons for many months 
past. The statement that the X-rays cure cancer is 
so utterly cruel and misleading, however, that it may 
be we 11 briefly andsummarily to nail the lie to the coun¬ 
ter. That the method is able to exercise a favourable 
influence over the surface of an ulcerating and slough¬ 
ing cancer is an acknowledged fact, but partial healing 
of a skin surface does not mean the cure of a deep- 
seated cancerous process. In a word, any man who 
says he can cure an internal cancer by exposure to 
the X or any other rays is making claims to which 
there is no scientific basis; in other words, he is air¬ 
ing falsehoods. When the cancer is of an absolutely 

c 




612 Thi M<i>xcal Fbzbs. 


NOTES ON CUBRENT TOPICS. 


Dec. 4 , 1901. 


Buperficial kind, affecting only the skin, and known | 
as an epithelioma, there is good evidence to show that 
it may in some instances be cured by the X*ray 
method. That is a very different affair from the im¬ 
pression that must necessarily be conveyed to the 
public by the general statement that cancer can be 
cured by the X*ra}^s. The wisdom of publishing 
matters of this kind in lay newspapers is more than 
questionable. In order that the practice of semi* 
quack administrators of X-ray cures may not be 
swelled by the credulity of sufferers from cancer, it 
becomes a duty of medical journalism to sound a clear 
note of warning. 

The Macclesfield Infirmary Dispute. 

The dispute between the honorary medical staff 
and the governors of Macclesfield Infirmary in 
regard to the appointment of Miss Murdoch Clark as 
junior house surgeon has not made any progress 
towards settlement. At the conference between the 
honorary medical staff and the board, which took 
place last week, the former insisted on their right, if 
not to appoint, at any rate to select for appointment 
the residents with whom they would have to work 
In practice, no doubt, this custom, for custom it is, 
makes for harmony and efficiency, but in this par¬ 
ticular instance the principle of the appointment of i 
qualified women on the junior staff is at stake, and | 
a deadlock is the result. It can hardly be doubted that 
at the present time the medical profession in general 
view the appointment of female resident medical 
officers with great disfavour, and in the present 
instance the honorary medical staff have our 
sympathy in so far as the general principle 
of their right to nominate candidates is con¬ 
cerned, but in so far as their objection is based 
on a prejudice against the appointment of qualified 
women we cannot support them. The paramount 
question, however, is the welfare of the institution, 
which is likely to suffer from the existing deadlock. 
If the staff persist in their refusal to work with a 
woman resident the interests of the patients demand 
an immediate solution — the most obvious course 
being the withdrawal of the “ bone of contention.” 

Medioal Men and Midwives. 

An elderly woman, described as a monthly nurse, 
was sentenced to a term of imprisonment a few days 
since, at the Central Criminal Court, on a charge of 
manslaughter by culpable negligence. She absolutely 
neglected her patient and left her without assistance 
or directions. A medical man was sent for, but at 
first refused to attend because, as he subsequently 
explained at the inquest, he had already attended 
several cases with this unqualified midwife, and was 
afraid lest the General Medical Council should 
prosecute him for *' covering.” The Judge 
was ” inclined to believe ” that the witness was 
under a misapprehension in supposing that the 
Council would view with disfavour his having 
responded to the summons. It is difficult to believe 
that the medical witness really laboured under this 
delusion, and it rather conveys the impression of 


being merely an excuse for his refusal to render 
assistance when first applied to. If a medical man 
habitually employed an unqualified female assistant 
and placed her in sole charge of obstetrical cases, 
only intervening to sign the certificate of death in 
the event of a mishap, he might conceivably render 
himself liable to be hauled before the Council; but 
that is a very different matter to attending cases in 
which, from carelessness or ignorance on the part of 
the midwife, the case has assumed a serious aspect. 

Scientifits in a Balloon. 

The hidden energy of modem scientific observers 
is in some ways one of the most remarkable features 
of the present age. Anything that offers an oppor¬ 
tunity of experimentation* under new conditions is 
seized upon eagerly as though it opened up the 
aveuues to boundless wealth instead of leading, as 
usually happens, to the fields of empty fame that 
too often await the single-minded man of science. 
The whole position is be'ng at the present moment 
iUustrated by a series of experiments recently con¬ 
ducted in Paris by three medical men in balloons, 
lent them for the occasion by the Aero Club. Their 
professed general purpose was to study the physio¬ 
logical condition of man in the upper air. One par¬ 
ticular object was to find out whether the high 
altitude sickness and other phenomena were due 
to oxygen saturation or to alterations in blood pres¬ 
sure. It was hoped that the point would be deter¬ 
mined by noting the effect of inhaling oxygen gas, 
and by examining the expired gases. Another set of 
experiments was devoted to the spectroscopic and 
microscopic appearances of the blood. The observa¬ 
tion of M. Gaute, of Zurich, that there was apparently 
a targe increase in the blood corpuscles after a rapid 
ascent in a balloon was to be tested. Had the pro¬ 
posal to throw fresh light on blood diseases by send¬ 
ing three learned medical men up in a balloon been 
advanced a generation ago the derision of the world 
would have been invited thereby. Nowadays, how¬ 
ever, nothing is too new or too strange. It is possible 
to see the bones of one’s hand through two feet of 
timber, why should it be impossible to find a cure for 
anromia a mile or so up in the skies P 

The Peers as Medical Advisera 

It is curious to observe how great an amount of 
support is bestowed upon quacks and quacklings by 
members of the peerage in the United Kingdom. 
Mattel’s cancer cures and almost every other noto¬ 
rious medical fraud of modern times has been pushed 
at one time or another by its titled admirers. 
Latterly we have had the claims of an unqualified 
bone-setter gravely upheld in public against those of 
the leading medical men of a provincial town. Quite 
seriously, too, the value of violet leaves as a cure for 
cancer has been proclaimed on the testimony of the 
sister of a belted earl. Can the persons who publish 
such hasty conclusions be conscious of the vast 
amount of groundless hope and of infinite des¬ 
pair and anguish they are calling into being? 

' There is another and less harmful class of 


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peers who simply rail against the medical 
profession. Among the most amusing instances 
on record was that of the Dnhe of Portland, 
who, in presiding at an antivivisectionist meet* 
ing some years since, was so anzions to make 
ont a case against the “ doctors’’that he defended 
the sacrednese of sport by asserting that the latter 
was for the good of ereryone concerned, including 
the hunted quarry. A week or two ago Lord Cam- 
perdown, in the course of a long, discursive speech 
delivered to his constituents in Forfarshire, deliverd 
his mind of some very noblemanlike sentiments on 
the matter of disease. According to the Dundee 
Courier, of November 22nd, his lordship said be did 
not believe much in disease, and he thought it was 
the doctors who brought about disease veiy much. 
If this sort of thing goes much further we shall have 
to attach a new reading to nobleese oblige, so far as 
regards its relations with the medical profession, and 
with scientific medicine. 

Red Tapeisxn and the Wounded. 

Some time ago a disabled soldier named McNamara 
sought and obtained admission to the North Dublin 
Union Workhouse. From the injuries he received 
in South Africa he became paralysed, for which he 
was invalided home. The doctor of the workhouse 
communicated with the War Office concerning the 
poor man’s pension, and received bank the intelli¬ 
gence that “ the soldier’s rate of pension was deferred 
uni il he left the Union.” Being paralysed and penni¬ 
less he cannot leave, he has no place to go, and is of 
necessity forced to remmn in the workhouse. Surely 
under such circumstances a little common sense 
might be ezernised in dealing with such a case. The 
course pursued is well calculated to make the Army 
unpopular in the very city which furnished some of 
the bravest men who went to South Africa. 

Glucose in Marmalade. 

The question of the liability of vendors of glucose 
made jam and other preserves to prosecution under 
the Food and Drugs Act has been at length disposed 
of in the higher courts. Last February a Worthing 
grocer was convicted of unlawfully selling, to the 
prejudice of the purchaser, marmalade adulterated 
with 13 per cent, of glucose. This verdict was 
brought up on appeal to the West Sussex Quarter 
Sessions, and having been dismissed thereat was 
brought before the Court of. Appeal. It was proved 
that glucose consisted of 40 per cent, of glucose, 
which is practically sugar, 40 per cent, of a gummy 
substance, deztime, and 20 per cent, of water. In 
the absence of a standard composition for marma¬ 
lade it is not easy to see how it could be proved that 
any material sold under that name was not of the 
"nature, substance, and quality” demanded by the 
purchaser. The Lord Chief Justice said he would 
not have come to the conclusion arrived at by the 
Quarter Sessions, namely, that when a man asked 
for marmalade he thought he was going to obtain 
only oranges and sugar, because there were a num¬ 
ber of other ingredients which might very properly 


be put into it. In his judgment there was no 
evidence of any inferior quality or adulteration, in 
the ordinary sense of the word. The appeal was 
dismissed and the common'sense view adopted that 
glucose is a legitimate preservative for making mar¬ 
malade, and presumably other jams and preserves. 
There are so many injurious adulterations in food 
that it would be a thousand pities were an important 
trade harassed by the imposition of restrictions that 
have no bearing upon the health of the public. 

The Small-pox Epidemic in London. 

The grip of the small-pox is tightening around the 
population of the metropolis. At the end of last week 
the Metropolitan Asylums Board had to report the 
substantial increase of 79 cases under treatment as 
against the numbers cf ibe previous week. Since 
August 10th no Irsi than 864 patients have been 
rrceived at the Wharf Shelter. Of that number 
858 were sent on to the hospital shi^s, while 369have 
been discharged end 136 have died. These figures 
show beyond a doubt that London is threatened 
with one of the most serh us outbreaks of small-pox 
that has been known in recent times. At this stag^ 
of development it sounds somewhat strange to 
hear the announcement of the Chairman of the 
Asylums Board that ” t he time had come 
when they could form a pretty good idea as to the 
outbreak, and he believed there was going to be 
rather a heavy epidemic.’’ Considering that the 
present development has arisen frcm a single case, 
and that the centres of infection have been multi¬ 
plied by several hundredfold in an enormously large 
and overcrowded community, imperfectly protected 
by vaccination, the situation is more than grave* 
The worst feature of the case in modem days is the 
certainty of spreading the disease sooner or later to 
various parts of the provinces, now that intercom, 
munication is cheap and universal. 

Honouriog the Memory of a Physician. 

On Sunday, November 17th, Senor Conde de 
Romanones, Minister of Public Instruction, of Spain, 
unveiled a tablet in Mxdrid which was erected in 
honour of Dr. Martinez Molina, in the house in 
which he died, 133, Calle de Atocha. The meeting 
was called together in the great amphitheatre of the 
Saint Charles Hospital, where in the presence of 
numerous members of the medical profession and 
many Court dignitaries and members of the Govern¬ 
ment, Senores Van Banberghem and Ruiz Jimenez 
delivered addresses on the memory of the deceased, 
after which the procession formed and marched to 
the site of the tablet, when the Minister, Senor 
Romanones, uncovered it. 

Changes in the Staff at St. Bartholomew’s 
Hospital. 

Wb understand that Mr. Alfred Willett, the 
senior surgeon at St. Bartholomew’s Hospital, has 
just handed in to the Govemoi-s his resignation of 
that post, thus leaving a vacancy on the surgical 
staff. In the ordinary course of things, doubtless, 

Dl" ' hw CjOO^ 


614 Thk Mbdioal Pssm. 


MANCHESTER. 


Dbc. 4. 1901, 


Mr. Cripps, the senior assistant snrgeon, will “ attain 
his majority’'and succeed to tbe poet racated by 
Mr. Willett. For tbe Tacancy upon tbe assistant 
snrgicai staff there are several who are eligible. Tbe 
senior on tbe list, whether or not be competes, is Mr. 
Berry, a former candidate; in addition, tbe snrgicai 
registrar, who has just resigned that post, as well as 
tbe senior demonstrator of anatomy. Tbe competiton 
is certain to be keen, whoever the competitors may 
be, while an election of tbe kind at St. Bartholomew’s 
always excites a large amount of interest, far beyond 
the confines of that noted institution, in medical 
circles. 

A COBBESPONDENT ot the St. James's Gatette re¬ 
lates a means of circumventing tbe Sale of Poisons’ 
Act, which, though ingenious, is for obvious reasons 
not likely to be often resorted to. A chemist, who 
happened to be busy when asked for some cyanide of 
potassium, handed some to the customer, but dis 
pensed him from signing the poison book, on the 
ground that though he dare not sell poison without 
complying with the law, he could give it away if he 
pleased without any attendant formality. 

It is interesting to note that for the first time 
the two Royal Colleges of London and tbe General 
Medical Council were officially represented at tbe 
last Guildhall banquet. It is stated that tbe inno¬ 
vation is the result of the subject having been 
brought before Sir Joseph Dimsdale by a memberof 
the College of Surgeons, and it must be conceded that 
the inclusion of these bodies in the list of official 
guests is in the fitness of things. 

Sbyebal cases of small-pox have occurred at the 
new Rowton Houses at Hammersmith, but stringent 
precautions have been taken to prevent the spread 
of the disease among tbe inmates. It is obviously 
out of the question to close these houses, since the 
only effect would be to disseminate possibly infected 
persons throughout the metropolis. 

The Fund hitherto known as the Prince of Wales’ 
Hospital Fond will, after January 1st, 1902, take 
the title of King Edward’s Hospital Fund for 
London. 

PERSONAL. 

Mb. John Quick, M.R.C.S. Eug., L.8.A., has been 
elected an alderman of the Torquay Town Council. 

Mb. Hsnbt Gabd, L.B.C.P., LB.C.8. Edin., L.F.P.S. 
Qlasg., has been elected a member of the Devonport 
Borough CounciL 

Mb. Colston Wintlb, LB.C.P. Lond., M.B.C.8. 
Eng., has been re-elected vice-chairman of the Bristol 
Health Committee. 

Pkopsssob Cobfibld has been awarded the bronze 
medal of the Boyal Society of Public Medicine of Bel¬ 
gium, in recognition of his devotion to public health 
work. 

SuBOEON Majob-Gxnbbal A. M. Tippetts has been 


granted a Good Service Pension of one hundred pounds 
a year after forty-seven years' service in the Army 
Medical Department, during which period he saw much 
active service. 

Db. McCbaith, of Liverpool, was last week presented 
with a handsome double barrelled gun by his medical 
friends of the Medical Institution, on the occasion of 
his leaving the city to occupy a Government appoint¬ 
ment in Old Calabar. 

Fbofebsob Cobfibld, of TJoiversity College, London, 
Consulting Sanitary Adviser to His Majesty's Office of 
Works, has been awarded the bronze medal of the Boyal 
Society of Medicine of Belgium, as a recognition of his 
devotion to public health work. 

Db. Ceablbs Balfoub Stewabt left on Saturday 
last at the head of a special expedition dispatched by 
the Liverpool School of Tropical Medicine to the Gold 
Coast, to investigate the means of improving the 
conditions of health and sanitation in that deadly 
climate. 

Suboeon-Genebal a. F. Fbbstox, who is temporarily 
acting as Director-General of the Army Medical Servioey 
is to resume the post of Principal Medical Officer on the 
Staff of the Duke of Connaught in Ireland, on being re¬ 
lieved at the War Office by Surgeon-General W. Taylor, 
returning from India to take up the post of Director- 
General 

Db. T. NBviLLB,of Sloane Street, met with an accident 
in Hyde Park a day or two since. Some park-keepers 
were shooting wild duck, and the report of their guns 
frightened the young horse Dr. Neville was riding, and 
it made for the railings, rearing and falUng, inflicting 
severe mtemal injuries, which necessitated his removal 
to St. George's Hospital. 

De. Cullihowobtu's term of office as obstetric phy¬ 
sician to St. Thomas’s Hospital expired some time since 
but he consented to a prolongation of three years on 
condition that his ooUeague, Dr. W. H. Tate, should be 
appointed additional obstetric physician, to have charge 
of twenty-one out of the twenty-eight beds. Dr. Tate 
has since been appointed in that capacity. 

Mb Jonathan Hutchinson, F.B.S., is leaving shortly 
for South Africa with the object of prosecuting his re¬ 
searches into the etiology of leprosy, especially in 
reepect of the transmission of the disease by the con¬ 
sumption of dried and badly-salted fish. He will go 
in the first instance to Bobben Island, and, later, to 
Natal and Basutoland—districts which, he believes, offer 
exceptional opportunities for investigations in this 
direction. 

Manchester. 

[raoir oua own cobbespondbnt.] 

Manchesteb as a School of Medicine. 

While nothing very remarkable has happened in the 
Manchester medical world during the last month, there 
has been no less activity, scientific and social, than is 
usual at this busy time of the year. Among social events 
two popular dinners may be mentioned. One was the 
annual meeting at the Queen’s Hotel of the Manchester 
Edinburgh tJniversity Club. The attendance was larger 

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SPECIAL ARTICLE. 


Thb Medical Pbbsb. 615 


than orasl, and nearly a hundred members and gneets 
were presided over by Dr. Baildon, of Sontbport. Sir 
Henry Littlejohn bad travelled from Edinburgh to be 
the guest of the evening, and be delighted bis old 
friend and neir acquaintonoes by a speech in his most 
characteristic vein of anecdote and reminiscence. The 
yearly medical students' dinner was also most success* 
fnl, with Mr. G. A. Wright in the chair. Deputations 
from the medical schools of Leeds and Liverpool 
were present and contributed to the evening’s 
enjoyment, both by speech and song. There was 
a serious element in many of the speeches, both students 
and teachers being evidently quite determined to 
keep Manchester well to the front as a school of 
medicine. The recently-formed Students’ Bepresen- 
tative Council promises well, and may soon be found 
to be a more powerful body than is at present even 
imagined. 

Medullary Narcosis bt Cocaine Injection. 

The societies have all held successful and well-attended 
meetings. .Among many good papers. Dr. Lea's com¬ 
munication to the Medical Society on medullary narcosis 
by cocaine injection possessed, perhaps, the most in¬ 
teresting features. Dr. Lea gave an analysis of eighteen 
cases in which he had injected a sterile solution of 
cocaine into the lumbar region of the spinal canal. In 
one of these cases the subject bad Cssarean section per¬ 
formed by Professor Sinclair. She vomited soon sifter 
the injection, but was comfortable throughout the 
operation, which was completely successful. There was 
moderate sickness for twelve hours afterwArds, and 
severe headache for two days. Recovery was good. 
Dr. Lea was able to operate with complete comfort to 
the patient in fifteen of the other seventeen oases. In 
one no discomfort was complained of during abdominal 
section, but during the subsequent removiJ of a small 
lipoma a small quantity of chloroform bad to 
be used, (n one case, in which blood escaped through 
the puncture, ansestheaia was not produced. Sicknessand 
bea«iaohe appeared to be the chief after-effects, and re¬ 
covery was always good. It is probable that medullary 
narcosis will be found useful in many instances where 
general ansesthesia is undesirable, and it is desirable that 
all who, like Dr. Les, have had the courage to employ the 
method, should publish their results. 

The Pathological Socibtt 

lost a secretary under whose guidance its member- 
^ip grew from about 250 to 4^ by Dr. Eelynaok's 
departure to London. It is hardly likely that its pre¬ 
sent membership can be much increased, but whil e the 
style of the communications continues to be '‘brief, 
bright, and breesy,” while the disonssions are weighted 
by no considerations of i 4 ;e and seniority, and while the 
table is always covered with a goodly show of card 
specimens, there is no reason to expect that the great 
popularity of this society will decrease. Mr. Collier 
genially occupies the presidential chair this session. 


(EdtrtBponiena. 


LWedo not hold oorMlTMiMponaible for tha opinions of our 
corraspondenta] 


BANTI'S DISEASE. 

To the Editor of The Medical Press and Ciroclar- 
Sir, —In the very interesting account given by yonr 
Berlin correspondent of Senator’s address on this some¬ 
what rare disease in the Medical Press and CiRCirLAR, 
November 27, p. 573, it is stated on his authority that 
Professor Banti, of Fioreuoe, in 1894 and snbs^uent 
years drew attention to this peculiar form of persistent 
antemia associated with hypertrophy of the spleen and 
hepatic cirrhosis, bnt, as a matter of fact, Goido Banti’s 
paper, “ Dell Ansemia Splenica ” was published much 
eariier, and will be fonnd in the Archtv. d. Senola d. Anat. 
Pathol,!^, p.58. 

1 am, Sir, yours truly, 

William Murrell. 
17, Welbeok Square, Cavenish Sqnare, W. 


THE VICISSITUDES OF DRUGS. 

To the Editor of The Medical Press and Circular. 

Sib,—R eferring to the leader on this subject in your 
last impression, I have for many years always given sar- 
saparilia in chronic syphilis. A case in which all the 
nails were destroyed, all the hair had fallen off, and 
large ma sses of syphilitic mpia on the legs, arms, and 
buttocks, which had been under treatment by other 
physicians for months, improved at once under sarsa¬ 
parilla. I made the patient bay the most expeusive 
kind, and make himself a fresh decoction daily, of 
whi^ he took a pint. I must add that the patient was 
taking mercury vapour baths at the same time, and 
wae under strict dietio treatment. 

I could mention a number of similar severe cases 
cured. I certainly believe the sarsaparilla aided the 
cure. The late Mr. Henry Lee, whose sneoess was great 
in the treatment oi syphilis, told me be always pre- 
Ecribed sarsaparilla in chronic syphilis, especially with 
skin lesions. I am like that eminently practical physi¬ 
cian, Dr. Murray, of Newcastle; when I prescribe a 
drug and it does good I never mind what may be written 
against it; I continue using it. Many drugs I got to 
know the nse of when in practice in a la^fe country dis¬ 
trict I nae to-day in consulting practice, but it would 
be difficult to explain how they act. 

I am. Sir, yours truly, 

Thomas Sutton, M D., M.B.C.P.Ed. 

7, Manchester Sqnare, W., November 29tb, 1901. 




THE TAXA'nON OP COSTS OP MEDICAL 
WITNESSES. 

A CASE of considerable interest and practical import¬ 
ance to medical men thronghont the United Kingdom 
was decided last week in the King’s Bench Coart, 
Dublin. In January last a man, of the name of Nolan 
bronght an action against the Great Northern Railway 
Company on account of personal damages received by 
him by reason of the negligenoe of its servants. He 
' won lus case and was awarded A450 damages and costs. 
These costa were then taxed, and the Taxing Master's 
award issued. To several items of this award, the de¬ 
fendant company objected, notably to the allowanoes 
made to medical witnesses. 

Counsel for the defendant company contended that 
Dr. Morrison, Dundalk, who attended the pliuntiff after 
he had sustained the injuries until he was removed to 
a hospital, should not be allowed for three separate 
attendances at Dublin prior to the trial in order that 
he might be present at the examination of the plaintiff 
by the doctors engaged by the defendiuit company. For 
each of these attendances. Dr. Morrieon claimed five 
gnineas. The defendant company contended that these 
charges were unreasonable, and that the visits 
were unnecessary, the plaintiff being at that time 
under the care of skillea Dublin snrgeons, who were 
called at the trial on behalf of the pl^tiff, and 
gave evidence. Snrmon Myles and Dr. O’CarroU 
had also been examined on behalf of the plaintiff, and 
had been allowed by the Taxing Master five guineas a 
day for their attendance in court daring the trial. 'The 
defendant company objected to these chaises, and 
relied on the sohed^e of costs by which, they snbmitted, 
the Taxing Master was bound. The schedule provided 
that, for professional witnessei residing within five milts 
of the city in which a trial took place, only one guinea 
a day should be allowed for attendance in Coart, nnless 
in the opinion of the Taxing Master the case was an 
exceptional one. It was contended on behalf of the de¬ 
fendant company that no special or exceptional cironm- 
stanoes existed in this case to justify an increase of the 
figure allowed by the sobednle. 

Mr. Jnstioe Kenny, in announcing the decision of the 
Court said that, with regard to the allowances to the 
medical witnesses the court considered they were 
bound by the schedule and by the decision of the 
Master of the Rolls in Maconohy v. The Bank of Ireland. 

. .Cjoo^le 


616 Tfli Hedioil Pbbss. 


OBITUARY. 


They held that Dr. Morrieon’s three attendances in 
Dublin were unreasonable, aad that he should be allowed 
for One visit only. With regard to the attendance of 
medical witnesses at the trial, the Court held that under 
the schedule they could not allow more than one guinea 
per day to doctors resident within five miles of Dublin, 
and three guineas to doctors outride the limit. They 
were unable to see any exceptional circumstances in 
this case that would justify the Taxing Master in 
allowing more than the guinea a day. The Court were 
sensible that the tendency of these decisions was to 
approximate ptuty and party costs to those between 
solicitor and client, but they did not see how they would 
be justified in allowing the doctors a greater sum than 
was provided for by the schedule of fees. They would 
not. however, be dissatisfied if the case were reviewed in 
the Court of Appeal. 

Mr. Justice Barton, in concurring, said he considered 
there was a great force in the argument that one rainea 
a day was not a reasonable fee for a Dnblin doctor 
between party and party for attendance in court, and 
that a case like the present was ao exceptional one. But 
he thought that argiiments such as these should be ad¬ 
dressed to the Court of Appeal or to the rule—making 
authority. The Court considered the scale was binding 
on the Master even in the case of doctors of exceptional 
eminence. 

Mr. Justice Wright also concurred. The case, ho said, 
was one of very great importance. The plaintiff was 
a minor. The money had been paid into Court, and 
it had been stated that the medical men bad been 
paid fully in advance. The result would be that the 
solicitor would have to pay the difference out of bis own 
pocket, tbe differencele'iweenthe sum the Coart allowed 
and tfae amount that had been paid to the doctors. On 
the other band the case was of immense importance to 
railway companies who had constantly to face claims of 
this kind, claims which sometimes did not rest on solid 
grounds, but were in fact sham claims. He had asked 
the question why it was in this case that medical 
gentlemen resident in DubUn should obtain anything 
beyond the ordinary scale, and the reply he had received 
was that Mr. Myles was a gentleman of great eminence. 
To use a colloquial expression, the case was a special 
one, because a gentleman drove a brougham with two 
horses and liv^ in Merriou Square. While the Court 
were conscious that their decision involved a diffionlty 
and a hardship they could not go outside the rule. He 
would bs glad if the C mrt of Appeal laid down some 
decision for their guidance. They would loyally follow 
it. The Taxing Master stated that the medical gentle¬ 
men remained a long time in Court. Sometimes medical 
men seemed to think that they were engaged in a duel. 
They remained in Court listening to the evidence for 
the claimant with a view—well of disproving what was 
said. One of the dangers arising from that was that 
they were apt to forget their character of witnesses to 
tell the truth, and to become rather advocates of the 
side that employed them. He did not say that their 
decision would have any effect in reducing that ten¬ 
dency, but certainly it would not encourage the doctors 
to lemain in Court, whatever the effect of it might be. 

Literature. 


HAEIKIDGE ON THE OPHTHALMOSCOPE, (a) 
This standard guide to the principles and use of the 
ophthalmoscope needs no praise at our hands, its reputa¬ 
tion is too solidly establi^ed with several generations 
of students. Even in the matter of revision there was 
little to do beyond recasting a phrase here and there, 
the sense of sshich was not as clear as one conld wish. 
There are sixty-five illostrations and four coloured 
plates, the latter especially being excellent specimens 
of colour printing. This, the fourth, edition cuinot well 
add to the author’s reputatiou, which dates from the 
first of the series. We can cordially recommend the 
work to students and practitioners as a concise and 

(a) " The OphthalmoMops.*' By Giutarus HsTbridge, F.R.C.S., 
Surgeon to the Bojal Westminetrr Ophthalmic Hospital, &c , &c. 
Fourth edition. L«ndon; J. anl A, Cnnrchill. 1901. Price 4s. 6d. 


Dbc. 4, 1901. 

well-arranged guide to the study of diseases of the eye 
as seen with the opbtbalmosoope. 

PIQG ON CLINICAL PATHOLOGY, (a) 

This is the second edition of a very commendable 
guide to cliuioal pathology. The technical directions 
are given in a direct, straightforward way, without dr- 
onmlooution or ambiguity, and they are sufficiently 
comprehensive to leave no point untouched. This 
branch of clinical work is one which daily assnmee 
greater importance, and without a thorough knowledge 
of the ttchniqut no student or practitioner can keep 
abreast of the times. The work is interleaved with 
blank pages to facilitate the record of alternative 
methods or modifications of existing ones, and comprisee 
a fair number of illustrations of a diagrammatic sort. 
The author rightly seeks to impress upon students the 
importance of actual practical work in this department; 
indeed, it has no valne except in the hands of those who 
have trained themselves to employ the methods herein 
described, and to uuderstand and interpret the lessons 
they oonvey. 


BUEDETT on the nubsing PEOFESSION. (4) 
This little book, indispensable to all who wish to join 
the profession of nursing, has already justified its exist¬ 
ence, and is in its third year. Everything to do with 
nurses is included, what to do, how to do it, and wher» 
to go, with particulars of societies and institutions, the 
objects of which iuoinde the promotion of thrift among 
nurses, the raising of their status, and the institation of 
examinations, and the issue of diplomas in snbjeote 
which will prove useful to them in their career. The 
book, too, will be very valuable to hospital officials in 
lessening the amount of oorxespondeuoe with which they 
are now inundated by inquirers who seek the informa¬ 
tion which it contains. 


(Dbituitrg. 


DE. A. CAMPBELL CLAEK, OF HAETWOOD. 

It is with sincere regret we have to announce the 
death of this gentleman, on Thursday last, at the early 
c^e of fifty. This regret is tinged with a person^ 
sorrow, as Dr. Clark was engaged on the staff of this 
journal for the past fifteen years as editor of oar 
*' Lunacy Department,” and as reviewer of most of the 
works in his specialty that appeared in these columns. 
Apart from his acknowledged eminence in the particu¬ 
lar department mapped out by himself, he was a 
man of marked individuality, fearless in speech and 
absolutely upright in character. 

Originally of a robust oonstitation, he last year had a- 
severe attack of influenza, which was followed by vis¬ 
ceral complications, from the effects of which he eventn* 
ally succumbed. Dr. Clark was trained for a commercial 
life, bnt not finding it congenial to his tastes he pro¬ 
ceeded to the University of Edinburgh, where be studied 
medicine and graduated a bachelor of medicine and 
master of surgery in 1878. He obtained bis M.D. de¬ 
gree iu 1886, graduating with bonoura. His first 
experience of the active duties of his profession was at 
Melrose Asylum, where he was appointed assistant 
medical officer. After a few months were spent there 
be was promoted to be an assistant to Dr. Clonston, of 
Momingside Asylum. Here he gained considerable 
experience of and insight into lunacy work, and turned 
his opportonities to such good account that he was 
appointed Medical Superintendent to Kirkland’s 
Asylum, Lanarkshire, at a comparatively early age, 
where he soon distinguished himself by writing 


(a) "Clinical Pathology and Practical ICorbid Histology." By 
T. Strangeway Pigg. MA., Demonstrator of Pathology in the 
University of Cambridge. Second Edition. London: Strangewny 
and Sons. 1901. 

(6) “ The Nursing Profession—How a^'d Where to Train: being 
a Onide to Training for the Profession of a Mnrse, with Particulars 
of Nurse Training Schools in the United Kingdom and Abroad, and 
an Outline of tbe Principal Laws affecting Nurses, Ac." Edited by 
Sir Heury Burdett, E.C.B., Ac. TMrd Tear. London; The 
Scientific Press, Limited. '901. Price net. 




Die 4,1901. 


MEDICAL NEWS. 


Thi Mkdical Pkxbb. 617 


numerons original papers on mental diseases, which 
appeared at the time in these oolnmns and in 
the pages of the Journal of Mental Science. On 
the completion of the new Lanark District A 87 lnm 
at Hartwood, Dr. Clark was elected the first M^ical 
Superintendent in 1895. This asylnm has accommoda¬ 
tion for orer 900 patients, and is regarded as a model of 
equipment and management. Dr. Clark held Tarions 
important appointments. Among others he was Professor 
of Psychological Medicine at St. Mango’s College, Glas¬ 
gow, and was President of the Caledonian Medical Society, 
which held its annual meeting this year in Glasgow. 
On his sick bed Dr. Clark prepared his presidential 
address, which lent a pathetic value to its genuine pic¬ 
ture of Celtic character and influence. In 1897, Dr. 
Clark published his mctpium opus, entitled a “ Clinical 
Manual of Mental Disease,” which is highly esteemed 
for its practical and origin^ character, and much used 
as a class-book by medical students. We believe it 
was mainly through his initiative that the “ Handbook 
for Attendants on the Insane” was compiled by a com¬ 
mittee of the Medico Psychological Association. This 
book has been enormously successful, and is the acknow 
ledged authority throughout the United Kingdom and 
in many of the asylums of America. Dr. Clark’s clear 
judgment and vigorous intellect vrill be greatly missed 
both by the Assooiatiou, and in the large Institution 
over which he presided, and in his death we feel the 
loss of an excellent colleague and sincere friend. 


^ctos. 


A diarwoman Abortionist. 

A CHABWOHAN, ^ed 58, was sentenced to six months' 
imprisonment at the Leicester Assizes last week for pro¬ 
curing abortion by the aid of a wooden skewer, which 
had for effect to render her ‘‘patient" very ill. It was 
stated that the prisoner was in the habit of rendering 
assistance of this kind. It is rather odd, by the way, 
that women who solicit the commission of this criminal 
act should escape scot free in spite of the fact that by 
law they are equally guilty. Incitation to procure 
abortion is of itself a very grave offence. 

The Irish Medical Schools' and Oradnates’ Association. 

The autumn dinner of this prosperous association took 
place last week in the Victoria Hall of the Hotel Cecil, 
upwards of a hundred ladies and gentlemen being 
pre'ent. Dr. William Alexander, of Liverpool, the 
president of the association, occupied the chair, and 
among those present were;—Sir Charles Crostbwaiie, 
the Hon. H. B. Lefroy, Agent-General for Western 
Australia: Inspector-Gene^ Turnbull, B.N.; In¬ 
spector-General Lloyd, B.H., Hon. Surgeon to the 
King; Surgeon-General Preston, Surgeon-General 
Sibthorpe, C.B.; Dr. Robert Barnes, Judge J. A. 
Bentou), M.P.; Professor C. B. Ball, Dublin; Dr. P. 8. 
Abraham, Mr. Atherley Jones, K.C., M.P.; Lieutenants 
Colonel Boileau, Dr. James Stewart, hon. sec.; Dr. J. H. 
Swanlon, hon. sec.; Mr. Freyer, chairman of the 
Council; Dr. B. Jocelyn Swan, hon. treasurer; and Dr. 
Irwin Scott, vice-president of the Council. After the 
usual loyal toasts. Professor Ball, of Dublin, pro¬ 
posed the toast of ” Our Defenders,” and, in 
doing so, he voiced the hope that ere long 
they would be able to welcome the Army back in 
peace with honour. Addressing himself to the position 
of the Royal Army Medical Corps, he said that though 
there had been much hostile critirism of the treatment 
of the rick and wounded, it was admitted on all hands 
that the members of that corps had done their utmost. 
He admitted that the Service had not of late been as 
popular as of yore, but an attempt had been made by 
the Government to remove some of the more serious 
causes of dissatisfaction, and though the attempt had 
been received in many different waj a, his belief was that 
the scheme was worthy of a trial, and would have the 
effect of improving the Service very materially. In¬ 
spector-General Turnbull replied for the Navy, Lieu¬ 
tenant Colonel C. J. Whitaker for the Army, and Sur¬ 
geon-Captain Sleman, Senior Medical Officer of the City 
Imperial Volunteers, for the Volunteers. Captain 


Sleman said that when at Pretoria he had a good many 
sick, and they all wanted to go to the Irish Hospital 
because of its splendid reputatioi. Ia3psct)r-Gin9ral 
Lloyd, B.N., proposed the to»st of ”Our Guists,” asso¬ 
ciating it with the names of Sir Charles Crosthwaite, 
Judge Bentoul, M.P., and Mr. Atherley Jones, K.C., 
M.P. The intorvaU between the toasts were enlivened 
by some excellent vocal and instrumental mure rendered 
by Mr. James Dunn, Mias Jessica Loeson, Miss Elsie 
Southgate, Mr. J. L. Shine, and Mr. Arthur Helmore. 

The Notification of Phthisis. 

Tbx Local Government Board dissents from the pro¬ 
posal of the Halifax Town Council to include phthisis in 
the list of compulsory notifiable diseases, pointing out 
that it is open to the Connsil to enter into an arrange¬ 
ment with the local practitioners for the voluntary 
notification of this particular disease, a step which does 
not require the sanction of the Board. The Town 
Clerk has asked the Board to refer the Council to the 
statute which authorises the Corporation to pay fees for 
voluntary notification. 

Drastic Anti-Phthislcsa Measurts. 

Tub immigration anthorities of New York have 
decided to deport consumptive immigrants, and their 
action has been supported by the Circuit Court in respect 
to one Boden, who, after residing for four years in 
Philadelphia, recently returned from Ireland suffering 
from pulmonary tuberculosis. 

London’s Milk Supply. 

Thb report of tbe committee which has been inves¬ 
tigating the question of preservatives and colouring 
matter in food and milk recommends the total prohibi¬ 
tion of the use of preservatives in milk. From inqniriea 
made it would appear that the regulation would be 
welcomed by Welford’s and other leading dairies of 
London, if only because it would in no way apply to 
them. The net result would be that those dealers who 
did use preservatives would be oompulsorily levelled up 
to those who did not. This might at first curtail the 
milk supply of London, but it should have no permanent 
effect in that direction. Naturally the large oonoerns 
have an advantage over small dealers, because they are 
able to turn their surplus milk into butter and cheese, 
and hence have no need to use preservatives. 

Toxic Insect Powder. 

A HixTUBB of robnrite and insect powder is a parasi¬ 
ticide much used in the mining districts, but its em¬ 
ployment appears to be fraught with danger. A few 
davB since a miner and his family were removed to the 
Wigan Infirmary, suffering from symptoms of irritant 
poisoning, and enquiry showed that these were due to 
the use of the above mixture to kill fleas, the heat and 
moisture of the bed having favonred absorption and 
inhalation of the nitrous fumes. The sufferers are 
now on the road to recovery. 

Unexplained Death of a Medical Student. 

An inquest was held by the Corouer for Westminster 
on the 27th ult. on the body of Humphry Warrington 
Hayward, who had died under peculiar circnmstauces. 
According to tbe medical evidence nothing was found 
at the autopsy to account for death, and as no unnatural 
cause could be alleged, a verdict of “ Death ftom natural 
causes " was returned. 

Arrest of a Wigan Practltlcner- 

Mb. Jahes j. P. D. O’Donnell, describel as a medical 
man, recently in practice at Wigan, was arrested at 
Birmingham last week, on a charge of stealing postal 
orders for £6 fis. He gave a false name, but was identi¬ 
fied by extensive tattoo marks on both arms. 

Death under Chloroform. 

A DEATH under chloroform at St. Bartholomew's 
Hospital was the subject of an inquest list week, the 
victim being a man about co undergo an opsratiou fora 
cancerous growth in the mouth. Tae ausesthetio was 
administered by Dr. Gill, who stated that this was only 
the third death he had had in 40,000 oases. It is obvious 
that death on the operating table may sometimes be of 
the nature of a simple coincidence, and the explanation 
is one which may readily be coui^ed when the proper- - 
tion of deaths is as low as this. i 

CjOOi'le 

o 


618 Thb Mtoioal Pbksb. KOriCES TO CORRESPONDENTS. 


fiotiusi to 

Corregy mtbnctg, gh0rt ^d terg, *£. 

i^r CouMPomm nqalrlnf a repljin tli<« oolnmn arapar- 
ticnlarly nqneatad to make nee of a distinctiv4 tignatun or 
and aToid the practice of eigninff themeelree " Beader, 
" Sobecrlber,” *'01d Sobsorlber,'’ dc. Mneh oonfoaion will be 
spared by attention to tbia role. 

Da. J. D. E. U.—▲ review of your book is in type awaiting epaoe 
■ Mb. Stuabt Montbath.— We are uuvble to ineeri your letter in 
its preeeDt involvedand obecnre phraseology. 

Bb. Babaoliati's cate of “Submucous Myomectomy'' ii markel 
for early insertion. 

M.B.C.S. (Manchester).—You will find a similar point to your 
In r^a^ to fees is discussed in our present number, and a recen' 
case in iUustiatlon, with the remarks of three judges thereon. 
BOYAL MBDICAL BENEVOLENT COLLEGE. 

Two female scholarships, providinfr free education and main 
tenanee at the School of St. Ann's Society in connection with this 
Colley, will shortly take place. In one case the presentation ii for 
the necessitous orphan daughter of a medical man who ^s been 
in independent practice in England or Wtdes for not Icee than Are 
years; in the other ease the restrictions are different, but the 
presentation is limited to the daughter of a me^cU man. Further 
particulars w ill be found in our advertisement columns. 

An Aoobibtid Pbactitioitib. —The Autumn Session of the 
General Medical Council is now on, but we hardly think your case 
is one this body could deal with. Looked at fdth a charitable eye 
the act might b e taken as one of thoughtlessness rather than wil 
fulness. We can, however, understand the annoyance it has caused 
you 

Oca Vubba CoBsrspoiiDBRT.-The receipt of Erlich's paper on 
“The Theory of Esmattc Antidotes’’ is acknowledge with thanks 
Db. W.—The questions at issue between yon and your partner 
are ordinary matters of custom, and should be capable of adjust¬ 
ment at the hands of an arbitrator, tc be mutually agreed upon. 
The legal remedy open to you is not only very costly, but neces¬ 
sarily involves a oanibersome and often ineffectual procedure. 

of the §odetics. 

LONDON. 

Wbdxbsdat, Bsc. 4th. 

Obstetbical Socibtt or lonnOH (20, Hanover ^uare, W.).— 8 
n.m. Bpecimene will be shown by the President (Dr. Horrocksj, 
Mr. Maxwell, Dr. Wilson, Dr. A. MUth, Dr. Stannus (introduced 
by Dr. Tate), and Dr, Locl^er. Dr. Griffith will show a Person of 
Uncertain Hex. PapersDr. B. Sanderson; A Case of combined 
Vaginal andAbdominal Hysterectomy for a Pregnancy of four and 
a half months complicated by Cancer of the Cervix. 

Thcbsdat, Dkc. 5th. 

Babvbiar Socibtt or Lomdor (Stafford Booms, Titobbome 
Etreet, Edgwore Bead, W.).—&30 p.m. Mr. C. W. Mansell 
MouUin; Some Unusual Effects of Movable Kidney. 

Childhood Societt (Library of the Sanitary Institute, Margaret 
Street, W.)—8 p.m. Lecture. 

BoRTOEK Societt (20, Hannver Square, W. - 8.30 p.m. Mr. J. H. 
Edwards; Bullets and their Billets: Experiences with Y-rays in 
South Africa. 

North-East Lokdor Clirical Societt (Tottenham Hospital).— 

4 p.m. Clinical Casea 

Fbidat, Dec. 6th. 

West Lordor Medico-Chirdbqical Society (West London 
Hospital, Hammersmithh Boad, W.).—8 p.m. Clinical Meeting. 

West Kert Medico-Chibuhoical Societt (Boyal Kent Dispen¬ 
sary, Greenwich Boad, S.E.).—8.45 pm. Dr. J. F. Goodhart: 
General Practice and Original Besearob (Parris Ontion.) Con- 
versasione. Exhibitions of Lantern Views of Foreign Health Be- 
sorts. Electrical and Scientflo Apparatus, Surgical Instruments, 
Therapeutic Preparations, Diabetic Foods, Ac. 

Labtmoolooical Societt op Lordor (20, Hanover Square, W.).— 

A p.m. Cases will be shown by Mr. Lawrence, Mr. late, 1^. 
Kelson, Dr. Horne, Dr. Potter, and Mr. Waggett. 

DUBLIN. 

Wedrabdat, Dec. 4th, 

Clinloil Meeting, PharmaoeHtical Society. 4 p.m. 

Thcbsdat. Dec. 5tr. 

Council Meeting, Boyal College of Surgeons, 

Dublin UniTersity Biological Association, Front Hall, Trinity 
College. 8.15p.m. 

Fbidat, Dec. 6th. 

Boyal Academy of Medicine in Ireland. Section of Surgery 


Dbc. 4, 1901. 


(Boyal College of Surgeons), at 8.30 p. 
Mr. J. S. McArdle, on Intracranial 


m. Papers will be read by 
Hsmorrhage; Mr. B. L. 
Swan, on The Surgl^ Treatment of Chronic Synovitis; and Mr. 
T. E. Gordon, on a Successful Case of Pylorectomy. Living Bx- 
bibits—I. Mr. D. Kennedy (a) Case of EnlaigedLiverafter Trauma, 
Two Cases showing R^ults of Osteotomy for Bow Leg. 2. Mr, 
B. L. Swan, Case of Bdatoral BadioslOure of Inguinal Httuia, with 
interval of four years between operations. 3, Mr. Henry Uroly, 
Patient operated on for Double Empysma. Card Specimens— 
1. Mr. H, Gray Croly (a) Stomach lacerated by Shaft of Dray 
(cycle accident., (b) LimbBemoved ^ Amptuatlon at Hip-Joint. 
(2| Mr. D. Kenner (a) Thymus and ’Thyroia Glands of Child who 
died under Cbloroform, (bj Four Skiagrams showing Foreign Body 
in (Esophagus, Stone in Bladder, Congenital absence of Badius and 
Fracture of Forearm. 3. Mr, B. L. Swan (a) Two Kidneys with 


EnlS'ged Ureter removed from patients, aged 23 and 35. (b) Com- 
miuiitel Betrs Capinlar Prantnre of Femur removed from Body 
of Man, eb. 90, three days after injure. A Mr Henry Croly (a) 
Tumour removed from Infia-Scapular fiegion, (b) Cystic Hjgroi^ 

Aschrb, M.B.Edln.,M,RC.8., Medical Officer to one of 
the XnBftTaal Concentration Campe. 

CUTHBERT, W^H,, L.B.CP., L.B.C.S7. Medical Offleerof Health 
under the Fnnton-on-Sea Urban District CouncU. 

Domaldsor. William Ibelard, B.A,, M.D.Unlv. Dub., 
Superinteitdent to the London (^untr Asylum. Eneotn. 

|•^9•R U.I..Juai<ir House Suigeon 
to the Miller Hospital and Boyal Kent DIspenBarr. 

Loro, Stdret H.. M.B.(^tab.. Physician to the Jenny Lind 
Inflrmere for Sick Children, Norwich. 

Nichol. F. E., k^.Cantab., Certifyi» Surgeon under the Factory 
Acts for the Margate District of ^nt. * 

’ B^.0.E.U.I., senior House SurgMn to 

the Miller Horoitel and Boyal Kent Diepenary 
PiBiiRs, Philip METLEB.M.B., B.8., M.B.C.S,, Hoose Pbysidan 
to the Sussex (kmnty Hospital, Brighton. 

Pbestor, L. L., M BDurh., M.B.C.S., Medical Officer of Health 
under the St, Helens Urban District Council. 

Seccombe. J. W. 8., M.B.C.B., L.B.C.P., Junior House Surgeon to 
the R^cliffe InArmery, Oxford, 


lacatuiee. 

Bethlem Hospital.—Two Resident House Physiciane recentlr 

J uauned in Medicine and Surgery. Term elx months from 
anuary Ist next. Apartments, complete boe^, and washing 
provided, and an honorarium at the rate of £25 each 
quarter will be paid. (See Advt.) 

Brad'ord Children’s Hospital.—House Surgeon. Salary £100 with 
T. washing. AppUoatione to the Socrotary. 

Bradford Boyal Inflrmare.—Diepeiuary Surgeon to visit patients at 
their own homes. Salary £100 per annum, with board and 
reeidenco. Applications to the Secretary. 

OmdenUnSon.-Medical Officer, Salary £I50peraiinnm aad£I0a 
year as Medical Officer of Health, together with the umal 
registration and vacoinetion fees. Application# to F. Kioir. 
Clerk of Union. (See Advt.) “*»s 

Coohty Asylum, Bainhill, neor Liverpool.—Assistant Meditnl 
Officer. Salary commences at £150 per annum, with apart- 
mente. lward, attendance, and washing. Application# to the 
Medical Superintendent 
Down District Lunetic Asylum.—iesistant Medical Officer. Salary 
commencing at £150 per annum, with board, apartments, wash¬ 
ing, & 0 . Applications to be addreesed to the Besident 
Superintendent. (See Advt.) 

Nottingham Genera! Hospital.—Honse Surgeon. Salary com¬ 
mencing at £100, with board, lodging, and wairiiiiur. Annlica- 
tione to the Secretary. 

Notts County Lunatic Asylum, Sneinton, Nottinghem.-Medical 
Superintendent. Salary £600 per annum, with famished houee 
coal, light, washing, and g^en produce. Forms of John 
Frederick Gell, Clerk to the Committee of Vidtore. 

Boyal Hospital for Incurables. Donnybrook, Dublin.—Besident 
Medical Offlorr, Salary £100 per annum, with board and 
aparmenta. Applications to J.J. Thompson, Eeo. (See Advt.) 
Steffon^hire General Infirmary,—Honee Surgeon. Applications 
to the Secretary. Salary £120 per annum, with boa^ 

Draex.—O n the 28th ulL, at Bafhgar Cottage, Stzeatham. Sorrey 
the wife of Conrtenay H. Drake, F.B.C.a., of a eon. 

Potts.- OnNov. 27th. at 160, HagleyBoad, E^baston, Birmiug- 
ham, the vrife of W. A. Potts, M,D., of a son. 


(IRmtagee. 

Qbroe—Whbeldor.- On Nov. 28th, at St. Werbnrgh's Church, 
Darby, George Gilbert Oenge, M.D., B.S., of Lansdowne Boad, 
Croydon, son of the Bev. E. H. Oenge, M.A., to CathcriTie. 
second daughter of the late George Wheeldon, of Park Fields, 
Darby. 

JoRES DixoR.-OnNov. 28th, at St Matthew's Church, Exeter, 
Robert Orford Jonn, L.B.C.P., L.B.C.S., of Slapton, Devon, 
■on of John Thomas Jones, M.D.. M.B.C.F., ofLondon.to Mrs. 
Ellen Flower Dixon, of Kingabridge, Devon. 

McLocohlir—Hahbibos. -On Nov. 21»t, at St Mary's, Great 

Chart, Kent, Captain George Somers MoLonghUn, D.S.O,, 
B.A.M.C., to Audr^ Katherine, eldest daughter of the Bev. 
Alban H. Harrison, Bector of Great Chart 
ZiMMERKARR. Watliro,—O n Oct 26th, at Holy Trinity Church. 
Murree, Punjab, India, Major B. F, Zimmermann, HA.M.C., 
to Ethel M a ri a n , eldest daughter of the late Colonel J. T. 
Watling. 


Eailbt.— On Nov. 24tb, at Ampton Street, London, W.C.. John 
Andrew, Ballev. M.B.C.S.. L.8.A., eg^ 72 yatra 
Knio.—On Nov. 25tb, at Boyfield House, Moulton, Spaldinir. 

Robert King, M.B.Centab., r.B.C.P.Lond„ ag«d 59years. 
Peirce.— On Nov. 26th, at 10, Warwick Boad. Jfaida Will, w, 
after a short illnees, Arthur Prince, M.B.C 8., L.E.C.prrin his 
67th year. 

WiLDBOBE On Nov. 26tfa. at bis residence, 2. Brunswick Boad. 
Hove, Sussex, Frederick Wildbore, late Assistant Surgeon, 
Coldstream Guards, aged 79 years, ^ . 



km anil iitnite. 


**SALUS POFULI SUFBEMA LEX.’* 


Tol. CXXIII WtDNEBDAT, DECEMBER 11, 1901. 


Ho. 24. 


Gtlinical ^wturc. 

FATTY TUMOURS 

AND 

GENERAL ADIPOSITY, (a) 

Bj JONATHAN HUTCHINSON, F.R.0.8.,r.R.S.. 

Coafnliiiig’ Sarreon to tbe Loudon HoapltaL 
[SPICIALLT BXFOBTID FOB THIB JOUBNAL.] 

G-SNTLnisN,—To-day ir© ohange our subject rather 
abraptly from diseases of vegetables to the oocorrenoe 
of increase of fat in the human enbjeot, but I give one 
little couneoting link between tbe two topics wb cb is of 
interest. I did not mention in my last lecture the 
occurrence of the tumours which are not very infrequent 
m some species of vemtables and trees more especially 
in the beech, in which a little, m«rble>like nodule 
developo under the bark, consisting of wood, and having 
no connection with the wo’tdy stem of the tree. The 
interesting point in reference to the development of 
these knots, as they are sometimes called is that ^ey 
are not knots in the sense in which that term is need in 
rcderenoe to some other stmobires Ton are all familiar 
with them. What is the explanation of their develop* 
ment? I believe it is this—thti in connection with a 
large stem, there is develop<«d a leaf-bud, which 

atte i>pte to grow out in connection with the cambinm. 
That leaf-bu<L owing to some defloienoy in its enpplv 
of up and in its connection with the tree, gets struck oil 
and covered in by tbe bark. It is detubed, its base 
narrowed, and in &e *>nd there remains only an embedded 
bud, and here we have proof of the vital tendencies of 
tissues—this piece of potential bud continues, although 
it has no object to fulfil in omnection with the tree, to 

C w into a little rounded woody mass, covered in by tbe 
k, Md this mass will form layer upon layer o* wood 
Soiretimes it may retain a very small base of attach¬ 
ment to the outer part of the stem. I have a very beau¬ 
tiful speoim-n. which I obtained a few weeks ago from 
a large fir tree, where they are not verv common. It was 
knocked off and had no stmotural connection with 
the tree. On cnttiog a section you saw layer 
after layer of wood tissue, as in tbe stem of 
a tree. It affords a carious instance of tissue 
endowed with life, for although it no longer devel >p 
for the good of the whole structure, it cannot help going 
oa ^wing. It is not absolutely dead. In reference to 
ordinary facty tumours their importance is very great, 
and also to malignant tumours. The explanation of the 
oocorrenoe of what are commonly called fatty tumours 
is that a little piece of fat is entirely dissociated from 
the general adipose tissue.aad is no longer in structural 
oontinuitv with tbe cellular tissue in which it is 
embedded, and this fatty detachment may grow at a 
very emriy period of life. It is suppoeed in oanoerons 
tumunrs that a little piece of foetal tissue gets encysted 
so that it no longer nndergoes tne ordinary laws of deve¬ 
lopment, but remains isolated, and may later on grow 

(a) I>elirered at the London Hospital on July 17th, 1901. 


into a cancer. In the simple cases of ordinary lipoma, 
or fatty tumours, my suggestion is that in all pro¬ 
bability, daring the primary development of the infant, 
little bits of fat become separated from the 
other fatty tisane and get encapsnled, then they 
grow not necessarily early in childhood—for fatty 
tumoura very rarely occnr then—but at some period 
long after childhood. This suggestion may apply to 
other tumours as well. That leads me to this statement 
that an isolated fatty tnmonr has a shell which is quite 
detached from the adipose tissue in which it is de- 
veliped, am that tells ns they can be enucleated. 1 
will not go into tbe general surgical relations of fat^ 
tumours. Their diagnoeis is perfectly easy. They are 
semi-fluotna'ing and very soft. They do not contain 
fluid, and yon must not mistake them for such a tumonr. 
If you press the tumour so that the borders bulge a 
oeitain amount of lobniation occurs, and that is tbe 
diaguoetio point. They occur on the shoulders or they 
may develop in any part ot the body where there is fa^ 
They are extremely rare in tbe sorotnm on.aocount 
the non-occu'rence of fat there. They are, however, 
extremely rare in the orbit, although it is full of fot. 
It may be that the fat in the orbit is serving a more 
definite physioltmoal purpose than the fat in ether parts 
of the body. It supports the eyeball and is mndi 
'ess liable to vary in quantity than tbe fot in o^er 
parts of th body. 

Since the tamoors are enoapsnled, it is not necessary 
for tbe surgeon to dissect them cat. Yon have to cat 
freely into tbe oapenle in which they are embedded an<) 
their coat, then they can be tamed oat very easily if 
the oapsnle is well opened. In ennoleating a fatty 
tumonr take your knife and squeeze up the fotty tnmonr 
quite tight in one band, and, with a good lone sweep of 
tbe knife, out right into the tumonr. Do not attempt to 
out round it, becanse if yon do you will have a long 
dissection to perform. This is all I have to say reepeot- 
ing what is ordinarily called a fatty tumonr. Bat it ia. 
a very small pert of the general snbjeot which I pur¬ 
pose to make some remarlm on; that is as to the oond^ 
tions under which fat may vary in the animal o^ans. 
We have the term lipomatosis as designating the 
tendency to tbe geneml increase of fat. We have 
several oorions forms of this tendency, and I will take 
first that which is most dosely relat^ to the isolated 
fatty tnmonr. Ton have all seen the symptoms which 
c-nstitnte diffuse lipoma. There is no tendency to 
general hypertrophy of the fat all over, bat in Certain 
•lefinite parts, such as the back of the bead, which is n 
common place for it. Great mansr? of fat also foroa 
under the chin, oa the neck and the pubes, where it may 
sunrouad and bury the penis { in these oases tbe fat ih 
not isolated as in a fatty tumour bat is continnons with 
the fat of the snrronndug parts. Here, if yon purpose’ 
operating, it will be no nse outtiag into tbe tumour, for 
it has no capsule; bat yon will have to cat into the' 
subontane ns fat and dissect it away because the mass' 
has no limiting membrane at all. These masses are of 
enormous size sometimes. Ton may have passed men' 
in the streets with fange growths disfiguring the n>-ck. 
The hnman being is far more freqnently attacked than 
the lower animals. I have only once b^n consulted on' 


D!'-' ‘ 


oog 


e 







620 Thi UsDicAL Fbiss. OBIOINAL COMMUNICATIONS. 


Dbc. 11, 1901. 


Booonnt of the inoonTenienoe oaosed by hypertrophy of fat 
in the pnbio re^on. The mertt was Tisible thiongh the 
clothes of the patient, who had no mnersl tendency to be¬ 
come oorpnlent. Snoh cases of local f^^regation of fat and 
local by]Mrtrophy of fatty tnmonrs oocor commonly in 
men. i nave never seen a definite case of it ina woman. 
They occur in men uid in connection generally with a 
caose, and that is diet. They are nearly always men 
who have been aoonstomed to drink malt liqnor very 
freely, and the patients generally o>'>me to recognise the 
fact that if they abstain from drink they can diminish 
the size and growth of the fatty tnmonr very consider¬ 
ably. But they are not inclined to adopt that mode of 
treatment. We learn then that the tendency to increase 
of fat is under the inflnence of diet. That, again, is 
generally recognised as regards general o^sity. A 
priori we should scarcely expect to find such a definite 
bearing in these local growths. They are attended by no 
serious symptoms, but the disfigurement they cause is 
very great. The breathing is unaffected in the majority 
of cases. 

Ought one to operate in such cases ? Well, that 
depends on the wish of the patient; if he has tried 
abstinence and found it of no avail, or if the disfigure¬ 
ment is very great, it is quite a justifiable case for the 
surgeon’s interference. In operating the surgeon will 
have difficulty in knowing when be mxut stop, for there 
is no limit to the fat, which gradually merges into the 
surrounding regions. The patient will probably do well. 
The wound is a very large one, involving probably the 
whole of the back of the neck. These large skin wounds, 
in my experience, give increased liability to the risk of 
erysipelas. For that reason I am always a little cautious 
ii) urging on a patient an operation which will involve 
an. extensive area of skin. In spite of antiseptic 
measures you cannot always prevent erysipelas. In a 
few extreme oases the patient has been pleased with the 
result. It is bettor not to do the operation at one sitting. 
The patient to whoml havereferied was admitted to the 
London Hospital and operated n;>on, the operation was 
followed by an attack of erysipelas, which be survived, 
and he is now pleased with the results. He has still a 
mass on the neck. He is engaged as an anotioneer’s 
assistant and sells horses, and consequently he is one of 
a class who drink very freely. He did abstain, and 
found it gave beneficial results. I need only mention 
to yon the names of Bolands and MacCormao to call 
to your mind their writings on the subject. I have 
recorded a good many cases myself. 

Perhaps this will be a good pla^ for me to speak of 
the general infinenoe of diet in respect to obesity. We 
get far more examples of general obesity, t.e., increase 
of fat in all parts of the l^y, though not necessarily 
an equal increase in all parte, in connection very fre¬ 
quently with diet, but not invariably. In a great many 
cases of extreme obesity it would not appear that diet 
has much to do with ih In the majority of the less 
ez^me oases I think on questioning the patient you 
would find reason to believe that beer-drinrag habits 
in connection with the consumption of fatty, starchy, 
smd Buccnlent matters are important factors. Race is 
also a oontributing factor. The Kaffirs and Zulus are 
fat people; some of them extremely fat, with pendulous 
breasts Ulw a woman’s, not due to hypertrophy of the 
m a mma ry glandular tissue, but to the increase of fat 
around the mammary gland. As we all know, this 
re^on in both sexes is one in which fat aoijumnlates. 
It is fairly common in elderly men for the breasts to 
assume almost the appearance of a female breast. If 
you were to cut such a breast across, you would find 
exceedingly little mammary glandular tissue. In 
wmnen, as age advances, there is the same tendency to 
fatness, but here again it is not enlarged mammary 
glandv^ tisrae, but the enormous quantity of fat 
u^on it. Sometimee in dissecting out a mass of 
soirrhns yon will find around the growth a very small 
quantity of mammary glandular tissue; what before 
operation looked like an enormous gland turns out to be 
fat. The tumour and the fot had taken its place. We 
have here an instance of the influence of the local 
structural peculiarities in regard to increase of fat. 

Negroes get very fat, and this is due, not only to the 


race tendency, but to their beer, which is an exceed¬ 
ingly fattening thing. It is quite thick, and contains 
more uofermentod matters than out own beer. It is as 
much a food as a liquid. The negroes drink large 
quantities of it. They also consume a large quantity 
of sugar. 

There are some races, just as there are some animals, 
which do not fatten. A pig easily puts on flesh in 
great quantity. But it is exceedingly difficult to fatten 
a goat, although a sheep will easily fatten. Some 
families have a tendency to fatten. In South Africa 
most of the races hare this tendency, especially the 
Boer w)men, who almost invariably lose their front 
teeth at the age of 30-35. The men do not fatten 
to such a great extent, and it is said that they ke-p 
their teeth. I am unaware if there is any connection 
between the loss of teeth and the increase of fat. 

Now I have to make one other suggestion, which takes 
ns into another department of physiology, in reference 
to the tendency to the accumulation of f«t, and that is 
it hassome relation to thesexual system. That, of course, 
is well-known to cattle breeders. The ovaries or the 
testes may be removed from an animal which has been 
allowed to retain them to adult life with a view to in¬ 
crease its tendency to put on fat. A so v has her ovaries 
removed to fatten her; in this way all sexual excitement 
is done away with. The tendency to leanness is propor¬ 
tionate to the physiological use of the sexual system and 
to sexual excitement. Very few persons wi^ highly- 
developed sexual habits will tend to put on fat to any 
large extent. With the suppression of the sexual 
system of function there comes a most definite 
tendency to fatness, especially about the mammary 
region; this is not infrequently the case in quite young 
persons. Some young men get abnormity fat: yonwiU 
find very probably the sexual system is in abeyance, the 
testes very smsll, and non-development of sexual hair. 
I will not go further into the subject than to hint at the 
definite relationship between the sexual function and the 
tendency to fatten, and that then a definite group of 
oases occurring chiefiy in young men in which the sexual 
system remains in abeyance. The voice is weak. The 
mammary glands become enormons apparently, though, 
as I have said, the fat aooumulates round the glandular 
tissue. Of such cases 1 have seen very remarkable ex¬ 
amples, and they are not attended nsnally with high 
intelletitoal development. Patients in whom the sezoal 
system is partially suppressed and the growth of fst 
enormous are more or less wanting iu mental energy. 
Then again we have onrions cases in the female sex of 
this. In men. so far as my experience goes, the cases to 
which I have just referred begin in quite early life to 
fatten. In women the sexn^ function may be snp- 

S reesed, and we may have almost an acute tendency to 
poma^is in a girl, hitherto perfectly healthy, who has 
menstmated regularly ; she may suddenly have a com¬ 
plete suspension of the menstrual periods, and will pnt on 
fat to an enormous extent. I have in my mind a very 
remarkable case A yoong lady was brought to me 
from a country town, very well developed, being very 
nearly six feet in height. At the age of eighteen, men- 
stmation was susp^ided and she began to fatten. In 
connection with the development of fat there is one 
symptom to be mentioned, and that is the development 
of snboutaneous soars in the skin. Here let ns refer 
again to vegetable ratbology. Soars in the bark of the 
tree are caused by tne groi^ of the tree being greater 
thu that of the bark, conieqnently the bark u unable 
to stand the pressure from within and it is tom in its 
deeper parts; soars result from the tear. Gardenevs 
cut a s^h in the bark to allow the tree to expand. 
Usually the growth of both bark and tree occurs pari 
pauu. But it is not so in these oases of abnormal fat¬ 
ness. Scars result on the skin of those patients—exactly 
similar to those on the abdomen of a woman who has 
borne children—whoee aocnmnlation of fat has a ten¬ 
dency to vary in amount; and thoes who have a alight 
temporary tendency to fetten in certain parts ot the 
body are infinitely more frequently met with than the 
extreme cases. Ton will often find these eoars ooourting 
in patients who have never definitely been out of healtn 
on the hips or ehouldere or other parte of b<^y; 


C 




Deo. 11, 1901. 


0RTGII7a1j COMMUNICATIOI^S. The HedioaIi Pebss. f-21 


then you mny be sure that, at some time or other, he has 
had a tende^y to fatten more than his skin woold oon- 
Teniently allow. 

To return to the yoting lady who fattened in all parts 
of the body; she was s^hed all orer her body with 
long florid soars; she was oovered with them. She was 
in a deplorable oondition and I need not say extremely 
disflgnied. la aatioipatioa of any remarks on treatment 
I will add that extract of cpinm appeared to do her a 
very great deal of good. She went to many oonsnltants 
and teied ererytl^g. She became very weak and 
lethargic and appeared likely to die. She has regained 
her he^th and menstmation has recommenced. I do not 
attribute the arrest of the tendency to fatten to the 
opiam, bat to the restoration of menstruation. The 
quantity of aocnmnlated fat has diminished. 

A fat person never lives to old age, as debility in some 
form ensues. The heart may become embarrass^; there 
may be fatty degeneration ^ the muscular substance of 
the heart, and we distinguish that from the accumulation 
of fat about it, but the latter is not to be wholly dis* 
regarded. In these cases of general lipomatosis, there 
is a large accumulation 61 fet about the heart, and the 
heart is thereby more or lees enfeebled. Fatty 
degeneration may occur in the heart in a person 
who has no tendency t> accumulate adipose tissue. 
The occurrence of hsMt disease in a fat patient is a fre* 
qnent source of danger as r^srde life; with regard to 
the extreme cases of obesity they are exposed to all 
sorts uf risks and dangers. A list of oases of enormous , 
increase of fat, snob, for instance, as that of Daniel 
Lambert, is given in an interesting book published in 
America by Mr. Gould. This list contains the namM 
of more n^es females. Young girls of eight or 
nine years age, with a tendency to fatness, have all 
the appearance of a girl of flf teen or sixteen. These fat 
children never live verv long. I know of no recorded 
examples. They may live to grow up, bnt never to old 
age. Cases of congenital corpulency are as inexplicable 
as those of congenital dwarfs. Some light has recently 
been thrown on the question of great growth, irrespec¬ 
tive of general adipose tissue increase, in connecting it 
with the pituitary body which has some power of 
regulating growth, just as it tends to produce the sym¬ 
ptoms in the dueaee known as acromegaly, where it is 
now proved in all oases that the pituitary body is la^er 
than normal; so it may be that we shall find that 
there is some part of the brain structure which 
presides over the tendency to fatten. It has been con¬ 
nected with the thyroid body, and it a as thought the 
use of thyroid extnust would prevent the accumulation 
of fat. I do not believe this; you are far more hkely 
to half poison your patient with it and cause great loss 
of strength. In the young lady I have mentioned 
thyroid extract signally foil^, although we made her 
ill with it. 

As r^aids the weight which may be attained it is 
enormous. There is an instance on record of a congeni¬ 
tal case in a child about fourteen years of i^, who was 
so fat that she could not get out of the door of her 
room. Bnt history does not tell ns the sise of the door. 
Mr. Gould, in his list, tells how some of these patients 
met their death. In some, death was quite accidental. 
The great quantity of fat embarrasses movement and 
respiration, and one woman, when in bed, turned over 
on her face and was found suffocated; she was unable 
to turn over again to brea’he. Many have very nearly 
met their death in that way; to avoid this, they sleep 
in an erect position, and even then some are believed to 
die from the pressure on the trachea and its consequent 
embarrassment. In one case, to prevent suffocation, a 
rather rough measure was taken. Needles were put 
into the back of the chair in whica the patient slept to 
prevent bis leaning back and getting into a sound 
sleep. 

A word or two now as to the occurrence of diffuse 
lipomatosis as a congenital thing. We tee these cases 
in children who are exhibited at shows. There seems to 
be no clesur explanation to give in regard to the enormous 
increase of fat. It is very seldom a family possession. 
Now and then two members of the same family are 
affected with it together, but generally there is only one. 


It may^ be present within a very short period of birth if 
there is a distinct tendency to it, irrespective of any 
supervening conditions after birto. It is peculiar that 
th^ is no proportionate increase of appetite or con- 
snmpti'>n of food. It is seldom much lar^r than natural. 
With the tendency to fatness there is aim a tendency to 
preoodous developments in other respects. I ^ve 
there are many oaaes where the sexnal fonetion is 
suppressed in which there is an early tendency to fat. 
The enormous weight of sixty stones is recorded against 
one of the oasee of general diffuse lipomatosis, and that 
oocnrred in a negress. It is, I b^eve, the greatest 
weight of a human being on record. I^iel Lambert 
weighed eight stonee lees, and several others have 
attained weights very nearly approaching tbeee. In 
most cases the sufferers become lethargic, and there is 
almost always a great tendon^ to sleepiness. In some 
oases, on the other hand, there is a fw mnount of mental 
activity. In Daniel Lambert the intell^noe was about 
the Bvera^, and he retained for the greater part of his 
life a considerable amonnt of cheerfulness. 

Quite recently a new affection has been described 
under the term lipomatosis dolorosa. In or^naiy 
lipomatosiB there is no pain. To the future must be 
left the question whether this supposed new form of 
the disease will stand examination. I believe a Dr. 
Dalton, a physician in Philadelphia, has described oases 
under this name, and their distinotivA feature is the 
repeated complaint on the part of the patient of aohing 
in the affeotM parts. The amount of lipomatosis in 
this form of the affection does not approach that which 
occurs in the other cases, and is often local, being con> 
fined to the breast and the lower part of the abdomen. 
PendnlonsnesB of the former may cause pain. This pain¬ 
ful form of the disease has probably some relation to 
myxoBdema, where the BUboutaneons cellular tissue in¬ 
creases or becomes charged with some poimnous snb- 
stsnoe. I must say that I have had no opportonity of 
observing any of these so-called cases of the painful 
form of lipomatosis. The other osaes where there is a 
great incresse of fat are to be distinguisbed from myzr 
Mema by snob signs as the absence M the peculiar facial 
expression and the general condition of health. There 
is no loss of hair in former. 

Now a few woi^ as to the oonverae picture. I refer 
to the living skeletons, in whom the snboataneons fat 
is remarkably absent, and let us also tom to the con¬ 
ditions under which it may occur. It is more com¬ 
monly found in oonneotion with women than with men. 
Extreme emaciation may happen very often in sssooia- 
tion with some reprewion of the sexual function. In 
smne young women, who become abnormally lean, thm?e 
is absence of mensbuation. The condition of leanness 
may occur coinddently with very fair health, just as 
in the oaaes of extreme fatness and good health. 

With regard to one young woman who was enor¬ 
mously fat, and in whom there was no arrest of the 
sexual function, she married and became a mother of 
several children, and enjoyed very fair health. Such 
oases, however, are exceptional. As a rule, very fat 
persons do not have child^, and, as I have said b^ore, 
the sexual function is almost in abeyance. 

It has been noted that sometimes a person will sud¬ 
denly become very lean indeed after enjoying quite an 
ordinary development of subontaneous fat, without any 
departim from ordinary good health. To get lean as 
yon get old is generally considered rather a good sin, 
and not to aocumnlate fot as yon get old is genersuly 
considered a happy augnry as regards long life. 

In reference to some of the extreme instances of living 
skeletoBB. some exemplify diseases of muscles. We afl 
know that the mosoles waste in nervous diseases and 
diseases of the spinal cord, and this wasting occurs in 
connection with well-understood oauser. But here it is 
different $ the cause is ill understood, as in tbe persons 
with a tendency to fatten. In connection with living 
skeletons I now mention a few oases which corre¬ 
spond with those of congenital lipomatosis in 
which the infant becomes very fat; that is to 
say, those in which the infant becomes very 
lean. First I must tell you it is a very much rarer 
condition. I have two very remarkable oases in my 


ORIGINAL COMMUNICATfONS. 


mind: they were both attended with dwarfing. In both 
the eexual eystem remained quite in abeyance; the 
testes were extremely small—the size of a hazel-nut. 
The Toice in both remained infantile althongh they had 
attained nearly adnlt age. One of these patients is still 
Uving. They were both males. In one of them the 
mammary gland was qnite absent; there was no nipple. 
In both the tendency to leanness was sooh that yon 
oonld not appreciate any snboataneons fat in any part 
of the body. The skin was drawn tightly over ^1 the 
mosoles, whose oontoor. as well as that of the enb* 
cntaneons bones, was visible. The ontline of the biceps 
along its whole length oonld easily be tra^i 
the mnscles themselves were of a very fair size. 
In both hair was entirely ab^t—^the appendages 
as well as the snbontsneons hair. In the case 
I best remember there was a pecnliar hereditary 
history; the scalp was drawn tightly over the 
whole of the skull (there was a little down but no 
hair on the head). Xow the mother of this boy had not 
a hair on her head; she was stout, almost fat, with 
large mammaiy glands. She was not bom hairless, but 
lost it in childbed. She had four or five daughters, all 
with excellent heads of hair, and well developed in every 
way. But her youngest child and only son was quite 
hairless. 

In the case which died a post>mortem was made, but 
nothing was found which gave any cause as to the 
absence of the normal adipose tissue. The clavide, 
which I have in my possession, is extremely ■ma.ii and 
Blender for one who Ims reached almost the age of an 
adnlt; it was like that of a little animal, and not so 
thick as a cedar pencil. Of course there must be some 
definite cause for this arrest of development. In the 
one case, there was some family history, and there may 
have been an hereditary tendency; but in the other, no 
history could be obtained. 

As regards treatment there is very little to be add, 
and I thinkl have in passing mentioned iheohiefpoints. 
Liquor potassm was used by our grandfathers, but we 
l^ve lost our confidence to a great extent in its use. 
^ere is the question of diet. A fat person must abstain 
from fatty materials; this is of extreme importance. 
Underdone beefsteaks and hot water as a t rea tm ent of 
obesity is well known and very efficacious. Many systems 
of diet have been devised for corpulency. But diet has 
little effect, if any, on the cases where there is great ex¬ 
cess of fat. Thyroid extract may be tried cautiously; 
it will ^bably reduce the patient’s strength out of all 
proportion to the benefit drived. Surgery is of no 
avail. 

SUBMUCOUS MYOMECTOMY 

BT 

HTSTEBOTOMY ob CiESARBAN SECTION, 

^OT HYSTERECTOMY, (a) 

By A. RABAGLIATI, F.E.C.S.Ed., 

Hoa. Ojmecologlst, Bradford Bojal Infirmaty. 

The mode in which the myoma of nterue to which 
I direct your attention was removed is one which is 
not very often adopted, and it so happens that 1 have 
not used it before. The myoma filled the whole of 
the uterus, and by opening the uterus, very much as 
is done in Cesarean section, or by hysterotomy, as 
distinguished from hysterectomy, it was possible to 
remove the tumour; and that was done with a suc¬ 
cessful result. 

History .—Patient was an unmarried milliner, et. 
35, whom I saw in September, 1901, along with Dr. 
Moorhead, of Tong, for retention of urine. The ure¬ 
thral pass^e seemed elongated and tortuous, and it 
was a little difficult to enter the catheter. The point 
of the glass catheter had to be pushed about two 
inches upwards in the direction of umbilicus, the 
opposite end being correspondiogly depressed be- 

<«) Ptper read before the Bradford ICedioO'ChintnrJcal Society. 
Hovember l»tb.l901. 


tween the thighs before the bright amber-coloured 
natural urine Sowed. About a pint was removed on 
that occasion, one or two drops of blood being 
visible at the end of the process of emptying. 
Patient’s account was that the inability to empty the 
bladder bad occurred on several previous occasions; 
as long ago as the previous May, aud always, so she 
said, at the catamenial period. The period were 
said also to have been profuse. The condition 
was vomewhat unusual, but having succeeded in over¬ 
coming the tortuosity and elongation of the urethra, 
and having emptied the bladder, I did not think mueb 
more about the condition and made no furtiier 
examination. However, the next evening, on 
being again sent for on account of the recurrence of 
a similar sta'e of things, and after agmn emptying 
the bladder, and finding that it contained no more 
than, say, ten or twelve ounces of urine, while there 
stiU seemed some swelling remaining, we proseented 
our inquiri* s further. There then -eemf>d to be firm 
resistance offered to the band pressed against the 
hypogastric region, and on passing the fit^:er per 
vaginam a tumour was found to be projecting from 
the os. It was round and smooth, and was accom¬ 
panied with “ development” of the cervix, t.a, there 
seemed to be little or no cervix discoverable, and the 
os was patent to the extent of qnite an inch in 
diameter in every direction. Patient said that her 
periods used to be more profuse than of late, though 
they were still more profuse than natural, and 
seemed also to occur to» often. 

Patient was recommended to become I.P. in the 
Boyal Infirmary in order to have the tumour re¬ 
moved, and Dr. Moorhead and myself thoiwbt that 
it might be possible, by separating the os worn the 
tumour, to seize it rmsellnm forceps and by 
pulling and clearing with the fingers, perhaps to get 
it away by that means. It seemed to be, and as the 
event showed it was, an intra-uterine mass lying 
inside the mucous covering of the uterus. How 
extensive it was could not then be determined, but a 
somewhat laige polypus in the act of being extruded 
from the uterine cavity was the impression con¬ 
veyed to our minds on examination, which 
might, perhaps, be dealt with by expediting 
and hastening its extrusion. If this method 
of removal should prove impracticable, then 
farther proceedings would be necessary ; and 
hysterectomy seemed to be a possible necessity. 
Patient was the only support of her aged and feeble 
parents, who, however, after much anxiety ^reed 
with herself as to our sug^tions offering the only 
possible chance of relief in the circumstances. Aooor- 
dinglj she came in on September 12th, and on the 
I5th, in the lithotomy position, under ether, the 
finger was passed through the cervix, and the fibroid 
cleared from the uterine wall by finger and blunt 
instruments. The cervix was divided anteriorly 
and posteriorly for about an inch in order to 
aid m this process and to min room. The 
growth, however, proved to M too large for 
remov^ by this means. The question then 
was, what was to be done. I had promised Dr. Moor¬ 
head that if further proceedings should prove to be 
necessaty, and especially if hysterectomy should 
have to be performed, I should g^ve him notice, and 
the opportunity of being present. However, the 
operation bad so far preceded to a considerable 
extent. A certain amount of laceration had taken 
place, and although aseptic precautions bad 
observed as far as possible, and further douching 
could be done, stiU it did not seem safe to leave a 
lacerated wound present in the uterine cavity, and 
the tumour partially tom from its attachments 
capable of setting up sepsis in the wound. For these 
reasons therefore, and as I was further urged 



Dxo. 11, 1901. 


OBIGINAL COMMUNICATIONS. 


Thk Mimcal PBsas. 623 


to this coTine hj the bonse anrgeon, Mr. Phillip 
who gave me Tery efficient aasistanoe Unxmghont the 
case, I proceeded to open Uie abdomen and to com* 
plete the operation then and there. On examin¬ 
ing from toe interior of the abdomen the whole 
uterine outline was enlarged and appeared like a 
uterus, which retained its shape, although on an 
enlarg^ or magnified scale. It seemed evident that 
the tumour-mass filled the whole of the uterine 
cavitj, and that the tumour was throughout a sub¬ 
mucous one. This being so, two courses offered 
tiiemselres for adoption, one, tiie usual one, to re>: 
more the uterus and tumour -to perform hysterec- j 
tomy, in fact; the other to open the uterine cavity, 
to clear the attachments of the tumour from the 
interior, and to remore the tumour, leaving the 
uterus, should ^at appear or prove possible. Ob- j 
riously if the la'tw course could be adopted: 
it would better for the patient to have' 

the u erus in its place thw to perform 
hysterectomy. Accordingly, I fixed a clamp 
on the broad ligament on each side so as to 
prevent hesmorrhage. I do not know if this was a 
necessary proceeding, for there was no hemorrhage. 
This may bye been due to the pressure of the clamps, 
but I doubt it, because no vessels ^nired to be tied 
after the clamps were removed; bringing out edge to 
cut edge b^g quite sufficient to stay all bleemng. 
However, the clamping was a safe precautionary 
measure, if not pres^ so tightly as to strangulate 
the bro^ ligament structures. An indrion was 
then made in the anterior uterine wall high up to¬ 
wards the fundus; this was carried r^ht through 
the fundus to the posterior wall, which was alM 
divided for about two inches. The tumour was 
then clemwd ^m the interior of the uterus, 
its attachments bmng tom through, and the contents 
of the cavity bong removed just as in Oaasarean 
section. The edges of the wound in anterior and 
posterior walls and through fundus were then 
brought together by catgut sutures, which passed 
tbougb the serous and muscular coats, but no6 
through the mucous coat, and the clamps were re¬ 
moved Bohemorrha^ and no vessels tied The 
abdomen was sponged dry and dean, and the wound 
closed in the usud way. Patient’s recovery was 
quite uneventful, which was a g^reat relief to my 
mind, the temperature never rising above 99'8° tlie 
day after the aeration, nor the pulse above 104 the 
same day. Patient’s temperature was subnormal 
when she left the hoepital on October 12th, and had 
been so for about a fortnight. The causes of this 
open up a very interesting inquiry which I will not 
enter on now, further than to say that I have no 
doubt that tbe causes which led to the tumour- 
growth are tiie same as those which made the 
temperature too low, and that no doubt patient’s 
temperature had been, like that of tbe vast majority 
of patients who suffer from chronic disease, su^ 
normal for a long time, probably for years before I 
saw her. 

The myoma measured 5^ inches by 4^ inches, and 
seems to consist of a myomatous tissue embedded in 
meshes of fibrous tissue. 

Remarks on ike Opero/ion.—I do not know if the 
operation just desonued has been performed before. 
I have not done it, having in other oases either per¬ 
formed vaginal enucleation or hysterectomy, vaguial 
or abdominal. All that I find in Baldy on the sub¬ 
ject are these few remarks, which, hs they do not 
unduly lengthen my paper, I shall quote; “A. 
Martin has connected his name with tbe operation 
of enucleation of interstitial fibroids by the abdo¬ 
men.’’ (My case is a submncoid fibrcnd, not an 
interstitim one.—A. B.) *' He removes the tumour 
in a bloodless way by using a temporary elastic liga¬ 
ture, and depends npon his sutures to permanently 


control bleeding. He reports sixteen oasee, tbe 
uterine cavity opeced in ten, and five deat^ Itdoes 
not appear that anything is gained by this opera¬ 
tion, and ^e mortality is hi^.” Evidently ^Idy 
does not like this mode of procedure. 

cfrfiixh CUiitkal Jkdxtxt, 

THE DIFFERENriAL DIAGNOSIS 

OF 

EPITHELIOMA and SYPHILIS ofthi PACE. 

By Db. DU CASTEL, 

Sorgreon to the 8t. Lonis Hospitel. 

[SPECIAIiLT TBAN8LATBD FOB THB MEDICAL PRESS 
AND CIBCtrLAB.*] 

A FORTNIGHT STO a strong, robust woman came to 
ns with an ulcer of two ycuuu’ standing on tbe tip of 
the nose which had been diagnosed to be of a cancer- 
cos nature by several surgeons. This lesion had 
a gradual course until the tip of the noee bad 
little by little disappeared under the infloenoe of the 
ulcerative process. 

Her conmtion was as follows:—Tbe tip of the nose 
was destroyed, and the small sore which apparently 
existed there was covered vrith a thick, wk, and 
adherent scab, tbe neighbouring skin being infil¬ 
trated, swollen, thicken^ and of a dark red colour. 
The redness and tumefaction extended to some dis¬ 
tance from tbe scab, and then grado^y men^ 
into the healthy intM^nment. There was no oww 
lemon on Uie rest of tne fiice. None the glands 
into which the regional lymphatics emptied were 
enlaiged. 

I removed the scab in order to ascertain the ftp- 
pea r anoe of the subjacent oloeration, a slight dm- 
cbai^ of a dark brown blood took place, tb^leeding 
oeasiog on the application of slight pressure. 

Tbe nicer was cairly regular in shape^ it measnied 
about 2 cm. across, and the centre was at a lower level 
than the edges, which gave it a oop-sbaped appear¬ 
ance. The surface was of a greyisn-red colour, and 
was smooth. At the oiroomferenoe ^e ulceration 
ceased abruptly, and was surrounded by tbe infil¬ 
trated and tnickened skin just described; there was 
no ^preoiable difference ox level at t^ line of de¬ 
marcation between the ulcer and the non-ulcerons 
skin, no prominent limiting irregulw granulating 
border as in epithelioma; neither had tbe surface 
the granular and blood-stained appearance which is 
characteristic of epithelioma, nor its tendency to 

bud.’’ It ocoarred to me that the ulcer presented 
the appearance of a syphilitic lesion rather that 

of epithelioma. Moreover,on carefullyexaminiug tbe 
rest of tbe face, no trace could be seen of tbe sli^tly 
P’^ojecting brownish stains of a dirty appearance, 
which con^tute tbe so-called seborrhosic or senile 
wart, and wbiob is so frequently met in subjects 
suffering from epithelioma of the face. 

On questioning tbe patient we failed to elicit from 
her any history pointing to syphiUtio infection. She 
stoutly denied having had a chancre or previous 
sypbmtio eruption, and her denials were apparently 
made m go^ faith She had never had a mis¬ 
carriage, indeed she had never been pregnant. We 
could not therefore favour the idea of syphilis of 
gravid ori^w, a variety of the disease which may 
well be anxnown to patients. The surface of the 
body bore neither stains nor scars nor exostoses of 
venereal origin. 

On examining tbe mouth the aspect of the case 
; changed completely. There was a small perforation 
I of the hard palate establishing a communication 
I between the buooal cavity and the nasal fosss, which 
did not, however, give rise to any disturoanoe of 

C 


624 Thi MiDicix PB18.. OBlOmAL COMMUNICATIONS. 


D*c. 11,.1901. 


function. The uynla had been destroyed; the hinder 
margin of the soft palate had been er^ed bj an 
nlceratire process, and was conTerted into oioatrioial 
tissue adherent extemallT to the posterior wall of 
the pharynx. I had no longer the slightest doubt 
that we were in the presence of graye and incon* 
testible syphilitic lesions of the nharyu. The 
diagnosis oif the syphilitic nature of tne lesion of the 
nose was thus conmmed. Anri>sjphilitio treatment 
was ordered (weekly injections of calomel and the 
administration of 4 grammes of iodide dail^). Im* 
mediately a^r the fint injection a rapid improTe* 
ment set in; the zone of inflammatory infiltration 
which surrounded the crust subsided and grew paler, 
and the ulceration appeared to be contracting 
beneath the crust, the ed^s of which grad^ll^ be* 
came loose. On the ^hth day a second injection of 
calomel was giyen. patient has now b^n under 
treatment for a fortnight; the scab has fallen off; 
the ulceration, as you see, has healed, and is replaced 
by a smooth and slightly depress^ cicatrix. In 
presence of the results so promptly obtained under 
the influence of the iodo*mercui^ treatment, no one 
can hesitate to admit that it is a syphilitio and not 
a cancerous lesion. 

It may appear stranue to yon that cancer of the 
face can be confounded with a syphilitic lesion. 
This confusion, howeyer, has occurred more than 
once. The nose is not the re^on in which the mis¬ 
take usually occurs, but usually in cancer of the 
chin and lipa As a general rule it is the syphilitic 
lesion which is mistaken for cancer; it is much 
rarer for cancer to be mistaken for a syphilitio lesion, 
though this is not impossible, as I wul proye to you 
later. 

The syphilitic lesions which are confounded with a 
malignant tumour are primary chancre or gumma. 
Chancre on the lips, and eyen more frequently on 
the lower part of tne face, and particnlwly on the 
chin, may attain a considerable size, so much so as to 
constitute a genuine tumour the size of a small 
apple. These “ chaocre-tumours ” were sometimes 
remoyed by surgeons, at an epoch when their 
nature was not so clearly established as it is at 
the present day, and before the dauMr of mistaking 
them for cancerous growths had been pointed 
out. 

The diagnosis is easy for one who has been warned. 
The chancre, in spite of its size, has a central cup- 
like depression, a smooth eyen surface, coyered with 
diphtheroid exudation, and presents a grey centi^ 
slough, surrounded by a red zone, from which oozes 
a dark sero-sanguineous fluid when the crust is 
remoyed, and this oozing, which has a yery charac¬ 
teristic appearance, is one of the most trustworthy 
symptoms of syphilitic chancre. The chancre, more- 
oyer, is a lesion which generally rune a more rapid 
course than epithelioma, and if it be not too hastily 
removed, cutaneons eruptions, which also inyade the 
mucous membranes, assist us in arriving at a 
dia^osis. 

The gummatous lesions very often puzzle the 
petitioner, especially when they occur on the lips, 
Ttey may appear in the form of isolated gummata, 
or gummatous infiltrations ** in sheets.’’ The latter 
are, perhaps, eyen more liable than the former to be 
confused with epithelioma, especially when they 
occur on the lips. 'When we are able to follow the 
evolution of the lesions from their starting point it 
is easy enough to recognise the gumma ; we find a 
noda<e commencing at a greater or lesser depth, 
forcing its way giMually towards the surface. It 
points, breaks down and ultimately ruptures, giving 
exit to a core, paving the vray to an ulceration which 
persists for a more or less protracted period Under 
these circumstances no error of diagnosis is possible. 
The difficulty arises when the case first comes under 


obeervation after ulceration has taken place in a 
tient who is unable to give a satisfactory history, 
e may have to deal with a patientwho does not know 
what syphilis is, a state affairs much less uncom¬ 
mon than one might imarine, eq>ecially in women. 
In roite of the resemblance which these lesions 

{ >re8ent at first sight, syphilitio and gummatous 
esions and epithelioma present certain characteristic 
features whi^ render it possible alvrays to form a 
dis^osis after close examination. 

^e gummatous ulceration is surrounded by a deep 
red inmunmatory zone, of a coppery or lean-ham 
colour, which beromee progressively less marked as 
we get further from the ulceration, but which only 
completely disappears at a certain distance there¬ 
from. 

The edges of the lesion are usually prominent; the 
border is nsually swollen; moreover, the margins of 
this swelling are not well-defined and do not stand ont 
in a prominent manner from the healthy tiasnes, and 
they pass into the adjacent tissues in a gentle and 
often very gradual alope. 

The syphilitic gummatous ulceration often assumes 
a crater-like form with abrupt margins; in rarer 
cases it may bniTOw beneath the edges, especially in 
recently ruptured gnmmata. Sometimes it occnrs 
in the form of a more or less extensive ulceration, 
hemmed in on all or part of the ciroomference by 
slight, soft swelling. The ulcerated surface may be 
irregular, covered with innumerable projections and 
depressions; the centie is generally the most de¬ 
pressed part of the nicer, and from the centre the 
ulcerated surface rises to the level of the healthy 
skin by a gentle slope; the wound has a tendency to 
assume a cup-like shape, which is well marked in 
the majority of syphilitic nloerations. 

The diseased surface is generally smooth or 
covered with large granulations, whicn are slightly 
moist; it is of a dnU-red or greyish coloor; sometimes 
it is wholly or partly coverM by a diphtheroid exac¬ 
tion : it bleeds easily, and the sangnineous discharge 
is of a dark colour, and is stop|:M by slight com¬ 
pression. The base of the nicer is rather hard to the 
tonob, and the glands of the ^ected region are 
nsnally intact, 

Several of the characteristics which I have just 
enumerated are either absent or much modified in 
epithelioma. 

The skin which surrounds an epitheliomatous 
ulceration is generally iioimal in appearance, neit^ 
infiltrated nor thickened; it is not surround^ by the 
erythematous zone usually observed round a syphi¬ 
litic ulceration. A thickened projecting margin cir- 
oumvente the lesion, the prominence wber^ varies 
with the size of the lesion. If the ulceration be small 
and dne to a superficial epithelioma, then a project¬ 
ing bordering nng of about 1 mm. wide may be saen 
around it. This border is of a finely ^ranulu nature, 
composed of a series of little nodules m close contact; 
this may eompleteU snrronnd the ulcer, circum¬ 
scribing the whole of the periphery, or it may be in¬ 
terrupts at various points, and omy be met with at 
certam points thereof. 

In epithelioma of a more serions nature the bor¬ 
dering ring acquires much lai^er dimensions ; it may 
measure a centimetre or more across; it ceases 
abruptly on its exteinal side, and the passage into the 
healthy akin is without transition; it is markedly 
projecting, and does not offer a progressive diminu¬ 
tion like the syphilitio border; it generally has a 
more or less granular aspect, at any rate in its 
internal half. The ulceration sometimee forms a 
depression which is more or less cup-shaped; it is 
nsually irregular, and is composed of a series of pro¬ 
jections and depressions havmg no regular or ^ed 
shape. The tissue is granular, formed by fine 
nodules, and is of a red or yellowish colour; it bleed 


O 



Die. 11, 1901. 


CLINICAL RECORDS. 


Thi Midioal Fbim. 625 


easily, the blood is red, and the hsmorrhage ia 
copious and is arrested with diffionlty, indeed this 
hfemorrh^ may become dan^rons. 

In epithelioma the lymphatic glands of the ooire* 
spondine region are umoat alwajs enlarged. The 
baae of ^e tnmoar is often so bard as to render it 
difficult to distinguish from that which occurs at the 
base of gummata. 

There is one variety of epithelioma which may 
easily be mistaken by one who has not previously 
observed and which is frequently mistaken for a 
syphilitic lesion. This variety of epithelioma 
generally occurs in the middle of the lower lip. It 
does not begin as a tumour, but commences as a 
small infiltration, a superficial thickening of the 
mucous and sub'mucous membrane, and is distinctly 
rounded in shape and of a greyish colour, having 
somewhat the diphtheroid aspect of the chancre; the 
surface is smootu and the affection is not painful. 

In spite of the analogy which it presents to the 
s^hilitic chancre, this lesion has certain peculiari¬ 
ties which enable it to be distinguished. The 
chancre, in the course of a month or so, begins to 
heal. Nothing of the kind is observed in epithe¬ 
lioma, in which there is no tendency towards repair. 
Slowly, but surely, it continues to spread. The 
white membrane which covers the cancerous leer 
is much more adherent than the diphtheroid exuda¬ 
tion of the chancre. In the neighbourhood there is 
usually very marked leucoplasia. A very important 
characteristic has been brought to light by M. 
Barier, viz.: If we take the little diseased patch and 
press it between the fingers there exudes from the 
whole of the surface yellowish filaments, very similar 
in appearance to little thread worms, to the laments 
obt^ed by the compression of the comedones of 
acne. These concretions have received the name of 
“ vermiotes ”; they are composed of homy cells and 
epidermic globes, and are of considerable import¬ 
ance from a diagnostic point of view. Histological 
examination shows that ^ese tumours belong to the 
class of tubular pavement epithelioma. In spite of 
their trivial appearance at first sight they are of a 
malignant nature. Beware, therefore, of white 
rounded patches of some standing which develop on 
the middle of the lower lip. 

When we are in doubt whether a lesion is or is not 
of a syphilitic nature, it is customary to put the 
patient under an antisyphilitic treatment, and we 
oase our judgment on the result obtained. When 
this has to be done to confirm a doubtful diagnosis 
of epithelioma, we must be careful, because the mercu¬ 
rial treatment has, more than once, seemed to aggra¬ 
vate cancers of the mouth; consequently, until 
lately, it was deprecated by many practitioners 
whenever there was a suspicion of epithelioma. 

Professor Fournier has called attention to a very 
interesting phenomenon, viz., when in a doubtfiu 
case the patient is put under the mercurial treat¬ 
ment, not by the mouth, but by subcutaneous injec¬ 
tions of calomel, there is usually observed to occur a 
diminution of the lesion daring the first few weeks, 
whether it be syphilis or cancer. In the case of 
epithelioma the amelioration ceases after a certain 
time, the disease recommences its destiuctive pro¬ 
gress, and nothing can stop it. If it be syphilis the 
amelioration continues until a cure takes place. The 
good effects of mercury do not, therefore, constitute 
absolute proof that we have to do with a syphilitic 
lesion, for we may have the same results in toe case 
of epithelioma; but in this case they are only 
transitory, and after a few weeks the disease lesumes 
its onwara march. This observation has often been 
made on the buccal mucous membrane; it has not 
been clearly ascertained whether it is of as frequent 
occurrence on the skin of the face and lips, but this 
would seem to be the case. 


In any case, when you the antisyphilitio treat- 
memt and observe a slight improvement in a doubtful 
lesion, do not cry victory too (piickly; wait till the 
improvement increases and continues, and remember 
that on the tongue and in the mouth it is not rare for 
epitheliomas to undergo temporary diminution under 
the influence of mercurial injections; moreover, it is 
not inconceivable that the same thing should also 
occur on the skin. 




[bIPOBTID BT OUB BXB1.1N COBBXSPOKDINT.] 

KAEEWSKI'S KLINIK, BERLIN. 

Cau 0/ OoHorrhoeal Joint Affection toHh Ltmonttration 
of Gonococci in the Blood. 

Under the Care of Hb. Unobb. 

A TouTH, eet. 18, hurt his hip in a swimming bath on 
June 1st. Acute pain settled in the spot with fever. On- 
admission into kiiuiir, osteomyelitis wav thought of,, 
amd a punctnre was made, but only pure blood came 
away. Then gonorrhoeal coxitis be^me the question, 
and gonococci were found in tiie urethral eecreti‘>n. The 
coxitis improved under a plaster-of-Paris dressing, but in 
a short time swelling of the elbow and wrist came on 
with a good deal of rise of temperature. On now ex¬ 
amining the blood gonococci were found. At the apex 
of the heart a slight systolic murmur was beard, and 
over the aorta a slight dUaatolio murmur. In examining 
the blood 10 ccm. were taken from the median vein, 
and development of gonococci took place when 
placed in ascetic fluid, whilst cultures on the wound 
remtined sterile. The speaker attributed the nega¬ 
tive results usually recorded to be due not to 
any killing off of the gooocoooi by high tempera¬ 
tures, but to improper methods of inveetigirtion. 
A proper method required, flrst, a large quantity of 
blood, as the gonococci were not numerous; secondly, 
dilution with a large quantity of nutrient fluid, whereby 
the bactericide action of the blood serum was weakened; 
and thirdly, a fluid nutrient medium as this aided the 
development of the cocci the same as in typhoid. 

Hr. Max Miobaelis thought Unger’s obMrvation of 
great interest. He quite agreed with his method of in¬ 
vestigation. By means of it be himself had proved the 
presence of streptococci and staphylococci in the blood 
in tuberculous cases. 

Dr. Klemperer had published an interesting oase of 
spread of gonococci by the blood tracts in the oase of an 
infant witii blenorrhoea. Multiple inflammation of 
joints soon followed the blenorrhoea, which, however, 
quickly receded. Then an abscess developed in 
the bsok, and on being opened a large luantity 
of gonococci were found in the pus, as ma^ ae 
were found in the blenorrboeio discharge. Local 
external transportation from the eye to the back 
was out of the question, the cocci mns^ therefore, have- 
got there through the blood track. Frankel had, 
moreover, always found pneumococci in the blood in 
pneumonia, even after the crisis. He also advocated 
the use of large quantities of blood and large quantitiee 
of nutrient soil to reduce the bactericide action of tho 
blood serum. Gonorrhoeal joint affections were com¬ 
paratively frequent. They were generally monoarti¬ 
cular, and were characterised by a doughy swelling 
around the joint from participation on the part of the 
periarticular tissuee. Such mflammatioos were fre¬ 
quently and wrongly considered to be rhenmatia 

Hr. Unger farther said that as the gonocdcci diiH 
appeared from the blood very rapidly, examinations were 
often made too late. Examination shooldalways be made 
within twenty-four hours of the flrst appearance of the 
swelling. The joint sffectiona were caused by the 
gooocoooi themselves and not by tbeir toxins, as the 
fluid containing them, after they had been Altered out, 
set up no infection in animals. 


c 


626 Thi Medical Pbim. TBANBACTIONS OF SOCIETIES. 


^rattBartiotiB of gotfcticB. 


OBSTETRICAL SOCIETY OF LONDON. 
Msbtino held Lecembeb 4th, 1001. 

Dr. Pbteb Hosboces, President, In the Chair. 


Specimens. 

BCPTTBED TUBAL GESTATION. 

Db. Ahand Bouth showed a specimen of mptored 
gravid Fallopian tube; the mptnre having apparently 
taken place while tnb^ abortion was slso in progress, or 
possibly soon i^terwards. The patient, set. 27, had 
been married three years, and had had one pregnancy, 
followed by abortion. In the beginning of September, 
1901, she had a normal period; at the end of the same 
month, and several times in the coarse of October she 
had a slight irregnlar show, and early in November she 
had an attack of syncope. The doctor who saw her 
di^fnosed colic, and gave her an opiate. Her condition 
oonttnoed very unsatisfactory, and Dr. Booth was 
asked to see her. She had then just had a second 
serions attack of syncope, and appeared to be 
almost dying. He proceeded at once to operate 
and foond a quantity of free blood in the 
peritoneal cavity. The left tube presented in the 
wound, and was found to be the seat of a mptnre from 
which hemorrhage was going on. From the open fim* 
briated end of the tube bleemng was also taking place. 
The fcstns had paaaed out of the tnbe, and was lying, 
with cord and placenta attached, in the abdominiJ 
cavity. The operation proaontod no special difficulty, 
but just before the abdomen was closed some fresh 
blooding took place from a vein at the back of the broad 
ligament, and at that moment the aniesthetist found 
that the chloroform had mn out. Dr. Booth conse¬ 
quently applied two clamps on the broad ligament, one 
at the nterine end and one near the pelvic wall; and 
the hemorrhage fortunately oeaaed at once. The olamps 
were left on, ganse was packed ronod them, and the 
abdomen was dosed, leaving the olamps and ganae pro¬ 
jecting. The damps were removed on the second day, 
and the gauze on the fourth. The patient happily did 
wdl, the recovery being assisted by saline tranifnsion. 

Dr. C. J. CuLLiNowoBTB sud that the case presented 
many features of interest from the clinical point of 
view. From the pathological standpoint the chief 
interest in the case consisted in the co-inddence of 
tnbal mptnre with hsemorrhage going on through an 
open fimbriated extremity, so that a double heemor- 
rbage took place. One wodd have expected that the 
fact that the abdominal ostium was patent would have 
been suffident to insure against mptnre of the tnbe, 
especially in former days when it was taogbt that the 
tube raptured because it conld not expand snfficientiy 
to accommo^te the growing ovnir. lAte teaching was 
to the effect that mptnre was due to sudden expansion 
of the tnbe by hemorrhage; for it had been shown that 
the walls of the tnbe conld expand dmost indefinitdy 
provided that the distension was gradual. More re¬ 
cently the view bad been propounded in Germany that 
rapture was brengbt about by infiltration and conse- 
qnent thinning of the wall of the tnbe by the ohorionio 
villi, and this would readily account for the condition 
fonnd in Dr. Bonth's case. 

Mr. J. 'H. Taboett remarked that the wall of the 
tube in this ca»e presented a very marked degree of 
thinning, and he Ium no doubt that this was the result 
of inflltmtion by the chorionic villi. 

Dr. Hubbbt Bobxbts recalled the fact that the 
thinning of the tubee in cases of extra-nterine gestation 
bad been specially insisted npoo by Ur. J. W. Taylor in 
his Ingleby Lectures. 

DOUBTTUL SEX. 

Dr. W. 8. A. Gbiteith showed a person of uncertain 
sex, »t. 26. The in<lividnal was considered to be of the 
male sex, but undeveloped. He had no beard, the voioe 
was feminine, and there was a larm amount of fat over 
the pnbes. On the other hand, there was no develop¬ 
ment of the breasts and there was no vagina. The penis 


_Dec. 11, 1 901. 

was very small, bnt was perforated terminally by the 
urethra. A small scrotum was present, bnt it was un¬ 
certain whether or not it contained a mdimentary gland 
on one side. 

Dr. Hubebt Bobebts showed the intoroal and ex¬ 
ternal generative organs of a male pseudo-herma¬ 
phrodite, the specimen belonging to the mueenm of 
St. Bartholomew’s Hospital. The male sex had been 
determined by microscopic examination of the genital 
glands, which proved to be testicles. There warn a fairly 
well-devel^d uteras. 

Dr. G. F. Bi.ackeb expressed the opinion that Dr. 
Griffith's case was an undeveloped man; the secondary 
sexual characters were of comparatively little import- 
ance in snch cases. If a gland were down in the scro- 
tiun, it was nearly always a testicle, and the cord, if it 
oonldbe felt, was oonolnsive evidence. He drew atten¬ 
tion to some recent investigations on the differential 
ossification of the thyroid cartilage as a means of dia- 
gnosis of sex, and suggested that Dr. Griffith should 
obtain an X-ray examination of the patient to elucidate 
this point. 

POrrAL DEPOBMITT. 

Dr. Stanmub (introduced by Dr. W. W. H. Tate) 
showed a specimen of a foetos with a curious deformity 
of the face. The specimen was referred to the Terato- 
logioal Committee for report. 

A short paper was read by Dr. Maxwbll on vomiting 
in pregnancy, with reports of two cases io whi<fii labcnr 
wtis induced. 

Dr. CuTBBEBT Locktbb showed two septicsemic nteri, 
removed post mortem, in each of which staphylococci 
were fonnd in the uterine muscle deep to the placental 
site. In the first esse the patient lived for fifty-one 
days after premature delivery of twins at the sixth 
month. Labour and the first eighteen days of thepner- 
perium were normal and apyiexial; on the nineteenth 
day violent bleeding set in and the doctor removed a 
piece of adherent placenta by the finger. Bigors fol¬ 
lowed, and the aooonohenr curetted; this operatiem was 
twice repeated. Bemoval of the utoins was out of the 
question, ss a membranons inflammatioD extended from 
toe fnndns nteri to the vnlva. Seram therapy and 
saline injection were of no avail, and the patient died 
of pulmonary infarction fifty-one days after delivery 
and thirty one days after infection. The specimen 
showed general thrombosis of the right pampiniform 
plexus with an absoees around the ovarian vessels; the 
right ovary was normal, and there was no peritemitis. 
At the time of death the ntoms and vagina were clean 
and death was due to the lung condition. The organisms 
present were proved by cultures, guinea-pig inocolation 
and staining to he staphylococons pyogenes albna. 
In the second case the patient lived for ten days after 
delivery, which was normal and unaided; there was no 
involution of the uteras, the cavity of which was slough, 
ing from fondns to internal os. General peritonitis set 
in on the third day, and at the autopsy the entire peri¬ 
toneum was covered with pnralent flaky lymph. There 
was no infective thrombow of the uterine vessels. The 
longs were cedematous, but there were no infarcts. 
The nterine muscle showed the presence of groups of 
coed, some in zooglcea masses, others in the typical 
stimbylo arrangement. 

Obeervations were made on the specimen by Dr. 
Drummond Bobinson, Dr. Horrooks, and Dr. Bontb. 

A paper was read by Mr. B. Sandbbson, M.6., Oxon. 
(Brighton), on 

VAOINO-ABDOMINAL HT8TSBECTOUT 

in a case of pregnancy of four and a-half months, com¬ 
plicated by epithelioma of the cervix uteri. The 
author reported a case of epithelioma of the cervix 
in a uteras that was foor mid a-half months pregnant. 
Finding that the epithelioma was operable, be removed 
the nterns and the growth by a combined vaginal and 
abdominal operation, withont previous induction of 
labour. Tbe specimen and microscopic section of the 
growth were described and shoen. The ethics and the 
treatment Copied were disonssed under the following 
h€«de. (1) That where pregnancy and operable cancer 
of the cervix co-existed the life the mother alone 



Die. 11. 1901. 


TRANSACTIONS OF SOCIETIES. Ths >1bdical Pbesb. 627 


-was to be considered. (2) That anterior to the fourth 
month of pregnano 7 vaginal hysterectomy wm the 
orthodox t^tment. (3) That after this period the 
alternative methods were (a) induction of labour fob 
lowed by vaginal hysterectomy; and (b) hysterectomy, 
-without induction of labour, by a combined vaginal and 
abdominal operation. (4) Tbat the latter of these 
alternatirea, having rega^ to the improved statistics 
of abdominal hysterectomy, was in this case to be 
j)referred. 

The paper was discussed by Dr. Griffith, Dr. Tate, 
Dr. Bonth, Dr. Dauber, and Dr. Spencer. 


KOYAL ACADEMY OF MEDICINE IN IBELAND. 

SxCTlON OF PatHOLOOT. 

Mbktinq Hbld Fbidat, Nov. 29th, 1901. 

E. J. McWixnxt, M.D., President in tbe Chair. 

Db. Pabsons read notes on a caee of 

aASTRXCTASIS. 

The patient was admitted into the Boyal City of Dublin 
'Hospital complaining of a continuous severe burning 
pain in tbe stomach. He vomited frequently a dear, 
-watery fluid without trace of blood. The vomiting 
always ocenned after food. This condition had ex< 
isted for two months, during which time tbe Mtient 
became thinner and weaker. For the flrst two days in 
hospital the patient did not vomit, but he belched wind 
freely. On the third day he vomited three pints of a 
dear fluid; on the fifth day two pints. In three days 
he vcmited three pints and a-faalf of fluid, dnring these 
three days be had taken eigbte'^n pints of fluid, so it 
was concluded that some al^rption had taken place. 
Dnring tbe first week in hospital he gained seven pounds 
in weight, but the following week lost four pounds, 
showing a gain of three pourds in weight during his 
fourteen days in hospital. He looked phthisical, was 
much wasted, had a malar blush, and big ears, but on 
examination bis chest was found to be normal. On 
feeling tbe abdom* n sneenssion was easily obtained—in 
fact, actual splashing wm obtaiuable. If he turned on 
one side the side other than that be was on became 
resonant, l^ecase was diagnosed as gastreotasis and 
hour-glass constriction suspected. Vomiting freely on 
Sept. 6th. The first vomit measured five pints, and the 
se^nd vomit on that date measured seven Sept. 

'6th not so well. On the 7th he vomited eight pints. On 
the 8th he was in a state of profound collapse. He com> 
plained of pains in his arms and legs, he was cold and 
pulseless; gastric tetany. 

Mr. Johnson now performed a gastro-enterectomy at 
Baif past four o'clock in the evening, and tbe same 
night the patient died. There was no trace of any 
local or general peritonitis. The stomach, from tbe 
pylorus to the fundus along the great curvature, 
measured thirty-one inches, by the lesser curvature 
thirteen inches. No fluid could be forced from the 
stomach into tbe duodenum, and it was not until it 
contained six pints of fluid that any leakage took place ' 
from the surgical wound. A tight stricture of the 
pylorus was present. A few days before the patient’s 
death hydrochloric acid was found in the gastric juice, 
its presence may, however, have been due to the use of 
solution of 8try(^uia, which had been prescribed for 
him. 

Dr. Pabsons does not lock upon the absence of 
hydrochloric acid as pathognomonic of carcinoma of the 
stomach, though he thinks its presence negatives the 
presence of the disease. 

Dr. McWxenxt asked what was the exact condition 
of the pylorus, and what diagnostic value he attached 
to the presence of hydrochloric acid; in what class of 
cases was hydrochloric acid absent, and, lastly, was a 
test meal given ? In bis experience be never found 
hydrochloric acid wanting in normal digestion j and he 
would like to hear some views on the stiolc^ of hour* 
glass contraction. 

Dr. Tbavebs SuiTH remarked that it was unusual that 
such a tight pyloric stricture should occur in so short a 
time as two months in a malignant case, though not 
so much so in one of gastric ulcer. A reasonable 


tbeory for tbe causation of hour-glass constriction is 
contraction of tbe central fibres, which not unusually 
results from post-mortem handling of the viscus. 

Dr. Knott said that he found in medical literature 
reference to post-mortem hour-glass contraction, but 
was not conFcions of having met with such a condition. 

In reply. Dr. Pabsokb said be bad not given a test 
meal. Hydrochloiic acid was absent in acase of supra¬ 
renal capsular disease that came under his care. He 
bad no theory to explain the etiology of honr-glass con- 
tnsetion. 

Professor O’Sullivan, who mssde a section through the 
pyloric orifice of the specimen, demonstrated the presence 
of two gastric ulcers which bad penetrated to the peri- 
toneal coat. No carcinoma preeent. 

Dr. Pabsons also read notn of a case of 


ANXURTSlf OF TBS AOBTA. 

This patient came under notice in 1897. He com¬ 
plained of violent paroxysms of pain in tbe chest, which 
shot down the left arm: they were preceded in every 
instance by a severe fit of coughing. He complained of 
no difficulty in swallowing. There wm no history of 
syphilis, gonorrhcea, or rheumatic fever. His face was 
^e; there was carotid pulsation, well marked; capil¬ 
lary pulsation was present, and tbe radial poises were 
synoDTonons and regnlar; doable aortic murmur 
heard distinctly. After a time in hospital he 
matly improved, and left feeling able to resume 
his oconpatinn. On October 17th last be returned. 
His apex beat was found in the seventh inter¬ 
costal space; the left vocal cord was immobUe. 
He suffered from aphonia and dysph^a, and died of 
cedexna of tbe Inng, Aneurysm of tbe ascending and 
transverse portions of the arch of the aorta with hyper¬ 
trophy of the left ventricle was fonnd. Dr. Parsons 
coDsidors that the doable aortic murmur was due to the 
aortic dilatation prodneing a relative inoompetenoy, as 
the aortic valves were perfectly normal, and could not 
be looked on as producing it. The interest of the 
specimen consisted in the freedom from disease of the 
valves and the fact that tbe aortic walls were diseased 
from their origin. 

Professor O’Sullivan exhibited 


BLOOD FBOU A CABS OF TBOPICAL 
CBI8CSNT6.” 


UALABIA BHOWINQ 


The specimen was prepared by Professor Ewing, of 
the Cornell University, New York. 

Dr. McWxxnbt considered the specimen as the finest 
Bomanoffeky staining ever exhibited in the Ac^emy. 

Mr. Stobt exhibited sections (made by Dr. Earl) of a 

ZONULAB cataract, 

removed from the eye of a man, set. 40, the second eye 
being similarly affected. The sections showed tbe same 
appearances which have been described by Beselin, Law* 
foi^ and Schirmer in sneb lenses, viz., normal cortex, a 
nnoleuB stndded with vacuoles, and zone of densely 
pMked vaonoles forming the cataractoos area just ont- 
side tbe more sparsely vacuolated nuolens. Mr. Story 
touched upon the various theories which have been pro¬ 
posed by Arlt, Homer, Sohirmer, and Peters, to account 
for this form of oatar^, its connection with dental de¬ 
formities, and association with rickets, and while express¬ 
ing his adhesion to tbe more modem form of Homer's 
tbeory as advocated by Schirmer, remarked that there 
was a good deal still to acconnt for before t-hin theory 
oonld be unhesitatingly accepted. One point was that 
no zonular cataract had yet been described, which was 
as large as the normal lens ^according to Ihib) in the 
first year of life, so that they should be all formed in 
utero. If so, where did the connection with the perma¬ 
nent teeth come in ? Tbe milk teeth are not affected in 
these cases so far as he knew. Again, if the whole lens 
existing at the time is implicated in the lesion, how is 
it that no observer has seen a cataract at first affecting 
tbe whole lens, that is the opacity reaching to the sur¬ 
face, and then gradnaily taming into a typical zonular 
cataract by the deposition of fresh transparent fibres on 
its exterior. 

Dr. McWbbnbt was of opinion that this ease raised 
many debateable points on tbe epiblastic theory. 



628 Th* Mxdical Pbibs. TRANSACTIONS OF SOCIETIES. Drc. 11, 1001* 

Dr. Eabl drew attention to the fact that the eo-oalled I over the liver, which was fender and waa felt two inrhee 


deft waa not well marked in three races, and the 
vacnolee might be looked on as artificial. There ia a 
great difficnlty in making sections of a lens. Scbirmer 
thinks that glycerine gives the best resnlts. 

Dr. L. Stkis remarked that rickets are so common 
and zonnlar cataract so rare that they cannot be looked 
on as canee and effect; in nystagmus occurring dnring 
convulsions in childhood the oscillation is not sufficient 
to produce the effects credited to it, besides, nystagmus 
is often present without zonnlar cataract, and in many 
oases of convulsions the eyes are perfectly still. The 
sstiology of the disease is to be sought in general 
debility. Mr. Story looks on nutritiond defect as the 
source of the trouble. 

Ur. H. Gbat Cbolt brought forward a case of 

BABCOMA OP TBK KNIB, 

for which amputation of the hip* joint was performed. 
Patient, a woman, set. 48, who enjoyed good health 
until twelve months ego, when she received a kick from 
a cow. Soon after receiving this injury her knee be¬ 
came very painful and swollen, and ebe was nnable to 
put ber foot to tbe ground. She was almitted to the 
Boyal City of Dublin Hospital nnder Ur. Croly'e care, 
on October 28th laet. Her knee was funnd to be con¬ 
siderably swollen, measnring several ioches more in 
circumference than the otber knee, her temperature 
before operation ran up in the evenings to a little 
above 101'*. On Tuesday, the 19th inst, Ur. Croly am¬ 
putated through the hip-joint. Patient doing very 
well. Temperature normal, and no trace of suppuration 
in the wound. 

Dr. B. White's note on the pathology of the above 
case:—"The tumour assumed a pyriform appearance, 
was sitnated at tbe lower epiphysis of the femur, tbe 
base downward, the size approached that of a medium¬ 
sized melon, and gave the idea on palpation of an india- 
rubber ball well distended with fluid, the appearance of 
the skin was mottled from staining round the veins. On 
cutting open tbe structures the^e was disclosed a 
greenish-white tissue, rather firm and elastic, and dotted 
over with vascular points, and one or two blood cysts. 
A portion examined under the microscope showed it to 
oorrespond to tbe stmcture of sarcoma, consisting of 
cells chiefly spindle in shape. Scanty in the cellular 
substance, blood channels, or spaces formed by or 
between, the cells, there waa no appearance of bone 
structure; it may ^ classed, therefore, from its position 
and struotare, as a spindle-celled periosteal sarcoma.” 

Tbe Section then adjourned. 

LIVEEPOOL MEDICAL INSTITUnON. 

UxxTina BBLD Hov. 218 t, 1901. 

The President, Ur. Edoab A. Bbownb, in the Chair. 

Casks were shown in the Library :— 

Ist. Mr. C. G. Lex a patient showing a typical 
example of persistent hyaloid artery. 

2nd. Dr. Akdxsson, “MoUusonm Fibrosum.*' 

3rd. Dr. Hunt, ''Hysterical Aphonia with Inspira¬ 
tory Stridor.” 

BBROIMX BTDBOCHLOBATX. 

Dr. Macfib Cahpbxlx said he had been in tbe habit 
of using this drug frequently in doses of 1-6 gr , but 
recently had an alarming experience with a 1-12 gr. 
dose. Tbe patient, a lady, was given a dose (1-12 gr.) 
at 9 p.m , was very restless during the night, and bi^ a 
second dose at 7.30 s.m., soon after which he found her 
livid, breathing short, oppressed pulse, contracted 
pupils, with a sense of impending death. Strong 
coffee was administered, and she was all right at night. 

It is noticeable that in the new edition of Uaitindale 
the dose is grain 1-26—1-12, and caution in its use is 
necessary. It is most useful in laryngeal congh. 

Dr. A. C. Bxmdlx read notes of a case of 

KHPTKUA AND ASCITBS 

associated with cirrhosis of tbe liver. The patient, a 
man, set. 33, with a history of being a heavy drinker, 
was seen in January, 1900, complaining of acute pain 


below the ooetsl margin. There was janndice, and the 
mine waa loaded with lithates. Treated with salicylate 
of soda the symptoms subsided in a week. Six weeks 
later he had a second attack, and soon afterwards d^ 
veloped a lobar plenro-pneumonia, tbe temperatuxa 
reaciiing 106^, accompanied by active delirium and 
defervescence by lysis, temperature being normal on 
the twelfth day. Ten days later there was well marked 
right-sided empyema, tinted by resection of rib and 
evacuation of pus. Five days later fluid was collecting 
in the peritonenm, and subsequently tbe patient was 
tapped three times at intervals of one and two weeks, tbe 
amouot of fluid at each tapping being from two and a- 
balf to three gallons. Tbe nature of the obstruction in 
the liver waa probably two-fold, alcoholic and syphilitic. 
The recovery was uninterrupted after tbe last topping, 
and the patient has been at hia work for tbe last twelve 
months. 

Dr. W. Cabtxb bad seen a dozen cases of aecitee 
recover, and related the case of a lady who had been 
tapped regularly many times at intervals of three 
weeks; an attack of pleurisy led to the application of a 
10 c.o. preparation of oleate of mercury in oleic arid, 
which by mistake was applied all over tbe abdomen, 
resulting in an acute erythema, and prolonging the 
interval of topping to six weeks, after which tbe patient 
recovered and remains well now, four years later. If, 
after tapping, the urine increa^ in quantity, there 
was a better nro^osis ; if, on the other hand, the quan¬ 
tity of urine diminished, it waa quite oertsio there would 
be no improvement. 

SirWiLLiAH Banks showed a lad of siiteen who bad 
been accidentally shot with a pea rifle, which went off 
at a distance of two feet from the patient’s face, enter¬ 
ing the skull just at the root of tbe nose, slightly to 
the right of the middle line. loseneibili^ followed 
which lasted a week. On recovery there was oompleto 
paralysis of the left arm and leg and partial paralysis 
in the face. Six weeks later the face had recovered and 
power partially returned to the arm and leg. He could 
close the fingers with a good, strong grasp, but be could 
not open them again exoept with tbe help of the other 
hand. An X-ray photograph showed the bullet in the 
cerebrum about an inch and a half in front of the skull 
and about one inch to the right of the middle. Small 
black specks at the point of entrance of the bullet into 
tbe skull showed where fragments of lead had been 
knocked off its surface; it had thus traversed the 
whole of the cerebrum from front to back. 

VOHITIKO A OALL-STONB, 

Ur. S. Kxllxt Suith and Dr. Fbancib Bailxt re¬ 
ported a case in which a small gall-stone was vomited. 
The patient was an old lady, set 60, who had had 
three previous attacks of biliary colic—paroxysmal re¬ 
curring pain, extreme tenderness over tbe liver region, 
incessant vomiting, emototions, and hioooogh, and deep 
jaundice. At no time was tbe gall-bladder enlarged, 
and in none of the attacks was any gall-stone found in 
the feecee, nor was anything discovei^ at all suggestive 
of a membranous cholecystitis. In January, 1900, ^e 
had another attack of colic, and shortly after its onset 
vomited a small gall-stone. Tbe symptoms subsided 
almeet as suddenly as they had commenced, and the 
patient has been well ever since. The vomited stone 
is a email, light brown stone, regularly pyramidal in 
shape, aud weighs 5 grs. 

Dr. Bailxt corroborated Mr. Smith’s history of tbe 
case, and pointed out tbe rarity of the condition, and 
comparing it with the records of oases of passage of the 
stone per rectum and throngh an abdomin^ smus. 
Tbe stone probably passed vtd the duot into tbe duo¬ 
denum and thenoe by a retroperist^tic wave into the 
stomach. 

Dr. Cbookx also reported a case of vomited gall-stone; 
a woman, set, 40, had an attack of biliary oolio, and 
develop'd acute intestinal obstruction, probably in the 
duodemam. She vomited a small gall-stone weighing 
13 grs., and two days later tbe obstmotion gave way, 
and she afterwards passed a large gall-stone, weighii^ 
198 grs. Seven otber stones were subsequently passed. 


Dec. II. 1901. 


GENERAL MEDICAL COUNCIL. Thi Medical Pbesb, 629 


The gall-stone probably ulcerated from the gall bladder 
into the duodenum. There was never any jaundice. 

Mr. Paul aaid it was rare for gall-stones to be 
vomited. He bad met with cases in which gill-stones were 
discharged through an abscess opening on the surface, 
also where they had ulcerated into the duodenum, and 
in many cases be had found adhesions between the gall¬ 
bladder and the stomach, the duodenum and colon, fie 
agreed that in the present cases the stones passed into 
the stomach through the pylorus, and as regards the 
sive of the latter orifice measurements were not to be 
taken as having much bearing npon the point, in view 
of the fact that tooth-plates, large knives, &o., fre¬ 
quently passed the valve with apparent ease. 

Dr. K. J. M. Bucuakan read notes of two cases. (1) 
Primary hydatid cyst in the right long. The patient 
was an Australian, and had suffered from the condition 
a long time. The contents of the cyst were expectorated 
dnring paroxysms of conghing. Radiographs of the 
thorax taken by Dr. Holland showed the cyst in posi¬ 
tion, and it was easily recognised on examination with 
the fluorescent screen. (2) Pneumothorax occurring 
dnring muscular strain in a healthy male. The lesion 
was in the left lung. No effusion of serous fluid took 
place, and the condition gave rise to but slight inconveni¬ 
ence to the patient. Fixation of the chest with strap¬ 
ping, and absolute rest for three weeks, resulted in com¬ 
plete absorption of the air and expansion of the lung. 
Radiographs of the thorax taken by Dr. Holland were 
exhibited, and showed the developed lung well defined, 
and surrounded by a clear area. With the fluorescent 
screen the condition was eisily recognisable. 

Dr. Boovekib McDonald read a note on 

SDTDBB OF THE FBACTUREO PATELLA, 

with Special Reference to Early Movement of the Knee- 
joint. He referred to the numerous methods devised 
for the treatment of the transverse fracture of the 
patella. Good results undoubtedly followed the em¬ 
ployment of simple retentive apparatus in many cases; 
functional usefulness sutlicient for the well-to-do 
patient, and even bony nnioo was reported to hive 
taken place, but in a large proportion of casea the limb 
was permanently weakened, and cases were reported of 
gangrene resnlting from the bandaging and amputa¬ 
tion, and even death from the use of hooks and pins. 
He pointed out, as an important factor in the prevention 
of coaptation, ^e effusion of blood separating the frac¬ 
tured surfaces, coagulating and forming a solid bar to 
any apposition by ordinary mechanical means. With 
antiseptic and aseptic precautions we can now, with 
comparative safety, open the knee joint, remove 
blood-clot, and overcome muscular contraction by 
the wire suture, and thus obtain bony union, resulting 
in a strong and useful limb. Suitable cases only 
should be selected for operation, i.e., individnals not b^ 
yond the prime of life and of healthy physiqne. Reference 
was made to the length of time (thxw to four months) 
usually taken for the treatment of snch a fracture as 
against five weeks for the open method, and the more 
eertain result of bony union was more favourable to 
the worfciDg class, who cannot efford a long and tedi¬ 
ous confinement, and for whom it is important the 
limb shonld be strong and perfect. Great importance 
was attached to passive movement, which shoold begin 
at the end of the first week. A snocesffnl case was 
reported and radiograph shown. 

Mr. Rushtoh Pabkib, while allowing all that oonld 
be claimed in favour of primary wiring, especially in 
selected cases of persons following laborious or active 
employment, feared it was not widely known what 
escellent resnlts, with strong and freely movable knees, 
■could be obtained by putting up the limb rigidly 
straight from the first, and continuing the tr-atment 
for four or six months. The best apparatus is Thomas’s 
■calliper knee-splint, with which cases of fractured 
patella may be treat^ with confinement to bed for a 
few days, or even not at all. He believed the chief 
separator of the fragments to be flexion of the knee, 
and that therefore the most important item ia mechanical 
treatment was the prevention of a single flexion of the 
joint until the nnion was strong enoogb to bear the usual 
strain. Bony union, though rarely thus occurring, was 


net important nor essential in oases to which this 
method is applicable. 

Mr. P. T. Paul said that some yeus ago he sntnred, 
by Mr. Barker's or an allied methc^, all the cases under 
his Of re, and although there were no failures, the re¬ 
snlts were not snch as to warrant operative treatment. 
Hence be had returned to the use of Thomas' splint, and 
the method of fixing the fragments employ^ with it. 
This method was certainly long, but he was not aware 
of a single patient who had complained of the sabie- 
qnent condition of the limb. This point was explained 
by the fact that an allied injury—rupture of tbe liga- 
mentnm patellffi —if treated without sutnre, gave a most 
unfortunate resnlt which conld not pass without notioe. 
It was essential to snture the ligament when ruptured. 

Mr. Robebt Jones thought that wiring should be 
reserved for the exceptional case, and not be adopted 
as a routine. By efficient mechanical methods exceUent 
results could be obtained without any risk, and the 
patient allowed, after the first few days, liberty to walk 
about. He had met with many cases where trouble 
had been roused by wire, after active treatment bad 
been disoontioued. He had many patients with fibrous 
nnion doing hard work at the docks. 

Dr. R. J. M. Buchanan, Dr. W, B. Bell, and Messrs. 
Thelwall Thomas and George Hamilton disonssedthe 
case, and Dr. McDonald replied. 


THE GENERAL MEDICAL COUNCIL 

OF 

EDUCATION AND REGISTRATION. 


Sir William Turner, E.C.B., President, in the Chair. 


SIXTH DAY.—Mondat, Decembeb 2nd. 

A Tbianqulab Duel. 

Tbe question of privilege allnded to by the President 
at Saturday's meeting of tbe Council had reference to 
a letter embodying what purported to be a quotation 
from a speech by Mr. Victor Horsley to the effect that 
Mr. Brown had been “ sbonted down " by tbe Conncil 
and “ flouted '* by the President. 

The President, in accordance with precedent, called 
open Mr. Horsley for bis reply. 

Mr. Hobslst thongbt that the first step ought to 
have been to oornmnnioate to bim the contents of Mr. 
Brown’s letter, and to have asked whether the contents 
of Mr. McCook Weir’s letter was a correct statement, 
because the whole question was “ a squalid electioneer¬ 
ing device." Tbe letter in question, he observed, was 
“ a literary forgery." He explained that in the spee^ 
from which the expressions in question purported 
to have been culled, he was urging the election 
of general practitioners to the Council who should 
woi^ily represent practitioners—persons, in fact, who 
would not "excite derision and contempt on the part 
of members of the Council." In respect of the words 
attributed to him he referred to the reports of his speech 
as evidence that he did not employ them. Tbe letter 
wsf a falsification, not only of the words he used, bnt of 
tbe sense of his speech, and this was not tbe first time 
his words had been falsified by Mr. McCook Weir. In 
reply to tbe President, Mr. Hobslet repeated that he 
entirely disclaimed the words and expressions in qnestion. 

Mr. Brown explained that he had felt it incumbent 
npon bim to take cognisance of the matter, because the 
conduct of the President towards himself had been 
called in question. He admitted that be had taken no 
steps to ascertain for himself whether Mr. Horsley had 
or had not said anything of the kind; he had no time 
to read Mr. Horsley's speechee, bnt he had been thirty 
years before the profession, and he was quite content 
to leave bis professional and public character with the 
profesnonal gentlemeo, who conld judge for themselves. 

After some discussion on a point of order, the Presi¬ 
dent said that the matter would end with tbe appear¬ 
ance on the Minntes of Mr. Horsley’s reply. 

The Prevention of Personation. 

The Conncil in committee then resumed the considera¬ 
tion of the provisional regnlations and notices of motion 
approved by the Personation Committee. , 


630 Th* Mxdical Pbsss. GENERAL IdEDICAL COUNCIL. 


Dec. 11, AflOl. 


Dr. Eruck moved that the matter be referred back to 
the Committee, in order to obtain detailed comments 
from the Branch Bej^ietrare on these regulations as for« 
mnlated by the Committee. 

After Eome diEcnesion the motion was carried. 

Scale of Scheduled Poisons. 

Dr. MacAlutbb brought up the question of a notice 
to be issued by the Council defining the precise nature 
of the offence, and after some discussion on the word¬ 
ing it was agreed that the notice should be issued 
in the following form; — “ Whereas it has been 
made to appear to the Council that certain registered 
medical practitioners, wbo keep medical halls or open 
shops in which schednled poisons or preparations con¬ 
taining s< heduled poisons are sold to the public, have 
been accustomed to leave in charge of such halls or 
shops assistants wbo are not legally qualified to sell 
schednled poisons to the public, and that such practi¬ 
tioners have thereby, for their own profit and under 
cover of their medical qualifications, enabled such un¬ 
qualified assistants to sell scheduled poisons, and so to 
commit breaches of the law; and whereas, in the opinion 
of the Council, such practices on the part of a registered 
medical practitioner are professionally discreditable and 
fraught with danger to the public, the Council hereby 
gives notice that any registered medical practitioner 
who is proved to have so offended is liable to be judged 
guilty of infamous conduct in a professional respect, 
and to have hie name erased from the Medical Segiiier, 
under Section 29 of the Medical Act, ISoS." 

Education Committee’s Export. ! 

After a futile attempt to shelve the report for this 
session. Sir John Battt Tuke said the eu^^stions of 
Mr. Boll and Dr. Bmce had been carefully considered 
by the Committee, but they bad been unable to come to 
any agreement on the subject allowing of a proper 
report, so he merely placed before Council a statement 
of the general principles involved in those Bngge<)tioD8. 
His feelings did not allow of bis moving the first item 
himself, and he therefore passed it on to— 

Sir Christopher Nixon, wbo asked the Council to 
affirm the principle that it would be desirable to estab¬ 
lish a preliminary scientific examination, that it was 
desirable to postpone the registration of stndents until 
the preliminary scientific examinations had been passed, 
and that the period for the medical oarricnlum 
for the date of registration should be four years, 
devoted to strictly medical study. He proposed 
to discuss the points that he had mention^ in 
a pnrely academic form so as to elicit from the Conn- 
oil its opinion whether it would be desirable to make 
what seemed a very radical change in their system of 
education. He, therefore, moved the adoption of the 
first item in the statement which embodied these sug¬ 
gestions. He wished to distinguish between the condi¬ 
tions with regard to the preliminary snbjeots and the 
length of the medical onrrionlnm after registration from 
the question as to where the preliminary scientific snb- 
jeots shonld be studied. He pointed ont that the snb- 
jeots of the first year of medical edncation were not 
medical subjects at all, bnt were put down only to en¬ 
sure a certain amount of general culture on the part of 
students. There was greater reason to introdnce a pre¬ 
liminary scientific examination now that the ordinary 
course bad been prolonged to five years. The 
question as to what institutions ought to be re¬ 
cognised, be thought, concerned more the licens¬ 
ing corporations than the universities, and he 
did not see why these institutions should not be 
put on the same footing as the University of London, 
whi^ required no specific conree of hctares to be 
attended. With regard to the points in dispute between 
the Boyal Colleges and the Council, be thought the 
Colleges weie in the right, though he might not ap¬ 
prove of their method of dealing with the matter. Be 
inclined to the view that when the Council recognised 
certain scientific institntione, in which training in 
medical subjects might be given, it gave away the 
whole case. At the sugeeetion of the President the 
speaker modified his resolution to read as follows:— 

That the Council approves of the suggestion that the 


registration of medical students should be postponed 
until the student had passed (1) a recognised examina¬ 
tion in arts, and (2) a recognised examination conducted 
by the qnalifying bodies in preliminary and scientific 
snbjeots, on the iinderstsuding that the course of pro¬ 
fessional study shonld occupy at least four academic 
years.” 

The motion having been seconded by Dr. Bmce pro 
forma. Dr. Pettiobxw spoke against the motion, urging 
that it would introduce confusion. 

Dr. Bennett observed that the University of Dublin 
held itself free to vary the five years’ curriculum in sncb 
a way as mightbeconaideied best in the interests of ito 
stndents and of medical education. He was instrocted 
to state that the proposed changes were held to operate 
against medical edncation in Ireland, and that to sub¬ 
stitute examinations for systematic teaching would be 
a retrograde step. The registration of medical stodents 
was inoouiplete in view of the action of the Boyal Col¬ 
leges, and in view of that fact the University of Dnblin 
held itself free in regard to the question of registration, 
and he supposed that most of the other bodies wooldtake 
the same coarse. 

Dr. Bell thought the motion, if adopted, would have 
for effect to place scientific subjects in the same catoeory 
ns sabjects in general edncation, and would enable them 
. to come to an agreement as to the font years’ profes¬ 
sional study. I f any better way of arriving at this result 
could be suggested, it would have bis approval and 
support. 

Dr. P&TNE, in the course of his remarks, observed 
that if the Conncil were to adopt this resolution it 
should not approve of any particular method for the 
acquirement of scientific edncation, but shonld allow a 
certain amount of liberty to the student. 

Dr. WiNDLX said that be should vote against the 
resolution, which be believed would be directly contrary 
to what his university believed to be the best 
in the interest of med'cal edncation; consequently, if 
passed, the condition was not one which his university 
would observe. 

Dr. McVail was satisfied that none of the Scotch 
universities would fall in with this proposed system, the 
effect of which would be to wreck the whole educational 
machinery of the Conncil. The University of London 
did not insist upon any curriculum in the arts and 
science*, yet no man could pase their examination unless 
he had been tbrongh a thoroughly good course. The 
proposition was framed in order to save the position of 
the Boyal Colleges, bnt what, be asked, of the other 
nniversities and corporations? 

Mr. Horslxt said that this question, in one form or 
another, had been brought up at every meeting which 
he bad attended thronghout the country, and general 
practitioners were watching the matter very closely. 
The profession, so far sm he could make out, was of one 
min<^viz., that the anthority of the Conncil shonld be 
maintained, as against the Colleges. 

Dr. Touno said his nniversity was waiting to see 
what course the Council would take; in other words, 
they held themselves free to deal with the question of 
the medical curriculnm in the way they thought beet. 

Dr. Glover pointed out that there was no essential 
difference between the arrangement proposed and that 
in practice at the London University. If it was right 
for the University to have a scientific examination, it 
conld not be wrong for the Boyal Colleges to do the 
same. 

Mr. Tichbornx and Dr. Little spoke against the 
proposal, and Mr. G. Brown pointed ont that the mem¬ 
bers of the College of Snrgeons were by no means in 
sympathy with the representatives of the Colleges on 
the Council. Be thought that if the Council yielded on 
this point medical edncation wonld be materially 
lowered. 

Sir John Williams approved the crying on of 
scientific edncation in the schools, at which 8n(^ tM^- 
ing would receive a great stimulus by their recognition 
by the Council as places where these subjects could bo 
taught. 

I Dr. Bruce endorsed the last speaker s remarks, and 
hoped the motion wonld be passed. ^ , 

^oo^'le 

o 





GERMANY. 


r>%c. 11 , 1901 . 

The motion was ultimately negatired by 17 to 10 
ToteB, and the Coimcil adjonined. 

SEVENTH DAT— Tubsdat, Dxckmbbr 3rd, 1901. 

Wbxn the Uinntes came up for confirmation 
Mr. Hobblet challenged their accuracy in reepect 
of his explanaticn on the privilege question reported 
in yesterday’s discussions, and incidentally he pro* 
tested against questions of privil^e being raised on 
irresponsible repoits of members’ speeches. He re¬ 
peated that he thought the contents of Mr. Brown’s 
Utter ought to have been communicated to hicn. Mr. 
Horsley’s corrections were embodied in the Minutes 
and the matter ended. 

Kk-slkctiok op tbs Frbbidekt. 

The President, having formally retigned his office as 
from to-day, was unanimously re*elected amid cheers, 
and in acknowledging the honour done to him the Pre* 
sident assured the Council of his intention to do his 
duty to them and to the profession. 

Thk Qubstion op Mbdical Education. 

Dr. McVail moved that a committee be appointed to 
report on the differences that have arisen between the 
Council and the Koyal Colleges of London in legard to 
the courses and conditions of study, such repoit to be 
conridered at a special meeting, when the Council should 
decide whe^er any action ought to be taken under 
Section 20 of the Medical Act (1858). The motion was 
seconded by Mr. YouNO.who insisted on the importance 
of dealing with the matter witiiout de'ay. He hoped 
that at the same time cognisance would be ti^en of the 
differences that had arisen between the Council and 
other licensing bodies. 

Dr Glovxb failed to see any reason for voting such an 
important resolution, thus superseding the Education 
Committee, and he soggested that the matter should be 
postponed for at least six months. 

Dr. Atbill objected to the proposed committee, which 
would entail futile expenditure. 

Mr. Eobslxt supported the motion, and urged that 
they ought to go st^ght to the Privy Council with a 
statement of the facta of the case and ask for a decision 
aa to who was the supreme authority in medical educa¬ 
tion, a decision which he waa confident would be in 
favour of the Council. 

Sir William Thomson pointed out that the Council 
existed, presumably, for the purpose of controlling and 
directing medical ^ncation, and if the Council posseesed 
any authority it ought to be exercised. If on the other 
^nd they bad no such authority, they should cease 
^uing imtructions which were received by the licens¬ 
ing bodies with contempt. He announced bis intention 
of supporting any proposal to app'y to the Privy Council. 

Sir Cbbistophbb Nixon observed that they appeared 
to be as far from a settlement as ever, and he appre¬ 
hended a movement of disintegration. 

After some further discussion, including some remarks 
from Dr. MacAlistbb adverse to the proposal, the 
motion was carried by 16 against 10. The Committee 
was nominated accordingly, to meet in February next. 

Instruction in ANa;8THBTics. 

The Education Committee brought up a report in 
regard to a communication from the Society of Anset- 
thetists, urging the desirability of including in the 
curriculum of medical examinations the administration 
of ancestbetics. Ibe Committee, however, did not see 
their way to making instruction in the administration 
of anses^etios a compulsory subject. The report was 
adopted. 

Thx Governubnt of India Edition of tub 
Pbabmacofieia Addendum. 

On the reoommendalion of the Pharmacopoeia Com¬ 
mittee the issue of a " Government of India Edition” 
of the Addtndum to the Pharmacopoeia was authorised. 

Thb Multiplicity of Pbblihinaby Examinations. 

On the motion of Dr. Windlb it was agreed to for¬ 
ward the memorial from the committee of the Head¬ 
masters’ Conference, on the ^sadvantages arising from 


Thb Mbdi cal Pbbsb. 631 

the multiplicity of examinations qualifying for entrant 
to the various professions, to the Lord President of Me 
Privy Council with the suggestion that the question 
was one suitable for the consideration of the consulta¬ 
tive committee to the Board of Education. 


[from oub own coerbspondbnt.] 

Bekliv. Deo. 7th, 1901. 

At the Dermatological Society, Hr. Held showed two 
cases of 

Elephantiasis of the External Genitals 
after bilateral operation for bubo. The first case was 
combined with sypbUis. In the second case (nlcos 
molle) the course was very protracted after extirpation 
of the bubonic glands. Even whilst the patient was in 
hospital some swelling of the scrotum was observed. In 
the first case the swelling did not begin until two years 
after the operation. In both cases there was extensive 
enlargement of the eorotnm, and a partial elephantiasal 
enlargement of the penis that led to actual deformity 
and flexion of the organ. In the second case, erysipe- 
latoos feverish attacks had been freqnent, with a tem¬ 
perature up to 104° F. In one case the appearance of a 
lymphorrh(ca was remarkable, shown by the cropping np 
of small vesicles. These opened, either by themselves 
or by intent, gave vent to a continnoas stream of clear 
watery fluid. Surgical measures had so far afforded no 
assistance. 

Hr. Lassan pointed out the importance of the cases 
broutiht forward in regard to the question of radical 
operation for bubo. He himself had observed a similar 
case in a yonng woman. Saenger, of Leipsic, had ob¬ 
tained good results as regarded the lympborrbcea by 
cauterisation of the vesicles. 

Hr. Weohselmann drew attention to the cases of el&- 
pbantiasis of the leg that had followed extirpation of 
lymphatic glands. 

Hr. Held in r^ply, said that he had already applied 
caustics. Ihe patient complained of feeling very on- 
comfortable after the stoppage of the discharge. He 
would report further as to the later course of the cases. 

COCAINB IN OBffrXTBIC PbACTICX. 

Hr. Westphalen has a paper on this subject in the 
Chl.f. Oyn., 37/1901. He first made some experiments 
with it in various forms of lingering labour, applying it 
to the floor of the pelvis. He found that it did not pre¬ 
vent reflex abdominal pressure, but that on the contrary 
it increased it to an extraordinary extent. It was clear 
that by partial an BBsthetisation of the pelvic floor certain 
inhibitory reflexes were temporarily abolished, so that 
the “xpelling power of the abdominal mnsdee had free 
play. For the past two years he has been employing 
cocaine in this way in cases in which, with low-lying 
head, dilated or nearly dilated os, and ruptured mem¬ 
branes, abdominal pressare does not come on, or only 
imperfeovly; further also, in oases of spasmodic oon- 
traction of the nterua and in thoae cases where severe 
pain remains during the pause between the pains. The 
pains became regular in from five to ten minutes after 
the introdnotion of a oocaine suppository, and remained 
so. No ill effects have been observed. Larger doses 
than 0*08 gramme have never been ordered, but a second 
suppository has been given in an hour and a half if 
neoessary. It was never noticed that the pains became 
weaker, bat the abnormal pains were relieved. Q Q 



632 Taa Mxdioal 


AUSTRIA 


Dsc. II, 1901. 


PuBBPSBAL Eclampsia. 

The asme journal (No. 40) contains a paper dealing 
vitb certain points in puerperal eclamp8il^ by Dr. W. 
Herzfeld. He remarks that in eclampsia in tbe first 
stage of labour in primipars, pressure on the ureters is 
found very frequently, which in the absence of material 
kidney or liver changes must be looked upon as im¬ 
portant from an setiological point of view. In eighty- 
one autopsies hsemorrbagio hepatitis was found thirty* 
-two times; in four of these there was also compression 
of the ureters. In another twenty-eight cases there was 
parenchymatous degeneration of the liver and kidneys, 
also with four cases of compression of the ureters. In 
'twenty-one oases no symptoms referable to the liver were 
observed. In 32 3 percent, of the cases (eighteen times) 
there was bilateral compression of the ureters; in 46‘6 
per cent, (thirty eight cases) chronic Bright’s disease, with 
more or less grave changes in the heart, and in 81'! per 
cent, (twenty-five times) parenchymatous degeneration 
of the kidneys, acute nephritis, &o. From a considera¬ 
tion of these facta, and from the typical occurrence of 
compression of the ureter in primipars in whom 
eclampsia occurred, the writer draws the conclusion 
that in the majority of cases the disposition to the out¬ 
break is due to changes in the uropoietic tract. Further 
support to this view is given by tbe cases in which 
eclampsia occurs in the earlier stages of pregnancy. In 
these cases serious nephritic changes are always 
present, and often were so before the pregnancy began, 
a circumstance of great importance as regards pro¬ 
phylaxis. In spite of these views tire author does not 
epeak of a urfemic eclampsia, but believes that the 
eclampsia is an intoxication. If these views, on being 
tested, are found to be correct, early delivery will be 
indicated, and perhaps even Cesarean section, as being 
t^e quickest mode of effecting it without farther damage 
to the uriimry organs. 


JluBtria. 

(raOM OUB OWN oobbbspondsnt.] 

ViEHKA, Dec. 7th, 1901. 

Absenical Debmatitis. 

At the “ Cesellschaft der Aerzte ” Lang showed the 
photograph of a patient suffering from dermatitis with 
acute exudation induced by the use of arsenic. He 
showed the photograph with the object of confirming 
Neumann’s opinion, to which he referred at the meeting 
last month, when he showed a patient suffering from the 
same symptoms on the palms of the hands and soles of 
the feet, from which the dermis could be removed in 
layers. The other affections occurring on the same 
localities, such as lichen rubra and syphilis, are easily 
distinguished by their appearinoe and course, and 
although malignant carcinoma closely simulates the 
disease, it also is easily distinguished. 

Tbaumatic Cabdiac Htpketbopht. 

Benedikt showed a patient who had fallen from a 
scaffold nine months ago. After the accident he was well 
till about two months ago, when be was seized with ex¬ 
treme cyanosis and dyspncea. This patient was in 
perfect health before the accident, and even retained 
that appearance up to the beginning of October last, 
wben be became deeply cyanotic, with great dyspncea. 
On examining the heart, it was found to have the apex 


beat in tbe axillary line, while tbe second sortio sonnd 
and Bdntgen rays clearly demonstrated hypertrophy of 
tbe organ. Tbe diagnosis was further confirmed by a 
subsequent reduction of the cardiac area associated with 
arterio-sclerosis. This was described in the clinical 
notes as acute aortitis, with softening and curvature of 
the aorta and pulmonary arteries. 

Brann thought this was not a oise of simple h 3 rper- 
trophy, but one of dilatation, to which Benedikt replied 
that tbe nodular hardness of the cardiac muscle could be 
felt through tbe walls of the chest. Braun adhered to 
his diagnosis, and thought that from the cardiac im¬ 
pulse hypertrophy of tbe organ most be cautionsly 
accepted, pointing out that the nodular thickening 
might also be produced by a dilated auriclo or enlarged 
pulmonary valves. 

Lead and Tf nia. 

Panli showed a worm he had obtained from a patient 
under treatment by male fern. The special feature was 
the colour of tbe parasite, as the young proglottides 
were white, while tbe older members were of a dark 
gray colour. The boat was a painter and had repeatedly 
suffered from plumbism, for which be bad been suo- 
cessfully treated. At tbe time ne parted with the worm 
be was free from any symptoms of lead poisoning, which 
seemed to justify the presumption that the colour of 
tbe tffinia was due to the lead taken into tbe system, 
which was supposed to have been eliminated by the 
bowels where it would come in contact with sulphur 
evolved from decomposition in tbe bowel and sub¬ 
sequently become deposited in the parasite. Tbe older 
members being deeply coloured while the younger were 
free, supported tbe hypothesis. Another idea was that 
the sulphur of tbe proteids in the tsnia split up and 
took on tbe colours present that were transmitted to 
their descendants. The splitting up of albuminoid 
bodies in alkaline fluids favoured this opinion. 

To set these doubts at rest tbe worm was submitted 
to Prof. Manthner for chemical analysis for lead, but no 
trace of that metal could be found. 

This fact conveys a practical lesson, viz., that the 
discovery of a worm is not an assurance that the patient 
passed it. It is therefore necessary to note that these 
worms are not always white when dead. 

Is Fat Evolved fbom Albumen ? 

To determine the question under discussion by 
physiologists, Horbaoyeweki, of Prague, selected three 
young dogs for experiment. No. 1 was killed and the 
fat carefully separated and weighed. From this pro¬ 
portion of fat that of the other two dogs was calculated. 
No. 2 was fed on a purely albuminous diet, containing 
only a small quantity of fat uid milk sugar. No. 3 
was fed daily with 6 grammes of fat with the minimum 
amount of albumen. At tbe beginning of tbe experi¬ 
ment No. 2 weighed 1,430 gramme*, which corresponded 
to the standard given by No. 1 of 141 grammes of fat. 
After deducting for loss by tbe bowel the daily intake 
m’ght be shown thus:— 

Albumen, 49 094 grammes 

Fat, 0074 „ V =19611 caloricj. 

Sugar, 0 072 „ ) 

At the end of fifty days it weighed 1,380 grammes, or 
60 less than at first; the fat of the body was 38'48 
grammes, or 102 grammes less than it should be in tbe 
same proportion as No. 1. No. 3 had an original weight 
of 1,290 grammes, and a daily intake of . 

D:-"zecl:: '^OO^IC 


Dfc. 11. 1901. 


THB OPERATING THEATRES. Th* M*dical Peiss. 633 


Albameo, 34 4 grammes j 

Fat, 49'5 „ ( »189'7 calorioe. 

Sagar, OB „ > 

At the end of thirty days it weighed 1,440 grammes, 
or an increase of 160. From this be oonolndes that 
albnmen produces no fat in the animal economy, and 
therefore both albumen and fat most be prorided to 
support the organism. 

Jimaci) gcpartntfnt. 

THE IiABOEATOEY SCHEME FOE THE IEI8H 
ASYLUMS. 

The sympathetic allusion of the President of the 
Eoyal College of Physicians of Ireland, in his address 
at the Catholic Unirersity School of Medicine, Dublin, 
which was recently published in these pages (a) may 
recall to the minds of our readers an editorial (A), pub¬ 
lished earlier in the year. In this article we dwelt at 
some length on the unfortunate lack of facilities for tLe 
study of the pathology of inEanity which prerails in 
Ireland as compared with most other cirilised countries, 
and commended to our readers’ consideration the very 
feasible project which is at present on foot for the 
supply of this deficiency. We are glad to be able to state 
that some further steps in adranoe hare since been made 
towards the fulfilment of this scheme. At that time pro¬ 
gress was effectually barred by the legal inabilityof asylum 
committees to contribute from Eisylnm funds towards any 
such object. As Sir Christopher Nixon mentioned, this 
barrier has now been removed. By a special clause 
introduced into Lord Ashbourne’s recent Act (1 Edw. 
Vn., cb. 17, sec. 5) “the committees for any two or 
more district lunatic asylums” are empowered to com¬ 
bine for the establishment of such a laboratory as would 
be required, and to defray the expenses thereof from 
the asylum funds. This important step is certainly a 
matter for congratulation to all concerned, and it is en¬ 
couraging to note that its success was secured not alone 
by the sympathy of the Chief Secretary and the Lord 
Chancellor of Ireland, but by the co-operation of indi¬ 
vidual members on both sides of the Bouse. Indispen¬ 
sable, however, as this measure was, it is after edl only a 
preliminary, and the real battle has still to be fought out 
in the Asylum committee-rooms and the Coimty Council 
chambers. The campaign, indeed, has edready been 
opened by the Laboratory Committee of the Irish division 
of the Medico Psychological Association, whohave written 
to all the medical superintendents of asylnms inireland, 
inviting their co-operation, and urging them to u(e their 
influence to win over to the scheme their respective 
committees. To assist the superintendents in their efforts 
a circular has been drawn np for general distribution, 
explaining tbe need for, and the objects of, such a 
laboratory. We understand that a number of the 
superintendents hate not yet answered, bat many have 
expressed their approval and have placed the circulars 
in the bands of their committees. It is satisfactory to 
know one of the latter bodies has already given proof of 
the enlightened spirit which animates it by promising 
an annual contribution of no less than £60, a good 
example which, we trust, wiU be widely followed. It 
cannot be too strongly urged upon the superintendents 

(a) Tbe Medical Pbbbs and Cibculab, November X7th, 1901, 
p. 5e7. 

(/') The Medical Pbess and Cibcvlab, April 10th, 1901, p. 395. ' 


of Asylums that tbe success or failure of this promising 
scheme lies to a large extent in their bands. If the 
committees, as they ehonld, look to tbe medical officers 
for guidance in matters purely professional, they 
cannot be blamed if they refuse to entertain a pro¬ 
posal which the superintendents evidently regard with 
indifference. Such indifference would not only be pre¬ 
judicial to tbe best interests of tbe public at large, but 
would indirectly have a most injarions effect on the 
status of the sJienist. If alienists are to occupy that 
position in the ranks of the profession to which they 
are entitled, it can only bu by cultivating in their own 
depaitment that scientific spirit which is more and 
more leaveniug the profession at large. Only thus can 
they do their best for their patients, and only thus can 
they rise above that merely administrative view of their 
duties with which so many have in the past been 
satisfied. As a means to this end, as well as in the inte¬ 
rests of the prevention and cure of insanity, we earnestly 
recommend this scheme for their support, assured that 
whatever form it ultimately takes, whether that sug¬ 
gested by Sir CbrUtopher Nixon or some other, it cannot 
fEkil toexert afar reachiug beneficial influence both upon 
patients and physicians. 


(Dpcrating 

GUY'S HOSPITAL. 

Unusual Case of Appxndicitis.— Mr. Abbuthnot 
Lake operated on a woman, Est 30, who for many years 
had suffered from recurrent attacks of what appeared 
to be obstruction of tbe colon in tbe situation of the 
hepatic flexure. This was associated with a consider¬ 
able Eunount of disturbance of the pelvic oi^ans, and 
with some evidence of recurrent trouble of the appendix. 
The whole length of the ascending ooion was freely 
exposed, when the hepatic flexure was found to 
be tied down by abundant adhesions extend¬ 
ing inwards from tbe abdominal wall external 
to it—a condition to which Mr. Lane said he first 
called attention in a lecture on movable kidney, pub¬ 
lished in the Ciinical Journal of this year. These 
bands were freely divided, and the hepatic flexure was 
completely liberated from the position in which it had 
been retained by them. A similar plane of peritoneal 
adhesions was removed along the whole length of the 
ciccnm on its enter aspect. The appendix was 
then found to be fixed deeply in the true 
pelvis, its extremity being attached to the 
outer limit of tbe Fallopian tube whose orifice 
it had occluded, the tube being considerably 
distended, so as to form a hydro-salpinx. The dis¬ 
tended tnbe was removed from the ovary when the 
appendix was freed from its attachments and excised, 
the stump of the appendix being buried by a pucee- 
string suture. Mr. Lane pointed ont that the chief 
symptom from which the patient had suffered was 
not the primary tronble in the appendix, nor that 
set np in the Fallopian tube, but tbe obstmotion in 
tbe situation of the hepatic flexure produced in con¬ 
sequence of very extreme constipation lasting over 
a period of many years. This ooniition had been de¬ 
scribed, he said, in the lecture he had before referred 
to, and was one of very considerable importance 
because of its freq;uency. ^ Disappointment frequently 



634 Thi Midical Fbk88. LEADING ARTICLES. 


eosned, he remarked, when, after operatioos for the 
removal of the appendix, the patient continnee to com* 
plain of recurrent attacks of the pain and tenderness 
in the ccecal region produced by distension of this portion 
of the gut, which is consequent upon an obstruction of 
the hepatic flexure; thisobstinction is produced by the 
contraction of an acquired mesentery or a band of ad* 
hesions which may have resulted simply and wholly 
from chronic constipation, or as a part of a general 
tuberoulouB peritonitis, or of a peritonitis produced by 
inflammation in and about the appendix; therefore the 
Burgeon should explore this region thoroughly when 
there is any suspicion of interference «ith the lumen of 
the flexure and not rest satisfied with excising an ap¬ 
pendix, the inflamed condition of which may merely be 
produced by the constipation, which is the common 
factor in the development of both. 

The patient, ten days after operation, is in a very 
satisfactory condition. 

Excision of Past of ths Stohacu foe Cabcinoma.— 
The same surgeon operated on a man, set. 43, suffering 
from cancer of the pyloric end of the stomach, which 
extended along the lesser curvature, and along 
both surfaces of the waU of the viscus for a 
considerable distance. He bad previously per¬ 
formed a gastro-enterostomy upon the patient since 
the case first came under his observation, the condition 
of the patient being then such as to render any mote 
serious operation inadvisable. The growth was freely 
exposed and separated from the surrounding parts; it 
was then excised, the openings of the duodenum and 
stomach being closed. A quantity of gauze was left in, 
which it was intended to remove in part from day to 
day. Ur. Lane said that, as he was unable to find any 
secondary growth and but very slight glandular infec¬ 
tion, he hoped that be bad increased considerably the 
length of the patient’s life by the second operation. 

A fortnight after operation the patient was going on 
in a very satisfactory manner. 

Opxbation fob Phtsical Disability Bibultino 

FBOX THB UnSATISFACTOBT UnION OF TBK FbAOKKNTB 
OF A BaDIUS, which HAD BKXN BbOKXN AT THE JUNC¬ 
TION OF THB Upper and Middle Third. —The same 
surgeon operated on a boy, set. 16, whose radius had been 
fractnred tbiiteen weeks before, and who had been 
treated by a very skilful surgeon in the usual manner. 
When the splints were removed, however, he found 
that the forearm remained in a semi-prone positiom 
supination being impossible, while pronation iras 
exceedingly limited. It was clear that although bony 
union bad ensued the axes of the fragments no longer 
corresponded with one another. The arm was practi¬ 
cally of very little use to the patient. The seat of frac¬ 
ture was exposed by a long inciston, and the radius was 
divided in two oblique planes, by mesms of which the 
axes of the fragments were made to correspond accu¬ 
rately, and the bone restored to its normal form and 
functions. They were retained immovably in this posi¬ 
tion by means of silver wire. This condition of incorrect 
union of the radial fragments is, Mr. lisne said, in a 
more or less marked degree a comparatively common one, 
and has frequently called for operative interference, 
the results being uniformly satisfactory. The chief 
difficulty in operations of this class is to determine with 
accuracy the exact obliquity of the two planes in which 


Dec. 11, 1901. 

the bone has to be divided, and if the surgeon is suc¬ 
cessful in doing this, does not hesitate to make a long 
incision, and keeps his fingers out of the wound, he will 
find, Mr. lAne thinks, such operations most beneficiaL 
Three weeks after operation the range of pronation 
and supination was complete, and the functions of the 
arm were normal. 


Bcoistibed for rRASsmasios Abroad. 

^ebical aitb (Sircnlar. 

Pnblisbod Bvety WedsMdsr moraios, Price Sd. Pest free, 5)4. 

ADVBBTISBMSNTB. 

Poa Oss IvszBTiox s— Wbole Pase, £6 Oi. Od. HrU Psc** 
ICb. Od.; Quarter Page, £l Sa.; One-eiffbth, 18a. 6d. 

Poa A SiBika or iRaaBnoxsWhole Page, tbiiteen Inaertioas 
(weekly, fortnightly, or monthly), at dS Ida. Od.; twenty-eix 
inaertiona (weekly or fortnightly) at £S 3a. Od.; flfty-two 
inaertiona (weekly) at £3 each. Ball Page, thirteen inaertiona 
at 35a.: twenty-eix at 3£a.: flfty-two inaertiona at SOa. each: 
Quarter-page, thirteen inaertiona at 18 b. ; twentj-fiz inaertiona 
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Small announcementa of Practices, Aaautancies,Vacancies, Booka, 
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beyond. 


JElfbital prws anb Cirmlar. 

'‘SiLXJS POPDLI SCPREMA LEX.” 


WEDNESDAY, DECEMBER 11, 1901. 


THE GENERAL MEDICAL COUNCIL AND 
THE ROYAL COLLEGES. 

The protracted discussion which took place at 
the meeting of the General Medical Council last 
week on the proposed revision of the regulations for 
the registration of medical students has not given 
any appreciable result, except to show that the 
Council is profoundly divided on the subject. In 
truth the Council has probably acted wisely in 
abstaining from what would have amounted to a re- 
volntion in its scheme of medical education, especially 
as it was abundantly evident that the example of the 
Royal Colleges of London in setting the authority 
of tbs Council at defiance is likely to be followed by 
the other licensing bodies and universities as, and 
when, an occasion presents itself. The proposal 
before tbe Council was to defer the completion of 
student’s registration until he should have passed 
an examination in scientific subjects in addition to 
the eai'lier examination in subjects of general edu¬ 
cation. It was hoped thus to find a means of 
obviating the difficult situation created by the action 
of the Royal Colleges, but even the Education 
Committee was so hopelessly divided on the proposals 
laid before it that no formal report was found 
possible, and the Chairman of the Committee was 
fain to delegate to another member tbe task of 
moving tbe adoption of tbe proposal embodying this 
principle. It seems to be generally admitted that, 
technically, the Colleges were in their strict right 

in claiming to recognise the institutions at whicK 

Uiniii/ed b\ 


Dec. 11, 1901. 


LEADING ARTICLES. 


The Uedical Press. 635 


scientific instruction might he imparted, bat the 
moral effect of the bru’ai method in which they 
formulated their claim has proved most disastrous; 
indeed, the Council has lost in great measure 
the power which it had gradually assumed of 
controlling the education of medical students ab 
initio. That the exercise of this authority, hitherto 
tacitly conceded, has been all to the advantage of 
medical education, no one, we imagine, would con¬ 
test, but since that tacit understanding no longer 
holds good, and in view of the fact that most of the 
other licensing bodies and universities threaten to 
break loose, the Council may well consider whether 
the moment has not come to appeal to the Privy 
Council or to initiate legislation confernngthe neces¬ 
sary powers on the Council. We fail to see that 
there is any obvious advantage in including purely 
scientific subjects in the medical curriculum. The 
■University of London does not iusist upon 
any set course of lectures from candidates for 
its degrees in science, yet no one could pass 
their examinations unless he had been through a 
thorough course of training. Why, then, should it 
not be left to the various licensing bodies either to 
hold an examination of their own in these subjects, 
or to exact other evidence of adequate training 
and knowledge ? The curriculum, which need not 
exceed four years under such an arrangement, could 
then be exclusively devoted to strictly medical sub- 
jects. By rejecting the proposals brought before it 
tbe Council has left matters as they were, and the 
position is anything but edifying. Radical measures 
will have to be taken before tbe Council can hope to 
regain its former authority in medical education, 
and every delay further complicates the inherent 
difficqlty of tbe situation. 


PRACTICAL ASPECTS OF MEDICAL 
REFORM. 

It has been long admitted by the thinking classes 
of the community that the regulation of medical 
practitioner's is vital (o the well being of the State. 
That position has been formally recognised by the 
laws that have been placed upon tbe Statute book 
with regard to the course of preliminary and pro¬ 
fessional education and to tbe granting of qualifica¬ 
tions to practice. The safeguarding of legitimate 
medical work is of importance not less to the mem¬ 
bers of the medical profession than to tbe outside 
public in whose interests the profession have been 
brought into being. So far as the current of 
medical opinion can he gauged tbe attempts of 
the legislature have failed miserably in both 
directions. Qualified practitioners on tbe one 
band are robbed of legitimate practice, while 
on the other tbe public are the easy prey of a 
hostof quacks, charlatans, and, in not a few instances, 
of cruel and fraudulent swindlers of the Viavi and 
Mattel cancer cure and Harness electrical belt 
nature. It is nobody’s business to suppress these 
deadly parasitic foes to tbe welfare of society. The 
General Medical Council make no such attempt on 


behalf of the medical piofession, and tbe Legislature 
and Government are equally inert with regard to the 
general public. Tbe existing medical acts, imperfect 
though they be, are not administered with anything 
like tbe thoroughness that might be looked for from 
a governing council that regarded tbe protection of 
the interests of tbe profession as a sacred trust. 
Neither are those Acts brought into requisition by 
tbe police and the Public Prosecutor, as often might 
be done, in tbe case of many fraudulent and crimi¬ 
nal offences of a quasi-medical nature. What, then, 
is to be done in order to bring under control at any 
rate the more rampant and dangerous of the myriad 
forms of medical quackery that now flouiish at tbe 
expense of tbe community ? The immediate means 
will probably be found in a temperate and well- 
considered reform of tbe medical acts, a consumma¬ 
tion devoutly to be wished for by every member of 
the medical profession. Behind that reform, how¬ 
ever, lies the education of both the people and of 
tbe parliamentary representatives as to tbe desira¬ 
bility of protection against irregular medical practice. 
To tbe ordinary common sense mind it would stand 
to reason that if it be necessary to protect the public 
against tbe qualification of imperfectly educated 
medical practitioners, it would be a thousand times 
more imperative to guard the citizen against the 
wiles of the unqualified and untrained pretender. 
Tet while the legislature and tbe General Medical 
Council surround the path to qualification with 
conditions that are ever increasing in number 
and in stringency ; yet on tbe other hand they take 
no steps to check tbe flowing tide of charlatanism.. 
The situation from this point of view represents the- 
esseuce of topsy-turveydom, and would be highly 
humorous were it not that the official neglect in 
question entails a vast annual loss in life and in> 
damaged health. A reformed General Medical 
Council might do an immense service both by edn- 
catiug the public and by bringing pressure to bear 
upon the legislature. Under present conditions, how> 
ever, it seems hopeless to look for help from a body 
that is conservative to a degree, and is mainly 
representative of collegiate interests sundered by a 
wide gulf fiom those of the medical profession. An 
increase of Direct Representatives upon the Council 
could hardly fail to impress upon that body the 
importance of a wider interpretation of its duties- 
and responsibilities. Another way in which a great 
step towards the reform of tbe Council might bo 
effected, would be by the members of colleges and 
tbe graduates of universities insisting upon 
choosing their own representatives. As things 
stand the licensing bodies are governed by 
a small knot of irresponsible persons who 
choose one of their number to sit at the Council. 
In that way an overwhelming majority of the 
General Medical Council is formed of the represen¬ 
tatives of interests that are for the most part alien 
from the main mass of the profession. Here, then,, 
is a practical issue in which every medical prac¬ 
titioner, whatever his position, can join, namely^. 



Dec. 11. 1901. 


636 The Medical Pbess. KOTES ON CT7RBENT TOPICS. 


an agitation to give the memberB of everj qualifying 
body the right to choose their own Council repre¬ 
sentative. In this way it may be hoped to bring 
the General Hedical Council to recognise that one 
of their main functions is to indicate to the legis¬ 
lature the direction in which reforms should be 
instituted, not only as regards the medical pro- 
fessioD, but also the public, inasmuch as they hare 
been created to protect and further the interests of 
both those classes. 


A NEW GENERAL ANESTHETIC. 

THEBsare a number of minor operations in sur¬ 
gery that occupy from five to twenty minutes, a 
period of time too long for completion under the 
amesthesia of nitrous oxide gas. To meet this diffi¬ 
culty the admixture of oxygen and nitrous oxide has 
been tried, but the compound has not met with 
general favour, and its use has never been very 
general. Cocainisation of the cord in the hands of : 
some French surgeons has given good results, but in 
quite a number of cases the results have been disas¬ 
trous. Schleich’s infiltration method has gradually 
lost ground, if, indeed, it could ever be said to have 
been in favour in this country. For a time the 
freezing methods by evaporation of ether and chloride 
of ethyl were tried, but at best they were only suited 
for a very limited group of cases. It is, therefore, 
witii pleasure that we note the good results that 
are being obtained by the use of pure chloride 
of ethyl as a general ansestbetic. At the 
recent Congress of Surgery, M. Malherbe, who 
has been using the anEcsthetio since lh98, when 
he first used it in the clinic of Professor von Hacker, 
speaks highly of its properties as an ansstbetic and 
its comparative freedom from toxic or other un¬ 
desirable after effects. We concede that the chorus 
of praise which ushers in new remedies should be 
largely discounted without there are good grounds 
for anticipating that the drug will prove a satisfac¬ 
tory and safe general ansestbetic for minor operations 
generally. We will do no more than draw attention 
to the fact that it belongs to the ethyl group, and 
that its percentage of chlorine is small. All the 
volatile ethyl compounds have ansestbetic properties 
and, as a rule, are not lethal; indeed, the oxide of 
the radical principally produces its injurious effects 
by producing inflammation of one or more of 
the tissues than by direct action as an anses- 
thetic. One of the great troubles of the 
use of the oxide is its irritating suffocative effect on 
the respiratory mucous membrane which the antece¬ 
dent use of nitrous oxide or chloroform does not 
wholly overcome. The chloride of ethyl, if we are 
to judge from the clinical reports, has no irritant 
action on the respiratory tract, and it has the further 
advantage of acting very quickly, and is not followed 
by the headache, vomiting, bronchial irritation, and 
renal pains which so often follow etherisation. The 
patient quickly recovers from the ansestfaetic effects 
of the vapour, and the return to consciousness is 
complete. M. Malherbe (Xe Frogres Midical) em¬ 


ployed the anessthetic 170 times without one un¬ 
pleasant result, and in each case found the effects 
of the chemical were uniform. We cannot, how¬ 
ever, judge from the experience of one surgeon in so 
small a number of cases, but we think a good case is 
made out for its tentative use. 

jiotEB on €nrnnt ‘topics. 

Sanitary Measures in India. 

A Blue-book just issued coatains the report, 
prepared for presentation to Parliament, on sanitary 
measures in India during the year 1899-1900. In it 
are to he found chapters on the health of European 
and native troops, of prisoners in gaols, and of the 
general population. There are as well chapters on 
vaccination, on medical institutions, and on sanitary 
works. In appendices are abstracts of reports of 
the three principal sanitaiy commissioners in India, 
and memoranda by the Army Sanitary Commission 
in England reviewing the several sanitary reports for 
India. It is stated that the health of the European 
troops in India is much more satisfactory than it 
was in 1898-99. As usual, venereal diseases head 
the list of the causes of admissions to the 
hospitals and of the causes of invaliding. They 
were the cause of 27 per cent, of the total sickness 
during 1899, and of over 20 per cent, of the invalid¬ 
ing of the European army of India. In thb con¬ 
nection we are pleased, however, to find that the 
admission-rate from venereal diseases per 1,000 of 
strength was 313'4, or 49'5 per 1,000 below that of 
1898, and 208 per 1,000 less than the marimum rate 
(522'3) recorded in 1895. This the Army Sanitary 
Commission considers to be “ a practical proof of the 
success of the sanitaiy measures recently enforced 
with the object of preventing these diseases from 
spreading amongst our young soldiers in India.” 
1 bese figures are decidedly encouraging, but it is 
greatly to be hoped that they may yet he still more 
materially decreased in future years. All four com¬ 
mands shared in the decrease, but it was most 
marked in Bombay and Bengal. An increase is 
recorded in the number of persons successfully 
vaccinated. Between seven and eight millions of 
the population were protected against small-pox in 
the year 1899-1900. 

The Mortality among File-Makers. 

The ordinary observer would hardly suppose 
that file making is one of the most deadly trades 
in Great Britain, yet, if we are to believe the 

tatisiics of Dr. Bobertson, the Medical Officer 
of Health for Sheffield, it is so in reality. Ac¬ 
cording to his statement—and he has devoted 
for some years past an unusually extensive 
portion of his report to the subject—the file- 
cutters pay a fearful tribute of death and disease 
every year. Among lead-workers 211 persons die 
every year from plumbism, and the same cause claims 
seventy-five file-cutters and seventeen potters. From 
other diseases attributable to lead poisoning the num¬ 
bers per year are: file-cutters 1,514, potters 1,482, lead- 
D^' tized by 



Die. 11, 1901. 


NOTES ON CURRENT TOPICS. 


Thv Msdioal PaiM. 637 


workers 1,421. The extraordinary mortality among 
file-oatters from plnmbism and diseases derived 
therefrom is dne to the method in which they carry 
oat their trade. The file-maker does not use lead in 
the same way as either the lead-worker or the potter, 
bnt he places the fi'e npon a leaden pad while he 
strikes the teeth. The sharp, incisive blows which 
he makes must disintegrate this piece of lead in some 
measure, and produce a fine impalpable lead dust 
which permeates the atmosphere. The places in 
which this work is cairied out are nearly all old and 
out ot repair, many of them being ruinous and dirty. 
The cubic apace of air appoiiioned to each worker is 
totally inadequate, and the whole surroundings in 
which the trade is carried out are a crying disgrace 
to any country claiming to be civilised. How Ir ng will 
the legislature allow 1,000 cubic feet of air-space for 
the convicted criminal, and consider that 250 feet is 
ample for the artisan who works at filr-cutting P 
Space will not allow us to quote the evidence that is 
brought forward by Dr. Robertson as to over-crowd¬ 
ing in the file-workers’ shops, but it can only be 
described as appalling. The same must be said of 
the sanitary anangements of the shops, or, rather, 
the absence of such arrangements. The indictment 
brought against the Sheffield work shop system by 
the health official of that city is a very heavy one. 
One cannot but feel that it is in this system of 
workshops, in which no man or woman can work at 
any occupation and keep healthy, that the dangers 
of trades lie, and nothing short of a drastic legisla¬ 
tion will bring about any amelioration. 

The Reputed Deterioration of the Race. 

Cebtaik alarmists have drawn attention recently 
to the deterioration of the English race. It 
has been said that the war has shown, by the small 
percentage of men who are up to the required stan¬ 
dard for service, that Englishmen are degenerating 
from a physical point of view. It is, however, very 
questionable whether this be so. It must be remem¬ 
bered that war imposes a special strain for which 
civilians are usually not prepared by braining, and a 
physicalendnrancenotrequiredinordinarylife. There- 
fore, to assume upon such data that a race is de¬ 
teriorating is altogether erroneous and fallacious. 
It has been pioposed to measuie and weigh school 
children twice a year in order to find whether the 
suspicion of deterioration is justified, but we fail to 
see how far such a process would prove preventive. 
Whether these suspicions bo correct or no, the im¬ 
portance of prevention is paramount. More care 
most be taken in the education of our children, and 
their work must be better adapted to their relative 
capacities. That great and terrible curse of the 
country, the craving for stimulants induced by the 
arduous struggle for existence, must be met and 
overcome. The cure for deterioration of race lies in 
preventing excessive drinking, in stoppiug the over¬ 
taxing of the physical system, in remedying the 
transmission of an evil heredity in the perpetuation 
of the race, in securing the best possible kind of 
education for our children, and in arming them to 


secure the best possible future for themselves and 
their offspring. It occurs to us that one outcome of 
the war is certain; the experience which has been 
gained by our soldiers after their long and severe 
exertions will result in our possessing the finest 
modem army in the world. 

Sleep by Machinery. 

.AccoBDiNa to a colonial contemporary theie are 
several novel sleep-producing contrivances upon the 
market, nearly all of which are designed to concen¬ 
trate the user’s attention upon one set of sensory 
impressions, so inducing the advent of nature’s sweet 
restorer by a kind of self-hypnotieui. A complicated 
arrangement called an “ alouette ” is one of them 
It consists of a compact mahogany box, five inohee 
high, four wide, and three and a half deep, from the 
top of which projects a nickel pivot penetrating the 
centres cf two horizontal rectangular ebony panels^ 
eight inches high by one inch wide. Clockwork in 
the box causes a series of ebony panels to revolve, 
each of which is studded on both sides by a hori¬ 
zontal row of bright, circular mirrors, of small size. 
The velocity maintained is one revolution a minute. 
Sleep is procured by darkening the room, save for 
one bright pencil of light arranged to fall upon the 
mirrors so that it is reflected into the eyes. Con¬ 
centration upon the revolving panels of the gaze- 
practically hypnotises the user until sleep relieves 
bis fatigue. And her and similar arrangement 
is the “ lighthouse,” in which a small flash 
light revolves like that used to warn the 
watchful mariner who skirts our coast. But 
the most complicated of these contrivances is 
one known as the “ vibrating coronet,’’ the invention 
of a Paris physician. This consists of three bands 
of metal encircling the head; a branch strip extends 
to either eyelid, and, by means of a spring, gently 
vibrates against it. We should imagine that this 
machine would have an aggravating effect rather 
than a sleep-producing one, and that it would serve 
to further accentuate the famous line of Shakespeare- 
that ” uneasy lies the head that wears a crown.” 

A Remarkable Statement. 

One of the most extraordinary of the many in¬ 
accurate statements made by the lay press, especially 
when dealing with medical matters, appeared in the- 
Evening Newt for December 4th. In connection 
with the death of Sir William MacCormao, we are 
told that he is said to have paid £500 for the- 
skeleton of the Irish giant, O’Brieo, which now 
stands in the mnseum of the College of Surgeons! It 
is a matter of common knowledge that the skeleton 
was obtained by John Hunter in 1783, and £500 
was borrowed to bribe certain persons to obtain it. 
O’Brien, having a horror of being dissected, left 
strict orders that his body should be watched day and 
night until a lead coffin was made, in which it was to 
be enclosed and sunk at sea. His precautions were,, 
however, frustrated, and the body was obtained by 
Hunter. The Hunterian Museum was, in 1799, 
bought by the Goverument for £15,000, and formed 


638 Tbx Mxdical Pbbss. 


NOTES ON CURRENT TOPICS. 


the foundation of the museum of the Royal Collej^ 
of Surgeons. That Sir William MacCormac should 
be confounded with John Hunter, who lived a cen¬ 
tury beforehand, is certainly remarkable, even allow¬ 
ing a wide margin for journalists’ ignorance of 
medical history. 

Instruction in Anaesthetics. 

In view of the by no means insignificant mortality 
associated with the administration of ansesthetics in 
this country we must confess to a feeling of sur¬ 
prise that the Gleneral Medical Council has not seen 
its way to give effect to the memorial of the Society 
of Ansesthetiste urging that instruction in the 
administration of anssthetics should be made a 
compulsory subject of medical education. The 
curriculum, it is true, is well filled, and would with 
difficulty admit of additious to the schedule of 
requirements, bnt the administration of anssstbetics 
is a subject of such importance that the Education 
Committee might well have been expected to insist 
upon it, even if some minor branch of study had to 
be jettisoned to make room for it. It cannot be too 
widely known that the great majority of newly- 
qualified men get their first practical experience of 
the administration of aneesthetics when they start in 
practice. In large dtiee the services of a skilled anes¬ 
thetist are usually available, but this is not, and cannot 
be, the case in country practices where the practitioner, 
however inexperienced be may be, is fain to discharge 
the functions of the anesthetist from time to time. 
It is highly probable that a large proportion of 
'deaths under ancesthesia are due to lack of skill and 
experience on the part of the administrator, and the 
present unsatisfactory condition of things is likely 
to continue until students are systematically and 
compulsorily instructed in this important detail of 
everyday practice. 

The Cruelty of Foie Gras. 

TuE sentimentalists who devote so much energy 
towards the suppression of experimental scientific 
research conducted upon the lower animals will find 
an abundant harvest of absolute wanton cruelty on 
all hands if they care to look for it. How many anti- 
vivisectionists, we wonder, eat foie gras P Do they 
know that it is made from the diseased livers of geese 
which are deliberately brought to death’s door by 
treatment that is diabolically cruel P The imfor- 
tunate birds are cooped up indoors in boxes so 
arranged that the head alone can be moved. They 
are then crammed with a rich diet, which is 
forced down their gullet. Under these circum¬ 
stances the liver quickly becomes affected, and in 
about three months has attained an enormous size 
from fatty degeneration. The larger the liver the 
more successful the process. The most valuable 
livers are those of a green tint; that is to say, fatty 
livers impregnated with bile pigments. The centre 
of this trade is Strasbuig, which sends out an¬ 
nually about £150,000 worth of this delicacy. A 
recent petition to the civic authorities of London to 
exclude foie gras from the banquet recently given 


Dec. 11, 1901. 

to the Prince of Wales has excited the liveliest 
alarm among the merchants of Strasburg, inas¬ 
much as, after Paris, England is their next best 
customer. Three months of forced feeding is 
required to bring the unfortimate birds to the proper 
pitch of organic degeneration, so that their livers 
may tickle the palate of fat gourmands. Of a 
truth, any anti-vivisectionist who eats foie gras is 
committing an act of farcical incongruity. On the 
one hand he is eating a toothsome morsel procured 
by a course of prolonged torture practised upon a 
harmless domestic fowl, while on the other be is rail¬ 
ing at scientific men whose aim in experimentation 
is the highest conceivable—namely, the alleviation cff 
sufferiog among mankind. Meanwhile, Strasbni^ 
flourishes and science is tied hand and foot in the 
United Kingdom. 

Be-fiUection of Sir William Turner. 

It appears that we were under a misapprehension 
in regard to the pntport of Sir William Turner’s 
announcement in his Inaugural Address that he was 
about to tender his resignation. He has apparently 
no desire to be relieved of the burden of the presi¬ 
dency, as is evidenced by his acquiescence in his 
re-election, which was unanimously carried amidst 
applause. It must be a source of satisfaction to 
most members of the General Medical Council that 
the services of so experienced a President are to be 
retained for a further period of five years, and we 
congratulate the Council on their choice. 

ORildren and the New Beer Begulations. 

In a few weeks’ time the new Act, known as the 
Intoxicating Liquors (Sale to Children) Act, will 
come into operation. Neither of Mr. Balfour's 
Governments have done much to the furtherance of 
temperance legislation. At the same time, it was 
hoped bythe friends of the movement that the small 
measure above-mentioned would remove one of the 
standing abuses of the publican’s trade. From all 
we cw" gather, however, that desirable consummation 
is still afar off. It appears that the Act has been so 
loosely drawn that it will be the easiest thing in the 
world for the drink vendor to go on supplying chil¬ 
dren with any amount of liquor. The whole 
scheme of evasion has been planned out and 
has become public property, as set forth in 
notices and handbills distributed to the publicans. The 
Act makes it illegal to sell intoxicants to any child 
under fourteen, except in “corked and sealed" 
vessels. Parents are informed that they may send 
bottles or jars, which will be corked and se^ed by 
the publican. The “sealing” can be technically 
carried out in the twinkling of an eyelid by merely 
affixing a gummed label. It has been stated that 
many publicans intended providing special vessels 
fhai. may be bought, borrowed, or hired by customers. 
No quantity less tiian a “ reputed ” pint can be sold 
to a child, and the publicans will doubtless hasten 
to establish the capacity of that measure. Almost 
the only practical outcome of the new Act will be to 
prevent children drinking out of the can on their 
Di-' zed b- lOO^ C 



Dec. 11, 1801. 


NOTES ON CUBRENT TOPICS. 


The Medical Pbbss- 389 


'waj home. It eeems absurd that Parliament cannot 
provide experts who can draft business-like and 
workable measures. 

Antiseptic Doormats. 

Of all the crazes that the inventoi's' brain has 
launched on the stream of time few can compare in 
grotesqueness with the antiseptic doormat. Latter- 
day science has shown that the reign of bacteria is 
well-nigh universal. Practically the only places 
devoid of these tiny organisms are high mountains, 
frozen climes, and mid'Ocean. As everyone knows, 
many of the necessai'y processes of nature, aa decay 
and fermentation, are carried on by the ageocy of 
bacteria. On the other hand, many maladies that 
attack mankind are cansed by the invasion of 
microbes. In towns the dust is specificaUy contami¬ 
nated by a vast amount of organic material, of which 
a good deal is doubtless brought into bouses by 
the boots of inmates and visitors. To render those 
boots aseptic would require a prolonged exposure to 
hot air, and would certainly be beyond the powers of 
any doormat. Besides, even supposing the doormat 
to act as an efficient safeguard in preventing the 
entrance of boot-home bacteria of evil nature, there 
is still the unceasing invasion of the house by air¬ 
borne microbes. From whatever standpoint the 
matter is viewed it is impossible to avoid the conclu¬ 
sion that the inventor of the “antiseptic doormat” 
is a crank whose misplaced ingenuity were worthy of 
a better cause. At the same time any adequate pro- 
Tision of doormats and scrapers is essential to every 
sanitaiy house. The systematic cleansing of the 
doormat is a point that does not always command 
the attention it deserves, even in otherwise well- 
regulated households. 

The Health of Aberystwyri^h. 

Fo£ some time past there have been rumours as 
to the unsatisfactory state of Aberystwyth from a 
health point of view. At a recent Council meeting 
one of the members, Mr. C. M. Williams, stated 
generally that the townsfolk had every reason to be 
pleased with the existing state of affairs. That 
statement has been vigorously attacked by a corre¬ 
spondent of the Cambrian N'ews, who says there have 
been eight deaths from diphtheria during the past 
twelve months or so. Enteric fever has also existed in 
various parts of the town, and one of the largest 
ladies' schools is closed on account of an outbreak 
of scarlet fever. A communication of this kind is 
of vital consequence to the welfare of a health 
lesort, and demands a full and impartial official 
reply. It is no use trusting to general and possibly 
ex parte statements by Councillors. What is wanted 
is a public declaration of what infectious disease has 
existed in Aberystwyth during the past few years; 
what provision is made for dealing with the same; 
and whether the record compares favourably or 
otherwise with other watering-places in North Wales. 
It is only by vigorous and candid measures that the 
confidence of visitors will be retained in that most 
beautiful and pleasant health resort The policy of 


many of the seaside towns of the United Kingdom in 
seeking to hide their sanitary defects is simply 
suicidal, as sooner or later the truth is certain to leak 
out. 

Insanity in the Country. 

A COUNTRY clei^man has recently called attention 
to the serious question of insanity in country 
parishes, which appears to be on the increase. That 
mental diseases aie on the increase is proved by 
statistics, but that some country parishes are per¬ 
fect hotbeds for its propagation is quite possible. 
In the past the rural population have been stay-at- 
homes, and the long-continued inter-marriages have 
caused a lamentable decline in intellect. The clergy¬ 
man referred to has been for five years in charge of 
a parish containing under 300 inhabitants, and 
during that time one in every eight that have been 
buried have been insane. At the present time two 
are in the asylum and two in the workhouse as 
imbeciles. In the parish itself there are four of 
weak intellect, but harmless. Among the school- 
children there are some half-dozen with intellects 
much below par, and whose ability to earn u living 
is doubtful. This percentage of mental deficiency 
in one small parish of 300 is undoubtedly high, and 
points to the grave want of new blood in our rural 
population. At the rate of progression, or, rather, of 
retrogression, in the parish referred to there should 
be hardly a sane inhabitant in a few more genera¬ 
tions. It is by no means uncommon to find, in 
small countiy parishes, some four or five families 
making up at least half the population, and every¬ 
body related to everybody else. It is a matter which 
calls for serious attention, or soon our rural peoples 
will have decayed intellectually beyond remedy. 

Friendly Microbes. 

A GOOD deal is being done to popularise that por¬ 
tion of science which has to do with the health of 
the community, and lectures given with this purpose 
are distinctly laudable. Such lectures should be 
simple in their language, and with a slight inclina¬ 
tion towards the humorous. This was the method 
chosen by Professor Bottomley in a discourse 
recently delivered by him at Nottingham on the 
subject of “ Microbes, Friendly and Otherwise.” He 
described the different kinds of bacteria as like bil¬ 
liard balls, pencils, and corkscrews, and pointed out 
the different methods of their culture, taking the 
mould found on jams as a familiar instance. Many 
microbes serve a useful purpose and only a few are 
dangerous. People scarcely realise how much we owe 
to the services of the former bodies in the way they 
complete the cycle of life by separating the oiganic 
tissues and preparing the way for life again, 
To them we owe the flavour of our butter, 
our cheeses, the aroma of tobacco, and many 
other of the luxuries of daily life. It is, how¬ 
ever, the ways of the bacteria of diseaee with which the 
laity should be acquainted, and with the methods by 
which they can bent be met and vanquished. In this 
regard it is less with antitoxins and similar subjects 
D!’- ‘ 7ecl t- 



640 Thb Medicai Pbbss. 


NOTES ON CURRENT TOPICS. 


DSC. 11. 1901. 


that their teachers should deal, hut it should be 
pointed out that darkness and want of ventilation 
mean dirt, disease, wretchedness, and death, whilst 
light and air spell health, cleanliness, truth, and 
righteousness. 

Cures for Baldness. 

Of so-called remedies for baldness there is no end. 
manj of them harmless and ineffectual, but some 
are injurious. The public appear to have an idea 
that there is only one cause for baldness, and fly to 
the hairdresser or quack who advertises in society 
papers, instead of to an experienced dermatologist. 
The barber recommends his special lotion, which is 
always infallible, although he himself may be bald, 
and the customer is satisfied, that is to say, until 
sufficient time has elapsed to prove its futility. The 
most remarkable theory of baldness, strangelyenough, 
is put forward by an American physician. Uis idea is 
that air contains organic matter which, if retained in 
the lungs and absorbed damages the growth of the 
hair. To this organic matter he gives the name 
“trichotoxicon.” He claims to have made experi¬ 
ments with this on animals which demonstrate ita 
toxicity. He explains the more frequent occurrence 
of baldness in men as compared with women by the 
fact that men, being chiefly abdominal breathers, do 
not empty the apical air cells. Women, whose 
respiration is chiefly costal, are said to develop little 

trichotoxicon,” and hence have luxuriant hair. 
Consumptive persons, in whose consolidated air cells 
the air cannot stagnate, are also said to be very free 
from baldness. That a member of the medica^ 
profession should bring forward such an idea 
is remarkable, if indeed he be a medical man. 
The various causes of baldness are now well known, 
and apart from ringworm and alopecia areata, com¬ 
prise seborrhcea capitis, acute specific fevers, syphilis, 
heredity and senility. To class all these causes 
together is not only unscientific but absurd. We 
cannot congratulate our American friend on his 
** discovery.” 

The Lay Frees and Cancer Cures. 

OuB daily papers have, apparently, not yet ex¬ 
hausted the subject of cancer cures. The latest 
” information ” comes from the New York correspon¬ 
dent of a well-known morning paper, who tells us 
that a certain specialist in cancerous diseases, whose 
name we do not wish to mention, succeeded in curing 
a severe case of cancer by the Bontgen rays. We are 
also informed that the surgeon in question has 
'‘written sn epoch-making chapter in medical his¬ 
tory.” It is really time that writers in the lay 
Press should either take some trouble to look 
up the subject they are writing about, or else 
refer to a medical man qualified to advise them on 
the subject in question. It is well known that the 
BOntgen rays have been used both for rodent ulcer 
and epithelioma for several years. Professors Finsen 
and TJnna have repeatedly tried it, often with suc¬ 
cess, and they have been followed by many others. 


so that our New York friend is by no means the first 
to make the “ epoch-making chapter.” Again, the 
csise is described in the daily paper as a cancer which 
spread over the face, eatiug away the lower lip and 
chin. The disease was of eight years duration, and 
the patient thirty-five years of age. Might it not 
have been rodent ulcer or lupus P The duration of 
the disease is more in favour of either of these than 
of true carcinoma. The patient’s age, however, is 
against rodent ulcer. The publicarion of such cases 
from second hand information, supplied by persons 
ignorant of the subject, is neither to the interest of 
the profession or the public. 

Uselees Exhibitions. 

Thebe has recently been an exhibition in 
London which can serve no useful purpose 
except to make money for the person who 
runs it. The public, however, is always drawn 
by fasting men and the like, and it is unlikely that 
the public taste will change for many years to come. 
The exhibition to which we allude is that of a South 
American, 34 years old, who, wrapped up in some 400 
yardsof flannel cut intostrips, was placed in a “cystal 
um” or stoutly-made triangular glass case. This 
um was sealed up so as to be watertight and lowered 
into a metal tank filled with water. In this situation 
the man remained, without food or water, for a week. 
Incandescent lights were kept burning in the urn so 
as to illuminate the man and the whole tank, so that 
the curious gaze of sensation-mongers could be grati¬ 
fied. Air was conveyed into the um and kept in motion 
by meum of a tube and electric fan. Yisitors who 
wished to do so, could talk with the man during his 
voluntary incarceration. The individual who 
chooses this curious and somewhat uncomfortable 
method of gaining a livelihood claims that by 
“ throwing himself into a cataleptic trance for the 
first twenty-four hours and by auto-suggestion that 
food and drink are wholly unnecessary and unknown, 
he can live under water the allotted time without 
nourishment of any kind.’* He is stated to have per¬ 
formed his feat in the chief cities of Europe 
and America. We have never been able to 
see what good can accrue from these absurd 
exhibitions of so-called endurance. They do but 
pander to the morbid appetite for sensation which 
afliicts a very large section of the population, an 
appetite which is shown in many ways and is 
apparently universal among all peoples. 

The Sale of Poisons hy Pharmaceutically 
Unqualified Assistants. 

The Council is about to issue a notice, the terms 
whereof have been approved, calling the attention of 
registered practitioners who keep medical balls or 
open surgeries to the fact that for them to cover the 
sale of scheduled poisons by assistants not qualified 
under the Pharmacy Act to dispense the same, will 
' expose them to be judged guilty of infamous 
I conduct in a professional respect. Public and 
professional opinion -will endorse the attitude O' 


Dic'lized by Google 



DfC. 11. 1901. 


NOTKR ON CtTBBENT TOPICS. th» Pmnw. 641 


tte Counca in decUring Bach conduct to be 
profeseionaily reprebensible, and no agitation 
wiU avail to modify>ithat attitude. It remain 
to be Been whether it will pay to keep open BorgerieB 
with aswBtante duly qualified to deal with poiBons or 
whether the difficulty will be got over by refuaing 
to Bell Bcheduled poisonB. The latter course would 
be a permanent Bource of dauger to the medical pr^ 
prietor because any misconduct on the part of hiu 
unqualified assistant in regard to the sale at 
scheduled poisons would expose him to a summons 
to appear before the Council. 

The New “Journal of Obstetrics and 
(Jynseoolc^.’* 

Wb understand that everything has now been 
settled with regard to the publication of the new 
journal, the first number of which will be issued 
early in January. No modem journal connected 
with medicine has ever been launched under more 
influential auspices, whilst the editorial and publish* 
ing departments are in capable hands. The leading 
idea is that the new journal shall be thoroughly re¬ 
presentative of all that is best in the domain of 
obstetrics and gynmoology, in its widest sense, of 
Great Britain and her Empire beyond the seas. For 
a full list of those connected with the venture we 
would refer our readers to the announcement in our 
advertisement columns; they will there find every 
chief city of Great Britmn editoriaUy represented, 
whilst India, Canada, Australia, New Zealand, &o., 
send names which are favourably known in this con¬ 
nection. 


Northumberland. He was 98 years of and he 
practised in Eirkby Stephen. He took his degree in 
1828, and continued in practice until a few years 
ago. Three brothers, also doctors by profession, 
attained the ages of 94, 93, and 80 respectively. 

Goveenoes of the National Hospital for the 
Paralysed and Epileptic, Queen Square, are re¬ 
quested to take note of the fact that an important 
meeting is fixed for to-morrow (Thursday), when the 
problem of carrying out the recommendations of the 
Committee of Enquiry will come up for discussion. 
So far, of course, noising has been done to carry 
these recommendations into effect, and it is extremely 
important that every governor who can possibly 
attend should do so, otherwise the reformation of 
existing abuses may suffer. 

PERSONAL. 

Db. Waltxe Esssx Wtntxb has been elected physi¬ 
cian to the Middlesex HoepitsL 

Sib Thohas Bablow, F.B.C.F.. has been ^ecbed a 
member of tiie Royal lostitution. 

H,R,H. THK Pbincx of Wales has been installed as 
President of the foundation of St. Bartholomew’s 
Hospital, 

Db. Qbobos K. Qivxh, medical officer for Gortin, 
County Tyrone, has been appointed a magistrate for 
the County Tyrone. 

Db. Robbbt Thobhtom Miadows, the Mayor of 
Saltash, has been sworn in as a Justice of the Peace for 
the oountv of ComwalL 


The Ooooentration Oamp Mortality. 

It is interesting, in view of the vigour of French 
criticism anent the regrettable mortality among the 
Boer children in the concentration camps, to note 
that official statistics show the mortality among in¬ 
fants put out to nurse—and these constitute a very 
large proportion of infants bom—in Paris, £a Ville 
Lumiire, is 80 per cent. I This is in spite of com- 
plicated regulations, of ample facilities for first-class 
medical care, and the existence of numerous societies 
for the promotion of the welfare of infante and for 
preventing tiie depopulation of Prance! Compared 
with this the mortality among the children in the 
camps is almost a negligible quantity. “Oh wad 
some power the ^tie gie us! “ 

Small-pox in London. 

Thbee hfta been a s'eady increase in the number 
of admissions of cases of small-pox during the past 
week, the number actually under treatment being, on 
Monday night, 499. 

Thb death is announced, by telegram, of Surgeon- 
General Robert Harvey, O.B., D.S.O., D.rector- 
General of the Indian Medical Service, shortly after 
his return to India. 

De. Johk Waeeen Edobe, who is believed to 
have been the oldest member of the medical profes¬ 
sion in England, has just died at Monkseaton, 


Mb. Thomas Bbyant, F.R.C.S., will open the new 
out-patient department of the Bolingbroke Hospital to¬ 
day (Wednesday) at 8 p.m. 

Db. J. E. O’Coknob has been appointed Medical 
Officer of Health for the combined districts of Lriceator- 
shire, Rutland, and Warwick. 

Suboson-Gskbbal W. Tatlob, C.B., who has been 
appointed to the post of Director-Oeneral of the Army 
Medical Service, has just returned to England. 

Db. Stbnson Hookbb, of Bastiugs, has been presented 
with sundry articles of plate, subscribed for by friends 
and patients, on his leaving to take np his residence in 
London. 

Dr. PuBDiB, Professor of Chemistry in tiie Uni¬ 
versity of St. Andrews, has offered to place at the dis¬ 
posal of that body a sum of ^£6,000 for the purpoee of 
building and famishing a smidl ohemioal research 
laboratory. 

Althouoh the result of the election of a direct re¬ 
presentative for Scotland to the General Medical Council 
has not yet been officially anuounoed, we ventnre to 
congratulate Dr Bruce, the sitting member, on his re- 
election by a considerable majority over his two com¬ 
petitors. 

Fbofbssob Edoab Cbookshahk has resigned the 
active duties of the Chair of Comparative Pathology 

D'^-.'edb-, OOg C 



642 Thu Ubdioal Pbb88. 


SPECIAL ARTICLE. 


Die. 11. 1901 


and Bactdriolo{fy at King's College, a post which he 
haa occupied for upwards of fifteen years. In reoogni> 
tion of his serrioes as fonnder and lecturer in this depart* 
ment he has been made Emeritns Professor. 

Pbofbssob G. D. Litkiko, of Cambridge University, 
was presented with a testimonial last week in reoogni- 
tiM of his long and valnable serricee to chemical 
science. The testimonial took the form of a snbemip* 
tion portrait of himself, which is to be hnng in the hall 
of St. John's, and a bronse bnst, which will grace the 
obemioal laboratory. 

Da J. J. Hopkins, Castlebar, has been presented with 
a beautifally illnminated address and valuable teeti- 
monial by a deputation from Leenane, where he had 
been medical officer for eight years prior to his present 
appointment in bis native town of Castlebar. The pre¬ 
sentation consisted of a valuable horse and trap and 
pneumatic tyres, massire lamps, and brass-mounted 
harness, as well as some valnable personal gifts, snob as 
a large American roll-top desk, Ac. 

THE PKINCB OF WALES'S HOUSEHOLD. 

H.B.H. THB Pbimcb or Walks has been pleased to 
make tiie following medical appointments to ois Boyal 
Highness’s Household: — 

fiiynoians in Ordinary.—Sir William H. Brosulben^ 
Bart., E.C.V.O., H.D., Sir James Beid. Bart, G.C.V.O.. 
K.C.B., M.D., and Sir Francis H. Laking, E.C. V.O., M.D. 

Surgeons in Ordinary.—Sir Frederick '^ves, E.C.V.O., 
C.B., F.B.C.8., and Herbert W. AUingham, Esq., 
F.E.C.8. 

Honorary Physicians.—BobertW.Bnmet, Esq., M.D., 
and Samuel J. Gee, Esq., M.D. 

Surgeon Apothecary to his Soyal Highness’s Hons^ 
hold m Ordinary.—Sir Francis H. L&ing, K.C.T.O., 
M.D. 

Snigeon Apotheoa^ to his Boyal Highness the Prince 
of Wales and to the Honsehold at Sandringham.—Alan 
B. Vanby, Esq., M.V.O., M.D. Chemist ana Dmggist.— 
Ur. Peter Wyatt Squire. 

§t0tlattb. 


Edinbusoh Sick Childbbn’s Hospital. 

Althoi^h the present hospital bnildings have been in 
existence only a few years the original out-patient ^ 
partment is proving quite inadequate to the work carried 
on, and the directors uve accordingly sanctioned plans 
for a new one, which will cost some ^£20,000. The groud 
fioor will contain a large hall for medi<^ cases, dressing 
room, consulting room, dispensary, and store, while the 
first storey is given up to the surgical, electrical, and 
ophth^mio departments. 

Kxw Fbvkb Hospital at Bathoatx. 

A new fever hospital was opened at Bathnte on 
November SOtii. It consists of two pavilions twelve 
beds each, and two observation wards of two beds each, 
attached to the administrative block. The building has 
cost about £316 per bed. Dr. Anderson, Armadale, has 
bMn appointed medical officer in charge, and Dr. Kirk, 
Bathgate, of curling fame, tiie honorary oonsolting 
physician. 




UEUOBUL TO THE LATE DB. ARCHIBALD 
HAMILTON JACOB. 

Thk Committee of tiie Jacob Uemorial desire to in¬ 
timate to the subeoribws of the Fund that they have 
iqiplied the money collected in part payment of the 

S orchase of the honse, 47, Morebamptou Bond, for lbs. 

acob and her danghtos. Th^ also take this <m>orto- 
nity to eKpross in Mrs. Jacob’s own wemds," Her neari- 
felt thanks and gxatitnde to the many generous sub* 
scribws to the l^d, and to state that it has been 
some consolation to her for his in^mrable loss to knew 
that her late dear husband’s professional friends and 
admirers hold in remembimnoe his life-ion^ work in the 
interests ot the profession, in token of which the^ have 
now ocme forward and assisted her so materially In her 
great trouble and bereavement." 

The Cknomittee herewith submit their aooonnt and 
disfaribution of the Fund. 

Hon. TnxAsuBBBs’ Aoooukt op ** Jacob Mbkobial 
Fomd." 

StC0>ved. 

A s. d. 

Total Subsoriptions received . 881 19 0 


[PBOK OUB OWN COBBXSFONDBMTS.] 


Elkction or a Dibxct Bbpbkskktativk. 

Although the result of the election whiob has just 
taken place cannot he officially announced until Decem¬ 
ber loth, it is generally understood that the oounting of 
the votM has placed Dr. Bruce, of Din^all, the late 
representative, at the top of the poU, so ^t the repre¬ 
sentation of the oonatitn^oy remains as before. Pend¬ 
ing a decision on some doubtful votes, the exact firares 
are not available, but it is understood that Dr. Bobert- 
eoD, of Glasgow, has some 600 votes; Dr. Walker, of 
Edtoburgh, some 800; while Dr. Bruoe has a sulMtantial 
majority over both oandidates. Doubt as to the validity 
of some votes has arisen through the voters appending 
unregistered qualifications to their siguati^s, and 
omitting titose under which they were registered. 
Glasgow Wbstsbn Infibmabt.—Pboposbd Extbnsiom. 

At the AnnHftl general meeting of this institution it 
was anuonnoed that the number of in-patients had in¬ 
creased by 479, and the out-patients by 1077 over the 
previous year. Though the ordinary income shows a 
satisfactory increase of £1,000, there was a deficit of 
£8,000 on the year, which has been made good out of 
the extraordinary inoome, consisting of legacies and 
large donations, thereby diminishing the capital funds 
by just BO much. A new wing, estimated to cost 
^£26,000, is in oontemplation. and meanwhile the directors 
are proceeding with a new out-pat'ent department 
which will eort £40,000, of which £20,000 has alreatdy 
been promised. 


£881 19 0 

Duhur$emefUi. 

Poeta^ Addressing Circulars, Ac. .., 12 2 9 

Brindley and Son, Printers . 7 16 8 

Handed to Mrs. Jacob, in part payment 

of House, 47, Morebamptou Road... 862 0 0 


£381 19 0 

Chablbs a. Cairron, C.B., 61, Pern-*) 
broke Bead, Dublin. 

L. H. OBXBBr, Vice-President, ^Hon. Treasurers. 
B C.S.I., 92, Merrion Square, Dub- | 
lin. J 

Gkobgk F. Blakb, J.P., Begistrar, 1 
Boyal CoUege of Surgeons. j Secretary. 

December 6tii, 1901. 


Boyal College of Surfsons, Ireland.—Fellowship 
Examination. 

The following oandidates haring passed the neoeesary 
examination, have been admitted Fellows of the 
Collie:—Hr. U. Ballesty, Mr. E. T. Coady, Hr. F. 
P. Colgan, Mr. H. C. Fox. Mr. P. G. Lodge. Hr. G. E. 
P. Mdlon, Mr. E. P. Stapleton, Mr. F. 8. Walker, Mr. 
B. J. White, and Hr. G. O'Keeffe Wilson. The foUowii^ 
0 %adidate 8 passed the primary part of the Fellowship 
examination: - Hiss L. A. Baker, Mr. M. Deeny, Hr. m. 
Fitzgerald Ur. A. E. F. Hastings, Hr. H. B Kapadia, 
Hr. E. B. Kenny, Hr. J. N. Hesnan, Hr. W. L. Hnndiy, 
Hr. H. B, C. Butherford, Hr. J. W. Butherford, ana lb. 
F. C. Sampson. 

Digitized by 


Google 


D>c. 11. 1901 


OBITUARY. 


Thb Mkdical Fbu8. (343 



(Dbiturtr0. 

SIR WILLIAM McCOSHAO, K.C.B., K.C.V.O., 
F.B.C.S. E. AND I. 

Ths death of Sir William McCormao, which took 
place on We^esday last, at Bath. depriFes the medioal 
profession of one of its best known and moet eminent 
representativee. The announcement, ooming as it did 
without any prevlons intimation of failing health, 
necessity excited general surprise m well as regret. It 
seems, however, that for two or three months 
past there had been disquieting symptoms, for 
the relief of which he was advised to undergo a course 
of treatment at Bath. He took his first bath 
on the day preceding his death, and appeared 
markedly lMne> 
fited thereby; 
but just before 
the time had 
arrived for the 
bath on Wednes* 
day, an attack of 
syncope brought 
IHe to an end. 

Sir William, 
who was bom at 
Belfast in 1886, 
was the ton of 
Dr. Henry 
MoCormao, who 
wash^selfadis* 
tingniehed and 
cultured pby8i> 
oian, and made 
a reputation as 
an espert in 
tropical diseases. 

He was, more* 
over, a strenuous 
advocate of the 
value of fresh 
air in the treat* 
ment of hisis. 

Sir Wiluam was 
educated at the 
Belfast Insti¬ 
tute, until the 
time came for 
him to go to 
Dublin to studv 
medicine, which 
he subsequently 
continued at the 
then dominant 
school of Paris. 

He took his M.D. 
at the Queen’s 
University of 
Ireland, and in 
1864 was ad¬ 
mitted a Fellow 
of the Boyal 
College of Sur¬ 
geons in Ireland, 
and was shortly 
after elected Sur¬ 
geon to the 

Boyal Belfast Hospital, a post which he held for six 
years, during which period he made a special study of 
injuries of joints. The services which he rendered to this 
institution in various ways were reoc^nisad in 1879 by 
having conferred upon him the honorary degree of M S., 
followed, in 1862, by that of D.Sc., in admtion to the 
gold me^. 

Tbe “tide in the affairs of men,” so far as Sir 
William’s career was concerned, came with tbe outbreak 
of war betwesn France and Prussia in 1870. The 
British Bed Cross Society orgacised a magnificent am¬ 
bulance expedition, officered by a number of British and 
American surgeons, in which Sir William (then Mr.) 


MoCormao played a very prominent roU as Chief Sur¬ 
geon of the Anglo-American Field Hospital They 
were ordered to M^zi^res, and thence to Sedan, whi<m 
they reached on Angust 80th, just in time for the 
fighting.^ This foreign ambulance was so placed, and so 
well equipped in the matter of surgical appliances and 
comforts, as to be able to render services such as no 
other ambulance in either army was in a position to 
perform doting this war. For a hospital they were 
assigned an infantry barrack on the rampi^ of 
Sedan, overlooking the Mense, in which 384 beds 
were set up. 

On Angust Slat MoCk>rmao, with several colleagues, 
went < n to Balan, where no fewer than 260 wonnded 
were attended to tbe same evening. On the next 
morning, September Ist, he was back in Sedan. The 

French wonnded 
were about 
12 ,000, and of 
these 274 were 
received in ^e 
course of that 
day into the 
be^ of the 
Anglo-American 
Ambulance, 
while many 
more were 
treated there 
and sent away. 
Each day con¬ 
siderably more 
than a hundred 
major operations 
were nmormed, 
and MoCormao’s 
share ^ these 
was a large one. 
A day of his 
work at the 
Caserne d’Asfeld 
is well deMvibed 
in bis own 
words: *' I did 
not snooeed in 
keeping a record 
of all the work 
that was done 
that day. In¬ 
deed, I only 
wonder I kept 
any record at 
all. I find, how. 
ever, that I pw- 
formed several 
amputations of 
the leg, the 
thigh, the fore¬ 
arm, and the 
aim, that I ex¬ 
cised tbe shoul¬ 
der and the 
elbow-joints, and 
also performed 
partial resec¬ 
tions of th^ up¬ 
per and lower 
maxillae and of 

nearly the whole ulna. The number of bnlleta and 
pieces of shell that were extraoted from various parte 
of the body are too numerous to reckou.” 

His energy, decision of character and robust con¬ 
stitution enabled him to withstand unheard-of vioissi- 
todes aud fatigue^ including a smart febrile attack, the 
result of inoculation with infective discharge. In spite 
of his mnltifarioui duties be kept a diary of bis expe¬ 
riences ia the field, the publioatioa of which, in weekly 
instalments, brought bis name prominently before the 

S rofession and the public, not only of his own country, 
at all over tbe civilised world. 

On his return to England he became a Fellow of the 

Digitized by . 











OBITUAET. 


Boyal Colley of Snrseons of Eoeluid and was elected Lord Methoen’s force advanointil' to tiie relief of Kim- 
Affliatuit Snrj^ntoSt. Thotnaa'sBoepitel, aninetitatioii berley. A shaip attaok.of dysent^ disabled tern* 
with wbioh he maintain^ his oonneotion np to the date porarily daring his stay in Booth Africa, bat he appeared 
of his death. He settled down in Harley Street, as befitted to have made a good recorery. 

his position, and in 1878 he was promoted to the fall Bor* Sir WilUam MoCormao remained apto the time of 
geonoy, and was anpointed joint leotnrer in snrgery at his death Consolting Soigeon'to the Boyid Belfast Hoe* 
the Uedkal Bohool. In 1876 he paid a brief visit to the tetal, St. Thomas’s Hospital, the French and Italian 
seat of war between Turkey and Servia. Hospitals, and Queen Charlotte’s Lying-in Hospital. 

In 1881 he had another great opportonity, as Seore- His services, besides receiving recognition at the bands 
tarv*General of the Inteimtional If edioal Oong ro es , of his Sovereign, were rewattM by a very large nambsr 
which waste meet that year in London. Histecoltyfor of foreign honoors, among them the Legion of 
organisation once Skgain came into play, with the reealt Honoor, the Order of the Bumebrog, the Order of tiie 
that the Congress u memorable for its soooees, and he Crown of Pmssia, the Order of ^e Crown of Italy, the 
was rewarded with a Knighthood. North Star of Sweden, the Order of Sunt Jago <n Por- 

In 1888 Sir W. McCormac was elected to the Cooncil tngal, the Order of Merit Spain, and the Order of ^ 
of the Colle^ of Sorgeonr, and thmewith b^an a closer Takovo of Servia. He was likewise honoared by the 
connection with Order of Bitter* 

that body, which kreaz of Bavaria 

helped greatly and the Hedji* 

to enhance bis dieh. Hisprotes- 

adminietrative sional honoon 

repatation. In were also very 

1687 he joined namerocs. He 

the Court of Ext* was member of 

miners, of which a very luge 

hebecsmeOhair- number of learn- 

man; in 1893 he ed societies both 

began the Brad* at home and 

shaw Lecture, abroad, and at 

on ” Sir Astley meet- 

Cooper and his ing of the Brit- 

Surgical Work,” ish Medical As- 

and in 1896 he sociation in Lon* 

became Presi* don in 1895 was 

dent of the Col* ^cesident of the 

lege, to be re- Section of Sur* 

elected year gory, in which 

after year. In capacity he de- 

1897 he received livered . an ad* 

a baronetcy dress which was 

among the Jubi- greatly and just- 

lee honours of ly a^ired, tak- 

that year, and ing f(n his theme 

was made Sur* the advance (tf 

geon - in * Ordi* war snrgery with 

nary to the special refemee 

Prince of Wales, to the effects of 

whom he treated modvm projec- 

suooessfuUy, tiles, 

soon after, for a Sir William 

fracture of the McCormac 

knee-cap, being married in 1861 

rewarded with a Katherine, 

K.C.V.O. Apart daughter of Mr. 

from his famous John Charters, 

war dia^ egd of Belfast, who 

oocasionu ad- survives him. 

< fao e se a, Sir Wil- He leaves no 

liamdidnotpnb* children, 

lish much of The funeral 

importance, bis took place on 

best-known Monday last, at 

works being the the Kensa 1 

article on ” Gun- Green Cemeteiy, 

shot Wounds,” unidst a large 

in Heath's ** Di^ and imposing 

tionary of Sur* concourse <n 

gery,’' and that colleagues and 

on “Hernia" in Treves’s “System." friends. 

On the outbreak of hostilities in Sooth Africa in the „ . . i. ,, 

autumn of 1899, Sir William accepted the offer of the Thi Bntish M 


autumn of 1899 SirVilUam accepted the offer of the Thi Bntish Medusal Temperance Association held 
War Office to go out as Consulting Surgeon. He pro* another meeting for medicel students on Thw- 
oeededte South Africa in the company of Mr. G. H. day. 6th Deoembef, in the Giveruora HUI of St. 
Makins, who was also appointed Consulting Surgeon, ThomM’sHoepital(bykindpenmsnonoftheTreii8urOT). 
Mr. (now Sir Frederick) Treves, foUowing some weeks Dr. H. G. Turney, Dean of the M^ioal Schwl, pr«i<W. 
later, and he soon found himself among the wounded In opening the conference, he smd he thought tte 
of Sir Bedvers BuUer’s army after the nnsuoceesfnl medical profession rather lagged ^ind puhUo opinion 
attempt, in December to cross the Tugela River and on this subject in this country. Abroad the reveree wm 
raise the siege of Ladysmith. He returned from Natal the case. The aloohoUo habit was an endemic duw m 
to Cape Colony, and proceeded to the Orange River to this country, and wMreepon|^le for an amount of disease 
txfca charge of the arrangements for the wounded from and death which it was difficult to appreciate. 

Digitized by Google 



COERESPOITDENCB. f hi Medical Pbisb. 645 

(lorrtfiponJjmc. 


D»c. 11> 19U1. 

A MKDICAL HERO. 

It is not necessary to relate to oar readers all the 
occurrences which led to the sad ending of the drama 
in which the late Dr. ‘William Smyth, of Burtonport, 
lost his life. The knowledge of these occurrences 
has been widely distributed throughout the country 
by letters and paragraphs in the lay press, which 
have brought vividly home to their readers ^e 
nature of the services which he had rendered to his 
fellow-men. In this matter the lay press have 
acted with the generous appreciation of acts 
of heroism which is characteristic of Bntons, 
but they have not, as yet, done fpite all 
that is asked of them. They have thrown a 
strODK lifiht upon Dr. Smyth’s services to stncken 
humtoity. by which he met his death. Will they now 
call attention to the duties his fellow-men owe to 
to his widow and eight orphans? An appem dm 
been sent forth on behalf of those whom he left 
behind, and if that appeal is brought generally to the 



IPhotn. Aj/ton, Lomlonikrrii. 

A Medical Hebo.—The Late Db. William Smvth. 
notice of a sympathetic public it will be answered 
in a manner which will secure the necessary sum of 
money to provide for htrs. Smyth and her children, as 
it is right they should be provided for. Already 
subscriptions have been sent in to the tr^urers of 
the fund by insi^ well-known men both in England 
and Ireland, and subscriptions from many more will 
come, if only the fact that such are required is 
brought prominently to the notice of the public. 
We trust that the members of the medical proiession 
will assist in this most deserving^ object. 
Subscriptions may be sent to the presidents of 
the ^yaJ Colleges of Physicians and Surgeons of 
of Irelrad. In this connexion it may be mentioned 
that at a meeting last week of the Irish Medical 
Association, the fmlowing resolution was passed 

“ That the Council of the Irish Medicu Associa¬ 
tion desire to express their earnest sympathy with 
Sirs. Smyth and her family in the irreparable loss 
they have sustained in the ^tb of her husband, 
Dr. Wm. Smyth, of Burtonport, who for many years 
was a member of this Association. They hope that 
the memory of his fearless and unselfish devotion to 
duty on ^e outbreak of typhus among the poor of 
Arranmore Island, by which his life was sacrificed, 
wlU, in some d^ree, sustain them in their afflic¬ 
tion.’* 

It is understood that the R<yal Commission on 
Arsenical Poisoning, which is presided over by Lord 
Kelvin, will not resume its sitting until a^ date ap¬ 
proximating to that of the opening of Parliament. 


l.We do not hold onwolvegienponBibl* for the opinion* of onr 
cortMpondent*.] 

PEEMATUEE BUEIAL. 

To the Editor of The Medical Pbbss and Cibculae. 
Sir, —In your note of November 27th, headed “A 
New Plea for Cremation,” you observe “ that no mstauce 
of live burial has yet bwn established with that com¬ 
pleteness of proof which is demanded by soientinc 
investigators before accepting the truth of auyassertioo. 
In other words, there is no evidence of any cs^ m 
premature burial other than that afforded by hew- 
gay or supported by statemeuts that are ob¬ 
viously riddled by fallacies of one kind and 
another.” What you understand by “completeness of 
proof,” “scientific investigation,” or_ “hearsay, or 
what are the fallacies you refer to. it is impoemble to 
, form any idea from your note. I would remark, ncw- 
ever, that to neglect an obvious precaution 
danger because there is no “ soientifio" proof of wc 
danger to be guarded against is not wisdom but insanity. 
Fancy a man leaving all his windows and doors open at 
night because, although be had heard of burglarws in 
the next street, it was only “ hearsay,” and he had not 
-‘scientific” proof of the facts alleged, 4o., 4c. 

Bishop Butler tells us that probability is the guide 
of life, but your leader-writer would seem to be quite of 
a different opinion. Except from “ hearsay,” how do 
we know of the existence of Julius Cteiar, Shake¬ 
speare, Napoleon, 4o. ? 

All history is hearsay. Without for a moment in¬ 
sisting that every tile of premature buri*l is to be 
depended on, I do assert thst^ from time to 
time living persons have been mistaken for dsad 
and treated as suoh, and that this is as certain as any 
fact in history. If I do not give instances it is not 
from want of material, but from difficulty of selection. 
Again, yon “ suggest that medical science can determine 
with precision whether a person is dead or alive.” Prom 
what I have read 1 should infer there are cases where medi¬ 
cal science can do nothing of the kind; but the point is 
quite immaterial in view of the common practice of 
doctors in giving certificates of death without cy«n 
seeing the alleged dead. What is the use of medical 
science if doctors do not avail themselves of it ? 

1 am, Sir, yours truly, 

Hebbebt N. Mozlet, M.A,. 

Barrister of Linooln’s Inn- 

East View, Murray Bead, Northwood, 

Deo. 4tii, 1901. 

[The weak logic of the above letter is hardly of the 
kind that might be looked for in a legally-trained mind. 
Burglary is a fact established by overwhelming evidence 
in myriads of oases in courts of law. Onr contention is 
that no instance of premature bnnal has been proved 
by evidence that wonld carry conviction to the minds of 
a legal tribanal. The danger is therefore not shown to 
exist otherwise in the imagination, and it is sorely 
somewhat superfluous to guard i^inst imagin a r y 
dangers. The honseholder who did not protect his 
house against burglary wonld be ignoring a well- 
recognised uid established danger. But if, let ns say> 
be were to put bars in his chimney to prevent Santa 
Clans entering his house in tiie night he would 
be providing against an ocemrenoe that is a simple 
fable, but hardly mote so than the sn^iestion of pre¬ 
mature bnriaL The fallacies of the subject have been 
duly set forth in a little book by Dr. Walsh (Bailb^re 
•nd Cox). Hearsay may bo divided into two classeo: 
hearsay of statements that are founded on fact and will 
bear and hearsay of statements that are not 

supported by fact and will not bear analysis. The 
evidence brought forward in support of the theory of 

nyCjOOglC 



646 Tm Msdical Pbsbs. 


MEDICAL NEWS, 


premature burial is of the latter order. We suf^geet 
tiiat our correepondent, as a lawyer^ should carefully in- 
Tsetigate the eyidence of any oases of premature burial 
he may find and set them forth in form of a brief. _Ed.] 

IK8ANITAEY ANGLES. 

To the Editor of The Medical Pbess and Cibcdlae. 

SiB,—In this age of the universal provider, “Enouire 
within upon everythmg may soon have to be announced 
overtteentra^toourpolice-oourts. It speaks volumes 
for the oharaotOT of our magistrates and the patience of 
OUT people that honesty of purpose has so lone been 
aooepted when it is patent to all concerned that the in- 
rtmment of jwtioe is so ^ten wanting in the technical 
knowledge without which an opinion is as likelv to h« 
wrong as right. ' 

When a inspector of a local authority differs 

from a qualified and experienced architect or rarineer 
as to the i n clination at which a drain should be laid the 
Legislature in its wisdom has imposed upon our maeis 
teates the duty of deciding between them, and thw it 
came about on Friday last that Mr. Curtis-Bennett. at 
the Mar,lebone Police Court, decided that a new stone¬ 
ware drain, bedded in concrete, proved to be sound and 
water-tight and thoroughly weB-ventUated, should be 
taken out and reconstructed because he shared the 
opinion of tibe sanitary inspector that a pipe at an 
Mgle of 90® with the horizontal did not give a suitable 
laU. 

Is this tile discovery of an insanitary angle ? Or is 
It a gross mterferenoe with reasonable liberty 9 Because 
I <»nBtni<rt^ a dr^ with a vertical faU rather than 
radanger the foundations of the house by puttins the 
them, can anyone ewiou.ly 
nusmtain that ^h a dram is. therefore, dangerous to 
heal^ ? If this cannot be maintained, has not the 
mterferenoe of the sanitary inspector reached a stase 
when some eeriousstand should be made against it? 

1 am. Sir, yours truly, 

Mark H. Judge, 

A.B.I.B A., Fellow Sao. Inst., Associate 

^ S^ety of Medical Offioersof Health. 
7, Pall Hall, December 8rd, 1901. 

THE VACANCY ON THE STAFF OF ST 
BARTHOLOMEW'S HOSPITAL. 

To the Editor ttf The Medical Pbess and Cibodla*. 

last issue yon mention my name as 
that of a possible ^didato for the forthoomiii vaosacy 
on ije snrgic^staff of St. Bartholomew’s HoemW^^ 
hMpmed at the last election 
acquainted with 
occasions 

at tors ancte^ *iU not be surprised to hear 

intentionof ever again 
oontee*iDg such an election. “a**® 

V of oome two or three 

himW 1^ ^TOTors. The acting medical and sur¬ 
gical staff of the hospital have no votes 

^ ^ortod seventeen 
^ ^ informed 

toMothsr ^ "“Jonty of the governors gave the poet 
I am. Sir, yours truly, 

BEBiiT,B.8.Loni,F.R.C.S. 
Simeon to the ^yal Free Hospital: formerly 
on^CM Registrar and Demonstmtor (sno* 

cesBively) of Anatomy, of Ope^ve Sur- 

STTl ^ Practical Surgery at St 
Bartholomew’s Hospital. 

Wimpole Street, W., Deoeml^r 9th, 1901. 

Death under Chlorofonn. 

V*^' autesthetised by the aid of 

oMorrf^ at the Birmmgham Ear and Throat Hospital 
lart week, for the purpose of removing a post-Msal 


Dec. 11,1901* 


(^ebical 


SmaU-poz in Philadelpbla. 

A LARGE increase in the number of small-pox cases is 
r^rted from the United States. In Philadelphia 
^ne over 120 deaths are reported to have taken place 
dnrmg last month. 

The Macclesfield Infirmary Dlsputa- 
We have received from the Hon Secretary of the 
Manchester Medical Guild the following resolution, 
whi^ wu passed at the last meeting of the ConncU of 
the Medi^ Guild on Friday last“ That the Couiuril 
j MMchester Medical Guild approves of the 
attitude of the honorary medical staff of the Maccles- 
neld Infirmary in the present dispute with the govern- 
mg committee, in contesting the right of lay boards to 
appomt bouse surgeons in opposition to the wishes of 
the honorary staff, and hopes that they will receive the 
nnuimons support of the honorary consnlting surgeons 
and of the whole profession.” 

A Medical dnb in Paris. 

. A “*WCAL olnb has recently been founded in Pari* 
1 ^7®””® ”® I’Opera, in premises belonging to 
the Carole National. Its object is to promote friendly 
relations among its members, to form a professional 
centra for the medical practitioners of Paris, and to 
provide the advantage of a club for provincial and 
foragn doctors visiting Paris. Visitors will be able to 
obtmn at th e olnb all the information they may require 
as to lectures, hospital visits, soientiflo and medical 
^eties, Ac. Professor Poizi is the president, and Dr. 
l^ens the secretary-general of the club. The medical 
prof^ion of Brussels is also, we learn, thinking of 
fonnding a olnb. ® 

Dublin Dsath-rate. 

Ik the Dublin registration araa the deaths registered 
for the week ending Saturday, November 30t£ 1901, 
K^rrot an annual rate of mortaUty of 19 6 in every 
S’ a “*PO|”«*tion Daring the 48 weeks endiag with 
Satur^y, November 23rd, the death-rate averaged 25-7. 
Tmj^-sm of the persons whose deaths were iMistered 
during the week were infante, of whom 13 were under 
one inonth old. In 7 casee the cause of death waa 
raoertifl^, there having been no medical attendant 
dnrmg the last illness. 

Katlenal Assodation for the Preveatieu of TubareuloEls. 

A MEETING of the Executive Committee of the Dublin 
Branch was held last week at the Royal College of 
Physio^ Sir John W. Moore, M.D., in the ohi^ The 
J^mim^ had under consideration the RegUtrar 

SSfh?* Marriages, Births, and 

Dwtbs m Ireland for the year 19C0, but in partionlar 
his sta^ent of fignres with regard to tubercnlosis. 
iroin th^ it appears that among diseases tubercnlosis 

mortaUty. and cUimed 
12,^ victims during 1900; 10^076 deaths were doe to 
pu^nary Lubercnlosis j 1,026 to tabes mesentoriea • 749 
* i5 meningitis; and 997 to other forms. Tbs 

total deaths from tubercnloeis represent a rate <rf 2'8S 
per 1,0TO being 003 per 1,000 in excess of the previons 
7^.1 ... from pnlmonary tnbetonloeis is 2-26 oer 
1,000 bvmg. The phthisical death-rate in the fw 
Leinster, 2 60: Monster. 
^2; Ulster, 2*24; and Connaught, 1-62 per 1000 
The moresae of tnberooloeu in Ireland is shown 
^ the foUowmg returns, which do not oonfirm 
UM statements that sometimes appear in regard to the 
dMreaM of this soonrge in Ireland. The rates per 1OOG 
population are:—Average for ten years, 
1871-80, 26; average for ten ysaia, 1881-90,2 7; average 
yew8,1891 9,28: average for twenty-nine years. 
1871-90, 2’7 : 1900, 29. Tlie want of any aooommoda- 
tion, pi^<»lly speaking, for advanced oonsumption 
other Uian m the workhouse infirmaries in Ireland. 

aooouata for the following reenlts in the nnions'_In 

the North Dublin Union the death-rate from tubercu¬ 
losis was 5-7 per 1.000; in the South DnbUn Union it 


v.j00gle 



Dxc. 11,1901. 


MEDICAL NEWS. 


Thi Mkdzoal Pbvs. 647 


was 5'6; in Belfast, 4'4; in Londonderry, 2’9; in 
Waterford, 8*6; and in Limerick, 8'4. The hon. eecre* 
taiy was diimt^ to draft a letter to tbe Fnblio Health 
aa^oritiee, to be sabmitted for consideration at the 
next meeting of the Committee, in reference to a more 
fall adoption of tiie notification of taberenlosie. 

The Medical Sickness and Accident Society. 

Trx nsoal monthly meeting of the Medical Sickness, 
Annnity, and Life Assnranoe Society was held on the 
29th alt, at 429, Strand, London, W.C. There were pre¬ 
sent Dr. de Havilland Hall, in the chair; Dr. J. B. 
Ball, Dr. Walter Smith, Mr. H. P. Symonds, Mr. William 
Thomas, Mr. F. S. Edwards, Dr. J. W. Han^ Dr. W 
Knowfley Sibley, and Dr. Fredk. 8. Palmer. The 
record of the S^iety for the snmmer months of this 
year has been very satisfactory. The siokness claims 
hare been light, and tbe rate of management expendi¬ 
ture exceedingly low. with tbe result that a subatwtial 
addition has been made to the funds of the Society. 
The number of new entrants has also been greater than 
in the oonespondiog period of last year, and as no ex¬ 
penditure is ever incurred in the nature of advertise¬ 
ment. the committee hope that tbe appeal they hare 
so often made to the existing members to help uem in 
extending tbe business is now bearing fruit. Tbe 
number of those permanently incapacitated remainsaboat 
tbe same, but one or more additions to this list are ex¬ 
pected shortly. Snch members draw nsnslly one 
hundred guineas a year, and special reeerves are made 
to eecnre this valuable benefit to those entitled to it. 
Frospeotusee and all ptriicnlars on application to Mr. 
F. Addisoott, Secretary, Medical Sickness and Accident 
Society, 33, Chanoery Lane, liondon, W.C. 

Tbe Bonslng Problem. 

Tbs question of the housing of the working classes is 
commanding a great deal of attention at tCe present 
time, and the Ulastnted article in the December num¬ 
ber of the iSfsdio, deeoribing Mr. George Cadbury’s 
successful solution of tite difficult problem at the villa^ 
of ^umrille, near Birmingham, will be read with con¬ 
siderable intmoet, and doubtless materially assist where 
snch a solution is possible. But Tillages are not found 
on tile outakirts of London, and it is here the difficulty 
presents insuperable obstaolea 

•tinioBas's Hos^tal.—Henae Appointments. 

Tbe following gentlemen hare been selected as house 
officers for tbe eosuing term:—House physkians— 

L. H. 0. Birkbeok, B.A., M.6., B.Ch., Oxon. (extension) ; 

V. 8. Hodson, B.A, M.H, B.Ch., Oxon. (extension); W. 

M. G. Glanrille, B.A., M.B., B.(%., Oxon.; and T. W. 8. 
Paterson, M.A., M.B., B.C., Caatab., L.B.C.P., M.B.C.8. 
Assistant house physidans—T. B. Henderson, H.A, 
M.B., B.Ch., Oxon., and H. 8. Stannns, L.B.C.P., 
M.B.C.8. House surgeons—C. A. B. Nitob, M.B. 
Lond., L.B.C.P.. M.E.C.3. j W. H. O. Woods, B.A., M.B., 

BC. , Cantab.; 8. Hunt. L.B.C.P., H.B.C.S.; A. 8. 
Grimwade, L.B.C.P., H.B.C S. (all extension). Assistant 
house surgeons—G. A. C. Shipman. MA., M.B., B.C., 
Cantab., LB.C.P., M.B.C.8.; W. Hill, B.A., Cantab., 

L. B.C.P., MB.C.8.: T. W. H. Downes, L.R.C.P., 

M. B.C8.; F. J. Child, M.A., M.B., B.C., Cantab., 
LB.C.P., M.B.C.8. (all extension. ObeteMc house 
physicians—(Senior) Z. Mennell, M.B., Lond., I,B.C.P., 
MB.C.8.; (junior) H. T. D. Aoland, L B.C.P., M.B.C.8, 
Clinioal assistanto in the speoisJ department for 
dirnasm of the throat—A. D. Hamilton, L.B.C.P., 
M ;B.0.8. (extension), and A. P. Bowdler, B.A., Cantab., 
L.8.C.P., M.B.C.8.;(Bkm) F. Clarkson, M.B., B.8.,Darh- 
(extension), and J; L. Timmins, If A., B.C, Cutab-, 
L-E.C.r-, M-B-C.S. (extension); (ear) F. Clarkaon, M-B-, 
B.S., Durh. (extenaion). Electrical department—L. 8. 
Dudgeon, MJ8.C.P., HB.C.S, 

The Irish Hospital Corps. 

His Excbllxnot thk Loko Lixutknaxt publicly 
presented »ar medals, on Saturday last, to the membm 
of the Irish Hospital Corps who reoentiy returned from 
Africa, where th^ had rendered most omupionous ser¬ 
vice. Tbe ceremony took place in the Upper Castle 
Yard, and Hia Boyal Highness tiie Duke of Connaught 
was among thoee present. 


His Excellency, before presenting the medals, made a 
short speech, in tbe course of which he said that it was 
the privilege of the illustrious medical profession that 
the career of its members was occnpted not only in 
securing their own advancement and snooesa, but in 
alleviating tbe snfferinss and ministering to the wants 
of others who stood in need of those services, and at no 
time are those services so valuable as in tbe time of 
war. The spirit in which the members of tbe 
medical and sni^cal professions bad performed their 
duties had been, from time immemorial, one which had 
earned for them the gratitude and respect of their 
oonntrymen. He then alluded to tbe service rendered 
by the late Sir William MacConnac daring the war, 
and to that pathetic history of the self-denving work 
which was performed by Dr. Smyth, of Burtonport, 
who met his death the other day under such painful 
and yet under such glorious circumstances. He believed • 
it was the spirit which animated these two great men 
that impellea hia hearers to go over six thousand miles 
to do what they could to relieve suffering, and to assist 
their felioir men who are fighting the battles of their 
country on those distant shores, and he was quite sure he 
was roe^iog on behalf not only of his Boyal Highness 
and himBelL but also of the whole of their fellow 
countrymen, when he said that they were grateful to them, 
that they were proud of them for what they had done, 
and that tbe recollection of their servioes would never 
be effaced from their memories. Sir W. Thomson then 
returned thanks. Tbe medals were pr ooo nted among 
others to the folloiring;->Sir Wm Thomson, Dr. Stoker, 
Dr. Coleman, Dr. Friel, Mr. Thomson, Dr. Edwards, 
Miss M'Dozul^I, who acted as matron of the hospital; 
and Miss M'Gonigle, one of the staff sisters. 

Hurreian Society of London. 

Thx annual dinner of the Harveian Society of London 
was held on Thursday, November 28th, in the Beeent 
Saloon of the Caf4 Monioo. The chair was occupied by 
Dr. David B. Lees, President, and seventy-seven mem¬ 
bers and guests sat down to dinner. Amongst thoee 
pr ese nt were:—Sir Thomee Barlow, Sir G. Anderaon 
Critohett, Mr. H. 6. Howse, Dr. W. H. Allchio, Mr. 
Howard Marsh, Mr. Alf. Cooper, Mr. Watson Cbeyne, 
Dr. Dundas Grant, Mr. G. P. Field, Mr. Edmund Owen, 
Hr. El. Noble Smith, Mr. C. B. B. Eeetley, &o. Tbe usual 
loyal toasts having been proposed by ths Preeident (Dr. 
I/Bob), Dr. W. H. Allobin, Preeid^t of the Medical 
Sooi^, proposed “ Soocees to the Harveian Society,” 
briefly sketcbing the career of the society 
from its foundation in 1831, and pointing out tbe 
varions causes which rendered it such an attractive 
society. Dr. Lees responded for the Harveian Society. 
Mr. C. B. B. Keetley then proposed "The Sister Societies” 
and "Our Quests” in his nsnal fanmorona style, draw¬ 
ing a fancy piotnre of what the profession might 
become in a few yean’ time should the members ever 
adopt trades union piinoiples in their work. Mr. Howard 
Manh, Preeident of the Clinical Society, reepraded for 
the Si^r Sooietiea, and Mr. H. G, Howse, Preeident of 
the Btyal College of Surgeons, responded for the Guests. 

“ The President ” was proposed by Mr. E. Noble Smith, 
Dr. Lees replied, and in his speech proposed ” The 
Honorary Seoretarie*,” to which toast tbe Senior Secre¬ 
tary, Mr. Hubert C. Phillips, replied. In the intervals 
between the speeches a selwtion of excellent music was 
rendered. 


’fists. 


Boyal CoUegee of PhyslcianB and Burgsona, Ireland. 
Thx following candidates have passed the examination 
for the Diploma in Public Health:—Uliok Joseph 
Bourke, Lt.-Col. B.A.M.C.; Michael James Bodkin C^ 
tello, M.B., B.Sorg., B.U.I.; Hampton Atkinson 
Dougan, M.B., B.Ch., Univ. Dubl.; Digby Patrick 
French, L.R.C.F.. and SEdin.; Alfred Moore, H.D. 
Univ. Dubl.: JohnEenry M’Aulay, L.B.C.P. andS.Edin.; 
Csdeb James Powell, L.BC.P. and 8.1.; Charles Lane 
Sansom, F.B.C.8.Ediji.; Bobert Fox Symons, L.B.C.P. 
Lond., M3.C.S.Eng. 

;'v Cookie 


648 Thi Medical Pbbsb. 


NOnCBS TO CORBB8PONDBNTS. 


Dbc. 11, 1901. 


^0tice0 to 

(irorrtB00nbettt0, ^hort TUHtte, ^r. 

Couutaronnra nqnirioE a npl7 in this eotanm an par- 
tiaalarlj requested to make om of a dietfncHve ripnofure or 
and avoid the pnotioe of aigninE themselrea ** Beader,’* 
'Sabeoriber,” “Old Sabaerlber,” do. Vnch oonfoeion wUl be 
spared by attention to this role. 

SUICIDES IN ENGLAND AND WALES. 

AccoKDiMQ to the last official retoms—those for 1S99—3,000 
snicides occurred In that year in England and Wales, a large pro¬ 
portion of which are regained as doe to the facility with which 
poisons can still be obtained br the pnblic- In the same year there 
were dSOdesibs by miiadventure, theresnlt of poisoning. 

DiL S. J.—The occoaion is not one calling for official representa¬ 
tion on our part. 

Da. J.- As a registered practitioner the lady has a ri^lit to fair 
play t/na treatment on terms of equality. The exercise of that 
right, however, stili calls for prudence, t^ct, and judgment, hut 
these qualities are necessary on tlie part of all concerned. 

ANTI-BACTEBIOLOOICAL INGENUITY. 

As amnsinc incident is reported from Queensland in connection 
with an attempt, on the part of a local bacteriologist, to import 
some microscopical slides of plague bacillus. Tbel^tomsauthori- 
ties w<re stron.ly adverse to th>-ir entrance, hut were at a loss to 
adduce legal warrant for such action until it occurred to one of them 
that the slides in question were put up in gelatine, which is a duti¬ 
able article, liable to seixure and conflscation upon non-declaration. 
This served as a pretext for the prompt deetruotion of the bacillary 
slides. It is a pretty story, but we do no* see where the gelatine 
came in, it notbeuig utilised fortbe purpose of mounting specimens. 
Moreover, bacilli embedded in Cana'la balsam, which was presum- 
ablv the excipient used, are necessarily as dead as Queen Anne 
and fully as innocuoua However, it seems a pity to subject so 
circumstantial an anecdote by hostile critidam, 

Mb. T. D. S.—Begret we ore unable to publish your communica¬ 
tion 1 it Is unsuitable for our columns. 

M.D. (Edinburgh).—Yourcommunication is unavoidably crowded 
out: we hope to have space in our next. 

Ms. MoBKiKOTon, Letter arrived as the journal was “at 
press." 

POST-DIVOBCE MOBTALITY. 

GxBMav statiitics on the death-rate among divorced persons 
reflect unfavourably on their longevity. Dr. Mozselli states that 
there are, in Prussia, 348 coses of suicide among women who have 
been divorced, asagainst 61 married women, per million of popula¬ 
tion. In regard to men the proportion is even higher, viz , 2,834, 
as against 286 among married men. 

QuesToB. Pr-ish parsley, chewed after eating onions, and bulhs 
of that class is reputed to annul the alliaceous odonr thereof, but 
there is no reason to suppose that the effect would be the same in 
respect of the emanations resulting from the ingestion of cacody- 
late of sodium. 

4ft«tin90 of tkt Societies, College 
l^ectures, 

LONDON. 

Wbdkbsdat, Dec. Uth. 

Botal CoLLiex or Scboeokb or Evolahp.— 5 p.m. Mr. T. B. 
Jessop: Personal Experiences in the Surgical Treatment of Certain 
Diseases. (Bradshaw Lecture.) 

Dxbkatolooicai. SociXTT or LoRDOH (11, CbandoB Street, 
Cavendish Square, W.).— 5.15 p.m. Demonstration of Cam of 
Interest. 

South-West Lordoh Medical Societt (BoUngbroke Hospital).— 
PaperDr. A. £. Giles: Diagnosis of Pelvic Tnmotu^, 

Thubsdat, Dec. ISth. 

Childhood Societt (Library of the Sanitary Institute, Margaret 
Street. W.).—8 p.m. l^ture. 

OrHTBALMOLOOiCAL SocixTT or THE Uhited Kikodoh (11. Chan 
doe Street, Cavenoish Sqnare, W.). Clinical Eveniw. Cases will 
be shown by Mr. H. W. Dodd, Mr. H. Juler. Mr. e 7^ CoUins, Mr. 
8. Stephenson, Mr. O. B. James, Mr. O Keeling, Mr. J. H Law. 
ford Mr. G. W. Boli, Mr. J. H. Fisher, and Mr. L. V. C^U. 

British Gthxcolooical Societt (20, Hanover Sqnare. W.).— 

S p.m. Specimens will be abowm Paper:—Mr. 8. Bionop; A 
Demonstration of Some Gbangee Observed in Uteri th« Seat of 
Fibromyomato. 

Fbidat, Dec. ISth.' 

Clihical Societt or Loxuov (20, Hanover Square, W.).—8.30 

t m. Papers: Dr. Habershon: The Association of Movable 
Idney on the Bight Side with Symptoms of Hepatio Disturbance. 
D'. 8. Wilson: The Theory of Compensation In Disease of the 
Mitral Valve. Dr. W. H. imte and Dr. W. G. Pokes: A Case of 
Mal'gsant Endocarditis ^vlng Widal's Beaetion. Mr. £. P. 
Paton: A Case of H«ir BaO removed from the Stomach ot a Child 
nine years. 

Epidekiolosical Societt (11, ChondosStreet, Cavendish Square, 
W.).—A30p,m. Paper:—Dr. Mott: Dysentery in Asylums. 

(DUBLIN. 

Thubsdat, Dec. ISth. 

Council Meeting, Boya! College of Snrgeons. 


Fbidat, Dec. 13th, 

BofBl Academy of Medicine in Ireland. Medioal Section (Boyal 
College of Physicians).—aSO p m. Exhibits:—!. Dr. Finny: A 
Case of Disseminated <r Insular Sclerosis in a girl ag^ 80. 
2. Dr. W. J. Thompson; A Case of Obeenre Abdominal Tumour, 
^peta:—I Dr. George Peacocke: Hemichorea and Parotitts com¬ 
plicating a Case of Diabetes. A Dr. W B Dawson: Glycosuria 
and Inaonity (Clinical Study) 3. Dr. J. M. Day: The Diagnosis of 
Scarlatina. 4. Dr. J. J. Buivees : A Case of Extreme Patty lufil- 
tration of the Bight Tent'icle with Acute Pericarditia and Hemor¬ 
rhage into the Pericardium. 


.^^n^onrimenta. 

Chotce, Chables C.. U.B., Cb.B.Edin., B.Sc.New Zealand, House 
Physician to the Leicester Inflrmsrv. 

Dubcah Ahdbkw, M.D. B.S.Lond., M.B.C.P.,F.B.C.S., Physician 
to the Westminster Dispensary. 

Gouoh.H.E. H.B.CS.. L.B.C.P. Load., Medical Officer of Health 
for the Bural District of Northwlch. 

Habvet, Foahx, M.a.C.8., L.8.A., Medical Officer of Health for 
Padstow, Comwall. 

Low V. Wabbeh. F.B.C.8., Snigeon to Out-patients at the Greet 
Northern Central Hospttel. Holloway. 

Mabb, H. C., M.D.Glasg., Medical Saperinteiideut at WoodBee 
Lunatic A^lnm, Lenzie, N.B. 

O'COHKOR, J.E., M.B.,B.S., BU.I , D.F.H.Camb., MedicsIOfficec 
of Health for the combined districts of Leicestershire. Bncland, 
and Warwick. 

Pabbt, LeomabdA.,F.B.C.S.. B.S., M D.Lond. Assistaut Surgeon 
to the Royal Alexandra Hospital for Children, Brighton. 

Sihclaib. Nobkan j., M B., Ch.B.Aberd.. Medical Officer of Health 
and Police SurgHon for the Burgh of Brechin. 

Shart. Walter, F.B C.S.I., L B.C.P.I., Medical Officer and Public 
Vaccinator of the Tarporley District of the Tstaiu Un on 
(Cheabire). 

Thokbov, B., M. K.Glasg., Assistant Medical Officer of the Holbom 
Infirmary at Highgate. 

Wtmter, Walter Kssex, M.D.. B.8., F.B.G.S., F.B.C.P., Physi¬ 
cian to the Middlesex Hospital. 


%acaiide0. 

Bethlem Hospital.—Two Resident Home Physicians recently 
ualified in Medicine and Surgery. Term six months from 
anuary 1st next. Apartments, complete board, and washi''g 
providM, and an honoiurlum at the rate of £25 each per 
quarter will be paid. (See Advt.) 

Buxion, Devonshire HospitaL - House Surgeon and Assistant 
House Suigeon. Salari, House Surgeon £100 pe annum. 
Assistant Houss Surgeon £50 per annum, with furnished apart¬ 
ments, board, and lodging in both cases. Full parti.:a!aES on 
application totheSecretary. 

Clifden Union. Medical Officer. Salary flSOperonnum, and£l0a 
year as Medical Otflerr of Health, together with the osnol 
registration and vaccination fees. Applications to F. King, 
Clerk of Union. (See Advt) 

County Asylum, Boiohill, near LiverpooL—Assietant Medical 
Officer. Salary commencing at £150 cer annnm, with apart¬ 
ments, board, attendance, and washing. Applications to the 
Medical Snpe^ntendent 

Down Disirict Lunatio Asylum.—Assistant Medical Officer. Salary 
commencing at £150 per annnm, with board, apMments, wash¬ 
ing & 0 . Applications to be addressed to the Besident Medical 
Superintendent. (Bee Advt.) 

Middlesex Hospital.—Assistant Physician on the honorary staff. 
Forms of F. Clare Melhado. Secntary-Snpertntendant. 

Nottlnghiam General Hospital.-Uouse Surgeon. Salary com¬ 
mencing at £100, rising to £120, with board, lodging, and 
washing. Applications to the Secratary. 

Rochdale Infinnary.—Besident Medical Officer. Salary £100 per 
annnm, with board, residence, and washing. Applications t> 
B. W. Shaw , Esq., Southfleld, feochdale. 

#trth0. 

GiLBBBTSOK.—On Deo. 8th, at Sonthboume, Hants, the wife of 
William Gilbertson. M.A., M.D.,of a daughtor. 

MonTOOMiaT-SKiTH.—On Dec. 4th, at 36, Abbey Boad, St. John's 
Wood, W., the wife of E. C. Mont^mery-Smith, K.HC.8., 
L.B.G.P.,of a son. 

Savbbt.— On Deo. 2nd, at 4, Mount Park Boad, Soling, the wife of 
Fiuk Savery, MUB.C ^ L.B.C.P., of a daughter. 

WiLBOH.—On D^ 3^, at £lstree Cottage, Boiffiey Heath, Herts, 
the wife of Daniel Wilson, M.A., M.D., of a son. 


(Parrtsge. 

Hacxevka—Bird.— On Dec. 3rd. at St. John the BvongaUst’s, 
Edinburgh, Bobert William Kiaokenna,H.A.,MB , B.ChJBdin., 
of Liverpool,second ton of Bev. Botiert MaokeiinB, M.A^ of 
Dumfries, to Harriet A. B., youngest doubter of the tots Bev. 
Charles B. Bird, M.A., Sector of Castle Eden, and Borol Deoa 
of Basington. 

jQ£ftth0. 

ACBLAHD.—On Dee. 7th, at Fairhaven, Cornwall, Sophia nuioa. 
widow of W. H. AoUand, M.D., J.P., late of Bidmcnd, in her 
8(>thyeiir. 

Habtxt.' Oq Deo. 1st, at Siml^ Snrgeon-OeDstal Bobect Harvey, 
C.B., D,8.0., F.B.C P., LL.I>., Director-General of the Dmiu 
Medical Servioe, eldest son of the late Dr, Alexander Harvey, 
Begius Professor of Materia Medioa in the Unlveroity of 
Abmeen. 


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*<aALUS POFULI 8UFSBUA. LE£.’* 


iimlat 


VoL. CXXIII. WEDNESDAY, DECEMBER 18, 1901. No. 25. 


©riginal dontmmixiratiotta. 
TRAUMATIC Ulcer of the 

CORNEA, (a) 

By 'A. MAITLAND RAMSAY, M.D., 

^*>V9eoD to th« OIm^ov C^btlulmio Institotlon, ProfoMor of 
Opbtbalmoloo in 8t. Hanfo'B CoUsfe &nd Lootnrer on 
Diaeaseo of the E je in Queen Uanreret Colley, U ni* 

▼enity of Olaa^ow. 

Among artiaana the commoneet accident to the 
eye ia that where a minate particle of metal becomea 
embedded in the corneal epithelinm. The workmen 
themaelyea spmk of each a foreign body aa a fire,” 
and the term is not inappropriate, beoanae aa a rule 
the bo dy i a at a white neat when it fliea from the 
tool, when it reachea the eye therefore it burna ita 
way into the tisenea, but aa the heat haa rendered it 
aseptic it rarely brings about any serious damage to 
the cornea. Its presence, however, gives rise to so 
much aulferlng that the patient is naturally desirous 
to have it removed at the earliest possible moment, 
and as often as not appeals to a fellow-workmen for 
help. Unskilful attempts at extraction are un¬ 
fortunately always more harmful than the “ fire ” 
itself, which, if left alone, becomes surrounded 
almost at once by an army of leucocytes. These 
immediately begin to manufacture a special 
ferment, which acts upon the tissues in such 
a manner that a whitish ring of softened epithelium 
forms round the foreign body, and in two or three 
days this loose tissue separates from the parts 
beneath, and the metallic particle is carried off in 
the slough. In this wry a superficial ulcer of the 
cornea is formed, bub toe breach of surface rarely 
causes any trouble, and is, in a remarkably short 
time, covered over by a new growth of epithelium. 

There is, however, no accident to the eye which is 
so trivial that it can be safely neglected or left to 
unskilled treatment. Whenever a foreign body is 
removed from the eye the patient expe iences an 
immediate sense of relief, and, as a rule, nothing 
more requires to be done 'han to bathe the conjunc¬ 
tival sac with boracic lotion, to apply cocaine oint¬ 
ment if the pain oontinuea, and to adjust a compress 
and bandage, with instructions that they must be 
worn until all si^s of irritation have disappeared. 
Lotions containing acetate of lead are deservedly 
popular in the treatment of conjunctival inflamma¬ 
tions, but they must never be ua^ when there is the 
slightest abrasion of the cornea, for under such cir¬ 
cumstances the acetate is decomposed, and a precipi¬ 
tate of white lead is deposits over the ulcer. 
Numerous instances might be cited of permanent 
damam to the eye following the use of a sugar of 
lead lotion. Quite recently I was consulted by a 
^ntleman over the surface of whose right cornea 

(a) A Poat-gradTUkts Lsotare d«livered iia the Qlaigow Ophthal* 
4nic Inetitntlra oo November Ifth, 1001, 


there was a white oloud, which seriously impaired 
its transparency, and dimmed the sight so fipreatly 
that fingers could not be counted when held more 
than tb^ or four feet away from the eye. The 
patient told me that three months previously, as be 
was entering a room in which he kept a pet canary, 
the bird flew to meet him, and accidentelly stmek 
bis right eye with its claw or beak. It is not certain 
whether the cornea was actually scratched at the 
time of the accident, but there was a minute 
cut at the margin of the upper lid, and an 
eyelash had been driven into the wound in 
such a way that with every act of winking 
it rubbed against the cornea. The irritation this 
induced occasioned intense suffering, and as the 
cause of it had been overlooked and only momentary 
relief was obtained from the use of the remedies pre¬ 
scribed, the geutleman, wbo was a pharmaceutical 
chemist, took the treatmeut of his case into his own 
hands, and sent to his shop for an ointo^pnt contain¬ 
ing carbolic acid, acetate of lead and cocaine. A 
more mischevioua combination oould hardly have 
been imagined, for no sooner was it applied to the 
eye than the sight, which had up to that nsoment 
b^n unaffected, suddenly became dim and the 
cornea was observed to have lost ita transparency 
owing to a deposit of white lead having taken place 
over its surface. As such an opacity is indelible, 
vision is permanently lost. What, in this case, had 
it been properly attended to, would have been a 
most trivial accident, terminated in serious disaster. 
The greatest ^nger to the eye, however, after 
an abrasiun of the cornea is the risk of 
infection of the wound. Micro-organisms, some of 
which may be pyogenic, are always lurking in the 
conjunctival sac, but as Ions the epithelium 
remains intact they do no narm. The corneal 
epithelium forms an insuperable barrier to the 
entrance of germs, but let it be abraded ever so 
little and at once micro-organisms find their way 
through the breach of surface and invade the tissues. 
This infection may occur at the time of the accident 
or may take place later from inoculation of the 
wound by secretion from the conjunctiva from 
diseased tear passages or from the nasal mucous 
membrane. In the presence of discharge from a 
blennorrboea of the lachrymal sac an abrasion of the 
cornea is almost certain to suppurate, and it U well 
known that to operate upon ^e cornea under such 
circumstances is simply to court defeat Naturally, 
suppuration is much more likely to occur 
in old and poorly - nourished subjects, or in 
those whose tissues have been rendered vulnerable 
as a result of alcoholic or other excesses; and in con¬ 
sidering the setiology of suppurative keratitis the 
predisposition of the patient must be taken into 
account equally with the infecting micro-organism. 
Unless that oe granted the explanation of those 
cases of suppuration which run a peculiarly fulmi- 

D?' ^^8 ^ 



650 Thb Mkdical Pbbbb. ORIGINAL COMUnN'iXjATIONS. Dsc. 18, idol. 

natiag course would be a matter of extreme difficulty, action is set up in blood-reesels at a considerable 
The folfewing is an example: J. Cl., st. 56, was play* distance from the original seat of infection. The 
ing with a cat when it accidentally inflict^ a slight process is analogous to that induoed by the diffusion 
scratch in the right cornea and the edge of the lower of a chemical poison, and as a result the circum- 
lid. Three days afterwards he was brought to the corneal vessels become dilated, and there is a rapid 
Ophthalmic Institution, and on admission it was migration of white blood corpuscles through tbeir 
found that the whole cornea had suppurated; there wa^. These leucocytes quickly force their way 
was pus in the anterior chamber, and ovnng to through the cornea to reach toe spot where the 
intense orbital cellulitis there was marked proptosis microbes are most actiye. The nearer they approach 
and ohemosis of the ocular conjunctiva, while the this, however, the more intense becomes the action 
skin over the eyelids, forehead, and cheek was so red of the toxins, and at length overpowered by the 
and inflamed as to raise the suspicion that poison many perish and form a purulent zone round 
the appearance might he due to erysipelas, about the ulcer, while those which survive 
Numerous pyogenic organisms were found in enter the microbio area to wage war against 
cultures taken from the cornea, but there can be tiie germs. According to this view the cornea 
no doubt that the peculiarly virulent course fol- is perfectly passive, and the leucocyte wander 
lowed in this case was largely determined by the through it at will, to overcome the action of the 
fact that the patient’s tissues had been rendered microbes, or to be themselves overcome and meet 
peculiarly vulnerable bv a lifetime’s indulgence to | tbeir death by poisoning in the neighbourhood of the 
excess in alcohol. In all cases where such rapid and infect^ area. But the cornea is not a passive agent 
complete suppuration of the cornea occurs, probably in this process; on the contrary, it is intensely active, 
the wisest treatment is to eviscerate at cnce, and so and its protoplasmic elements respond at once to the 
save the patient the severe and protracted suffering very slightest irritation. Throughout every {^rt of 
alwajs attendant unon an attack of panophthalmitis, the substance of the cornea are corpuscles, unit^ the 
Associated with toe presence of the pneumococcus one to the other bv thread-like prolongations, so 
is a form of ulceration of the cornea to which the ; that in its essence tne cornea may m regarded as a 
name seiriginous nicer has been given, Although sheet of protoplasm, and consequently one of the 
one of the most dangerous diseases of the eye it most vital structures in the body. Under ordinary 
usually follows a very trivial injury. A miner or a circumstances these corpuscles proliferate and 
stone-breaker gets his eye struck by a piece of coal multiply to provide for the growth and mmntenanoe 
or of stone, but so little does be think of it that he of the corneal tissue, so it is not surprising to find 
continues at his work ; a mother while nursing and that under the increased stimulation brought about 
playing with her child receives a tiny scratch in the by ^sease this physiological process becomes g e^y 
cornea from the infan'’s finger nail; an artisan, with exaggerated. No one has investigated this subject 
a fire in his eye, gets the corned epithelium abraded with greater care than Dr. Thomas Reid, and he has 
by the clumsy attempts of a companion to remove demonstrated that this process of proliferation of the 
the foreign BMy with the point of his pocket-knife, ^ed oomeal corpuscles begins almost from the very 
Such accidents, most trivim in themselves, and con- momentof the injury, and in a specimen be obt-unea 
sisting of nothing more than a breach of the comeal ennoltsated twenty-four hours after the ocourrenoe of 
epith^nm, may lead to most disastrous consequences an abrasion, this new development of protoplasm 
ii the wound becomes infected by the pneumococcus, extended throughout the entire thic-ness of 
This form of nlceration attacks adults for the most: the oomea, and even at this early period there were 
part, and as the virulence of the micro-organism signs of exudation in Descemeta membrane asso- 
seems to be favoured by hot weather, some of the dated with proliferation of its endothelial cells. Dr. 
very worst cases are seen among ^ricoltural Beid's microphotographs also demonstrate that at a 
labourers whose eyes have been injured in the later stage the protoplasm gets broken op and filled 
harvest field. The nicer is usually situated towards by round bodies which brar no resemblance to 
the centre of the cornea. It is somewhat cres- leucocytes on the one hand, or to the original nuclei 
oentio in shape, and while its floor shows only of the corneal corpuscles on the other. Whatever 
a shallow depression, rough and glistening, its they may be, they seem to be the result of an expiring 
maigins are opaque, raised, undermined and sup- effort on the part of the protoplasm to restore tn- 
purating. One of the most striking character- jured tissue before the corpuscles become completely 
istics of this ulcer, and that from which it destroyed. It appears probable therefore tha^ coin- 
derives its name, is the tendency it has to creep over cident with the migration of leucocytes, there is also 
the surface of the oomea, but while progressive in proliferation of the fixed oomeal oorpu-cles, the one 
one direction it usually trads to cicatrise along the to protect the oomea from the invasion of the 
opposite border, although in Pome cases it spreads microbes, the other to repair the structural dam^;o 
with such intense rapidity that the whole cornea which the micro-organisms have induced, 
may be eaten away in a few days. Its peculiarly The irritant action of the toxins extends deeply 
infective nature may be early diagnosed by its ex- as well as superficially, so in addition to the changes 
treme painfulness, by the occurrence of deposits iu already described as occurring in the circumcomeal 
Desoemet’s membrane, and by the formation of pus vessels, those of the iris and ciliary body are impU- 
in the most dependent parts of the aqueous chamber, cated ve^ early in the course of a serpiginous ulcer, 
while corresponding with these there are always It is this action of the toxins upon the highly 
more or less intolerance of light, injection of tne vascular uveal tract that in great part determines 
conjunctival and ciliary blood vessels, and swelling the occurrence of hypopyon. Formerly it was 
of me lids. The early involvement of the deeper believed the pus in the anterior chamber came direct 
parts of the oomea leads to inflammation of the iris, from the ulcer through a perforation iu Desoemet’s 
and with the occurrence of iritis there is always an membranes, but that at least is not a full explana- 
increase in tbe hypopyon. tion, because in some instances pus can actually bo 

The researches of Leber have thrown considerable seen rising up from behind the iris and entering tho 
light upon the pathology of serpiginous ulcer. As a aqueous thronuh the pupil. Sforeover, if in all cases 
result of experiment be has shown that when there was direct communication between the uloer 
the cornea is inoculated with micro-organisms and the hypopyon, one would exp-ct to find in the 
tiie toxins they manufacture ue speedily carried by latter micro-oiganisms similar m kind to those 
diffusion to the surrounding parts, and an irritant present in the former. Such, however, ia 

e 


o 




Dm. 18, 1901. 


ORIGINAL COMMUNICATIONS. Tn Mmioal Paibs. ^51 


rarely the case, for if in tbe earl^ stages 
the pas in the anterior chamber be examined bl^ 
teriologic^y, no microK>rganism8 are found, and 
such a negatire resalt can only point to the ooncla* 
sion that hypopyon is dae, in its beginning at least, 
to tbe irritant action of toxins rather than to the 
presence of the micro-oi^nisms themseWes. In 
many cases, also, and especially daring the early 
periods of the disease, the pas in the anterior cbam* 
Mr is intimately mixed with fibrinoas exudation 
which can be derived only fiom the blood-vessels of 
the iris and ciliary body. Clinical experience also 
lends support to this view of tbe case. In hypopyon 
ulcer, where the exudation into the anterior cnamber 
is so plastic that it does not flow out after paraoen* 
tesis but requires to be removed by forceps from the 
lips of the wound in the com^ the promosis is 
usually more favourable than it is when the pus is 
quite fluid, varying in amount from day to day, and 
emptying it»^ completely after an opening has been 
made into the aqueous-chamber. I have never been 
able to ^monstrete it, but I think it is very probable 
that in ^e latter oases a rapture has taken place in 
Desoemet^s membrane, whereby the microH>rganismB 
have gained entrance to the interior of tbe eye, and 
have inoculated the hypopyon, which tb^ have 
liquefied by their action upon the fibrin inten^gled 
vntb tbe pus cells. 

If left to itself, serpiginous ulcer from its very 
nature progresses ^eaduy until at length the cornea 
pves way, and in the most virulent cases tbe micro¬ 
organisms finding a soil suitable for their propaga¬ 
tion in tbe uve^ tract and the vitreous speedily set 
up such intense inflammation that every tissue in the 
eye-ball is involved. Happily, however, pan-ophthal¬ 
mitis is now-a-days not a common sequel to hypopyon 
ulcer, for in many cases perforation of the 
cornea is the turning point in tbe course 
of the disease, and recovery may be said 
to begin from tbe time of its occurrence. The pro¬ 
gnosis of serpiginous ulcer is, however, always serious, 
for even where early perforation brings with it arrest 
of suppuration before the cornea has been exten¬ 
sively destroys^ a dense white scar remai^ and as 
this 18 usually situated in front of the pupil, sight is 
seriouslv impaired, and can only be impeneotly 
restored by operation. There is, moreover, another 
source of anxiety. If pyc^nic micro-organisms 
gain admission to the eyeball their presence causes 
d^ger not only to the eye primarily attacked, but 
also to its fellow, which, from the intimate and 
peculiar nervous and vascular connection existing 
Mtween the two eyes, is liable to suffer from S 3 rmpa- 
t-hetio ophthalmitis. Whenever, therefore, the cornea 
has been destroyed so completely as to preclude all 
hope of restoring sight the wisest treatment is to 
enncleate with as little delay as possible. 

The most important indications for the treatment 
of serpiginous ulcer are to keep tbe eye at rest, to 
protect it from further injury, and to relieve pain. 
The patient ought to be kept in bed and all bright 
light excluded from the room, and the eyelids should 
be closed by a handle, which keeps the part at rest, 
and so promotes healing. In order that tne bandage 
may lie smoothly, and not exert unequal pressure, 
the hollows at tbe inner canthus and beneath the 
orbital margin should be filled up carefully with 
cotton wooL This ought never to be negle^d; a 
bandage carelessly applied is worse thim useless. 
When there is discharge from the lachrymal sac 
means must be taken not only to arrest it, but also 
to keep the tear-passages clear. As iritis is a con¬ 
stant complication in serpiginous ulcer atropine 
must be instilled from the very outset; locally, it 
soothes the nerves and diminishes vascular con¬ 
gestion, whUe by dilating the pupil and paralysing 


the ciliary muscle it ensures physiological rest for 
the eye. Tbe effect of atropine upon the pupil 
is one of tbe safest guides in prc^osis, for the 
more quickly the iris responds to the influence of 
the mydriatic, the more favourable will be the 
course of the disease. When pain is acute and 
there is much congestion of ^e iris the good effect 
of ^e atropine is greatly increased by the applica- 
cation of leeches. In the early stages, free blee^g 
from the temple ^ways does good, at least for the 
time being, and in many cases brings a^uta favour¬ 
able turn in the coarse of the disease. Three to six 
leeches may be ^plied round the outer canthus, a 
Henrteloup’s artincial leech can he employed. In 
either case, free bleeding from tbe wounds should be 
encoura^^. It often ^ppens that after leeching 
tbe pupil begms to dilate, although before the blood- 
lettmg it had remuned persistently contracted. The 
atropine, in a 1 to 2 pw cent, solution, should be in¬ 
stilled three or four times a day, but it must not be 
forgotten that this drug acts on some persons as an ir> 
ritwt, producing redness and swelling of the eyelids, 
accompanied by an eczematous eruption of the skin in 
tbe neighbourhood of the eye, and at tbe same time, 
Mpecia^ the old and feeble, it may cause acute deli¬ 
rium. ^ Such instances, however, are nothing more 
than idioBraorasies of which it is necessary to 
aware, so that when they do occur the atropine may 
at once be stopped ana another mydriatic substi¬ 
tuted. When the ulcer is about to perforate, the 
use of eMrine is preferable to that of atropine, but 
with this exception, the former drug has, in ser¬ 
piginous ulcer, a very limited sphere of usefulness, 
and almost invariably it is the latter which should 
be employed To avoid acmdents, however, care 
ought to be taken to guard against any of the solu¬ 
tion finding its way into tbe mouth, and while it is 
being instilled the lid should be drawn well away 
from the eyeball, and pressure applied over the 
inner canthus to prevent absorption by tbe tear 
passu^. Moreover, when the patient is to use the 
drug himself it is safer to prescnbe it the form of an 
ointment or of tabellm, rather than of a li<|uid. 

The liquid extract of belladonna applied to the 
brow will sometimes cause the pupil to dilate what 
instillations of atropine have fallea. When the irri¬ 
tation is very severe, and there is much pericorneal 
congestion, great bmefit is obtained from the appli¬ 
cation of fomentations. Moist heat, by diminisoing 
tbe engorged state of the blood vessels and thereby 
reducing intra-ocular tension, speedily relieves pain, 
but just as with bandages a fomentation to be 
effective must be properly applied, and it must be 
repeated every two or th>ee hours. It may be made 
more soothing by the addition of Battleya sedative 
solution of opium, or by an infusion of chamomile 
flowers. 

If, however, in spite of the above treatment the 
ulcer continues to progress, a knowledge of its 
pathology affords the clue to its farther t^tment. 
Disinfectants must be applied to its surface. The 
eye should be freely irrigate by a hot saturated solu¬ 
tion of boracio acid until all discharge has been 
washed away and tbe floor of tbe ulcer made as clean 
as possible ; then a powder composed of equal parts 
of iodoform and boracic acid very finely triturated 
ought to be dusted freely over its surmoe. Many 
other disinfectants have been recommended, the most 
satisfactory being a collyrium of chinosol, 1 in 
4,000, and protargol in a 5 per cent, solution. Some 
advocate the use of suboonjunotival injections of solu¬ 
tions of mercurial salts, but my own experience of 
tlfis form of treatment of serpiginous ulcer is not 
such as to warrant one in expressing a strong opinion 
in its favour. 

In addition to these local means, general oonstitn- 


652 Thi IfcDioAii Pbiss. ORIGIM^AL COMMUNICATIONS. Dsc. 18, 1001 . 


tional' treatmeni ia always reqoired. The patient 
mnat be well fed, and, if old and ^<^klj, a small 
quantity^ of alcohol should be given with meale, malt 
uquors, if they do not disturb digestion, being pre¬ 
ferable to any other form of stimol^t. The drugs 
most to be relied upon are quinine in full doses, and 
opium, administered by the month or morphia by 
hypodermio injection. 

If, in spite of the above means of treatment, the 
ulcer continued to spread there was till a recent 
period nothing further for the surgeon to do except 
to stand by and watch the disease pursue its disas¬ 
trous progress. Saemisch, of Bonn, was the first to 
alter tnis condition of things by advocating a bold 
indsion of the cornea through the ulcer, both the 
puncture and the counter-puncture being made in 
sound tissue. He treated the eye just as a general 
surgeon would treat an abscess, and the free incision 
allowed not only the escape of the hypopyon, but also 

E irmitted the drainage of pus held witbm the comeal 
mel^. The wound should be kept open for several 
days to allow free drmnage. The treatment of hypo¬ 
pyon ulcer, however, is not a parallel to the problem 
presented to the surgeon in an ordinary abs<^s, and 
Saemisch’s incision has the obvious disadvantage of 
allowing the iris to become extensively adherent to 
the wound in the cornea. Nevertheless the method 
which h e introduced has saved eight to many eyes 
which would under former conditions have become 
wholly blind. Since the introduction of the cautery, 
however, Saemisch’sincision is only applicable to cases 
where the ulceration is very extensive, and where per¬ 
foration of the cornea appears imminent. Whenever, 
after twenty-four hours of medical treatm^ nt, the ulcer 
shows no signs of improvement the cautery should 
be applied without delay. Under such circumstances 
^e only hope of arresting the disease lies in the 
^struction of the infiltrate spreading edge of the 
ulcer. To be of any service, however, the cautery 
must be applied thoroughly, and as the infection of 
the cornea extends beyond the apparent margin, no 
operation should be attempted imtil the boundaries 
are demarcated by instilling an alkaline solution of 
flnorescine. This drug maps out the area of the 
ulcer by a bright green lino, which serves as a guide 
in the application of the cautery. A fine platinum 
wire heated to a dull red heat ought then to be 
applied to the cornea just outside of this green line, 
and the burning continued until every pait of the 
in^trated margin is thoroughly destroyed. As the 
h walin g of the mcer will be greatly promoted by the 
reduction of the intraocular tension, the cornea 
should be incised at its lower aspect, and the 
anterior chamber emptied slowly. The evacuation 
of the aqueous and the hypopyon may 1 m followed 
by h»morrrhago from the iris, and is always 
attended by severe pmn, owing to the forward dis- 

E lacement of the inflamed iris and ciliary bo<^. If, 
owever, a fomentation be at once applied to the eye, 
and one-sixth of a grain of moi^bia iojected tmder 
the skin of the temple the patient's sufferings are 
mitigated so much that in a short time he falls 
asleep for the first time perhaps since the onset of 
the disease. If the cauterisation has been properly 
performed the ulcer rapidly begins to heal, and 
unless any fresh inoculation occur the progress of 
the case will be uninterrupted until cicatrisation is 
complete, the resultant scarring being usually much 
less than would have been anticmated from the 
extent and virulence of the ulcer. Irresh infection of 
the ulcer is always accompanied by recurrence of 
pain, and is in most instances due to carelessness on 
the part of the patient. 

The practical lesson to be learnt from all this is 
that as it is infection rather than traumatism that 
brings about serious injury to the cornea, proper 


precautions and early attention to all trivial injuries 
will prevent the occurrence of suppurative keratitis, 
but if perehance inoculation has occurred and 
ulceration is progressive, early and thorough appli¬ 
cation of the caute^ is likely to cause its anesit. 
In the treatment of serpiginous ulcer, once so for¬ 
midable and intractable, modem ophthalmology has 
obtained one of its most brilliant sucoessee. 


SOME CLINICAL OBSERVATIONS 

Oir THE 

TEMPERATURE OF PHTHISIS 
TREATED BY 
OPEN-AIR METHODS, (a) 

By Db. DAVID LAWSON, 

Senior Physieian, Nordncb.on-I>eo Sazkatorinm. 

Ths speaker first described a new graphic method 
of showing the temperature so as to give a more 
distinct idea of the course of the case than that 
generally employed does. The temperature is taken 
four-hourly, and the highest and lowest readings of 
each series of four days are averaged, and markM on 
a chart, each space of which, therefore, represente a 

E eriod of ninety-six hours. The space between the 
igbest and lowest curves on the chart so obtained 
is blackened in, and the irregular band of ink thus 
got gives a better idea of the course of the case than 
the usual temperature curve. On the same chart the 
amount of sputum and the body-weight are graphi¬ 
cally represented. In the case of an active lesion 
undergomg arrest the black band is at first broad 
and, especially on its upper margin, irregular; as 
improvement takes place, the breadth of the band 
diminishes, showing less diurnal variation in the 
temperature, and the band as a whole falls. With 
this character of the temperature the weight curve 
rises and the sputum curve falls. It ia of coarse, 
necessary to consider all these factors in estimating 
the progress of a case, and charts were shown illus¬ 
trating a steady rise of body weight, combined with 
a broadening and rising tempeiature band in a fatal 
case, as well as one showing a gain in weight plus a 
falling temperature in a case which was not pro¬ 
gressing favourably. The two features of the tem¬ 
perature of phthisis were its “ inelasticity,*' shown 
m the resistance with which it remained high under 
circumstances in which, in a normal subject, it would 
have fallen to normal, and its *' instability " as shown 
in the excessive daily range, and in the ease with 
which it rose on trivial provocation. Charts were 
shown illustrating such points as the rise fol¬ 
lowing on slight excitement after an unex¬ 
pected visit from a friend, that following gastric 
disturbance, Ac. Dr. Lawson had noticed that 
during some of the very hot days l8«t summer, rises 
of temperature were found in nearly all the patients 
in the Nordrach on-Dee Sanatorium. After care¬ 
fully excluding other causes, he concluded that these 
rises must depend on the external temperature—an 
example of the “ inelasticity '* of the temperature of 
phthisis. He put forward a strong plea for the 
rectal method of taking temperatures, claiming for 
it not only greater accuracy, but also that it gave 
indications of a rise twelve hours before such could 
be detected in the axilla or mouth. The mouth 
temperature was easily affected by the swallowing of 
hot fluids or ice before the thermometer was inserted, 
and observations on this point were related. When 
the advantages of the rectal method were frankly 
l(ud before the patient he had never found that 

(<0 Abstimctof Pspsr read before the Sdinbor^h Uedico-Chirnixi* 
oa! Society. 


v.jOo>-le 

O 


OBIGINAL COMMTJNICATIONS. 


Thx Mbdical PbB88. 653 


Die. 18, 1901. 

serious objectios was raised. Attention was then 
drawn to some of the common errors of dia^osis 
dae to faulty temperatare records, which were liable 
to occur when only the morning and evening readings 
were noted, as was often the case in private practice, 
and, in particular, the speaker remarked on the com¬ 
parative frequency of the mouse type, which was 
^ble to escape notice unless the thermometer was 
used during the night. Numerous charts of miliary 
tuberculosis, typhoid, and phthisis were shown and 
their bearing on diagnosis discussed. Dr. Lawson 
then described some of his observations on tbe effects 
•of exercise on the tuberculous and healthy subject. 
It was often one of the most difficult things to settle, 
as well as one of the most important, at what point 
in the open-air treatment exercise should commence. 
The dictum bad been laid down that absolute quiet 
should be enforced so lo^ as the temperature at 
•eight a.m. was above 98‘6 Fahrenheit. Dr. Lawson 
had not found this rule by any means absolute, and 
preferred to take as a guide tbe course of 
the temperature after exercise. In a healthy 
subject the result of active exercise was to raise the 
temperature one or two degrees, but after tbe effort 
was over the temperature fell in less than a quarter 
of an hour to normal In tuberculous persons, on 
the contrary, not only did much less exercise suffice 
to raise the temperature, but the fall to normal was 
much more gradual, requiring sometimes an hour or 
more. His rule was to send the patient out for a-walk 
in the forenoon, returning at twelve o'clock. The 
temperature was taken then, and unless it was normal 
at one o'clock, after an hour’s rest, the amount done 
must be restricted, or a further period of complete 
rest enjoined. In other wajs tbe practical value of 
the temperature records as guides to treatment was 
very great, and charts were shown illustrating this. 
The possibility of complications must always be 
borne in mind, and he claimed for the rectal method 
of taking temperatures that it gave earlier and more 
■certain indications of slight disturbances, and there¬ 
fore gave one a better ol^oe of treating and cutting 
short these. He regarded the presence of the diazo- 
reaction as very unfavourable; three out of four cases 
in which it was prescribed had died, and the fourth 
was going downhill steadily. 


SUPRA-PUBIC PROSTATEC¬ 
TOMY. (a) 

By DAVID WALLACE, F.R.C.S.Ed., 

Amriafamf Barveon, Edinbn^h Bojal In&rmtry. 

The mtiology of prostatic enlargement, the author 
■observed, was as yet obscure; neither age alone, nor 
the more recently advanced view that it was caused 
by arterio-sclerosis could explain it, and one was 
rather driven to the idea that it might have analogies 
with fibroid tumour of tbe uterus. It was found in 
three chief varieties:—(1) Vascular or erectile 5 (2) 
fibrotic, usually quite small; (3) fibro-adenomatous, 
•or actual tumour growth in the gland. The four 
methods of treatment chiefly in vogue were (1) 
catheter life; (2) cystotomy, perineal or supra¬ 
pubic; (3) castration or vasectomy; (4) prostatec¬ 
tomy, perineal or supra-pubic. In eany cases, 
before there was atony of the bladder, and where no 
-complications had arisen, he advised the initiation of 
catheter life, and if difficulty in catheterisation in¬ 
creased, or if cystitis developed, castration or vasec¬ 
tomy might be employed. These operations 
bad met with considerable success, and statis¬ 
tics were read showing their low mortality. 
Criticising these, Mr. Wallace said that every 

(a) Abstrset of paper read before Edinbuzx^ Medico-Chirursical 
■Socletj, 


fatal case where death could be ascribed to anything 
else than operation had been excluded, and 
hence, practically, the mortality was higher than 
appeared from them. Tbe operation was quite as 
severe as cystotomy, and it bad this disadvantage, 
that if tbe diagnosis was incorrect, e.g., if there 
should be unsuspected malignant disease of the 
prostate, it was ^uite useless. “Prostatism,” as tbe 
French called it, was a collection of symptoms 
which might be doe to hypertrophy of the organ, or 
to septic mischief apart from this. The differential 
diagnosis was often impossible. Rectal examination 
alone was not sufficient to enable one to decide 
which was present; measurement of tbe length of the 
urethra was a help, but not an absolutely trustworthy 
one, while cystoscopy was not always practicable. 
He entered a plea for cystotomy in such cases; if the 
condition proved to M due to sepsis without en¬ 
larged prostate it was the operation of election, 
while castration, naturally, was useless. Tne ques¬ 
tion then came to be whether supra-pubic or perineal 
cystotomy should be done. He strongly urged tbe 
former. Drainage could be as well carried out in this 
method if Cathey’s modification of Sprengel’s pump 
was used, as in the low operation. Then it hfM the 
great advantage that the prostate could be examined 
and dealt with—either divided or removed—as cir¬ 
cumstances might requii'e. The objections alleged 
were tbe greater dangers of supra-pubic cystotomy, 
pre-vesical cellulitis, and the like, but with ordinary 
care these should not occur. He did not think that 
the risks of cystotomy were increased when prosta¬ 
tectomy was done. In forty cases of cystotomy he 
had had four deaths 112*5 per cent.) only one of 
which was a case in which prostatectomy had been 
carried out. The fatal cases were as follows:—(1) 
Palliative cystotomy for vesical cancer; (2) two 
palliative cystotomies for tuberculous cystitis; (3) 
septic cystitis, with stricture, for which repeated 
operations had been performed, and an abscess had 
formed outside the bladder; (4) prostatectomy. He 
thought that prostatectomy was specially indicated in 
fibro-adenomatous enlai^ment where masses of 
glandular tissue could be enucleated. Sepsis was no 
contra-indication; in ten out of his eleven cases 
there had been cystitis. The operation should 
be done at one time, not in two stages, because 
the bladder contracted after it was drained, 
and there was much greater difficulty in removing 
the prostate at a second operation. Hsemorrhage 
was not great, and the risk of permanent fistula was 
negligible, because if once the urine could escape 
by a natural passage it would do so in preference to 
draining through the wound. The bladder should be 
drained for from one to ten days, according to tbe 
condition of the patient, provided it had remained 
contractile; if there was atony from three to four 
weeks was required. Mr. 'W’alutce had removed the 
prostate in eleven patients, whose ages varied from 
fifty-four to seventy-four years. In five there was 
enl^gement of tbe middle lobe, in three of the 
lateral lobes, while hypertrophy of both middle and 
latei'al lobes, circular hypertrophy round the orifice 
of the urethra, an enlargement of tbe left lobe was 
each met with once. Five of these patients were 
cured, three markedly improved, one temporarily 
improved, in one it was too early to say how long the 
improvement would last, while one case (that referred 
to above^ died. 


Accidental Death of a Cardiff Practitioner. 

An inquest was held last week on tbe body of Edward 
Christian Hodgson, practising at Cardiff, who was found 
insensible in an area in Paddington, and subsequently 
died at St. Mary’s Hospital from tbeeffeotsof a rac- 
tured skull. There was no evidence to show bow he came 
there, and a verdict of accidental death was returned. 

C D 



654 Thi Mipicai. Pbbs b. _ CLINICAL 

MODERN METBODS OP VACCINATION 

A.ND tHBIS 

SCIENTIFIC BASIS, (a) 

Bt MONCKTON COPEMAN, M.D., F.R.O.P., 

lectarar oo Public Baaltb, Westmlnktcr BotpiUI, Ac. 

Aptsb Iriefly recapitulatingthe Listory of the in- 
troiluction of vaccmation and the various Acs of 
Parliament regulating its application, Dr. Copeman 
mentioned that bis attention bad early been directed 
to the prevention of erysipelas as an accidental com¬ 
plication of vaccination by an unfortunate epidemic 
at Norwich, which suggested to him the desirability 
of substituting serum preparations of calf lymph for 
the prevailing arm-to-arm method. AUudmg to the 
common belief that calf lymph produced worse arms 
than the method of arm-to-arm vaccination, he ob¬ 
served that, as a matter of fact, culture plates inocu- 
cnlated from calf lymph showed a greater number 
of CO omes of micro-organisms than when 
inoculated from lymph taken from the human 
arm. This, he bad no doubt, was due to the greater 
difficulty in cleansing the skin of the calf as com¬ 
pared with that of a child. The opacity which 
occurred in stored lymph was due to the increase in 
the number of bacteria in the tube. He bad been 
able to obtain inhibition of the growth of these 
organisms by mixing the lymph with 50 per cent, of 
pure glycerine in water, and further, he had been 
able to show by a series of plate cultivations that the 
number of bacteria steadily diminished, so that at 
the end of one month after the admixture no organ¬ 
isms were present on the culture medium. Not on'y 
did this method kill off all the usual contamination 
bacteria but it would also destroy those of tubercle 
and erysipelas, when these were added experi¬ 
mentally, in comparatively large quantities. Dr. 
Copeman then dealt with the preparation of the 
lymph under the following beads. 1. Vaccination of 
(he calf. —Suitable animals had to be selected, from 
three to six months old; they were placed in the 
quarantine stable for a week, their general health 
was ascertained, and they were weighed and 
tbeir temperatures were noted. The lower part 
of the abdomen was shaved, and after cleansing 
was inoculated with glycerinated calf lymph 
by numerous parallel linear incisions. 2, Couection 
of the vaccine material.—This was taken 120 hours 
after inoculation. The vesicles and their contents 
were collected with a sterilised Yolkmann's spoon, 
and in this way the vesicular pulp was removed with¬ 
out admixture with blood. Tbe aniinal was then 
slaughtered and was examined by a veterinary sur¬ 
geon and the lymph was not used until tbe animal 
in question had been certified to have been healthy. 
3. Ulycerination of the vaccine material.— lymph 
pulp was tritunited and mixed with six times its 
weight of a sterilised mixture of 50 per cent, pure 
glycerine in distilled water. 4. Storage of emuleion. 
—The emulsion was then placed in small test-tubes 
and put into an ice-chest, and week by week ag^-agar ! 
plates were established from tbe emulsion with the ' 
result that tbe number of colonies was shown to 
diminish successively. At the end of a month the 
plate rarely showed any colonies. 5. Use of the 
lymph at tke animal vaccine eatahliehment prior to 
aietribuiion. —Samples of tbe lymph were taken and 
children were vaccmated. The results of these vac¬ 
cinations were recorded, and from the number and 
size of the vesicles an estimate was made as to 
the potency of the lymph. 6. Traneference of the 
glycerinated lymph toeapillary tubes for distrihvUion, 

(al ateUaet of poper md before Ihe Ronl Medioel end ChtnirKleal 
Soeietjr, December 10th, 1001. 


EECOBDS. _ Dec. 18 , i901. 

—Tbe lymph was transferred to capillary tubes and 
sMled and stored in ice-cbests re^y for distribu¬ 
tion. 7. Recording ihe resu Us of vaccinalion by 
public vaccinators. —Each public vaccinator had to 
record tbe number of the tube used, the number of 
persons vaccinated, tbe number of scarifications 
made, and tbe number of vesicles obtwned. Tbe 
success attending the use of ib is lymph in tbe first- 
year showed a case success of 93 per cent, and an 
insertion success of 83 per cent., and at the present 
time it was no unusual experience for returns to 
show complete case and in ertion suixiesses. Dr. 
Copeman then dealt with the regulation as to the 
mode of vaccination, with tbe question as to what 
constituted efficient vaccination, and with tbe after- 
treatment of tbe arm. He said that he had removed 
the glycerine from tbe lymph in order that tbe 
lymph mi^bt dry more rapidly on the arm, but he 
did not think that the results were worth the trouble 
involved in the preparation of such lymph. There 
were fifty-nine deatns in which vaccination was men¬ 
tioned as a cause, or one of the causes, in the certi¬ 
ficate, in tbe year 1893, rather more than one a week, 
whilst in tbe year 1899 in only 25 deaths was vaccina¬ 
tion incriminated. He then dealt with tbe relation 
of vaccinia to small-pox and stated bis belief 
that the former was an attenuated form of 
the latter, and in support of this statement be 
quoted the following experiments. He said that 
it was well known that a calf cou'd seldom be 
inoculated directly from a case of even confluent 
small-pox in tbe human subject, but that if in the 
first place a monkey were inoculated with lymph 
from such a case good vesicles develops. If lymph 
was taken from these vesiedes and a calf was inocu¬ 
lated poor vesicles were produced; if a second calf 
was then inoculated from the first a good crop of 
vesicles was produced; and then if a child was 
inoculated vrith lymph ^m this calf a typical 
vaccinia was produoea A second series of esperi- 
ments in which tbe lymph from a case of confluent 
small-pox was passed through two monkefs in suc¬ 
cession and then through two calves before the child 
was vaccinated gave similar results to the experi¬ 
ments above described. Such evidence seemed 
strongly to support the view that vaccinia was an 
attenuated form of small-pox. He thought the 
evidence went to show that though ordinary, even 
severe, small-pox was with difficulty inoculate in 
tbe calf, the inoculated variety of small-pox, ».e., 
that which was produced when the inoculation of 
small-pox virus was the recognised means of obtain¬ 
ing immunity, might be transmitted to animals and 
thus produce tbe disease in the calf from which 
vaccine was derived. 


(Eliniral JIleairbB. 

TWO CASES OF CONGENITAL ELEVATION OP 
THE SCAPULA, (a) 

Bt Mb. Bobxbt Jomxs, F B.C.S., £n.. 

Honorary Surgeon, Boyal Southern HoepiUl, Lirerpool, Ac. 

The condition was first described by Sprengel in 
1890, and is known as “Sprengel’s deformity.” It 
consists of an elevation of the soapnla above the 
level of its fellow, accompanied by rotation, ap¬ 
proximating the lower angle to tbe middle line^ with 
limitation of scapular and humeral motion and 
sometimes with a slight curvature of tbe spine. The 
etiology of the affection is doubtful, but the probability 
is in favour of constrained foetal position. 

Cask I.—A 1x>y, et 6. The deformity was noticed 
when he was vaccinated at thr*e months old. The 

(a) Notes of OMes sow before the Lirerpool Medkul Institution, 


3 ),c. 18, 1901 . _ TBAKSAOTTONS 

child ia weird-loolnng', walks with a stoop, and oarries 
his head slightly bent to the left side. The left 
shonldi-r is raised two inches above the right. The dis¬ 
tance of the inferior angle of the scapnla to tiie spinous 
process of the ver^bra is It ins., on the right side 
Ins. The left superior angle | of an inch from the spine, 
the right 2 ins. The scapnla is therefore rotated. The 
length of the posterior border of the left scapnla 4 ina, 
right 6. From left acromion to epistemal notch 8|, 
right 4 ins. The arms are of rqnal length. The dorsal 
spine is slightly corred, the oonvezity {Minting back* 
wards. There in a marked limitation in the movement 
of the scapula. Rotation of the arm is normal. 
Abduction and addnetion are limited. The trapezius 
muscle is oontiacted and tight. Ko exostoses canbefelt, 
and no articulation with rib or spinous process. 

Cask II.—a girl, set. 7. The left scapula is displaced 
tmwards, its lower angle touches the mtb rib, whereas 
the right touches the seventh rib. The movements of 
the shoulder are limited, so that the arm only comes up 
to a right angle without movement of the scapula; she 
cannot place the band at the back of the neck. The 
right scapnla, as shown by the radiograph, is normal in 
site and structure. The left, or displao^ bone, has the 
axillary border shorter and more curved than that on the 
opposite side. Ifae posterior border consists of an upper 
portion with which the extraneous portion of bone 
articulates, and a lower portion which is nearly straight. 
At the jnnotion of these two {Mrtions there is a distinct 
projecting angle. The abnormal portion of bone is 
triangular, its outer border articulating with the upper 
portion of the posterior border of the scapula, and its 
inner angle with a spinous process of the cervical verte¬ 
bra. The extraneous portion of bone was removed in 
order to increase the range of scapular movement, and 
proved sncoessfnl. Examined three years later, the 
patient hss much improved, mid stands with shoulders 
square. There is a projection of the upper and inner 
angle of the scapula, and this still blocks somewhat the 
movement of placing the hand behind the back of 
the neck. The deformity was noticed a month after 
birth. 

A CASE OF CONGENITAL DISLOCATION OP 
THE SHOULDER. 

Cases of this kind may be grouped into those due to 
faulty development and those due to injury during 
birth. 

The patient, set. 9, showed the head of the humerus 
displaced backwards under the acromion and rotated 
inwards, so teat the rounded portion was felt^teriorly. 
On pressing in front the inner margin of tee glenoid 
cavity is felt. The condyles of the humerus point 
ante^posteriorly as the arm falls to the side. Measure¬ 
ments :—Length of post, border of left scapula, 6 ins.; 
ditto of right, 4} ios. From angle of scapula to left 
acromion, 6 ins. \ ditto of right. ins. Post border of 
left scapula, 5^ ins.} ditto right, ins. The arm 
measurement from apex of right acromion to ext. condyle, 
7f ins.; ditto from left acromion, 9 ins. 

There is an elevation of scapula, and on fixing it, the 
humerus can be slightly abducted but not adducted. 
The range of scapular movement is increased, so that in 
spite of humeral fixation the boy can place his hand 
behind his head and behind bis back. Radiograph shows 
the glenoid thickened, not due to exostosis but to the 
new socket formed on its posterior aspect. The head of 
the humerus smaller than its fellow, the shaft attenu¬ 
ated. Mr. Jones classes the case among the co-natal 
traumatic displacements, and as to treatment, trusts to 
stretching exercises. 


Mb. O. Kbllin has offered to place at the dis¬ 
posal of the Prince of Wales’s Hospital Fund for 
London a quantity of '‘Hellin’s Food’’ equivalent 
in value to £10,000, to be distributed among Ijondon 
hospitals at the rate of £2,500 worth per annum. 
The offer has been gladly accepted. 


OF SOOIBTJES. Thb Mxdical Pbxss. 655 


^ranjBRrtionB uf 

CLINICAL SOCIETY OP LONDON. 
Mxxtino hxlh FamAT, Die. IStb, 1901. 

Mb. Howard Mabsh, F.B.C.S., President, in the 
Chair. 


Da. S. H. Habxbshon on 

THB ASSOCIATION OV HOVABLl KIDNXT ON THB BIOHT 
Sina WITH STHFTOIfS or HEPATIC DISTUBBAHCB. 

In introducing the subject of his paper Dr. Habershon 
defined the term hepatic diathesis, and instanoed three 
classes of patients in whom functional hepatic symptoms 
were liable to be set up, viz, those of definite biliary 
snsoeptibili^, the cases in whom biliousness was in¬ 
duced by oircumstanoes well within their control, and a 
third olm in whom the hepatic symptoms depended on 
a ptosis of kidney or liver. The object of the paper 
was to emphasise tee medical aspect of the con¬ 
dition known as movable kidney, and to describe certain 
groups of biliary symptoms which were prominent. 
1 be oases of movable kidney ocourred obiefly in women,, 
and atatistios were given from tee writings of Gl^nard, 
Landau, Maibieu, and others to show that from 20 te 
28 per cent, of all dyspeptic women possessed a mov¬ 
able kidney. The causes, diagnosis, and symptoms were 
then narrated, and among the difficulties that ocourred 
in the recognition of the condition, tee variability of 
position, the simulation of an enlarg^ gall bladder, of 
Riedel's lobe (of the floating lobe) of the liver, and of 
oertaia renal and appendicular conditions were cited. 
Tbe mortality occurred in an enormous proportion of 
tee cases on the right side. The symptoms of movable 
kidney weie tuijeriiv« and vUctral. Among the latter 
class the left kidney was more prone to prodnoe 
gastric than hepatic symptoms. Hepatio conditions 
occurred in oases of movable kidney of tee right side. 
They were defined in three gronps:— general 
tgmptomt of severe attacke of eohe simulat¬ 

ing true btlia^ colic from tlie passage of gall stones, 
and probably identical with DieWB crises, (c) attacks of 
jaundice, three oases reported by MaoGlagan being 
quoted. Tbe cause of these hepatic disturMnoes waa 
next discussed, and of tbe three possible oaoses, due to 
pressure on the duodenum or common bile duct, traetiom 
00 tee middle portion of the dnodeanm, and refiex irrita- 
Uon of tee pnenm<^a8tric nerve, steess was laid on tee 
latter two. The author divided cases of hepatio 
symptoms into three classes from the point of view of 
teeir symptomatology. 1. Cases of nnoomplioated ptoeis 
of right kidney. 2. Cases in which the renal oonmtiOB 
was accompanied by a ooinmdent ptosis of liver. 8. 
Cases in which the renal ptosis was part of a general 
enteroptosis. In the slighter d^rees of ptosis of right 
kidney the hepatic symptoms were often paramonnt> 
and the following classes of symptoms should lead to 
the suspicion of movable kidney. First tbe tafroc^- 
of the hepatio condition which did not yield to 
ordinary method of treatment. Secondly, the fact 
teat tbe synptoms were produced or aggravated 
shaking or exertion in any form, this being entirely 
contrary to tbe experience with regard to an ordinary 
biliousness, not due to ptosis of kidney. Eight oases 
were reported to illustrate the various forms of hepatio 
symptoms, and the relief afforded by replacing tea 
kidney in position. 

Mr. Lucas said be did not peroeive anything peculiar 
in the symptoms to which the author fa^ called atten¬ 
tion. He had remarked teem in quite a number of 
cases and he referred to one case in particular, that of 
a trmned athlete, who suffered from very severe sym¬ 
ptoms which absolutely incapacitated him for work. They 
were attributed to gall-stones, but he was seen by Sir 
Spenoer Wells, who discovert a floating kidney for 
which a belt was ordered, which only exaftgeratod his 
sufferings. This patient was teoronghly and perman¬ 
ently relieved by nxation of tee organ He suggested 
teat tee ooonrreiice of hepatic symptoms in this asso- 
tion was amply aoootmtoa for by the relatimislup of tea 

C 


656 Tn MxDicAt Pb>8b. TRANSACTIONS OF SOCIETIES. Bso. 18, 1901. 


right kidney to the second part of the daodenam into 
which the bile doot opened. He himself had long since 
remarked that the pain of right moTsble kidney was 
▼ery apt to asenme a hepatic character. 

Dr. tf ACLaoAN referred to a case he had seen many 
.years ago in oonsnltation with the late Blattbews 
Donoan, who had disoorered the tamonr, bat frankly 
said he did not know what it was, adding that it did not 
seem to harm the patient maoh, and had beet be left 
alone. In other oases, bowerer, the condition gare rise 
to great inconvenience mid discomfort, and these were 
almost invariably oases of right movable kidney, the 
left rarely giving rise to tronble. He had seen two left 
fioatiog kidneys, both in males. He had never seen any 
good remit from the use of a belt and pad, bat 
there was a truss invented by Treves which, 
if properly applied, was very effectual. In emaciated 
women the rest care was often very beneficial 
probably beoanse it favoured the redeposition of fat 
aronnd the kidneys and elsewhere. These catses might 
be divided into three olassee, (1) those in which the 
displacement gave rise to no great trouble, (2) those in 
which it oausM much distress and discomfort, and (3) 
those which required to be dealt with surgically. He 
mentioned three cases which had been di^nosed as due 
to gall-stones in which fixation of the kidney was 
followed by permanent cure. 

Dr. T. Staokt Wilson dissented from the view that 
a belt did no good in these oases. He himself had been 
in the habit of using the same form of belt for all 
patients, and with good resnlta. 

Dr. T. Staoit Wilson read a paper in which he laid 
down the following propositions:—In Mitral Inoompet- 
enoe: 1.—The prooess of compensation neoessitetes 
dilatation of the oavity of the left ventricle, as well as 
hypertrophy of ite walls, and the amount of dilatation 
in the oompensated heart is directly proportional to the 
amount of blood which regm^tatm into the annole 
at each beat of the heart. As mitral incompetence 
involves the leakage back into the auricle of a certain 
part of the contents of the ventricle at each beat of the 
heart, it therefore follows that in order to compensate 
for this leakage and allow of a normal amount being 
thrown into tee aorta at each beat, 1. Firstly: the 
ventricle most enlarge so as to hold both the normal 
amount and that which will escape back into the 
auricle. 2. Secondly: It must thicken its walls so as to 
be able to move this additional volume of blood. 3. 
The theory of the enlargement of the ventrionlar cavity 
is as follows:—On tee first ooonrrenoe of regnrgitation 
terongb the mitral v^ve a progressive overKlistension 
of the auricle will theoretically resnlt from tbe leakage 
of blood back into that chamber. As sosn, how¬ 
ever, as tee size of the anricle exceeds that 
■ot the ventricle, the latter will during its ex¬ 
pansion be drawing towards itself more blood 
than it can hold; and the momentnm of the blood which 
nannot find entr^oe will tend to dilate the oavity of the 
ventricle. In this way tee ventricle will be dilated by 
its own aspiratory force until it* size is oomparable te 
that of the anricle. This will not ooonr nntil the 
ventricle is lai^ enongb to hold tbe fall amount of the 
leakage in addition to its normal contents. (Vide 
writer's paMr “ Clin. Soo. Trans.," voL xxxiv., Cbm 3.) 
II. - The dilatation and hypertrophy, which can com¬ 
pensate for the defective working of the left 
ventricle daring systole, will, according to this theory, 
also relieve the auricle from embarrassment daring 
diastole by ensuring the proper filling of the ventricle. 
For (1) Since the enlaig^ ventricle is able to accom¬ 
modate all the regni^itated blood in addition to its 
normal contents, it foUows that it will be as easy for 
tee abnormal amount of blood to enter tbe abnormally 
large ventricle as for the normal amount to enter the 
normal ventricle. And (2) The increased muscularity 
of tee enlarged ventricle will ensure the slight addition 
to the aspiratory force which is reqniiM to draw 
the larger amoant into the ventricle. III.—There¬ 
fore by the time tbe expansion of the ventricle 
has ceased, the anricle will have been relieved 
of all the regurgitated blood, and only the normal 
amount will remain to be dealt with by it. 


IV.—Therefore in fally-oompeasatod mitral r^urgita- 
tionno extra work aill be thrown npon the left anricle, 
and there will be no embarrassment of the pulmonary 
oironlation and no accentuation of the pnlmonary seoond 
sound. V.—Neither would there be smy dilatation of the 
left anririe unless tbe regnrgitation were extreme. 
Since the systole of the anricle and of the ventricle 
together occupy one-half of tbe cardiac cycle, it f<^ows 
that only one-half of the full volume of blood will 
normally enter the auricle daring this portioa 
the cycle. Therefore there will be room in the anricle 
daring tbe ventrlcnlar systole for any amoant of regur¬ 
gitate blood up to one half of the total qnantity put 
into circulation at each b<*at. If, ou the other hand, the 
amoant of regurgitation were to exceed one half of tbe 
normal ontpnt of the ventricle there might be dilatation 
of the auricle, even when compensation was folly 
established. VI.—According to tw theory of oompen- 
sation there ought to be a slight increase in the londneas 
of the aortic part of the seoond sound, because the 
greater expansile force of the hypertrophied and dilated 
ventricle will induce a more powerful recoil of the blood 
in the aorta, and will result in a more puw«f al closing 
and stretching of the aortic valves than in tbe oase of 
the normally-acting ventricle. In mitral stenosis, 
according to this theory, the left ventricle increases its 
aspiratory power in order bo facilitate the entry of 
blood through the narrowed orifice, and so establish 
compensation. This is brought a^ut as follows:— 

VII. —In mitral stenosis the left ventricle contracts with 
greater force than normal in order that the rebonnd, 
both musoular and elastic, may be correspondingly in¬ 
creased. 1. An evidence of this is the increased lonthiess 
of tee first sound which occurs in mitral stenosis. 2. 
Temporary embarrassment of the circulation is accom¬ 
panied by an increase, often excessive, in the londness 
of tee f^t soond, which lessens again as the circula¬ 
tion improves. 8. This increase in the force of the 
ventricular contraction is also suggested by tbe occur¬ 
rence of tee hypertrophy of tbe left ventricle, which 
is not infrequently noticed in mitral stenosis. 

VIII. —The left ventricle alters its beat. Its oonteaction 
terminates with greater soddenness and force than 
normaL This concentration of ventrionlar effort at tbe 
termination of tbe systole has the effect of further in¬ 
creasing the force of the ventricular recoil which imme¬ 
diately follows the systole, lasting as it does only one- 
tenth of a second. 1. This is the explanation of the 
sharp and loud end of the first sound which is so 
ohanuitoristio of mitral stenosis. 2. Tbe oharaoteristic 
cardiograms of mitral stenosis often show a more sodden 
reoession of the heart from the chest wall at 
tee end of tbe systole than in the normally- 
beating heart. IX.—As a result of this additions 
aspiration the anricle can be relieved of much, if not all 
of tbe additional work which tee narrowness of the 
mitral valve entails. We find very frequently an 
absence of dilatation of the left anricle iu mitral 
stenosis where oompeusation was perfect at tbe time of 
death. X.—Therefore, in compensated mitral stenosis, 
if the narrowing be not very excessive, no extra work is 
thrown upon the right side of the bea^ and there is no 
engorgement of the longs. 1. As evidence of this, we 
find the pulmonary second soond of normal londness, 
even in cases of severe mitral stenosis. 2- We find that 
the aooentnation of the pulmonary second sound which 
is characteristic of faUing compensation, gradually 
lessens as oompensation improves. 3. We may find no 
clinical evidences of pnlmonary congestion or engorge¬ 
ment even in severe cases of mitr^ stenosis. XI.— 
We may also expect some increase in the lond- 
ness of the aortic second sound, apart from that due to 
increased arterial pressure, because of tbe increased 
ventricular aspiration, as suggested in Proposition VI. 

After some remarks by Dr. Ross, who challenged the 
suggestion that the enction of the anrioles conferred 
any momentnm on tbe incoming blood. Dr. Kihoston 
Fowls a observed that the anthor’s views were contrary 
to those which be himself taught. He maintained that 
whereas in the normal heart while the blood fiowed 
from the auricle into the ventricle, the curtains of the 
mitral valve were gradually floated up and came into 




Die. 18, 1901. 


TRANSACTIONS OF SOCIETIES. Thi Midical P««. 657 


apposition before the acme of the dilatation took place, 
the first sound resulting from the edge of the closed 
curtain. In mitral stenosis this closure could not take 
place, and the accentuation of the firrt sound was 
then produced bj the shock bringing together these 
thickened curtains. 


EOTAL ACADEMY OP MEDICINE IN IRELAND. 

SiCriON OF SUBOIBT. 

HbITINO HXLD, ROTAL CoLLIOI OF StTSOBONS, ON 

Die. 6 th, 1901. 


The President, Mb. Thokas Mtlbs, in the chair. 

Tex following living exhibits were shown:— 

Mr. D. Kbnnidt : (a) Case of enlarged liver after 
trauma; (b) Two cases showing results of osteotomy 
for bow leg. 

Mr. R. L. SwAN; Case of bilateral radical cure of 
inguinal |hemia, with interval of four years between 
operations. 

Mr. Hikbt Cbolt : Patient operated on for double 
etroyema. 

The following card specimens were also shown:— 

Mr. H. Gbat Cbolt : (a) Stomach lacerat^ by shaft 
of dray—cycle accidmt; (b) limb removed by ampnta* 
tation at hip-joint for sarcoma. 

Mr. D. Kxnnbot : (a) Thymus and thyroid glands of 
child who died under chloroform; (b) four skiagrams 
showing foreign body in cesophagne, stone in blMder, 
oongential absrace of radius, and fracture of olecranon. 

Mr. R. L. Swan : (a) Two kidneys snd part of hyper¬ 
trophied ureter removed by ventral incision from 
patients, tet. 23 and 36; (b) comminuted extraoapsular 
fracture from man, mt. 90, who died three days after 
injury, 

Mr. Hxnbt Cbolt ; (a) Tumour removed from infra¬ 
scapular r^ion; (b) stricture of pylorus; (o) cystic 
hygroma. 

Mr. J. 8 . McAbdlb read a paper 

ON INTBACBANIAL HSnfOBBHAQB, 

which we hope to publish in full in our next. lutroduo 
ing the subject, the author said that the present paper 
him its origin in hisdesire to show bow futile the treatoent 
uf intracraoial bemorrh^e is by applying ice to the 
head and depressing the feet. It is not so very long 
ago that he heard such treatment advocated in that 
room. Brain surgery seemed to have been n^lected for 
abdominal surgery, a fact which may in pi^ account 
for the want of progress made in the former. It is, 
however, necessary that a great change should come over 
our theories and procedure in brain surgery—he had 
seen patients die from intracraoial pressure who should 
have lived. Tumours of the brain due to microbic 
tension will ^terwards receive more thought, for 
such drugs and applications to relieve intracranial 
tension are at their best only palliatives. 
He bad no belief in the well-known general practice of 
ice to the head and the internal administration of mer¬ 
cury. Intracranial over-tension should be treated as 
yon treat over-tension elsewhere, and as illustrative of j 
the value of relieving the tension by operative means. I 
He quoted the following cases ;— I 

Cabi I.—William Qreen, tet. 40, came under observa¬ 
tion. in 1890. On November 18th of that year he fell 
into the hold of a vessel; he cot the forehead over the 
right eye, and went to Sir P. Dun's Hospital, where it 
was dressed, and afterwards he went home apparently 
all right. On i^e following Monday, three days ^ter- 
wards, his stomach wss sick, and be snffered from a pain 
in the head. Tuesday bis left leg became powerless, 
Wednesday he came under care in St. Vincent’s Hospital. 
The house sn^eon reported his temperature as sub¬ 
normal, bis pulse was slow, but he answered questions 
quickly and intelligently. The next day the house sur¬ 
geon reported that the patient had had convulsions, his 
thumb was fiexed on hi8palm,hi8 hand on his forearm, his 
forearm on his arm, and his arms were raised. That 
evening the skull over the point of injury was trepanned 


and a dot the sixe of a sispence was come on, which was 
Burronnded by a greenish effusion. Immediately after 
the operation the patient showed signs of improve¬ 
ment, and in fourteen days was going about. 

Casb II.—A boy, et. 16, got a kick of a horse on the 
forehead, and he became nnoonsciouB. Whilst in this 
state the boy’s wound was dressed; after a little his 
conicionsness was restored to be again lost; then he 
came to 8t. Viooent's Hospital. On admission hia 
breathing was Isbonred, bis pulse slow, and the site of 
the wound greatly swollen. The skull was trq»anned 
over the site of the middle meniogeal artery, which was 
found to have been penetrated by a fine spicnla of bone, 
removed the effused blood and some portions of the 
frontal bone, togetiier with the crista galli of the 
ethmoid. The effect of the injury on the boy’s temper 
was peculiar. Prior to the injnry he was of a good 
temper, afterwards he became a devil, and has gradually 
become his old self. 

Casb III.—A boy fell, striking his bead on a metal 
step. He got np, walked home, and came into dinner; 
whilst at the table he got drowsy, vomited, and in a few 
days got epileptic fits. The parents of the boy thought 
hia case hopelMs. It was noticed that joet before a con- 
vnlsion the eyes defieoted. Trepanned over the fissure 
of Rolando, giving exit to two grammes of flnid. The 
boy made an uninterrupted reoove^. 

Casb IV.—A boy playing on a pile of boxes fell The 
I case was an aggravated one, and the parents were hope¬ 
less. The father said, ** Do what yon like with him; 
anything is ^tter than his present state.” The boy 
complained of a ourions series of phenomena of the 
visnal sense. He had a single ring of fire, then a flash, 
then he knew no more. Tropann^ over the flssore of 
Rolando, and found nothing until the auriform lobe was 
probed, when exit wia given to a small quantity of flnid. 

Casb V.—A boy riding ^wn the Phoenix iratk on a 
bicycle, fell, coming down on his cycle. His wound 
was dressed at Hteeven’s Hospital, and he felt so well 
that he w^ed home. He gradually, however, loet the 
power of his right limbs, and when he came under 
notioe was trepanned over the poeterior braaoh of the 
mid^e meningeal artery. An eitm-dnral hsmorrhage 
was oome down on, whkh spread backwards and down¬ 
wards, making its way into the middle oranial fossi^ 
from which it was scraped out. The case pro g r e s se d to 
oouvalesoenoe withont one nnfavonrable symptom. 

Casb VI.—A man riding a race fell, and the h<H8e 
coming after hit him with &e lock of hia shoe. He never 
lost oonsoiousness and was driven home, a distance of 
seven miles, on a car. He was trepanned, and a blood- 
clot about an ounce in weight was removed. He was 
practically well, when, on the thirteenth day after the 
operation, be became thirsty and got dissatisfied with 
short drinks of water. At 7 am. he got a tumbler of 
water, which he drank off, and soon afterwards died. 
The cause of death was septic infection, the sooroe of 
which could not be found on*. Some months afterwards 
the mystery was solved by the confession of a friend of 
the patient that on the day of the accident he had 
probM the wound with hJs finger—a ouriosity that 
cost a valuable life. 

Mr. Mtlbs thought it might safely be said that no 
surgeon hesitates, when necessary, to raise or remove 
portions of the cranial bones. Where they were now 
assembled excellent papers on oranial surgery for oer^ 
bral effosive pressure effects, and operation on the 
sinuses had been read, indeed the " Transaotions ” of the 
Academy are rich in such. It is open to question if the 
symptoms in a case are wholly doe to intracranial ten¬ 
sion or injnry to cerebral tissue. Withal it seems that 
death is usn^ly due to intracranial tension rather than 
cerebral injniy. To trepan the skull, examine the 
ventricles, and tap them seems easy, bnt the case is not 
BO simple when the injury results from some underlying 
condition of the kidnty, as Bright’s disease, atheroma 
of the aiteriee, or syphilis. Some oases recover after 
many hours, or even days, withont any operative inter- 
ferenoe, nevertheless they must acknowledge that all 
the drugs of the Pharmacopoeia will not relieve intra¬ 
cranial tension. He had a case of a man who fell from 




658 Thv Medical Pbbbs. 


TRANSACTIONS OF SOCIETIES. 


Die. 18, 1901- 


a twD-storey window; be wae, when seen, quite ancon* 
soiooB, nnd there was no indication other than the an* 
oonadooBneeB of the ardent. It ooonrred to him that 
an X-ray photograph woald aasist them, and it did, for 
it revealed a whole series of cranial fractures. He tre* 
panned in three places, removed a large clot, and the 
patient became coneciooB. In a case of Jacksonian epi* 
l^y he operated, and Uie patient remained well for a 
time, but has had one fit since. 

Mr. Swan remarked that Mr. MoArdle’s paper had 
opened for them a new line of thought as to the condi¬ 
tions that produce cerebral tensions. From the title of 
the paper he thought it would have dealt with other 
than tiaumatic cases. Most persons would have acted 
as Mr. McArdle did in similar oases. The great difficulty 
in oases of intracranial tension is to locate the injury | 
when there is a depressed fraotnre the difflcnlty of 
di^nosis does not exist. A girl, who fell off a merry- 
go-round, came under his care with a depressed fracture 
^ the skull. Her head was contracted; she bad epi¬ 
leptic convulsions. He trepanned, raised the depree^ 
portion of bone, and the girl got well, and remained so 
for six months; then the fits recurred. Shock appears 
to have the power of interrupting the sequence of the 
Jacksonian epUeptio fits. 

Dr. Pollock said that severe oases might recover 
without any operative interference was known to all of 
thmn, but the following case so well illustrated this that 
he thought it worth recording. An Australian geutle* 
man, when riding over his farm, met with an accident. 
His horse fell, tl^wing him, and there he lay for two 
hours nnoonscions; when be came to he found the horse 
lying on top of him; be used his spurs on the animal, 
which cans^ it to rise. Then he succeeded in getting 
on his feet, mounted the horse, and rode home, a journey 
of nine miles. When he reached home he became 
again nnoonscions, and remained unconscioue for 
three weeks. There was no medical advice obtain¬ 
able in the district, and advice was procured by 
telegraph from Sydney two hundred mil(« 
away. After oonscionsnees returned he had from 
five to ten epileptic fits daily. He went by rail to 
Sydney, from Sydney to London, on the journey home 
Le never had a fit. After some time at home, finding be 
was free from fits, he rejoined his militia regiment, and 
being an excellent judge of horses he was offered a good 
appointment by the Hovemment in South Africa, where 
he now is, and has remained free from the fits since he 
left Sydney. 

Mr. H. Gbat Cbolt said that when he filled the pre¬ 
sidential chair of the College, he read a paper on injuries 
of the head, and advocated then and now prompt sur¬ 
gical intervention. Some years ago he was called to see 
a man who fell on some spiked railings, getting a punc¬ 
tured fixture of the skull. On his arrival he tound 
the patient aphasio and in the hands of physicians, 
who, five of them, were doeing the poor man with 
bromides and iodides, and refused to sanction trepan¬ 
ning. The gentleman left the country and went to the 
United States to be trepanned, and from there went to 
Paris, where the piece of broken bone came away be¬ 
fore the surgeons could operate, and now be is quite 
well. _ In the case of a boy who was kicked by a mule, 
he raised the fractured portions of the cranial bones, 
and came on a large blood-olot lyin^ on the dura mater. 
When it was removed the boy regained oonsciousness, 
and in a short time was quite well. The difficulty in 
all these oases is to find the locus of tension. 
He had seen Arming hsamorrhaKe from the ear, without 
any sign of e^rnal injury. A man was brought to 
him with the history of having fallen on the back of his 
head ; he answered in monoq^llables and gradually be- 
o^e nnoonsdouB. Prior to death he bad 260 oonvul- 
eione. The autopsy revealed a broken occipital, with a 
blood-olot that covered the cerebellum. Where were yon, 
in such a case, to apply the trephine ? 

Mr. Tobin had the advantage of seeing almost 
all Mr. MoArdle's cases, but one must not expect the 
same progress in cranial and cerebral surgery 
as in abdominal. In the latter, one can see 
and handle all the viscera, but the skull opening 
is so small that but a limited view could be obtained of 


the cavity ruid its contents. All surgeons trepan in 
oases of compound fracture. But he considered that a 
fracture associated with soft tissues necrosed from 
pressure is quite as dangerous as the compound, and 
necessitates equal care in drersiog. Another point he 
would call attention to by an illustrative case:—A ser¬ 
geant put a revolver to his bead and produced a com¬ 
pound fraotoro, the wound never properly healed, the 
patient got epileptic fits, and a small projeotiiig spioula of 
bone was then removed. All this time there appeared no 
evidence of teosion. The patient was placM on his 
side with the trepanned bone on the pillow, and during 
the following night there was a profuse fiow of serum, 
after which the man made an imintorrnpted recovery. 
There seems a dread of putting a patient on the tre¬ 
panned side, which he considers is the most suitable one 
to allow of free exit for any fluid present. 

Dr. Cox remarked that be was a believer in surgery, 
and advocated it in such casee as those refe r red to. He 
once trepanned a patient in a provincial infirmary, and 
removed a portion of a reaping hook from the brain of a 
Western peasant. He also recommended trepaiming of 
the mastoid in a case in which he was ooiunlted s his 
advice was not followed. Afterwards the patient was 
twice trepaimed, but not at the loons of the pus; finally 
he died. He bolds that oases of kidney disease or 
disease of vesMle ue not amenable to sn^oal inter¬ 
ference. 

Mr. Lxntaionb said Mr. MoArdle’s paper alluded to 
the treatment of intracranial hamorrhage eome tiiite 
after it had occurred. It may so nappen that 
the snrgeon is called in when bleeding is actually 
taki^ place from a small opening in the vessel. 
Mr. victor Horsley in snob cases recommends liga- 
tnre of the carotid. A case of ^ was of this nature; 
The patient, a lady, had convulsions of the right 1^ and 
right arm. He made pressnre on the left carotid, the 
convulsions ceased in the leg and arm, and the patient 
was able to move the np and down. The pressure 
was now discontinued, and soon afterwards she got 
diffionlW of speech and paralysis of the limba of the 
right side. By the aid of assistants pressure was now 
kept np for some time, and the patient recovered to a 
great extent the use of speech and the power oi W 
limbs. 

Dr. Mobb O’Fabbbll would like to ask Mr. Mo irdle 
on the use of trepazming in intracranial tension in 
tuberouloos meningitis, where day by day the tension 
increases. If in such oases we oonld operate there 
might for such cases be a chance of lile. Even to open 
the abdomen in peritoneal tnberoalesis benefits, might 
it not be equally useful in tuberculous meningitis. 

Mr. McAbdlb, in reply, said that on a future occasion 
he proposed treating of operative measures in iotin- 
craoial tension of non-traumatio origin. 

The Section then adjourned. 

EDINBURGH MEDICO-CHIRURGICAL SOCIETY. 

Mbbtino hbld Dbcbxbbb 4th, 1901. 

Db. T. R. Fbasbb, President, in the Chair. 

Db. WiLLiAjf ELDBBand Mr. Miles showed a patient 
after removal of a tumour from the left prefrontal lobe 
of the brain. The patient was a man, eet. 47, «ilmitted 
to hospital in September with the history of having 
suffered from pain in the back of the head since May. His 
symptoms otherwise were chiefly mental—he bad be¬ 
come melancholic and emotional, and had been quite 
unfit for work for about a month before admission. 
There was a syphilitic histor.i, and a scar resulting from 
an old gumma in the right frontal region. On ftHtniaairtTi 
the patient was dull and apathetic; he bad lost all self- 
control, and exposed himself indecently. His reflexes 
were normal, but he bad lost oomoiand of his bowels and 
bladder The optic discs were blurred, and there was a 
soft swelling over the left frontal bone. Shortly after 
a dmis sion he became comatose, and was obviously 
going down bill. A diagnosis of left prefrontal trunour 
was made, and on trephining a very hard gamma was 
found in the brain at tiiat situation. This was shelled 
oat, and the patient reoovered. The benefit of the 


C 



Drc. IR, 1901. 


TRANSA.CTIONS OF SOGTFTIFS. Thb Mxdicu Pbisb. 659 


operation was immediate. Next da; the patient was 
entire]; sensible, and, from being dnll and melanoholio. 
he passed to the opposite extreme, becoming rather 
forward, and inolinM to be familiar. This, however, 
passed off, and be gradnall; regained his normal mental 
state. 

Drs. Ottlland and Looam Tvbnkb showed a girl after 
operative treatment for laryngeal tn^rcnlosis. The 
patient had phthisis of both apices, and a localised tuber- 
onions deposit completely obscnring the left true cord. 
This was removed by int^larynge^ forceps at several 
sittings, and the girl had benefit^ greatly. The laryn¬ 
geal mischief was apparently headed, while the pnl- 
monary tnberole was undergoing arrest. 

Mr. 8haw McLabbk showed a patient after recovery 
from compound deinessed fracture of the sknll and 
leptomeningitis. 

The following card specimens were shown:—By Dr. 
Elder and Ur. Miles, tnmonr removed from prefrontal 
lobe of brain; by Dr. P. D. Boyd, bowel from a case of 
acute dysent^; by Dr. Burn Murdoch, la^e gall-stones 
which produced practically no symptoms; by Mr. Alexis 
Thomson, large gall-stone which caused scute intestinal 
obstiuction, and wu removed by enterotomy; by Dr. 
Harvey Littlejohn, (1) surreal instruments used by 
natives of Northern Nigeria; (2) kidney and ureter 
showing effect of suwidental ligature of ureter for re¬ 
moval of intra-ligamentons ovarian cyst; (8) injuries 
received in a fall from a window; by Hr. C. W. Cath- 
cart, (1) Toy whistle removed from the ttaobeaof a boy, 
set. 9, alter being six weeks in the air passage ; (2) por¬ 
tions of needle and thread, also Bdn^;en ray photog^ph 
of same, removed from the knee of a girl, et. 7; by 
Mr. CaM, oaroinoma of ascending colon from a case 
primary resection and sntnre, sad long preparations of 
Buohbold’s method. 

Dr. Chalxbbs Watson showed photographs of pooltry, 
showing some results of sm experimental research on 
the comparative pathology of gont. 

Mr. David Wallacb demonstrated Beckmann's 
apparatus for ascertaining the freezing point of blood. 

Dr. Dawson Tubnbb showed an apparatus he had 
devised for estimating the electrical resistance of blood 
It ootuisted of two electrodes, one cup-shaped, the other 
conical and fitting the cup. These were covered with 
spongy platinum, and could be adjusted to one another 
by a microm» ter screw. Five mg. of blood were taken up 
in a graduated pipette and blown into the cup electrode. 
The second electrode was then screwed down upon it so 
that a layer of blood of known thickness was interposed 
between the two. The resistance to alternating onrrente 
was measured by a Wheatstone bridge and a telephone. 
From abont 500 observations he found that the average 
resistance of normal blood was from 600 to 600 ohms. 
He was now making observations on the blood in various 
diseases, the most striking result obtained so far being 
that in pemioions ansemia the resistance was reduced 
to abont 260 ohms. 

Dr. Tubnsb also showed skiagrams of a case of syphilis 
in whiifii the bones were absolntely transparent to the 
X-rays. 

Dr. Lawson read a paper on “ Some Clinical Observa¬ 
tions of the Temperature of Phthisis trea-ed by Open-air 
Methods," which will be found on page 652. 

The paper was disoossed by Dr. Javcs, who pointed 
out that inverse temperatures could sometimes be ex¬ 
plained by a reference to the previous habits of the 
patient; he had seen it in night nurses, night police¬ 
men, and so on; by Dr. Oddland, and by Dr. Tatlob, 
who expressed his preference for the method of taking 
temperatoree in the axilla rather than in the mouth or 
rectum. 

i>T. David Wallacb read a paper on “ Supra-pubio 
Prostatectomy,’’ which will be found on page 668. 

The paper was discussed by Mr. Caibd, who endorsed 
Mr. Wallaoe’s opinion as to the supsriority of snpra- 
pubic cystotomy, by Mr. Cathcabt, by Mr. Millab, 
who deprecated too early initiation of catheter life, by 
Mr. OorrsaiLL, who favoured the perineal method in 
many oases, and by Mr. Scot Skibvino. 


LIVERPOOL MEDICAL INSTITUTION. 
Mbbtino hbld Dxo. 7th, 1901. 

The President, Mr. Edoab A. Bbownb, in the Chair. 


Casxs were shown by Mr. Bobxbt Jonbs (for which 
see " Clinical Beoords.") 

Dr. W. B. Wabbinoton brought forward two oases. 
(1) Aonte pneumonia charaotm-Ued by long daration 
and intermittent type of pyrexia, the crisis not occurring 
till the nioeteeuth day. This condition suggested that 
the case miget be an aonte phthisis beginning with 
acute pneumonia. Symptoms were profuse sweating, 
progressive emadatiott and hsemorrb^e. The sub- 
sequent course of the disease showed that he had to deal 
with a migrating pnenmonia, possibly of infloenzal 
origin. (2) Acquired hydrocephalus in a man, st. 86. 
The patient for eight months showed signs of cerebral 
tumour, vis., marked optic neuritis, with headache and 
some vomiting, taremominthe tongue, slight exophthal¬ 
mos r>f one eye, and weakness in the l^s. His mental 
faculties became markedly impaired, and be gradoally 
passed into a comatose condition. At ibe autopsy 
dilatation of the lateral ventriolee was the only gross 
lesion found, ,the microscope showed inflammatory 
thickening of the ependyma of the fourth ventricle. 
The natnra and diagnosis of each case were briefly dis- 
enssed. 

Dr. T. E. Oltnn briefly remarked npon the second 
case, and related a case similar to this in which there 
was marked optic neuritis, headache, reeling gait, 
staggers, Ac., and a di^:no8iB of cerebellar tnmonr 
made. Phe patient was trephined over the cerebellum, 
no tumour was found, but some oerebro-splnal fluid 
escaped after opening the ventricle, and the pstient 
recovered. Snch oases explain those oases of apparent 
cerebral tumour that reoovOT. 

Mr. Daikxb Habbison related a similar case of relief 
of symptoms after opening the lateral ventricle. 

Mr. Bdshton Pabsbb read a note on "a series of 
fourteen foreign bodies, various in nature and loo^ty." 
and remarked that some foreign bodies are mere 
cariosities more or less amusing, others, while extra¬ 
ordinary, are curious from the little harm they do, while 
others, commonplace in themselree, may be the cause 
of danger and even tragedy. An in^vidual foreign 
body may be very interesting itself, and in its cironm- 
atances ^one, but he thought that collective reference 
to a selected eet might by comparison and contrast give 
an interest to each intrader quite as great as tiiat 
afforded by considering it alone. The cases were, with 
one exception, from his own practice. 1. Wooden 
splinter, over 2^ ins. long and from i to i in. wide and 
thick, embedded in the pterygo-maxillary region of a 
man, where it was broken off a handle of swinging 
boards that struck him in the right lower eyelid. The 
object was thought to be loose brae, and was withdrawn 
after a few wee^ early in 1876. 2. Piece of a sailor's 
knife blade, 2i ins. long and } wide, broken off in the 
left pterygo-maxillary region of a man stabbed in New 
York. The object was removed fourteen days later at 
the Liverpool Northern Hospital by Mr. Pnzey In 1879. 

3. Onn breech and screw bolt, foro^ by the bursting of 
a fowling-piece into the middle of the owner’s face and 
lodging five years in the nose. Removed tbrongh an 
incision under the upper lip, December 20, 1883. The 
objects weighed 3^ ozs., measuring 8 by 1} by 1 in. 

4. Piece of parasol rib, 3 ins. long, broken off in a 
woman’s forearm. Removed after twelve days. 
6 and 6. Cases in which a ballet was displayed by 

I radiography and removed from sabcntaneoni regions of 
the 1^ and band respectively in boys. 7. Radiographs 
of small ballet flattened against ttte lower end of the 
radius in a young man, and when seen two days after 
the accident the wonnd was healed and the ballet was 
left alone; and seen five years later had caused no in¬ 
convenient and was radiographed again. 6. Radio¬ 
graph of leaden pellet from an air-gnn, between the 
metacarpal bones; removed a fortnight later, as it 
caused annoyance and apparently pressed on a nerve 
9, Photo of a piece of rM rubber catheter over 8 ins- 


C 


660 Thi Midioal Pems TRANSACTIONS OF SOOTETIES. 


long) enoraeted with phoephatio calonlQB, from the 
bladder of a man, set 71. Calcnlna crashed and 
erftoaated, catheter removed bj litbotrite. 10. Photo 
of silver tooth-plate 2 by 1 ins., extracted from the 
pharynx of a man, set. 36, ^ter nine hours. 11. Photo of 
tooth-plate, vulcanite and metal, with attachment hooks, 
2 by 1 by 1 ins., swallowed, and removed eight days 
later by oesophagotomy with snoeess. 12. Iron staple 
1 in. long 1 in. wide, swallowed by a boy, radiographed 
and shown lying in the pelvis uree days later and 
passed per annm next day. 18. A piece of turned oak, 
7 by I by i in., known as a ‘’knitting-sheath," removed 
from the rectum of a man. set. 70, after a fortnight Ko 
barm resulted. 14. Badiograph of the ankle of a girl, 
tet. 16, showing a piece of glass broken off a strip of 
window-glass 1 in. long more than \ in. wide and less 
than in. thick. The object had been there five years, 
causing slight but very persistent, disability of the 
ankle-joint. It was removed with an end to all trouble. 
A radi<^raph was shown of the parts after removal of 
the glass and its shadow. 

llrs. and Messrs. Darner Harrison, Alexander, Hill, 
and Briggs related instances of other foreign bodies, 
and commented upon some of Mr. Parker's series. 


HAEVEIAN SOCIETY OF LONDON. 
Mbktieo sxnn Thubsdat, Dso. 6th, 1901. 

The President, Dr. D. B. Lbxs, in the Chair. 


Mb- Mambbll Moullin read a paper upon 

BOMB UMUStTAL OASIS OP MOVABLE EIDIfBT. 

Instanoes were given in wfaiuh a movable kidney had 
given rise to all ^e symptoms ordinarily present in 
chronic gastric ulcer, including htematemesis, and had 
closely imitat^ biliary colic and inflammation of the 
appendix. It was pointed out that the diagnosis 
could nearly always be made by conflning the 
patient to bed for a few days, as in the reonm- 
l^t position the kidney fell back into its proper 
place and ceased to press unduly upon snrronndmg 
structures. Mr. Mansell Monllin p^icnlarly called 
attention to tbe oocnnence of these symptoms in cases 
in which only the upper end of tbo kidney, and not tbe 
whole organ was displaced. This form of movable kidney 
had been called anteversion by Fotain, who was tbe flrst 
to deeoribe it, and who associated it with the occurrence 
of biliary symptoms, bnt who mistook the effect for the 
oause. la such probability anteversion of the kidney, 
which only be appreciated by examining the patient 
when stooping forwards in a semi-erect attitnde.ismuch 
more common than is nsnally believed, and ienotnn- 
freqnently the cause of symptoms which are often 
thought to be of subjective origin. 

Tbe President, Mr. F. Jaffrey, Dr. Macevoy, and Mr. 
Hubert Phillips took part in the disonssion, and Mr. 
Mansxll Moullim replied. 


WEST LONDON MEDICO-CHIBUEGICAL SOCIETY. 
Mbktino HBi.i) Dxc. 6th (West London Hospital). 

The President, Mr. A.lfbbd Coopbb, in the Chair. 


Clinical Evening. 

Mb. Bbbtlxt and Dr. Saundbbb showed a case of 
Paroxysmal Nenralgia of tbe Trigeminal Nerve, in 
which pain bad been relieved by stretching and excision 
of a portion of the two lower divisions of ^s nerve. 

Mr. Kbbtlbt showed also a case of an Osteoplastic 
Beeeotion for Malignant Disease of tbe Nasal Fossa. 

Dr. T&tlob showed a case of Congenital Absence of 
Clavicles. In reply to remarks by Mr. MoAdam Ecdes, 
Mr. Lloyd, and Mr. Eeetley, be pointed out that though 
the sternal epiphysis showed some attempt at develop¬ 
ment, there was no part of tbe stemo mastoid attached 
to it; tha^ the patient showed some signs of congenital 
syphilis which might be a factor in the production of 
we deformity; and that ^though possibly tbe nether 
limbs are more frequently the subject of congenita 


Dbc. 18. 1901. 

defects, arrests of development are more serions and 
more profound as a rule when they occur in the upper 
limbs. 

Dr. Ball showed for Dr. Abraham a case of Lupne 
ErsrthematOAus of the Face assodated with Lapa» 
Vulgaris of the Palate.’ 

Dr. Chambbbs showed for Dr. Abraham a case of 
Nscvus Linearis (so-called), affecting the right of the 
trunk. 

Dr. Saunokbs showed a case of Pigmentation of the 
Sxin in a boy, set. 13, probably Addison’s disease. Thia 
affection had come on gradually in the last four months. 
The pigmentation was general, with accentuation over the 
region of tbe back of tbe neck, tbe axillae, the groins and 
genitals, and over the prominent dorsal spines. It was least 
over the chest, and backs of the upper arms. The muooue 
membrane of the month was affected. The syiDptoms 
were debility, anaemia, and heart weakness, with ooca- 
sional attamks of vomiting and diarrbcea. The boy had 
improved considerably in geneial health under treat* 
ment, after attention to tbe digestion, with cod-liver oil 
and iron, though the pigmentation had somewhat in* 
creased. 

Dr. Gbunbaum drew attention to two methods based 
on physiological observation, which might assist in tbG 
diagnosis of early cawee of Addison's disease. Langlois 
found that the ergographio tracings obtained from 
patients with diseased suprarenal glands were unique, in 
that the curve produced by joining tbe apices of the 
contraustions fell very rapidly. This indicates a rapid 
diminution in power on the part of the musole, this 
diminution being much more rapid in Addison's disease 
tham in any wasting dieeaM>e, such as advauioed phthisis. 
Dr. Qrunbmm had had the opportunity of oonflrming 
Lamglois's observations. The other metiiod is based 
upon the effects of the administration per ot of sup¬ 
rarenal gland Tbe only oases in which Dr. Grnnbaum 
haul been able to measure any increase in blood pressure 
were patients suffering from Addison's disease, but 
whether tbia was di^noetic of the disease he wa» not at 
present prepared to say. 

SHEFFIELD MEDICO-CHIEUBGICAL SOCIETY. 

Mbbtino hbld Dbc. 6th, 1901. 

The Piesident, Dr. C. H. Willbt, in the Chair. 


Mb. Edwabd Seinmbs showed spedmens from a caie 
of Melanotic Sarcoma of Liver. 

Dr. Bcbosn read notes of the following oases:— 1. The 
GaMtro-intestinal Form of BenalCadcalns: 2. Pernicious 
Anaemia. 

Dr. SiNCLAiB White exhibited and made remarks 
on the following specimens:—!. Anenrysni of the 
commencement of the right common carotid for 
which distal ligature of the carotid and subclavian had 
been nnsncceesfully practised, the patient eventually 
dying of exhaustion incidental to proximal ligature. The 
case was interesting on account of tbe abMnce of an 
aneurysmal pulse, sphygmographio tracings taken from 
both common carotids showing no appreciable differences. 
The aneurysmal tumour, which was of the size of a 
turkey’s egg, caused no pressure symptoms beyond con- 
traction of the right pupil, and there was entire absence 
of a tbriU and trvit. Tbe patient was a retired soldier, 
set. 40, and bad had syphilis. 2. Resection of tbe 
transverse colon and a portion of the small intestine for 
a rapidly growing malignant tumour of the omentum 
in a man, eot. 24. The patient bad made an excel¬ 
lent recovery from tbe operation, but as a number of 
infected mesenteric glands were unavoidably left speedy 
recurrence was anticipated. 3. Excised chronic nicer 
from tbe stomach of a man, ict. 62. The history 
dated back four years, and tbe patient had become much 
emaciated and was no longer able to work. The nicer 
was situated at the upper and back part of tbe stomach 
near ^e pyloric end, and measured one inch in diameter. 
It bad almost eaten through the stomach walls, and waa 
surrounded by extensive adhesions. The patient had 
made a good recovery aad was getting strong again. A. 
noteworay feature in the case was the advent of 

-oog e 



AUSTRIA. 


Tbb Msdical Pbb8s. 661 


Dbc. 18, 19D1. 

aUrmiog hemorrhage after inflation of the stomachfor 
diagnoetio pnrpoeee, although pTeTionslj there had been 
no hiematemeBiB. 4. Seeection of email inteetine for a 
ronnd'Celled sarooma that had prodnoed obetmotion. 
The patient wae a female, et. 62. The operation -was 
followed bj death from shook. 

TBXATXBMT OF COMSVMPTION BY FOBXIC aLDBBTDB. 

Dr. J. SoBLST read some notes of apersonal interview 
he had daring the sommer with Mr. Crdtte, the founder 
of a comparatively recent method of treating oonsnmp* 
tion practised in Paris. The method consists in the 
transfosion of a specially-prepared solution of formic 
aldehydn into the tissues of the body by means of a very 
powerful static machine. The method has at least a 
certain amount of probability as regards its efficacy, and 
some of Crdtte’s principles have t^n confirmed by in¬ 
dependent observers. A needless amount of eeare< 7 , 
however, surrounds the nature of the formic aldehyde 
solution, and the method, until the former is pub¬ 
lished in full to the world, cannot but be tainted with 
a suspicion of quackery. The examination and treat¬ 
ment of patients seem to be conducted on sufficiently 
rigid lines, and their statistics are, if true, little short 
of marvellous. The treatment is in operation in Paris 
Boim, and New York. 

cfrante. 

[fbom oub. own cobbxspondbnt.] 

Paxis, December 16tb, 1901. 

CjNAfilAM SbCTION FoLLOWID BY HySTEBBCTOHY. 

At the Academic de M^eoine, M. Bibee communicated 
the case of a woman, set. 26, on whom was practised the 
Casarian operation, followed by hysterectomy, delivery 
being otherwise rendered impossible from the presence 
of a lai^e number of hydatid cysts. The operation was 
Bucoeesfal, both as regards the mother and child. 

PoTATOXS AND DiABXTXS. 

M. Moese read a paper in which he related a certain 
number of cases proving that in the treatment of 
different varieties of diabetes and its complications, 
potatoes might be substituted with advantage for bread. 
Yet he was of the opinion that the cure by potatoes, 
which was equivalent to the alkaline cure by reason of 
the potash they contained, should not be prescribed in 
all oases without distinction, and especially so in 
patients suffering from chronic nephritis, the potash 
increasing the toxic condition of the blood. 

Diagnosis of Tbaohatibh of tbb Skull. I 

M. Poirier spoke at the Soci4t6 de Chimigie of a 
patient who, having fallen from a height, was carried 
to his ward. The idea of meningitis suggested itself at 
first, but such wae not the case, as was proved by a punc¬ 
ture in the lumbar region, which wae followed by a 
flow of blood-coloured liquid, and in a day or two by the 
presence of local and sub-oonjunotival eochymosis; it 
was evidently a caseof fracture of the skull. Whatwas 
particularly interesting in the ceise was that the lumbar 
puncture produced an immediate improvement in the 
patient, such that he was able to leave the hospital after 
a few days. 

M. Bochard said that he had employed the lumbar 
puncture in three cases of cranial traumatism. In 
one case, that of a child, the liquid was projected with 
such force that it was all lost, and it was impossible to 
notice if it contained blood; but the' condition of the 
patient was immediately improved. A wtmilxr result 
was obtained in another case, 

SPLBNBCTOMr FOB BuPTUBB OF TBB flPLBBN. 

M. Bichelot reported a case of rupture of the spleen 


followed by slow hemorrhage and treated with succeea 
by splenectomy. It was that of a woman, et. 60, pre¬ 
senting in the left hypoohondrium a considerable 
tumefaction which seemed to have developed slowly, 
and progressively. Believing at first that it was a case 
of hydronephrosis he made a lumbar incision, which 
showed him a small kidney, but of normal appearance. 

; He closed the wound ud performed laparotomy, and 
fell on a large collection of blood, the origin of which be 
found on the under edge of the spleen, where there was 
a loss of substance. He removed the spleen, and the 
patient made a good recovery. 

c Tbbatbbnt OF Acutb Dysbktbby by Oxygbnatbd 
Watbb. 

The importane role of antiseptic enemata in the treat¬ 
ment of dysentery is well known. Among the agente- 
usually employed may be mentioned nitrate of silver, 
recommended by Trousseau, peimanganate of potassium, 
ichthyol, methylene blue, do. According to Dr. Bocanz, 
of the Children's Hospital at Bordeaux, oxygen water 
constituted a valoable remedy in the dysentery troubles 
of children. He had an opportunity of trying the agent 
in an epidemic of dysentery in a dozen children of from 
two to twelve years old. He employed the oxygenated 
water at twelve volumes, snd diluted with five times its 
volume of warm boiled water (oxygenated water, Jij; 
sterilised water, Jx). The quantity of the liquid in¬ 
jected varied with the age of the patient, and also with 
the tolerance of the colon. In all the oases treated the 
state of the patients improved raindly. 

Tbb Tbxbapbutics of Supbbebatbd Aib. 

Dr. Qariel presented at the November meeting of the- 
Acad^mie de Medecine, in the name of Dr, Ostwal, four 
patients cured by the therapeutical application of a 
physical agent. The agent in question was the local 
bath of superheated air according to the Tallerman 
method, originatedsome yearsagoinEngland. Thecasee 
included:—Double sciatica of eighteen months dura¬ 
tion, cured at the nineteenth sitting; chronic articular 
rheumatism of more than two years standing, cured at 
the tenth sitting; inflammation of the knee-joint without 
effusion, very marked improvement; and chronic multi- 
articular gout, wbidi began a year ago, and has been- 
extending for six m<mths—cure very rapid, treatment 
prolonged to twenty sittings to guard against a return. 

Dr. Landouzy observed that for moie than fire yeara 
he had avaUed himself of the Tallerman superheated 
air treatment in his wards at the Laennec Hospital with 
great success in sub-acute and chronic affections of the 
joints, and notably in cases of gonorrhoeal rheumatism, 
in which it appears to him the best of all possible 
methods of treatment. 


Jltutrta. 

[fbon oub own oobbxbpondxnt.] 

ViSKSA, Dec. llth, 1901. 

Elbpbantiabis. 

Favabobb, at the " Qeeellschaft,*' showed a farmer, 
at. 26, from Omndleee, in Styria, with a monstrous 
form of elephantiasis. The peripheral left thigh 
measured 124 centimetres (48'S18 inches) while his waist 
only 62 centimetres, or 82'288 inches. The skin was 
was covered with a homy ^sourf that could be easily 



662 Thi Msdioh. Pans. 


THE OPERATING THEATRES. 


Die. 18. 1801. 


rnbbed off. The patient had never travelled beyond 
bis own ne'ghboorhood until constrained to do so by 
the neoeesity of seeling relief from hit distreesing 
malady. It appears to be a non-tropioal sporadic form 
of the disease which from the history had taken about 
eight years to develop. Favai^r gave it as his opinion 
that the aetiology might be due to ooncretio pericardii 
cum corde. or some other affection of the heart with 
repeated attacks of erysipelas or erysipeloid skin affec- 
tion. Lymphorrhosa or chyluria had never at anytime 
been observed. 

A Test Apfarstub fob F^ces. 

Zweig commenced his demonstration of an instrument 
for separating undigested fibre from the fcoces. He 
draw attention to the difference in digestion of fibrous 
tissue and muscular tissue when exposed to artificial 
digestives, the former breaking up in two hours while 
the latter required twenty*fonr hours. The conditions 
were inverted, when the albuminoid was brought in 
contact with the pancreatic fluid. This fact has led to 
the physiological examination of the fssoee as the 
most tnutworthy test of the digestive function, 
with Boar's fiscal sieve, which is a spheroidal ball 
separable at the equator, and containing fine wire 
to catch the undigested fibres. The ball has fine open* 
ings at both poles for the admission and egress of pure 
water for washing the d^rit when charged. The 
patient is first prepared and then given a lightly cooked 
beefsteak. The next two stools are put in the sieve, 
washed, weighed, and carefully examined, which, with 
-the history of the case, gives a fair knowled ge of any 
morbid changes in the alimentary tract. 

Tbauxatic Cardiac Htpxbtbopht. 

Benedikt demonstrated the Bdntgen photograph of 
the patient be showed at the last meeting, who fell from 
a scaffold and who, six months after, was found to be 
suffering from aortitis acuta and hypertrophy of the 
heart, which had since receded. Since the last meeting 
the patient had died. The post-mortem examination 
•confirmed the diagnosis of aortitia acuta with cardiac 
hypertrophy. 

Braun repeated that the correct diagnosis of such a 
case was a very difficult undertaking. As Hirsch had 
pointed out the anatomical diagnosis of the heart did 
not depend on a simple examination of its walls or bulk, 
but on its anatomical weight after the pericardium and 
auricles are removed, as the thickness of the wall 
depends very much on the mode of death, whether in 
systole or diastole, which considerably alters the general 
appearance and bulk of the organ. It would seem from 
evidence of Benedikt’s case that the arterio*sclerosi8 was 
not the cause of cudiao hypertrophy. 

CovxBiKos FOB Scabs. 

Hennig showed a contrivance for covering soars or 
-other cosmetic defects, which bad the advantage of 
allowing free movement for air and moisture, which 
have been the defects hitherto met with in this cos¬ 
metic requisite. Small noses or ears can be enlarged at 
■will and appear perfectly natural. 

Mibban Oil ob Nitbobenzol Foisonino. 

At the Budapesth “ Vereine ” Jassinger related a case 
■of poisoning with a few drops of nitrobenzol. The 
patient, st. 32, was an operative in one of the cleaning 
industries. Immediately after swallowing the poison he 
^vas seized with fainting fits and cyanosis. Medical aid 


was soon obtained, and the patient recovered, although 
it was rapidly succeeded by papillitis and changes in 
the blood, the corpuscles being maorocystic, with nuclei 
>n tiie ted blood corpusoles or the degenmation phe¬ 
nomenon : the colour was reduced, smd the plasma 
retracted the rings after the red blood corpuscles were 
removed' The blood, therefore, had the property of 
both degeneration and regeneration. 

Vasblike Ihfections. 

Notwithstanding the danger Dersuny pointed out 
some time ago in a case that died suddenly after injec¬ 
tion of vaseline, Hercyl claims credit for the few cases 
he brought before the society as an example of his 
success without any untoward symptoms to »»*** the 
efficiency of the treatment. The first was a vesico- 
v^nal fistula, which he closed after ten sittings. 

' Another of bis oases vras prolapse of the rectum, which 
was perfectly cured. Many other operations of a cos¬ 
metic nature were shown, such as saddle nose, shrunken 
glands, Ac., Ac, 

Tcbebcdlosis. 

Stmppler records a case of tuberculosis he was 
attending in which the patient died rather unexpectedly 
wilh perforation of the pylorus. The patient was a 
young m«M», mt. 18, who was suffering from tuberculosis 
of the lung with a little tenderness on pressure over the 
pyloric region. He died suddenly after an attack of 
pain in the bowel. Post-mortem examination revealed 
a hole measuring 2*6 oentimetrM across on the smaller 
curvature of the pylorus, with a circular ulcer running 
round the bowel. Towards the duodenum a ridge of 
mneons membrane 2 mm. wide lay detached. The 
ulcer had sharp edges, with fine tubercles strewn 
through its texture, and a quantity of cheesy matter. 
This portion lay in front of the stomach, and for 8 mm. 
around was covered with fibrin. 

Such ulcus tnbercnlosns serpens must be due to auto- 
infection by coughing it from the lung and then swallow¬ 
ing it, as the ulceration must have been of recent date, 
since there were no adhesions or swellings of the 
mesenteric glands. It cannot be attributed to a 
hffimogenio origin, as there was no evidence of miliary 
tuberculosis. 

Bacilli in Sputum. 

Since the observations of Hesse, that the baoilli in 
sputum increased in Heyden’s media after incubation, 
very little information has been forthcoming thereof. 
G^tgens has repeated the experiments on different 
media, and confirms the increase in number without any 
obvious change in the first bacilli observed. He has 
taken the sputum alone and examined it, then put it in 
an incubator for six or eight hours, when the increase 
will be found to be enormous. This must be considered 
a very serious matter in large communities, where the 
sputum has every opportunity to germinate. 

QDpfiraUng ^heatree. 

WEST LONDON HOSPITAL. 

Ilio-Colostomt fob Malignant Disease of the 
CiECDM. —Mr. SwiNFOBD Edwabds Operated on a man, 
st about 40, who had been admitted for a tumour on 
the right side of the abdomen, with the following his¬ 
tory. He had three months before noticed a swelling in 
his side for which he had sought relief at a hoepitaL 
The surgeon under whose care he came, imagining it was 

Di'^izedby C 




Dio. 18 , 1901. THE OPERATING THEATRES, Thb Mioical Pbbss. 663 


A aweUiog of the kidney lie bad to deal with, explored 
the right kidney by a Inmbar inoiBion. In doing this he 
inadvertently opened the peritonenm and then found 
that the tumour was not oonneoted with the kidney, but 
appeared to be a malignant growth of the cscnm. The 
wounds were then stitohed up, and the tumour was left 
to be dealt with on some future occasion. The 
symptoms the patient presented on coming to 
the West London Hospital were diarrbcea alternating 
with constipation, but no rnelmna nor any parti¬ 
cular pain; there was a sinus in the Inmbar region 
in the site of the former wound which bad not com¬ 
pletely healed. The swelling in the right flank was dis¬ 
tinctly marked and apparently fixed. An incision was 
made in the right semilunar line through the abdominal 
parietes, when what appeared to be a malignant growth 
of the cscum was exposed. It completely encircled the 
bowel at about the junction of the ceonmand ascending 
colon. It was tightly bound down behind, owing, no 
doubt, to the previous operation. As, owing to these 
extreme adhesions, colectomy seemed out of the ques¬ 
tion, Mr. Hdwards elected to do a lateral anastomosU 
between ihe lower part of the ileum and the transverse 
colon : this was effected by means of a Mayo Bobson 
bone bobbin in the following manner:—A puree string 
suture was introduced into the small intestine first, the 
bone bobbin then inserted and the suture tied tightly; 
this was repeated in the transvexse colon, and to fortify 
this a series of Balsted’s sutures were introduced into 
the apposing surfaces of the ileum, and transverse colon, 
completely encircling the c^iening, and the abdominal 
wound was finally dosed in layers, and the patient re¬ 
moved. Mr. Edwards said that although ocdnsion of 
the bowel had evidently not taken place at the site of 
the tumonr, for he could make his little fingers meet 
throng the malignant growth by invagination of the 
bowel above and below the stricture,yet it appeared that 
this would probably soon have resulted, and as he did not 
feel justified in attempting to remove the carcinomatous 
mass he oondnded that the best thing he could do under 
the oircamstances was to short circuit the intestine in 
the manner he had done. With regard to the 
original diagnosis he said he did not think that any 
blame could be attached to the surgeon for having 
mistaken this tnmonr of the colon for an enlarged kid¬ 
ney, for at that time there were no bowel symptoms, 
and the pain the patient then complained of appeared 
to have been somewhat charaoteristio of renal pain, 
though Mr. Edwards was unable to learn that there 
had been any deposit of either blood or pus in the 
urine. 

Ten days after operation the abdominal wound 
was healed, the patient's bowels were acting com¬ 
fortably, and he was already taking semi solid food. 

BOYAL FBEE HOSPITAL. 

Ofxbation for BuFTUBxn Etdbo-Nxphrosu.— Mr 
E. W. Bodobtob operated on a boy, set. 6, who had 
been admitted on account of hiematnria following a 
fall three days previously. On admission examination 
of the abdomen was negative; the child had hsematnria, 
but in every other respect was normal. After three 
days in hospital the hsematnria ceased suddenly, and a 
tnmonr the size of a child’s bead developed in the left 
kidney region. Mr. Boughton thmi made the dia¬ 
gnosis of a ruptured pelvis of the kidney, with blockage 


of the ureter by clot, and consequently extravasation of 
urine in the neighbourhood of the kidney; therefore, 
be decided to operate. Heexposed the swelling through 
an oblique inoiBion extending from the anterior.superior 
spine to the angle between the last rib and the erector 
spines, dividing all the abdominal layers till reach¬ 
ing the peritonenm, which was pushed forward. 
The swelling proved to be an enormously dilated 
pelvis of the kidney (which, as he pointed out, is really 
hydronephrosis) { it contained a pint and a-half of blood¬ 
stained urine; this being evacuated by puncture, the 
dilated pelvis.of thekidney waafreely opened; it wasthen 
found that on the anterior aspect of the hydronephrosis 
there was a rent nearly two inches long. The important 
point about this, Mr. Boughton remarked was, that the 
peritonenm over the rent was intact, so that there had 
been no extravasation of urine. There was very little 
k idney tissue left, consequently he decided to remove the 
organ. On removing the kidney, and about an inch 
of the ureter, he found that at the junction of 
the kidney and ureter there was a nurowing which 
would barely admit a probe, this evidently being 
the cause of the hydronephrosis. The external wound 
was closed and a dnun left in. Mr. Boughton said that 
the points about the case were, in the first place, the 
diagnosiB on admission, when there was simply hssma- 
turia, nothing could be made out on exmnination of 
the abdomen, this leading at first to the thought of 
ruptured bladder, which was negatived by the passage 
of a catheter, when two or three ounces of blood stained 
urine were drawn off. In the absence of any definite 
symptoms to afford an accurate diagnosis, it was decided 
to wait and watch the turn of events. When bematuzia 
ceased and an abdominal swelling in ihe kidney region 
developed, it became obvious that the urine from the 
left kidney was not passing into the bladder, and that 
this was dne in some way to an injury; what it was at 
that time he was unable to say, but the operation made 
it quite obvious that thenarrowed orifice of the ureter was 
occluded by a clot, thus causing the sudden development 
of a tnmonr in the kidney region coincidently with 
cessation of hsematnria. On removing the kidney the 
condition of the pelvis and ureter made it quite clear 
that be had bad to dealwith a case of congenital hydron^ 
phrosis, which had been ruptured by the fall. He 
thought it wiser to remove the kidney rather than drain 
it, because there was very little kidney tissue remain¬ 
ing, and on account of the extensive laceration of the 
pelvu, if the kidney had been left he considered that a 
permanent ntinary fistula would have almost certainly 
resulted. 

Ten days after operation the child was convalescent, 
the wound being healed, and the other kidney working 
well. 

The Mortality In Foreign Cities. 

Tax following are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several 
of the populations:—Calcutta 81, Bombay 62, Madras 
71, Paris 19, Brussels 16, Amsterdam 11, Copenhagen 
16, Stockholm 16, Cbristiania 11, 8t Petersburg 22, 
Moscow 22, Hambui^ 16, Munich 22, Vienna 17, Prague 
22, Buda-Pesth 16, Trieste 24, Borne 17, Venice IS, Cairo 
38, Alexandria 32, New York (including Brooklyn) 16, 
Philadelphia 16. ^ 




664 Thb Medical Pbbss. 


LEADING ARTICLES. 


Bec. 18. 1901. 


BKOIBTB&BD rOB rBASBEIBSlON ABBOAD. 

JHcbttal $rtBB aitb Cirntlar. 

PnbUBhed every WedneedaymomioE. Pne* M. Feet free, B)d. 


IDVEBTIBEMBIITB. 

Fob Ora Ixbbbtioh s-^Wbole Face, F6 Oe. Od. Half Pare, 
FS10B.0d.; Quarter PaEe.FlSe.; Oae^rbth.lSe. 6d. 

Poe a Sxbdeb or Ixbxbtiokb r—Wbole Pife, thirteeo inaertlona 
(weekly, fortniEbtly, or montbly), at AS lOe. Od. t twentyeiz 
iueertioiia (weekly or fortnigbtly) at £S 8a. Od.: flftytwo 
iBseitioBB (weekly) at AS each. Half Paye, thirteea inaarUona 
at 86 b. 1 twenty>Biz at 88a. t fifty-two inaertiou at SOa. each: 
Qnarter-paEO, thirteen inaertiona at 18a.: twenty-aiz inaertlona 
at 16a. I fifty-two inaertionB at 16a each. 

Small annooncementa of Practloee, Aeaiatancieo.Vaoaneieo, Booka, 
iio.—Seven linea or under, 4a. per inaertioB} 6d. per Una 
beyond. 


Wxt Jlttbuftl fxtBB «nb Circular. 


“ 811.08 POPULI 8UPBBUA I.BX.” 


WEDNESDAY, DECEMBER 18, 1901. 


DOES ANTI-DIPTHEBITIO SERUM INFLU¬ 
ENCE DIPHTHERIA MORTALITY P 
A soFFiciBKT period of time has elapsed since the 
anti-diphtheritic serum came into genera! use to 
render it possible to gauge the results by the statis¬ 
tical method. It majbe urged that this method has 
OTer and over again been employed with results 
almost uniformly in faTOur of the therapeutical 
value of this tieatment, but if we look into the 
matter more closely it will be apparent that the case 
mortality alone daring a given period does not afford 
trustworthy data for a final opinion. It must be home 
in mind that the proportional mortality of diphtheria, 
as with most other infections diseases, varies within 
wide limits in virtue of causes which are still ill-under- 
stood. It behoves us therefore to be on our guard 
against fallacies euch as would result from our forth¬ 
with attributing reduction in the total or pro¬ 
portional mortality to the influence of any partirular 
method of treatment. A highly important article on 
the influenoe of treatment on the oscillations in diph¬ 
theria mortality appeared in last Wednesday’s issue 
of La Semaine Medicate, from the pen of Dr. G. de 
Maurans. The author had in view to compare the 
case mortality of diphtheria in the principal cities I 
of the world before and after the introduction of the j 
serum treatment, in order to establish the influence 
of the latter. He found himself confronted with the 
difficulty that in very few instances did the notifica¬ 
tion returns afford trustworthy ioformation as to the 
number of cases of the disease, so that he was fain 
to abandon the idea. The author, therefore, falls 
back on the total mortality, and establishes in 
graphic form a series of comparisons which, he sug¬ 
gests, throw doubt upon the direct influence of 
the serum treatment in lessening the mor¬ 
tality. The tables of curves iUustrating the 
incidence of the disease in various cities at 
different periods show very clearly that diphtheria 


everywhere proceeds by fits and starts. Each out¬ 
break follows an ascensional course, reachiog its 
acme in about three years, and then gradually 
falls until it reaches a minimum, where it remains 
for a vaiiable period. When we compare the curves 
of cities as far apart as Paris and Berlin, Amster¬ 
dam and Geneva, we see at a glance that the maxi¬ 
mal and minimal dates for any one city are quits 
independent of those of otheis, and, what'is of even 
gisater significance, of the introduction of the 
serum treatment. These same curves show how¬ 
ever that the great wave of diphtheria which 
traversed Europe between 1887 and 1893 reached its 
apogee at some point between those years, and, 
with one or two exceptions, the curves have since 
more or less been steadily downward, all subsequent 
maxima being at a point far below those of previous 
years. It must be admitted that in most instances 
the descent set in before the introdnetion of 
seruui treatment, and followed a course, roughly 
speaking, the same as at similar previous periods. 
The exceptions are Glasgow in 1894, Dublin in 1897, 
Stockholm in 1898, Bucharest and Liverpool 
in 1899. In one or two instances the author found it 
possible to establish the proportional mortality of 
diphtheria in regard to the total number of 
cases, and from the fact that this varied within 
wide limits he infers that the serum treat¬ 
ment was without itifluence on that mortality, an 
assumption which does not commend itself for 
acceptance since it is recognised that the virulenoe 
of the disease varies within wide limits in different 
epidemics and at different periods of the same 
epidemic. It is therefore unreasonable to expect 
that the effect of any particular treatment, as 
measured by the proportional mortality, will be 
equally efficacious—t.e., will keep the mortality at 
about the same proportional leveL This is well 
shown by the fact that while in 1895 the case 
mortality from diphtheria in Paris during the 
first eleven months was 9‘42 per cent. (3,842 
declarations with 362 deaths), that during the 
corresponding period of the present year was 14’49 
per cent. (4,317 declarations with 630 deaths), that 
is to say, with 505 declarations more the deaths 
were in an excess of 268. It would seem that since 
1887-1893 the total mortality from diphtheria all 
over the world has been progreasively, and, in most 
instances, rapidly, diminishing. It may conse¬ 
quently be maintained with some show of reason 
that the serum treatment at most has but accen¬ 
tuated a natural decrease in that mortality, and, 
that it does not prevent a comparatively high rate 
of mortality at seasons of epidemic virulenoe. 

PULMONARY PHTHISIS IN GENERAL 
HOSPITALS. 

Mobe tha-Ti fifty years ago Sir Thomas Watson, in 
bis admirable lectures on the Practice of Medicine, 
said:—“ There are many diseases also over which 
medicine has very little control, but the causes of 
which, when ascertained, may be avoided or eitin- 

Di"'lizecl by Google 




Dkc. 18, 1901 


LBiDINa ARTICLES. 


Thb Hsdioal Psk88. C65 


guisbed. Such causes, when they do not happen to 
be removable by individual efforts, are often suscep¬ 
tible of extinction by the united measures of a 
community; and for this reason it is very desirable 
that correct opinions respecting the causes of disease 
should be widely diffused among the public.” These 
words might well be taken to-day as the text for the 
crusade against pulmonary tuberculosis, but lear 
that here, as elsewhere, the practice falls far short of 
the ideals preached. Over and over again the dangers 
of treating patients with phthisis in the general | 
wards of our hospitals have been pointed out, but 
still little or nothing is done to put an end to the 
practice. Dr. William Stone, in a recent number of 
-an American contemporary, states that the medical 
wards of the municipal hospitals of New York are 
still crowded with phthisical patients, and quotes 
two cases, in each of which a patient admitted with 
healthy lungs, while undergoing prolonged treat¬ 
ment in hospital, became infected with, and died of, 
acute miliary tuberculosis. That similar oases may 
occur in our own hospitals cannot be doubted, and 
that such a state of affairs should be possible in the 
light of our present knowledge reflects the greatest 
discredit on our hospital management. It is quite 
beside the point to say that measures are taken to 
prevent infection, and that such cases are admitted 
as seldom as possible, for one can never be sure that 
these measures are always effectual or constantly 
carried out, while one such case may be a source of 
the greatest danger to all the other patients in the 
ward. We can hardly expect ignorant patients to 
realise the infectious nature of their complaint if 
they are permitted to mingle with other persons. 
The only argument which can be urged in defence of 
the practice is that it is necessary, and that in the 
present state of our hospitals no other plan can be 
adopted. Were this true, nothing more could be 
said, and the present practice would have to be 
accepted as inevitable. But is it true, and have the 
hospital authorities made any real effort to find an 
alternative ? If each of the clinical hospitals in our 
large cities were compelled to open at least one, or 
possibly two, wards with five or six beds each, 
exclusively for the treatment of consumptives, the 
difficulty would in a laige measure be solved. 
Phthisical patients form a considerable proportion 
of the patients who present themselves for medi¬ 
cal treatment in our hospitals, and if these institu¬ 
tions are primarily for the relief of the sick poor, 
surely it is unfair to exclude a large class. 
The real difficulty appears to be that any 
such procedure would in many cases sen- 
ously restrict the number of beds available 
for cases of more interest for clinical instruc¬ 
tion. This plan has, however, been carried out 
in the case of typhus, scarlatina and small>pox, and 
why should it not be done for phthisis? If the 
public grants to the hospitals were made to depend 
on its being done, the difficulty would be solved. 
If such wards were established, they might be so 
arranged as to be capable of easy and frequent dis-1 


infection. Only advanced cases, or those presenting 
I some complication requiring hospital treatment, 
should be admitted, and the latter only tempotarily, 
for the situation of a city hospital is not suitable for 
a sanatorium for consumptives. Such patients could 
at least be impressed with the infections nature of 
their disease, and be prevented from becoming a 
source of danger to their fellow creatures, while at 
the same time a very serious responsibility would be 
removed from those who have been constituted their 
I guardians. 


I SMALL POX AND THE ASYLUMS BOARD 
HOSPITALS. 

Thebs can be no more eloquent testimony to the 
excellence of the hospital accommodation afforded 
for small-pox patients than the eager way in which 
sufferers of all classes crowd into those institutions 
in their time of need. In the long run the popu¬ 
larity of a hospital invariably furnishes an unfailing 
proof of the fitness or otherwise of that organisation 
to discharge the functions for which it has been 
called into existence. It must be borne m mind in 
considering the case of the public infections hospi¬ 
tals that all ratepayers have a right to de¬ 
mand admission whatever their position in 
the social scale, and that no costs are recover¬ 
able for such accommodation by the sanitary 
authorities. It is somewhat amusing under these 
circumstances to read a letter published recently in 
the Daily Nevot from a correspondent who signs 
himself Middle Class.” He first admits that prompt 
removal to the board hospitals, hospital ships, 
shelters is, doubtless, in the interests of the general 
public. On the other band, he coneiders the matter 
from the standpoint of the patient, and asks whether 
the long journey, the crowded hospital, and the 
indiscriminate mixture of all sorts and conditions of 
men among the patients would not considerably 
lessen the chances of recovery in persons used to a 
comfortable home. The picture drawn by this oorre- 
spondentof the fateof the small-pox patient entrusted 
to the tender mercies of the Metropolitan Asylums 
Board would do credit to the most realistic pen of 
modem imaginative literature. He depicts the drive 
in an ambulance, the weary miles that lie be¬ 
tween the comfortable bedroom and the distant 
shelter; the journey down the Thames the stay in 
a crowded hospital, tended by overworked nurses, 
and surrounded by an atmosphere laden with damp 
river mists; and, above all, the contact with '* tramps 
and vagrants, who have hitherto been the chief 
victims of the disease.” This communication has a 
distinct value as indicating the somewhat hazy view 
held by many worthy middle-class persons with 
regard to the whole question of small-pox and its 
prevention. The system now being applied in 
London is the most perfect that the world has 
hitherto seen. There is no compulsion, however, as 
“ Middle Claes ” appears to imagine, for patients to 
go to the public hospitals, save and except in the case 
of any person who is suffering from any dangerous 

Dic'"ze j C 



666 Th« M*dicai Pa«88. NOTES ON CURRENT TOPICS. 


Die. 18, 1901. 


iafectioas disorder, and is withoat proper lodging or 
accommodation, or lodged in a room occupied bj 
more than one family, or is an inmate of any corn* 
mon lodging bouse, or is on board any ship or vessel 
may,be compulsorily removed by tbe local antbority.’’ 
The later legal decisions have narrowed down tbe 
words " without proper lodging or accommodation ” 
in such a way that under certain circumstances they 
bring compulsion to bear upon members of tbe 
middle and upper classes. Tbe words are now inter* 
preted as having reference to tbe unfitness of tbe 
lodging or accommodation for tbe reception and 
treatment of a case of infectious illuess, and to the 
possible danger to others from inadequate isolation 
of a case. To take an illustration, suppose a 
well-to-do person living in an hotel or in fur¬ 
nished apartments to be attacked with small-pox, 
be could forthwith be compulsorily removed by 
the authorities to a public infectious hospital. 
From an impersonal point of view there can 
be no doubt that such a removal would be in the 
interests not only of the public but also of the 
patient himself. As to the distance of the hMpitals 
from the main mass of the citizens in a great city 
that drawback arises from the inherent circumstances 
of tbe case. There is great difficulty in finding sites 
for infections hospitals, as the proposal to erect such 
a building is usually enough to set all tbe inhabitants 
of the district selected up in arma Moreover, there 
are strong reasons for placing small-pox hospitals 
as far as may be away from centres of popula¬ 
tion. As regards the risks of transportation, 
of residence in tbe hospital wards, and of the 
river and other items of special environment the 
answer is to be found in the fact that the total 
average mortality for the last twenty years of patients 
treated in the Asylums Board hospitals has been 
only 16’53 per cent., as gainst 6 07 for scarlet fever, 
19'^ for diphtheria, 20 54 for typhus, and 18*44 for 
enteric fever. There can be no doubt that the small¬ 
pox mortality would have been still further lessened 
by efficient vaccination, but as it stands the figures 
are satisfactory in connection with so serious an in¬ 
fection. Tbe risks of ambulance and of hospital 
isolation, therefore, cannot be r^;arded as of any great 
importance. As to the social aspects of the case, 
they can hardly be taken into consideration. Small¬ 
pox is no respecter of persons, and the public 
accommodation is or should be good enough for all 
For those who wish special hospital accom¬ 
modation several excellent private institutions are 
always available. There is something to be said 
in favour of special hospital accommodation in 
public hospitals for paying patients, but on the 
other hand tbe subject is surrounded with many 
difficulties. On tbe whole the safest principle is to 
safeguard the interests of the many by making good 
and adequate infectious disease hospital pro¬ 
vision without any distinction of class or ac¬ 
ceptance of fee. Tbe right to tbe general 
treatment provided is shared in common by all 
ratepayers just as the resulting benefits in tiie pre¬ 


vention of disease are conferred upon all classes 
society. Some day the whole of our TWA^^^cs .^ charities 
may be absorbed in some scheme of public adminis¬ 
tration on lines similar to tbe institutions so ably 
controlled by the Metropolitan Asylums Board. 


OR Corrmt "^opico. 

The Election of Direct BepresentatiTes. 

Tbe eleotion of direct representatives for England 
and Wales has resulted in the return of Mr. Gkobob 
Jackson and Mr. Geoboe Bbown, Dr. Woodcock 
following at a respectful distance, and Dr. Hayward 
in the far rear. The most unsatisfactory feature of 
the election is the indifference of so large a propor^ 
tion of practitioners to the matters at issue, the 
abstentions on this occasion having been much more 
numerous than at the 1896 election, amounting 
indeed to nearly sixty per cent. This indifference, 
no doubt, is mainly due to the general feel¬ 
ing that the small number of direct repre¬ 
sentatives can do little in the direction of reform 
in tbe General Medical Council as at present consti¬ 
tuted. A study of the proceedings of the Council 
since tbe introduction of this new element would 
show, however, that this belief is founded on error, 
for influence is by no means in direct proportion to 
numbers. It cannot be questioned that since tbe 
advent of tbe direct representatives on the Council 
the interests of practitioners have received a much 
larger share of attention, and in tbe person of Mr. 
Horsley suhetantial reforms have been initiated 
in the financial and legal administration of 
the Council and in other directions. One great 
obstacle to moving the profession in view of these 
elections is the Uiffioulty of getting into touch with 
more than an infinitesimal fraction of a con- 
stituenoy. Be tbe candidate never so active, he 
can but address directly a few hundreds out of as many 
thousands; and even the addresses printed in the 
medical journals ore read, it is to be feared, by only 
a minority of the electors, so many of whom do not 
find time to keep themselves au eotirant with the 
varying phases of medical politics. Be tbe explana^ 
tion what it may, the prevailing indifference cannot 
but have a damaging effect on the principle of direct 
representation, and will enhance the difficulty of 
increasing the elective element on the Council. 

The Physiology of Cycling. 

One of the principal physical advantages of the 
cycle is that it enables one to obtain exercise withoat 
fatigue, though, of course, fatigue can be had for the 
asking. This assumption has recently been verified 
by an ingenious German physiologist. Dr. L. Zontz, 
who took the trouble to collect tbe air expired by a 
cyclist for analysis. He found that when travelling 
at the rate of ^teen kilometres an hour the eneigy 
expended by the cyclist is 10 per cent, in excess of 
that liberated by a pedestiian walking at the rate of 
six kilometres an hour, white at twen^ kilometres an 
hour the energy expended is olose upon twice as 

D!c: ze , ’OOg C 


D»c. 18, 1901. NOTES ON CURRENT TOPICS. Thi Mmdioal Fust. 667 


great aa tbat of the six Icilometre an hour pedestrian. 
This extraordinary consumption of energy, associated 
as it is with comparatively slight fatigue, indicates 
cycling as the pastime par txeellence for the obese. 
In common with most forms of muscular exercise 
cycling diminishes the amount of sugar in the urine 
of diabetes ; and in moderate degrees of anaemia 
cycling markedly stimulates hsematosis byactuat* 
iog metabolism. Its usefulness in the latter 
direction is limited by the ability of the weakened 
organism to have recourse thereto. Speaking 
generally, whenever a person is strong enough to 
take walking exercise moderate indulgence on the 
cycle is permissible, not excepting persons suffering 
from heart disease, other than aortic, who are able 
to ride. Learning to ride is quite another matter, 
and it presents special dangers to cardiac and elderly 
persons on account of the excitement and risk of 
physical injury associated with the first attempts at 
attaining equilibrium on wheels. We hear little 
nowadays of injuries of joints, &c.. as the 
direct consequence of cycling, as distinguished 
from falls, and it may safely be assumed that the 
oases placed on record were those of persons predis¬ 
posed to arthritia Nevertheless, faulty position 
may in certain subjects determine more or less 
troublesome disturbanoe of function. A pedal out 
of the true, for instance, may throw an intolerable 
strain on the ligaments of the knee-joint, just as an 
ill-shapen or ill-placed saddle may determine genito* 
urinary trouble. These, however, are not drawbacks 
inherent to cycling, any more than the prostration 
which results from immoderate feats of endurance 
or speed. 

Methylated Liniments. 

When soap liniment is prescribed, the chemist 
who dispensed liniment made with methylated spirit 
would unquestionably expose himself to a prosecu¬ 
tion for having sold an article not of the nature, 
quality, and substance demanded, because, unless 
otherwise specified, preparations embodied in pre¬ 
scriptions should conform to the official description. 
Whether, when an ordinary customer asks for soap 
liniment and is supplied with the methylated article 
at a price in proportion to its quality the dispenser 
is liable to prosecution is a point which has recently 
been raised at the Clerkenwell Police Court, the 
defendants being Parkes’ Drug Stores. Similar 
proceedings against “ Boots, Cash Chemists ’’ a few 
days earlier resulted in a conviction, followed by a 
fino of £20 and heavy costs. A case has been applied 
for in respect of the latter, so that we may hope to 
have the point authoritatively decided. Incidentally 
a nice point of law was raised, viz., whether a limited 
liability company could be convicted under the Acts. 
If they cannot the law would to a great extent be¬ 
come nugatory, seeing that retail pharmacy is fast 
being monopolised by such companies. With respect 
to the therapeutical aspect of the case, of course, it 
matters nothing whether the pure or the methylated 
spirit be used in the preparation of medicines for 
external application so that the prejudice to the cus¬ 


tomer, if any, would be merely in connection with 
the price charged. It is, indeed, rather surprising 
that the Pharmacopoeia Committee should not have 
authorised the use of the cheaper article under a 
suitable distinctive denomination. That methylated 
spirit should ever be used in preparations for internal 
use is alt'gether inadmissible in view of the dis¬ 
agreeable taste of the impure spirit. It is weU that 
the question should be thoroughly threshed out, and 
this is now in process of accomplishment. 

PoacbiDg by Public Vaccinators. 

UMDBfi pretext of placing the services of public 
vaccinators at the disposal of the public many dis¬ 
tricts of the Metropolis and elsewhere have been 
inundated with posters and leaflets bearing in large 
type the names and addresses of these officers, con¬ 
veying the intimation that anyone can be vaccinated 
grati$ with Government lymph. Not content with 
exhibiting these bills in every prominent spot, the 
handbills have been left at all the houses in the 
respective districts, of rich and poor alike. No 
wonder that protests are making themselves heard 
against a practice which is in every respect as objec¬ 
tionable as that alleged against the medical officers 
of medical aid associatious. Moreover, by inciting 
persons who are willing to pay to be vaccinated free 
of charge an unnecessary burden is thrown on the 
ratepayers. It must be borne in mind that the public 
vaccinator is invariably engaged in private practice 
and is directly interested in this wholesale advertise¬ 
ment. The leaflets in question are usually signed by 
the Clerk to the Guardians, and are issued, it is 
asserted, in conformity with the regulations of the 
Local Government Board. Surely, however, it would 
suffice for the officer to be designated as the Public 
Yaccinator without giving his name P In any case, 
the practice is one which has very naturally excited 
much feeling on the part of private practitioners and 
urgently calls for repression. 


The Macolesfleld Dilemma. 

Miss Mubdock Clabke, the resident officer at 
the Macclesfield Infirmary, having decided not to 
resign, the Governors in their turn have declined to 
dismiss her, although they have agreed to release 
her from her promise to remain twelve months. An 
appeal was made to the honorary staff to withdraw 
their resignations, and matters therefore remain in 
the state quo ante helium. The medical staff cannot 
well recede from the position they have taken up and, 
on the other hand. Miss Clarke cannot carry on the 
work of the infirmary single-handed. It is extremely 
unlikely that other practitioners will step in to stop 
the gaps, and it is inconceivable that an important 
medical charity should continue to suffer from the 
internecine conflict. With every sympathy for Miss 
Clarke, who plays the role of the Turk's head in this 
unfortunate controversy, we cannot help thinking 
that it would be becoming if she consented to place 
the interests of her patients before her own and 
vacated an untenable position. 




668 Ta« MiDiciL Pbibs. NOTES ON CURBENT TOPICS._ D»c. 18 . 1901. 


The Proposed Reforms ia the Royal Army 
Medioal Corps. 

A GBNTLEUAN, described 88 a high authority, has 
sent from Germany various sn^estioDs aud criti¬ 
cisms on the proposed reforms in the Army Helical 
Service to the current number of The Outlook. 
Perhaps the two most important points in the paper 
are his proposals with i-egard to the Advisory Board 
and his suggestions for obtaining the required 
number of suitable candidates. With regard to the 
former of these, be suggests that appointments to 
the posts of consulting physicians and surgeons to 
the Army should already be made in times of peace 
by the Crown, acting on the advice of the Secretary 
of State or director-general, such appointments being 
honorary and given to the most eminent practitioners 
and scientists of the day throughout the whole king¬ 
dom. In times of war,‘only such men who have held 
the appointment should become eligible for active 
service. By this means the director-general would 
have a staff of the most prominent men throughout 
the whole country at his disposal who might be 
-called upon to serve on the Advisory Board 
for certain periods, or in any other capacity 
in connection with the R.A.M.C. In order 
to attract u greater number of candidates cer¬ 
tain inducements should be held out to them at 
the very outset of their career. The writer proposes 
a system of scholarships similar to those in vogue in 
the German service. Candidatesentering the Fried¬ 
rich Wilhelm’s Instltut at Berlin receive board and 
lodging there and their full medical education at the 
Berlin University gratis. Before taking their final 
degree, they become attached to a main hospital of 
the medical school (Charite) for a year, during which 
they act as resident medical sub-officers in the 
various wards. After the ordinary term of military 
service (six months for medical students), they join 
military hospitals for another space of six months. 
Then they are eligible for the Army Medical Service. 
If the probationer is found acceptable, his appoint¬ 
ment is recommended by the Director-General to 
the Crown. He engages to remain in the service 
for a period which bears a certain relation to the time 
he has bad the scholarship. Timeof study,as arule> 
lasts five years, candidates pledging themselves for 
ten years’ service. Licensed medioal practitioners, 
who have had no scholarships and enter the 
Army, receive a gratification amoimting to £50. 
The idea of a system by which a large body of medi¬ 
cal men throughout the country would be at the 
call of the War Office when required is by no means 
a. new one. Further, it is one which will probably 
receive more attention in the future than it has in 
the past. We are coming to recognise that, in this 
country it is impossible to maintain a war establish¬ 
ment during peace time. Hitherto the difference 
between the two establishments has been made up 
when necessary in a haphazard and put-your-trust-in- 
Providence kind of manner. We look forward to a 
definite change in this in all our naval and military 
• departments -a change which will enable the 


Government to place themselves in oommnnicatioa 
with the required men, and to obtain their services 
as matter of right. 


The General Medical Council and the First 
Tear of Profeeeional Study. 

Sib Chbistophbb Nixon’s speech at the 
General Medical Council, when proposing the adop¬ 
tion of the first of the recommendations of the 
Educational Committee, has secured a large meed of 
praise even from those who did not altogether agree 
with the proposals be brought forward. The resolu¬ 
tion runs as follows:—That the Council approve of 
the suggestion that the registration of a medical 
student should be postponed until he has passed (1) a 
recognised examination in arts, and (2) a recognised 
examination conducted by the qualifying bodies in 
the preliminary scientific subjects, on the under¬ 
standing that ^e subsequent course of professional 
study should occupy at least four academic years. 
Sir Christopher Nixon argued in favour of 
such a radical change that the subjects to which 
the resolution alluded weie subjects of general 
education, subjects to ensure that the student had a 
broad, general culture; that, in other words, medi¬ 
cal education had two sides—the arts side and the 
scientific side—and that if the Council added to the 
arts requirements the amount of scieuce training 
which it required from the student as his first year 
of study, it would have students with such a broad 
degree of culture that when they came to medimne 
they would be capable of taking a broad view of the 
subject. Sir Christopher Nixon almost, we fancy, 
succeeded in persuading his hearers that the scheme 
embodied in the resolution was preferable to the pre¬ 
sent scheme; he could not, however, succeed in per¬ 
suading them that it was feasible. A criticism 
which was passed upon it at the time was that it 
was a few years too late. If such a proposal had 
been as clearly laid before the Council at the time of 
the adoption of the five years' system as it was at 
the Council’s last meeting, there is, we think, little 
doubt that it would have been carried. Now we 
fear the licensing bodies and medical schools would 
look askance at a proposal which would entail an 
almost complete revision of a lately-revised curri¬ 
culum. Sir C. Nixon’s resolution recommended 
what was, perhaps, to be regarded as a final attempt 
to bridge over the difficulties which exist between the 
Council and tbe English colleges. For that reason, 
and in view of the grave doubts which surround an 
appeal to the Privy Council, it might have been well 
if the recommendations of the Educational Com¬ 
mittee had been adopted. 


Small-pox in London. 

The small-pox epidemic in the metropolis, al¬ 
though it has not, so far, realised tbe predictions of 
certain pessimistic health officers, continues steadily 
to spread. Tbe admissions last week num¬ 
bered 132 which, if not alarming, is at any rate 
disquieting. 


Digitized by Googie 



D«0. 18, 1901, 


NOTES ON OTJRBBNT TOPICS. 


Thb Midioal P&X88. 669 


The ‘William Smyth Memorial Fund. 

We are glad to be able to atate that the William 
Smjtb Memorial Fond is making steady and satia- 
factory progress. It is especially pleasing to note 
that subscriptions to it come not alone from all oyer 
Ireland, but from all over the British Isles. The 
efforts of the promoters of the fond and their sup* 
porters must not, however, be lessened. The late 
Dr. Smyth left a widow and family of eight young 
children behind him, and it will necessitate a con* 
tinned effort to provide even the minimum sum to 
support and educate them. We are sure that oar 
refers will agree that this is not a case in which 
merely the minim nm sum necessary to effect the 
required object should be deemed sufficient. The 
response to the appeal of the Presidents of the Irish 
Colleges must be such that ample funds are pro* 
vided to enable Mrs. Smyth to fight her battle of life 
untrammelled by harsh and undeserved poverty. 


Inquest on a Mummy. 

The humours of the Coroner’s Court are few and 
far between, inasmuch as they are for the most 
part possessed of tragedy and gruesome circumstance- 
American writers have made the most of the coroner 
who, being paid for each inquest, insists on holding 
a formal inquiry on every human fragment found 
within his jurisdiction. In this way an unfortunate 
engine*driver, blown to fragments by an explosion, 
has furnished material for a dozen or more inquests 
in his own district, and for almost as many more in 
neighbouring counties. Tbe imaginative brain of 
that type of author, however, has failed to grasp 
the possibilities opened up by “sitting" upon 
imported mummies. That stroke of genius was left 
for an English coroner. Dr. Wynn Westcott, who 
has achieved thereby a world-wide fame through the 
agency of the Law Courts. Tbe facts of the case 
are simple. A benevolent English lady wished to 
present to the museum of a religious institution in 
Belgium a Peruvian mummy. After some difficulty 
she obtained the body of an Inca, a young princess 
of the Royal family, and this she shipped to Eng* 
land. On reaching Liverpool tbe mummy was sent 
by the London and North Western Railway Com¬ 
pany. The case was opened, and tbe contents, 
which included two ancient skulls and a piece of 
pottery were damaged. On reaching Belgium the 
police ordered the burial of the mum. my. The 
London coroner, when informed of the discovery of 
the body, held an inquest. The solemn verdict of tbe 
jury was to tbe following effect:—“ That this woman 
was found dead at the railway goods station, Sun 
Street, on April 13Ui, and did die on some date un¬ 
known in some foreign country, probably South 
America, from some cause unknown. No proofs of 
a violent death are found, and the body has been 
dried and buried in some foreign land, probably 
sun-dried and cave-buried. The jurors are satisfied 
that the body does not show any recent crime in this 
countiy, and that deceased was unknown, and about 
twenty-five years of age.” The mummy was some ‘ 


400 or 500 years of age, and the plaintiff was 
awarded £75 dam^^s for injury of goods in transit. 
These facts suggest a field hitherto unworked by the 
coroners, for there must be a vast number of 
mummies in private and public collections scattered 
through the United Kingdom. Under such circum¬ 
stances tile British Museum might be made as pro¬ 
ductive as the gold mines of King Prempeh. If an 
ancient mummy is to be “ sat upon ” by the coroner, 
surely all the fragments of human ori^n should 
logically share tbe same inquisition. It is not likely, 
however, that so farcical a waste of public funds 
would be permitted for any length of time. Grotes¬ 
que inquests of the kind indicated will not add to 
tbe dignity of an ancient and honourable court of 
law. ■ ' 

An UnBUCcesaful Claim for Dam^es. 

The idea of instituting a civil claim for damages 
on the strength of an alleged criminal assault is 
peculiar to the English mind, just as is the practice 
of claiming a pecuniary solatium for a wife's dis¬ 
honour. An instance of the fonner procedure came 
before the Solihull County Court a few days since, 
when a married woman setup a claim for ten guineas 
by way of compensation for an assault of which, she 
alleged, the defendant. Dr. Vincent Hall, has been 
guilty. She had consulted the defendant in respect 
of her infertility, and eventually an examination 
was instituted, which was apparently construed by 
the plaintiff to have been the assault complained of. 
Before the evidence had been fuUy beard tbe jury 
returned a verdict for the defendant, with costs on 
the B scale. Dr. Hall was defended by Mr. F. 
Colam, on behalf of the Medical Deience Union. 

The Last of the Dog Muzzles. 

The disappearance of rabies from Great Britain 
must be regarded as a triumph of preventive legisla¬ 
tion. That happy result is pretty confidently 
assumed by the Board of Agriculture, which has 
accordingly removed the muzzling order from the 
last remaining counties of Breconshire, Glamorgan¬ 
shire, and Carmarthenshire, and has thus released 
the dogs of the whole of England and Wales. Tbe 
Board has, moreover, good reason for believing that 
rabies has now ceased to exist in any part of the 
United Kingdom. However, as the disease is 
still common in many parts of the Continent, 
it is necessary to keep a strict watch upon all 
dogs entering the United Kingdom from abroad. 
A new Order has, therefore, been issued under 
the title of Transportation of Dogs Order of 1901. 
Its main direction is that after March 13th next 
every dog so entering shall be detained and isolated 
at the expense of its owner upon premises in the 
occupation or under the control of a veterinary sur¬ 
geon for a period of six months from the date of 
landing. Licenses are required for each dog upon 
landing, but special regulations are made for dogs 
that are merely sent through Great Britain in tran¬ 
sit, and for foreign performing dogs. Mr. Long has 
for some years been the centre of abuse from senti¬ 
mentalists, who think the comfort of their dogs of 

D oo e 


670 Teb Midioal pBxes. 


NOTES ON CURRENT TOPICS. 


Dbc. 18. 1901- 


more acconnb the death-toU of a certain 

number of tbeir fellow creatures from one of tbe 
most terrible of all human maladies. He has, how* 
erer, by bis persistence, achieved a notable success 
which registers, in point of fact, one of the few solid 
benefits conferred upon the community during tiie 
past few years in the direction of domestic legisla¬ 
tion. 

Forgotten Remedies. 

In looking over a catalogue of foreign, medical 
works, tbe title of one of them, “ Lee Bem^des 
Oubli^s,’* stt(^eeted an interesting and possibly in¬ 
structive train of thought. If tbe size of the work is 
at all proportional to tbe subject of which it treats* 
it must be a library in itself. Vast as tbe tomes are 
that deal with the remedies of tbe first year of tbe 
twentieth century, they are nothing to tbe stupen¬ 
dous piles of literature dealing with drugs and methods 
that have outlived tbeir fleeting day. Of the vanished 
host many have been mere superstitious follies or 
fantastic fashions, while some few have been redis¬ 
covered and flaunt tbeir virtues once again xmder a 
new and more or less scientific guise. The present 
generation has witnesced tbe rise and fall of scores 
of these therapeutic shooting stars, and is still 
doubtless directing its gaze heavenwards at many 
equally unsubstantial meteors. The oommerolal side 
of the question is worthy of careful consideration at 
the hands of our social philosophers. Vast sums of 
money have been poured out like water in that direc¬ 
tion in foisting not a few of those now forgotten drugs 
upon the market. Had the drugs been sound and 
their virtues recognised they would have been 
adopted by the medical profession quite apart from 
advertisement. It is safe to say that every really 
good remedy brought before the notice of medical men 
sooner or later is bound to be adopted. But in nine 
cases out of ten they are forgotten, and the list of the 
forgotten grows even greater with the lapse of years, 
The moral is that judgment were best suspended as 
to tbe value of new remedies, or, to amend the old 
proverb so as to read “ Time tries all ~ remedies.” 
A. work on these forgotten remedies is not without a 
value of its own. History repeats itself in medical 
as in other departments of human industry and 
thought, and a retrospective glance at this foigotten 
lore would often enable us to avoid misplaced enthu¬ 
siasm and to discard hopes which experience has 
already shown to be without foundation. 

The Concentration Camp Mortality Batea 
Aftbb considerable delay tbe concentration 
camp mortality statistics have been published for 
the months of October and November. Up to tb 
commencement of that time the figures had been 
regularly announced, and tbeir abrupt suspension 
had naturally enough given rise to all kinds of 
unfavourable comments. The thousand tongues of 
rumour nave now found some sort of justification, 
inasmuch as tbe figures just issued are worse than 
any previously given, a fact that is certainly not 
calculated to increase the confidence of the public in 


tbe methods and candour of the Government. Miss 
Hobhouse, had she been allowed to land at tbe 
Cape, could not have done more than confirm the ter¬ 
rible mortality rates now officially announced to the 
world. Tbe rate per 1,000 per annum of deaths 
of pere<ms of all ages in the camps was 398 in 
October and 284 in November, as against 109 in 
June. The death-rate amoug children was 433 in 
September, 572 in October, and 469 in November. 
Such a mortality among non-combatants under 
British protection points to a deplorable loss of life 
from more or lees preventible causes. The original 
statements of Miss Hobhouse have been amply 
confirmed by subsequent Government reporte. It is 
a pity that the vigorous measures now announced as 
about to be taken to reoi^aniee and reconstruct the 
camps was not undertaken before attention was 
drawn to the state of matters by a civilian. The 
attempt to put off the evil day by withholding inf<M> 
mation is unwoithy of tbe statesmanship of a great 
' nation. 


▲ suggested Mectro-Therspeutio Society. 

Thk suggestion that a new society should be 
formed for dealing with electro-therapeutics invites 
some plain speaking cm the part of the medical pro¬ 
fession. Apart from actual cautery and electrolysis* 
the definitely curative field of electrical treatment is 
extremely limited. That view may be confirmed by 
a perusal of a standard work like that of Dr. Lewis 
Jones, who discusses the subject with moderation and 
full knowledge. The fact appears to be that the 
results of medical electricity are not commensurate 
with tbe time that method has been before tbe pro¬ 
fession. It may be, of course, that advancing know¬ 
ledge may bring fresh weapons within the grasp of 
the medical electrician. Among recent development, 
Rontgen ray therapeutics and high frequency cur¬ 
rent effects certainly suggest a field of unexhausted 
possibilities. It is tolerabl y safe to say, however, 
that within tbe next ten years Bontgen ray thera¬ 
peutics will be as dead as Queen Anne, that is to say, 
unless new and hitherto unsuspected potentialitaes 
are meanwhile revealed. The Bontgen Society, in the 
person of its honorary treasurer, utters the mildest 
and politest of protests against the formation of 
a new electro-therapeutic association, and states that 
it has been for some time under the consideration of 
his own society toextend the scope of tbeir constitution 
so as to include radiations and electrical phenomena 
other than those discovered by Bontgen. The sug¬ 
gestion that the society already established should 
throw open its doors to the electrical therapeutists 
seems obviously well founded, that is to say, if any 
oiganisation of the kind be really wanted. 


The Prince of Wales’s Hospital Fund is expected 
to benefit by upwards of £25,000 under a bequest in 
the will of the late Mr. Bernard Hirsch, who died in 
London last month. A sum of £3,000 also goes to 
the North London Consumption Hospital and £1,000 
to the Hospital for Sick Children under the will. 

Dic' zeTi hu CjOO^ 




Die. 18. 1901._NOTES ON OUBBENT TOPTO^. Tgi Midioal Pmw. 671 


Menageriea and the Spread of Tuberouloeifi* 

Ds. S. A. Enopf, of New York, has recentlj drawn 
attention to the danger of tnbercnlons infection in 
ohUdhood from visits to memories. These greatly 
loved visits of the little ones shoold, he thinks, give 
oonoem to sanitarians. To visit the monkey-honses 
in the Zoological Gardens and to remain there as 
long as nurses, time and temper will allow is the 
delight of every child. But monkeys also, like the 
children of men, are prone to tubercle. The commo¬ 
tion, dust, impure air of the average monkey-house 
are certainly favourable to the dissemination of 
tubercle. Managers of menageries and directors of 
zoological gardens should do their utmost to reduce 
any danger to a minimum. 

Spinal Oooainiaation. 

OccASiONaL deaths continue to be recorded from 
time to time as the result of amesthesia by means of 
intra-spinal injeotiona of coemne. Dr. Legueu, of 
Paris, related two instructive cases before the French 
Society of Sui^ry a few days since. The first victim 
was an elderly man, who had ruptured the tendon of 
the triceps. Lees than a third of a grain of cocaine 
was injected, but ten minutes later he became 
agitated, and died in two or three minutes afterwards. 
A few weeks later a man, sixty-one years of age, with 
strangulated hernia, was subjected to a similar injec¬ 
tion, and even before anmstheaia was complete, 
respiration became laboured, the pupils dilated, and 
death ensued. The moral to be deduced from these 
oases is that when the condition of the patient 
contra-indicates the administration of chloroform, 
resort to spinal oooainisation does not minimise the 
risks. It would seem, too, that in some of these cases 
local anmthesia would have answered every purpose 
without placing the life of the patient in jeopardy. 

Hie Notifloation ResponsibilitieB of 
Householders. 

The clause in the Notification of Infections 
Diseases Act which renders it incumbent on the 
householders to notify the existence of infectious 
has been allowed to fall into abeyance, and in 
some cases it has no doubt become the practice to 
abstain from calling in a medical man in order to be 
able to plead ignorance of the nature of the disease. 
We are pleased to see that this plea is not always 
allowed to protect the delinquents. In a case at 
Spitalfields last week a man was fined the full penalty 
for neglecting to notify. As the penalty is only 
forty shillings it cannot be expected to act as a very 
efficient deterrent, but it ought, nevertheless, to Iw 

rigorously enforced. - 

Mosquitos at South Kensington. 

Until quite recently the Natural History M useum 
at South Kensington did not contain any collection 
of moequitos worthy of the name, but the deficiency 
is now rapidly beiug remedied, extensive collections 
arriving weekly from every comer of the world. 
Students of natural history, and those for whom this 
insect possesses special interest in view of the part it 


plays in the dissemination of disease, will henceforth 
be enabled to pnrsue their researches without let er 

hindrance. - 

Jews as Doctors. 

It is a significant fact that the great majority of 
female students at the Continental schools of medi¬ 
cine are Israelites. In Germany and what may be 
called German Austria the practice of medicine is 
mainly in the hands of Jews, a large number of the 
moat eminent specialists being of that ilk. In this 
country medicine has not attracted their attention 
to anything like the same degree, although here no 
overt racial prejudice militates against their success. 

PaoF. BsHRiNa is reported to have discovered a 
means of rendering cattle refractory to tuberculosis 
by inoculations carried out in accordance with 

Pasteur’s method. - 

PEBSONAIi. 

PaoriRSOB J. SvinMOTON has been appointed Begistrar 
of Queen's C<dl^, Belfast, in place of Professor Parser, 
resigned. ■ 

Majob Coustkit Mambfuld, of the Indian Medical 
Service, has been promoted to the rank of Lieutenant- 
Ccdonel for gallant servioea in China, 

Da. McViaoh sustained severe injoriee last week as 
the leeult a fell down stairs. The most recent reports 
give his condition as precarious. 

Db, Chablbs Pobtbb, Medical Officer of Health for 
Shropshire, has been selected for the appointment of 
Mediobl Officer of Health to the Muaicipality of 
Johannesburg, The salary is <82,000 per annum. 

It affords us pleasure to announce that Dr. Neil Kerr, 
assistant to the late Dr. Campbell Clark, Medical 
Superintendent of the Lanark District Asylum, has 
been appointed to the senior post in that large and im¬ 
portant institution. ' 

Db. T. N. Esltmaok has been iqipointed Assistant 
Physician to the Mount Vernon Hospital for Consump¬ 
tion, Hampstead, Nortiiwood, and Fitzroy ^uare (North 
London Hospital for Consumption and Diseases of the 
Chest). - 

Mb. M. a Adaks, county analyst for Kent, has been 
presented with an oil painting of himself, handsomdy 
framed, in recognition of his thirty-seven years’ 
gratuitons eervioes as sui^^n to tiie Kent County 0{di- 
thalmio Hospital at Maidstone. 

Db. D. a, Wblsh, Pathologist to the Boyal Infirmary, 
Edinburgh, has been appointed Professor of Pathology 
in the University of Sydney, and is to take up the 
duties of his Chair in Maroh, 1902. Dr. Welsh has an 
excellent record; he obtained the gold medal in 
graduation, was the Wightman Priseman in 1892, and 
Murchison Memorial Scholar in 1893. 

GENERAL MEDICAL COUNCIL. 

Thb result of the p<Jl for the election of two direct 
representatives for England on the General Medical 
Council is announced by the returning officer. Sir Wil¬ 
liam Turner, to be as follows: —Mr. Georg-i Jaokson, 
Plymouth, 6,618; Mr. George Brown, London, 6,569; Dr. 
8. WoodoMk, Manchester, 8,161; Dr. C. W. Hayward, 

Li..rpool. 1,886. ,OOQ e 



672 Thi Midioal Pbiss. 


OOBBBSPONDENOB, 


Die. 18, 1901. 


§cxrtlattb» 


[fBOX OT7B OWN COBBCSPOKOKNTB.j 


Edinbttbqh Hospital fob Womkn and Childbsn. 

Thb tweD^-second annoal meeting in connection 
with this institution, which is the only hospital in Edin¬ 
burgh staffed entirely by medical women, was held on 
December 8th, under the preeidency of Lady Helen 
Munro Ferguson. The anni^ report showed that 112 
patients bad enjoyed the benefits of the hospital. An 
anonymous donation of .£1,000 had been offers on con¬ 
dition that the contributions otherwise should reach 
£1,000 during the year—a condition which had bera 
fulfilled. The payments by patients amounted to £207, 
as against £73 last year. The medical officer’s report, 
presented by Dr. Jeesie Maegregor, set forth that ^e 
number of dispensary patients was 221, and 271 Tisits 
were paid at their own homes. The first year of steady 
work justified the hope of a wide and snooeesfal career 
for the hoepital. 

Unitibsitt Coubt op 8t. Andbbws. 

At the last meeting of this body Principal Mackay, 
LL.D., Univursity College, Dundee, was elected as repr^ 
sentative of tbe Crniyeraity on ^e General Medical 
Council for a period of fire years, from January 8ch, 
1002. A letter from Professor Purdie, Professor of 
Chemistry in tbe University, offering to the University 
a gift of £6,000 for the purpose of building and equipping 
a chemical research department at 8t. Andrews was 
read. It was resolved :—“ That the Unireraity Court 
accept with gratitude Professor Pnrdie’s generous offer 
of £6,000 for the purpose of establishing a chemical re¬ 
search department at St* Andrews. The Court agree to 
tbe conditions laid down in Professor Pnrdie’sletter, 
and will transmit a copy of the letter to tbe Carnegie 
trustees with a request wat they will give their favour¬ 
able consideration to the scheme. In accepting tbe gift, 
the Court desire to record their high appreciation of the 
spirit which has prompted it, and express the hope that 
l^fessor Purdie may hold the Chair of Chemistry for 
many years to come, so that he may himself see the fruits 
of his generosity.” At the meeting of the General 
Council of St. Andrews University, questions connected 
with the arts curriculum were chiefiy under discussion, 
and the only business of medical int«est was contained 
in the report of the Committee on Ordinances. The two 
Chairs of Anatomy and Physiology have been established, 
BO that the medical school in St. Andrews is now well 
provided for two years. 

A '* Class ” fob Midwivbs. 

At Glasgow Small Debt Court recently Sheriff Muir 
gave decree in an action by a would-be midwife against 
a Glasgow medical man for repayment of three guineas, 
which had been paid by pursuer to defender as a fee in 
connection with a class in midwifery. Apparently the 
pursuer bad answered an advertisement for pupils, uid 
bad paid the fee on tbe understanding that other 
women were anxious that the class should be started. 
She, however, turned out to be the only pupil, and 
stat^ that instead of gaining instruction her time had 
been wasted. Her teacher, on tbe other hand, con¬ 
tended that she had received full and ample instruction. 
The Sheriff, in granting decree, with expenses, said he 
had no hesitation in characterising the case as a fraud. 
If any additional evidence were neMed of the necessity 
for putting tbe instruction of midwives on some 
definite foundation surely a case such as this supplies 
it. It is obviously ridiculous to suppose that any man 
can give instruction to a class of one for three guineas, 
and the fact is that tbe sooner classes for monthly 
nurses given by private individuals who are responsible 
to nobody are put a stop to, the better for all concerned. 

Edinbubob Bbctobial Eliction. 

Sir ficbert Bannatyne Finlay, E.C., M.P., the 
Attorney-General, has been officially announced as the 
Unionist candidate for the next BeeWial election. Sir 
^bert Finlay’s legal attainments are too well known to 
need comment, but it may not be so generally known 
that he was originally intended for medicine, and, in 


fact, graduated in 1863 at Edinburgh University. 
Thereafter he assisted his father in practice in Trinity, 
bnt soon abandoned medioine for the English Bar. His 
brother is a well-known practicioner in Edinbui^h. 

Elbction of Dibxct Bxpbxbintativx. 

We were enabled to announce xmofficially in our lait 
issue the re-election of Dr. Bruoe, the sitting member; 
we now give tbe official figures of this ele^on r-^Dr. 
Bruce, Dingwall, 976; Dr. Walker, Edinbni^b, 864; 
Dr. '^bertson, Glasgow, 618; majority, 121. 1,432 

el actors did not vote, 260 papers were returned owing to 
death, change of address, As., while 28 papers were 
spoiled. 


](tber)iool. 


[fbom ottb own COBBXSPONDBNT.J 


Thi Spitting Noisancb. 

At a meeting of the lAverpool City Council, held 
on Thursday last, to consider certain proposed exten¬ 
sions of municipal powers, it waspropoMd, among other 
things, to add the following danse respecting expec¬ 
toration in pnblio conveyances and on the sidewalks of 
the streets:—Any person who, after being cautioned 
by a constable or by any officer in uniform of the Cor¬ 
poration, expectorates on any public footwalk, or who 
after being cautioned by the condnotor or any fellow- 
passenger expectorates in, on, or from aay public oon- 
veyanue, shall be liable to a penalty not exceeding 
twenty shillings.” After' a considerable discussion, 
lasting over an hour and a half, a vote was taken, there 
being fifty-two votes for and thirty-three aga’ost it. 
The Lord Mayor remarked that the clause required sixty- 
one votes to carry it. It therefore had to go. Upon the 
whole, the termination reached was a desirable one, as 
on the face of it the danse allows one free expectoration 
on tbe floor of a trsmear to each person entering. If a 
man enters twelve conveyances a^ybe would be entitled 
to spit once in each of them, as no proceedings would be 
taken without a previous caution. This we imagine is 
scarcely what is aimed at by those opposed to the objec¬ 
tionable practioe. It would have been better to obtain 
power to make the offender wipe up the mess with his 
pocket-handkerchief, even if a first offence, on pain of 
ejectment from the car with loss of his fare. With re¬ 
gard to spitting on the sidewalk, a small stream _ of 
water might be kept running in the gutter, into which 
pedestrians might expectorate. A place for the purpose 
would then be provided, and offenders might be dealt 
with for not conforming. Such a stream would also be 
a trap for flying dust and carry away a very material 
proportion of it. Sputum containing tubercle badlli 
wodd then be carried off without the possibility of 
becoming dust, the only form practically in which it is 
likely to be injurious. As regards the cost of such a 
stream of water, that concerns City Councils, bnt it 
would probably save a large sum annually, and keep the 
citizens in health. 


CorrcspoTiiiaiic. 

LWe do not hold ouselves zesponsihla for the opinions of onr 
correspondents.] 

PRACTICAL ASPEOTd OF MEDICAL REFORM. 

To th « Editor of Thb Medical Pbbss and Cibcttlab. 

Sib. —It most not be forgotten that the powers and 
fnnotions of the General Medical ponncil, diaonssed in 
your leader of this week, are strictly limited and defined 
by Aot of Parliament; and that however mnoh the 
qualities of its members might be improved from the 
point of view of those who crave for reforms advan¬ 
tageous to the rank and file of the profession, no improve¬ 
ment in that respect would bring ns any nearer to 
what is needed, unless at the same ti me new and neater 
powers were conferred upon the Council by the legisla¬ 
ture. It is, I believe, open to tbe strictest proof that 
reform in medical law putting a oheok upon the grosser 
forms of onqnalified practice, fraud, and qoMkecy would 


Dtc. 18,1901. 


CORRESPONDENCE. 


Tbs Medical Pbus. 673 


prove of far neater advanti^ to the public than to the 
profeaeion. If the entire nnselflehnees of the profession 
in seeking to pat an end to the more glaring of the 
abases ana evils wUoh at present exist cannot be proved, 
it can at any rate be demonstrated that more stringent 
laws wonld act in tiie main for the benefit of 
the weak, the afflicted and the helpless, the 
rlnnnm who have most claim apon the goardian- 
ship and protection of the State. Reform is worth 
working for; and being striven for by a profession 
practio^y nnanimons, wonld in the end, there can 
be no donbt, be attained. Who is to oi^anise the pnv 
feesion and make felt its power at once ? An organisa¬ 
tion existe in the British Medical Association, bnt prac¬ 
tically it htt BO far accomplished nothing. The Asso¬ 
ciation is virtoally nothing more than a co-operative 
eccie^ for the pablioation of a cheap medical newspaper, 
oat of the profits of which they are now able to offer 
some slight enconrs^ment to scientific research and to 
irimilar objects. Tolwds achievement of medical reform 
it has long seemed to me the first step most be reform 
of the British Medical Association—r^orm which wonld 
enable the power and inflnenoe of a great profeesion to 
be concentnted npon the object which is of the most 
vital importance the vast majority of members, and 
of almost eqnal importance to the bnlk of the pnblic, 
for whom the profession existe. 

I am, Sir, yonrs tmly, 

Deo. 12th, 1001. T7 bi<)u>. 


UNTRUSTWORTHY SEBUM. 

To th* Editor of Teb Mbdical Pbbss and CiaonLAn. 

Sib, —In reading the last volnme of the Report of the 
IndianPl^^ie Commission and the disappointing reenlts 
of ^e treatment, onr thonghts are natnrally carried 
back to the origin of treating infections disoasee by in- 
ocnlation. Pastenr was the first to apply that method 
to the core of hydrophobia. When Pastenr snbmitted 
to the Paris Academy the treatment of rabies by inocn- 
lation wi^ bonillon mixed with a piece of spinal cord of 
a monkey poisoned with rabic vims, be raised a storm 
of opposition : “ Why! That is the way to roread rabies 
inrte ed of coring it." Bnt ti>e storm was allayed by the 
reply of some anthoritiee: '* Gentiemen, this is not 
patriotic." Even some years after the inangnration of 
the treatment, when the Pastenr Institute was at the 
smith of its popularity and similar institutions had been 
established in different conntries, some leading clinical 
teachers and professors of the Paris Faculty continned 
their dislike d such an institation in their midst. 
Mais, qne vonles vons P .Now we find, after the lapse of 
fifteen years, that hydrophobia in Paris is on the in¬ 
crease—the deaths having risen to the total of 8,079. This 
is a high price to pay for mistaken patriotism, 

2. The 6elat of the Pasteur's initiative encouraged 
Koch to announce a cure for tubercnlosis with reason¬ 
able hope of success, for, whilst we do not know the 
nature of the poison in the saliva of rabid animals, nor 
have we separated the micro-organism which causes it, 
and Pasteur had to rely mainly npon his ingenuity in 
improving on an old sugg^eetion of Italian physioians, 
Yaili and Tissoni, Eoch had apparantly a substan¬ 
tial foundation to build upon; for be had dis¬ 
covered the baocilns which is the cause of tubercle, 
and then pionounoed the dictum:—" Tubercnlous bacilli 
produce toxin (poison) which infiiots injury npon 
the human organism; the bacilli produce ^so at the 
same time a so-called antitoxin (Eoch), which destroys 
the vitality of the bacilli themsdves.” By separating 
the two antagonistic elements and by killing and filter¬ 
ing the bacilli and toxin he expected to ob^n the pure 
antidote, which be called tuberculin, as a cure for 
phthisie. Bnt unfortunately Eooh’s tuberculin proved 
to aggravate the disease, causing disseminated tuber- 
enloeis, pulmonary cavities, Ac. The fault lay in the 
ontcular dictum, which requires facta to be established 
by proof before building a system npon tikem. 

It by no means follows that, when we have caught a 
bacillas, we can make a curative bouillon from it. 

8. The antidiphtberitio serum treatment belongs to 


the same cat^fory. In 1884, Elebs discovered a bacillns 
in the f^se membranoe, of which LOffler made a cultiva¬ 
tion, which is called the Ldffler bacillus, of which 
Behring made a serum (called antitoxin) by passing it 
through horses. This serum obtained, and still enjoys, 
great popularity in all countries, and has since b^n 
the favourite remedy in diphtheria. It is considered a 
panacea, an unfailing remedy. Now information has 
reached ns from America and Italy of epidemics of fatal 
tetanus supervening on its employment. Of course some 
explanation will be forthcoming, but in this connection 
I Mould refer the reader to lectures delivered by Pro¬ 
fessor Eassowicz, of Vienna, and published in Thx 
Mbdical P&bss and Cibculab, of 1898. Professor Easso- 
wicz’s speciality in the University of Vienna is di s e a s es 
of ohildnn. After long trial he found it injurious. He 
gives us also a glimpse at the means which were 
employed to hustle the serum into popularity. The 
advocates of the antitoxin shield it behind vaccination, 
which only causes prejudice gainst Jenner’s immunisa¬ 
tion. Antitoxin has been tried on a large scale as a 
preventive, when all inoculated passed through a crisis 
and many of them died. In reading Eassowios’s lec¬ 
tures we are prepared to r^;ard the fatal tetanus 
epidemics as a sequel of the treatment. Indeed, it is 
only by the occurrence of such disasters that a popular 
erase nag be cured. 

There is a sublime arrogance in the manner in which 
scientific discussions are conducted in some quarters. 
Subsequently to Eoch's pronouncement at the Tuberou- 
loeis Congress in London, Virchow, addressing the Clini¬ 
cal Society in Berlin, said," For the last ten years I have 
been teaching that human tubercnloeis is quite different 
from bovine tubercnlosis. This view has been brushed 
aside by Eoch's school as of no consideration, and I 
had to submit. I am not surprised that Eoch has now 
convinced himself of the distinction between the two 
forms of tuberculosis i for indeed I could never under¬ 
stand how their identity could be maintained." Here 
we have the veritable Hercules among the Lilipntians, 
who are screeching at him in their peculiar jargon, 
which they consider as philosophical inspiration. Poor 
HercnleB has no show. 


1 am. Sir, yonrs truly, 
Edinburgh, December 6tb, 1901. 


M.D. 


THE LATE R. B. ANDERSON FUND. 

7b th» Editor of Thb Mbdical PaBes and Cibcclab. 

Sib,—W ith reference to the affairs of the late Mr. 
R. 6. Anderson, it may be within the recollection of 
your readers that in July last we made an appeal to 
the profession for subscriptions towards the support d 
his widow and twin sons. This subscription now 
amounts to about X80, a very inadequate sum; bnt the 
committee feel that it is useless to keep the fund open 
much longer. It therefore been decided to dose it 
on Wednesday, January 8th, 1902, and to make an 
earnest appeal in the meanwhile for farther donations. 
The amount realised will be at once sent out to the 
Island of Tobago to be used for the benefit of Mrs. 
Andersen and her two sons, at the discretion of the 
Warden of that island. 

We may add, in view of a rumour which has pre¬ 
vailed that the Civil Rights' Defence Committee was. 
dissolved in consequence of some misconduct on Mr. 
Anderson’s part, that the only reason for the dissolu¬ 
tion of that Committee was its failure to collect, in the - 
time given for the purpose, the funds required for the 
contemplated appeal to the Privy ConneiL 

Donations are to be marked, “ for the late R. B.. 
Anderson's Fund,’' and to be sent, and made payable 
to, the Manser, Union Bank of London, Chancery Lane,. 
London. They will be duly acknowledged. 

We are. Sir, yours tmly, 

(Signed) Stakpobd, Chairman. 

Tivotitt HoLina, Hon. Treasurer. 

Dec. 9th, 1901. 

CjOOi'le 

O 




LABOEA.TOBT NOTES. 


Die. 18.1001. 


674 Thb Midioal Pbibb. 


ICtUrature. 

TILLEY ON PUEULENT NASAL DISCHAEGE8. (a) 
This work oontains the sabjeot* matter of a series of 
three lectures which first appeared in book form about 
twelve mouths affo. The; are now re*edited, with the 
addition of six plates end many new illustrations. We 
can hardly sgree that the author has succeeded in his 
objent to present a concise and practical aco-tunt of 
chronic suppuration of tbe nasal accessory cavities, un¬ 
less he is writing purely for rhinologists. For example, 
nearly all operations, and even diagnosis, of purulent 
affections of the middle meatos depend on removal of 
part or the whole of the middle turbinated bone as a pre* 
liminary step, yet we are never told practically how to 
do it. On p. 73 we read '* If it be possible the middle 
tnrbinal bone should be divided along the anterior haJf 
of its attachment to tbe outer wall of the nose, by means 
of Griinwald’s forceps, after which the semi-detached 
portion may be easily removed by means of a wire snare.’’ 
This is a statement of fact, not a praotiosl description, 
and an illustration would not have been de trap. 
Theoperation of passing Hartmann’s caimala (which, by- 
the-bye, is not easy, safe, or even always possible) is 
most carefully described, but this is often most difficult 
nnless tbe anterior half of the middle tnrbinal is first 
removed. Surely, too, the author is in error when he 
attributes the use of Carmalt Jones’ turbinotome to the 
middle turbinated bone. It is in removal of enlarged 
inferior bone that it is both quick and easy to use. 
And why should he give a figure of it when be says 
there is such danger in using it ? 

For radically curing antral empysma the author does 
a modification of Euster’s method; he inserts one or 
two fine catgut sutures through ^e margins of the 
gingifo-labial incision, thus avoiding re-infection from 
&e month, and withdraws the packed gause through 
the nose on the third day. For chronic empyeema of 
the frontal sinus Kubnt’s operation is modified so as not 
to have too much noticeable deformity, the author using 
a special burr, and not removing the entire anterior 
bony wall. The author takes several liberties with the 
English language, e.g., p. 20 we read “to cocaine the 
hypertrophy’’; p. 46, “ue patient was very intelligent 
and in no sense a neurotio,'’ and, lastly, p. 70, “ It will 
at once be obvious how ineffloiratl^ such an i^rtnre 
would function for purposes of drain^e.” The old 
fashioned word “act’’ takes up less room and sounds 
infinitely better. Perhapi some day the author will 
pve us tbe result of his knowledge and experience in a 
more complete form. 


NEW BOOKS AND NEW EDITIONS. 

Tbi following have been received since the publica¬ 
tion of our last list:— 

London sad Puis: Buu.usi, Tisdall asd Ck)x. 

Jfunnlof DlMsaes of tbeEro. Swond Edition. BrChnrlMH. 
May, U.D. Witk S7S Original lUnstmtions, uusluding 3S 
oolonred. Pp 406 Price 8b. Sd. net. 

The Cure of the Morphia Hnhit withont Snflarinff, with n chapter 
on Bel evins the Cravins for Drink. BrOaoar Jenninsa, H.D., 
of Paris. Pp.SlL Price 3a. ^ 

Bemiolo^e Pratique d-w Ponmona et dela Plevre. Par Henri 
Barbier, M.D., et ^of. Qrancher. M.D. Pp. 831. Pitoe 
4 franca. 

Edinhnrfh and London: Willux Blackwood aito Bovs. 

Tbe En I of an Epoch: being the Peraonal Narrative of Adam 
Godwin, the Survivor. Bj A. Lincoln Green. Pp. 391. 
Price 6a. 

CXKTBAL LOSDOK TbBOAT AXD EaB HOSPITAL. 
Formu^eanpplemental to those in the British Pharmacopoeia. 
Compiled t^tbeBonoraty Medical Staff. Pp. 84 Price Is. 

London: J. axd A. Chubcbu.l. 

Elementary 
Bhmoeoo] 

Price 

Bepor*B of the Society for the Study of Disease In Children. 
Vol. I. 1900-190L Pp. 83S. Price lii. 6cL 


itary Ophthalmic Hints, inoludinc Ophthalmoso<m and 
oecopy. By J. Herbert Paznons, B.S., P.B.C.S. Pp. 168. 
16 a. od. 


(a) “Pumlent Naaal Dischargee, their Diagnosis and Treatment.'* 
^Herbert Ttlley, M.D., B.S.Lond., F.B.C.B., Surgeon, Throat 
Hoapiia), Golden Square, ko.,Ac. London: H, K. Lewis, 1901. 
4e. net. 


London: C. W. Dxacox ako Co. 

a Hoapital Dog. By Geo. A. B. Dabbs. M.D. Pp. 200. 
Price Is, 

London: Hivst Eimptok. 

Commentary on the British Pharmacoposia, 
1896. Pp. 696, with 46 plates. Prioe 14s. net. 

Loadon: B. E. Liwis. 

^ ®^ Medicine for Stadents and Practitioners. By Dr. 

Adolf Strumpel. Third Americap Edition. Trani^tea by 
Md Enapp. With Notea by F. C. Shattnek, A.M., 
M.D. Pp. 1,248. Price34a.net 

Philadelphia and London: Lippixcott avd Co. 

Photographic Atlas of Diseases of the Skin. By Geo. Hy. Fox, 
A.M.,M.D. Parte VII. to XII. 

I^ndon: Lovoxahs, Greks akd Co. 

The Eaaentials of Chemical Phyiiologr. By W. D. Halliburton. 
M.D., P.B.S. Fourth Edition. Pp. 220. Price 5s. 

London ; Hachiixak and Co., Lixitxd. 

On Uieorders of Assimilation, Digestion, Ac. By Sir Lander 
Brunton, M.D., D.Sc., F.B.8., P.B.C.P. Pp. 405. Prioe 
Kb. 6d. net 

London : Swax Soxxxxschxir axd Co. 

Psychology, Normal and Morbid. By Charles A. Mercier M.B 
M.B.C.P., F.R.C.8. Pp. 518. 


5taboratorfi f^oUs. 

NEW TABLOIDS. 

Among recent additions to the list of “tabloid” pre¬ 
parations of Messrs. Burroughs Welloome and Co. we 
may note the Tabloid Galbanum Co, gr. iv. The car¬ 
minative, antispasmodio, and stimnlsmt propertaes of 
this product are well known, though perhaps lees fre- 
quently made use of now than formerly. 

The Tabloids of Eigotin and Strychnine commend 
themselves for general nse in view of the unquestionable 
advanti^es attending the association of these two drugs. 
Each tabloid oontains ergotin, g^. iii., with sulphate of 
strychnine gr. 

fhete are two varietiee of Tabloid Hyoeoine Co., A and 
B. Tabloid A contains hyoeoine bydrobromide gr., ; 
morahine sulphate, g^. and atrs>pine sulphate, gr. 
Tabloid B oontains hyoeoine hydrobromide, gr. ; 
morphine snlphate gr. and atropine sulphate gr. 

The sedative effects of byosoine in acute mani* are well 
recognised, and the addition of morphine and atropine 
are stated to enhanoe these effects. 

A further addition to their list of “Tabloid” 
products is one oontaming sodium oaoodylate gr. 
i, and another for hypo<&rmio use of l^e same 
strength. We need not here insist on the peculiar 
properties of this oompound of arsenic, the thera- 

K ntical value whereof is nqw g^enwally known. 

this form accuracy of dosage is ensured, a point of 
oousiderable importance in prescribing arsenical pie- 
parations; and experience has taught us to rely with 
oonfldMioe on tiie pority of the products issued by this 
firm. 

Tbe oombination morphine snlphate (gr. witii 
emetine (gr. has been introdnoM in tobloid form 
for use in oases where sedative and expectorant 
effects sure desired, as in irritative dry cough. They 
should be allowed to disintegrate slowly in &e monw 
in ordor to obtain the local as well as the constitutional 
effects. These tabloids are put up in hotUes of 100. 

Bot^ quinine and camphor are popularly credited 
with a curative action in oorysa and catarrh^ states in 
gmeral. In obedience to the ^mand, Messrs. Burroughs 
Welloome and Co. have prepared tabloids (1) of quinine, 
gr. ), and camphor, gr. (8) quinine bismphate, 

gr. i, camphor, gr. i, and green extract of beHadonna, 
gr. 4. The tabloids afford a oonvenient and accurate 
means of a^inistering these combinations of drugs. 

Among the most recent additions to tbe lUt of 
“Tabloid” products issued by Messrs. Bnrroaghs 
Wellcome and Co. we note the TaUoid containing per- 
chloride of mercury (gr. l/16th) and iodide of potaa- 
Siam (gr. 6) for what is known as tiio “ mixed ” treat¬ 
ment of syphilis. It is obrioosly a great advantage 
in regard to continuity of treatment that the patient 
should have his medicine in aform which can be carried 


Digit.-- 


Googie 



Sic. 18 , lOUl. 


MEDTCAL NEWS. 


Thi Msdioal P&us. 675 


in the pocket, and from this point of riew the adminis¬ 
tration of these dmgs in tabloid form is preferable. 

Hsssrb. Burbodohs Willcomb AMD Co. have added 
to their list of ophthalmic tabloid prodnots a tabloid 
containing alum (gr. 1;'260). This is readily solaUe in 
the lachrymal secretion, and may be insert^ into the 
oonjonctiral sac or diswlred in a little water for in¬ 
stillation, as preforred. 


Jttebical ^ctos. 


IHnner to Dr. J. Takamlne, F.C.8. 

Dr. Takaminb, the disooTerer of taka-diastase and 
adrenalin, who U travelling from the United States to 
Japan, was entertained to dinner a few days since by a 
nnmbOT of medical and chemical friends at the Midland 
Grand Hotel, N.W. After his health bad been drunk, 
Sr, Takamine acknowledged it in a speech in which be 
gave some very interesting information on the bearing 
of the study of medicine on the recent development of 
Japan. The desire to study medicine brought the 
younger generation into close touch with Western 
dviliMtion, and proved the starting point of a move¬ 
ment which bad had for effect to develop Japanese 
civilisation on the European model. He mention^ that 
it was while he was studying in Glasgow University 
that be began the investigation of the rice ferment 
which resulted in his discovering that the preparation 
of Sake, the Japanese rioe-bmr, did not depend 
upon the action of a yeast, as in the fermentation of 
n^t, but on a micro-organism which possessed diastase- 
producing properties. That diastase, which is exceed¬ 
ingly sotive,isnow knownas taka-diastase,and is manu¬ 
factured on a commercial ecale. Passing on to his 
inveetigatione on the suprarenal body he described the 
method by which he had succeeded in isolating a defi¬ 
nite crystalline active principle—adrenalin—which was 
possessed of remarkable chemical and physiological pro¬ 
perties. Dr. Takamine concluded by showing a series of 
etereoptioon views of Japan in natural colours illustrat¬ 
ing the beautiee of the countries and the manners of its 
inhabitants. These views and Dr. Takamine’s humorous 
exp'tsition thereof were highly appreciated, and the en¬ 
joyment of the evening was enhanced by t^ music of a 
ae!ect orchestra in an ^joining room. 

Snbatltating Brandy. 

Thb vexed question ol substituting brandy which was 
not of the quality and title demands by the purchaser 
was again before the law courts last week—this time in 
the Yioe-Chanoellor’s Court, Dublin, Messrs. Jas. 
Henneesy and Co., the well-known brandy distillers of 
Cognac, being the proeecntors. They applied for an 
ininnotion to restrain a trader from selling brandy as 
their “Three Star " brandy, which was not their brand 
at all. Evidence was called for the plaintiffs to show 
that a spirit was sold to a customer who asked for 
Henneesy8 “Three Star” brandy, which was not 
Benneesy’s “ Three Star *' brandy, but was a totally 
different kind. A number of witnesses were called for 
the defence to contradict the evidence, but the Vio^ 
Chancellor, in giving judgment, said that he felt no 
doubt that the tnrandy hM been sold as Henuessy’s 
"Three Star” brandy, and granted an injunction, with 
costs. This subs ti t u tion has beoome so common of late 
in various parts the United Kingdom that the sucy 
oessful res^t of an action such as this will, we hope, 
do much to put a stop to such trading in the public 
interest, and it affords ns pleasure to record this result 
and to congratulate Messrs. Henneesy thereon. The 
pcofeesion. as well as the public, is interested in a ques¬ 
tion ol this nature, brandy iMing one of its meet 
anchors in certain oases, and the substitution of an 
inferior article is in tiie case of a patient as dangwons 
as the substitution of one dr^ for another in a 
prescription. 

A Surgeon's Fees Bsdnced. 

In an action tried at the Nottingham County Court 
last week Mr. Elder, surgeon to the Nottingham Znfir- 
mai 7 ,' 8 ned a head coachman for .£26 6s. for fees in oonnee- 
tion^with professional services rendered to the 


wife of the defendant. It appears that the 
defendant’s wife was suffering from acute peritonitis, 
for which sn operation was deemed necessary, 
and with that object in view she was taken 
to Mr. Elder's private hospital, where she died 
three weeks later. The def endimt pleaded that he had 
no idea that his wife was going to be removed to the 
private hospital, and offered ^18 in settlement. The 
judge left it to the jury to say what amount would be 
fair and reasonable, and they put it at nine guineas, for 
which judgement was given. 

Change of Hospital Name. 

At a recent General Court of Governors of the North 
London Hospital for Consumption and Diseases of the 
Chest, it was proposed to alter the name of the institu¬ 
tion to “ The Mount Vernon Hospital for Consump¬ 
tion and Diseases of the Chest, Hrapstead and North- 
wood,” and finally it was arranged that in future, in 
order to prevent any confusion with University College 
Hospital, or any others bearing the name of North 
London, that it be called “ The Mount Vernon Hospital 
for Consumption.” The hospital is situate at Hamp¬ 
stead, the new sanatoria are at Northwood, and the 
central out-patients’ department is at Fitsroy Square. 
This hospital, it will be remembered, recently received 
£100,000 from an anonymous donor, and it is well 
toat in case like gifts are yet to come, that there should 
arise no legal difficulties regarding the name of the 
institution. 

Ths Peenltar People Again. 

Tn parents of a child, age 4, who had died of 
diphtheria in the absence of medical treatment, were 
committed for trial last week by the coroner for 
Sontiiend. 

Vital Statistloa 

Thb deaths registered in the week ending December 
7th in 87 large towns of the United Kingdom corre¬ 
sponded to an annual rate of I9'7 per 1,000 of their 
aggregate population, which is estimated at 11,468,026 
persons in the middle of this year:— 

Belfast 19. Birkenhead 18. Birmingham 21, Blackburn 28, 
Bolton 19, Bradford 15, Brighton 19, Bristol 16, Burnley 19, 
Cardiff 19, Croydon 18, Derby 14, Dublin 20. E^nburgh 19, 
Glasgow 21, Gateshead 16, Halifax 16, Huddersfield 16, 
Hull 17, Le^ 19, Leicester 16, Liverpool 22, London 19, 
Manchester 23, Newcastle-on-Tyne 17, Norwich 29, 
Nottingham 20, Oldham 23, Plymouth 17, Portsmouth 14, 
Preston 18, Salford 21, Sheffield 19, Sunderland 17, 
Swansea 20, West TT«.Tn 19, Wolverhampton 19. The 
highest annual death-rates per 1,000 living, as measured 
by last week's mortality, were:—From measles, 1*0 in 
Sheffield. 1*6 in Manchester, 8 0 in Oldham, 8'6 in 
Halifax, 6'6 in Blackburn, and 7.0 in Norwich; from 
scarlet fever, 1*2 in Birmingham; and from fever, I’O in 
Plymouth. In none of tiie large towns did the death- 
rate from whooping-cough reach lO per 1*000. The 80 
deaths from diphtoeria included 86 in London, 6 in 
Liverpool, 4 in Sheffield, 4 in Glasgow, 4 in B^fsst, 
3 in Wert Ham, and 8 in Bristol. Sixteen dea^ 
from small-pox were registered in London, but not one 
in any of the other large towns. 

VnivsTslty of for Hononn. 

Tub following is an official list of candidates who were 
successful at the recent M. B. Examination.—Medicine.— 
First Class: Alfred Ernest Jones (Gold Medal^, Henry 
Crewe Kea^, John Henry Sheldon. Harold Weightman 
Sinclair, Chas. J. Thomas, B.Sc. (Scholarship and Gold 
Medal). Second Class: Carey Franklin Coombs, Myer 
Coplana, Robert Kelsall, Albert Edward Thomas. 
Third Class: Ernest Gilbert Bark. William Henry 
Bowen, John Charlton Briscoe, Ellen Mary Sharp, 
James Ernest Stratton, Geoi^ Ernest Waugh. 

Obstetrio Medimne.'-First Claes: Alfred Ernest Jones 
(Scholarship and Gold Medal), John Henry Sheldon, 
Charles James Thomas, B.Sc. (Gold Medal), &oert Eric 
Tonng. Second Class : Olive Claydon, Carey Franklin 
Comnbs, Ellra Mary Sharp, Harold Weightman Sinclair, 
William Henry Wynn, B.Sc. Third Class: Arthur 
Edmunds, B.Sc., Robert Kelsall, John Ford Northcott 


O 



676 Thi Mbdioai. Pbiob. 


NOnOBS TO COERB8PONDBNTS. 


DSC. 18, 1901. 


(lUrticee to 

dTnrrteqronbtntB, $hort TMtvOt 

IV* COBSsirovDxn* raqairlaf » raply in thii oolnmn ftra p^r* 
tlcnlmrly reqaarted to ouke om of t dUtinctiv* lignMtwrt or 
faitMf, «od avoid the prmotloe of ei g nin g themMlvee " Beader," 
•* SnbMrfber,’* **01d Soheoribar," do. Ifiieh ooafoaion wlU be 
•pared by atteation to thie rule. 

SLECnON OF DIBEOT BSPBESEKTATITE FOB 
SCOTLAND. 

Db. BaucB b^ to thank the Soottieh regUtered medical praa* 
titlonere, through the eelnmne of Thb Uedical Pbxss ivD 
CiBCULAB, totheniuuber of 97&, who, by their votee, placed him at 
the top of the poll at the late election. EepeciaQy he wiehee to 
expreee hie moat grateful thanke to the large number of tboee who 
have taken the trouble to pereonally ecngratnlate him on hie 
victory. Now that the fight ie over he aeeuree the eonatituency 
generally of hia deeire to give hia ntmoet energiee toward a 
advancing their intereate, in ao far aa it may be la hia power to do 
BO, during hia term of office. 

QoBBBRa.~Coeca ia, or ahould be. a paate oi powder of the nut, 
without addition of any kind. When augar, ataroh, or other 
farinaoeona aubatance and flavouring mattere are mixed with it the 
mixture ia known aa chocolate. To sell chocolate aa cocoa is 
therefore a fraud on the onatomer. 

M. 8. P.—There are plenty of institutions where the lady coold 
be received, but under the olronmatancea and In view of her eocia} 
poaitioc it would perhaps be more conducive to her happiness if 
the were placed witn a medical praotitioBer as resident pat^t. 

A NICE POINT. 

A> inspector under the Sale of Food and Drugs Act entered a 
London ohemiat'a ahop the other day end aaked for four ounoes of 
aconite liniment. “I cannot supply you,” said the ohemiat, 
** Why not ? queried Mr. Inspector. B^nae I do not know 
yon, and nnder the Pharmacy Act I am liable to a penalty if I sell 
a preparation of aeonite to anyone unknown to m&” “Well. 
I am the inspector for this borough nnder the Sale of Food and 
Drugs Act, and that Act says you are liable to a penalty if yon 
refnse to supply me.” The chemiat was loyal to his own Act, and 
the inspector retired aconiteless. But it would be intereating to 
learn which law has the first claim to allegiance.—Ckemist and 
DrvugUU 

Kb. Fisk,—W e have complied with your euggestion. 

A SrsBCBiBKB.—(1) Ton cannot compel them to make the room 
habitable. Try persuasion—vou have a good case to place before 
reasonable men. To leave without permlsaion would M to vacate 
the appointment. (2) Ton were neither requisitioned by the 
relieving officer nor appointed locum tenena bv the tnardiana 
Ton were simply acting aa a friend. Under the circumstanoee 
oourtesy requires that the official named should waive his claim to 
hia extreme leal rights. 

VENTILATING COWLS. 

Mb.Bobkbt Botlb, of ‘‘Ventilation” fame, has effectually dis¬ 
posed of the claim of the Sanitary Institute to be regard^ aa an 
authority on ventilation hy meena of cowla. The Institute appears 
to have laaued a report of trials made with various cowla, and to 
have awarded hish commendation to three, which were cot^dered 
by practical experts both out of date and defective, the fl^ awa^ 
being to a patent held by tbe Institute iteelf. If this may be taken 
aa a fair ample of the work aecompUahed in this direction we 
would advise the Institute to stick to the depajtmenta and the 
work originally designed for it by its founder, the late Dr. Parkes, 

Meetings of the ScdcticB. College 
JccturcB, ^c. 

LONDON. 

Wedrisdat, Dkc. ISth. 

Botal Micbobcofical SocircT (20, Hanover Square, W.).—7.30 
p.m. Mr F. W. W. Baker: Exhibition on Development and 
Structure of Eyes (illustrated by micro-alides). 

BaiTISH BALRBOLOeiCAl, ARD Clikatolooical Socutt (20, 
Hanover Square, W.).—8.30 um. Adjourned General Meeting. 
B.iSp.m. Ordinary Meeting. Paper:—Cllppingdale; Tbe Clay 
and Gravel Soils of London and the Relative Advantages of 
Dwelling on either. 

TauBaDAT, Dkc. I^h. 

Habteiah Socixtt or Lordor (Stafford Booms, Titchborne 
Street, EdgwareBoad, W.).—8.30 p.m. Clinical Evening. Coaee :— 
Mr. F. Jeffrey: (1) Trephining for Doubtful Cerebral Mischief; 
(2) Diffuse Craniotaba. Dr. E. Cantley; Infantile Scurvy simu¬ 
lating Acute Epiphyaltla. Ac. 

DUBLIN. 

Tbcbsdat, Dec. Iffre. 

Dublin Univenity Biological Association, Front Hall, Trinity 
Collage.—8.15 p.m. 

Fbidat, Dec. 20tb. 

Boyal Academy of Medicine in Ireland. Section of Ohetetrics- 
College of Physicianit.—8.30 p.m. Paper:—Dr Horne; Notes on a 
Caae of Cmarian Section. Specimena:-Dr. Alfred Smitii: (1) 
Large Fibro-cystic Tumour with extensive Adbesiona; (2) Double 
^OMlpinx (two apecimeaa); (3) Ovarian Abeceaa. Dr. Hutings 
Tweedy: Two Ovarian Cystomata. 




BxRRETT, WiLLiAK B., H.B.C S.Eng., L.B.C.P., HoBOTaty Sumoo 
to the St. Oeorge’a Hospital for Dlaeaiee of the fw", 
LiverpooL 

BxREsroBD, SnwTR B., M.B.C.8., L.B.C.S.Lond., 

Superintendent of the New MetroTMlitan A^Ium, Tooting Bee. 

Bet AH, Abthub, M.B.Lond.. House Phyaiclan to the Hospital for 
81^ Children, Gnat Ormond Street. London. 

Clattor, Jobr Cxcn., L.B.C.P.Lond., MB.C.8.Eng., 

Surgeon to the Bristol Eye Inflrmarv. 

COLLiRa. E. TBEACHEa, F.B.C.8., Visiting Ophthalmic Surgeon 
to the Metropolitim Asylums Board OpnthiJjBUa Isolation 
Schools at Brentwood and Swanley. 

CuTEBBBTSOR. J. 0., M.B., B.Ch.Oion., Ssniof House Surgeon, 
Badclifie In&rmmry. Oxford. 

Dalt, Joseph P., M.D., M.Ch.B.U.L, Certifying Surgeon under 
the Factory Acts for tbe Monaaterevan Dtstriet of the County 
of Sildare. 

DAaLET, A. B., M.D.Dub., Medical Offlon of Besdth for Daventry. 

Halasar, Bobxbt, M.B.. B.Cb.Dub.Univ., House Surgeon to 
Stevfna’ Hospital, Dublin. 

Habdbrbkbo. E. J. F., M.B.C.8.Eng.. L.B,C.P.. Junior Beridnit 
Medical Officer to the North-west London Hospital. 

Hurtkb, William, M B., C.M.Aberd., (loveroment Bacteriologist 
to the Colony of Hong Kong. 

Mkachbr, O.Noehar, M.B., B.S.Lond., M.B.C.P Edin., Honoimry 
Phyvician to the St. Pancras and Northern Dispensary. 

Mcschahp, B., L.B.C.P.£din.. L.R.C.S.Edin-, Medical Ofihser of 
Health for the Tadon Urban District Council. 


^oamdta. 

Birmingham General Dispensaty.—Beeident Surgeon. Salary £15(1 
per annnm (with an allowance of £30 per annum for cab-hiie), 
and furnished rooms, fire, ligbta, and attendance. Applicationa 
to Ernest W. Forrat, Secretary. 

Glasgow Boyal Infirmary.—Superintendent. Salary £500 per 
annnm, with board, house free of taxes, ooala and light. Am 
not to exceed forty-five. Full partionlars of Henry 
Secretary. 

Meroer's HospitsL—Resident Medical Officer. AppUations, with 
teBtimoniale, to the Begistrar, John Bobinaon. (See Advt.) 

Middleeei Hoepital.—Assistant Physician, honoiury. Applications 
to F. Clare Melbado, Secretary-Superintendent. 

Boyal Portamoutb, Porteea, and Ooeport HospitaL—Aaaistaat 
House Surgeon. Bemuneration at the rate of £50 per annnm, 
with board and residence. AppUations to J. A. Bverlev. 
Secretary. ' 

Boyal Surrey County HospitaL Guildford.—House Surgeom Salary 
£100; board, raidence, and laundry found. Applicationa to 
the Hon. Secretary at the Hoepital. 

School Board for London.—Two Oculists (of either sex) for testiag 
tbe eyesight of ehUdren in the Senior I^partments of the 
Schools. Salary 100 gi^eaa. The appointment will be tern* 
MnUT, for one year. Forms of sppllatioa may be obtained at 
the offloa of the Board, Victoria Embankment, W.C. 

South Devon and East CornwaU HapitaL Flymootb.—House 
Surgeon. Salsiy £100, with board and residence. Applioatiom 
to Hemsley H. Shanks, B.N., Hon. Saeretary. 

Waterford DMrict Asylum.—Assistant Medial Officer. Salsiy 
£100 per annum, with board, washing and attendance. AppU* 
atlons to the Beeident Medical Saperlntendent. (See Advt.) 


4irth0. 

OaiPFiTxs.—O b Dee. 16th, at 5, Kensington Square, London, the 
wife of Herbert T. Oriffiths, M.D., of a daughter. 

Last. On Deo. llth, at Tork Villa, Alumhurit Boad, Bonrne- 
moutta, the wife of T. Clifford l«st, M.B.C.S., L.B.CP., 
of a son. 


4l9^tnage6. 

ATKXT-HxRtiBS.-On Dec. 14tb, at Holy Trinity Chureh, Byde, 
Percy J, Atkey.M.B.C.S , L.R.C.P.,D.P.B., of Sontham^on, to 
Barbara only daughter of the late Gapt. William kfeniiee,. 
B,N , and Mrs. Menxles, Byde. 

Bowbr-Joreb - EvARB.- On Dee. 12th, at St. Catherine’s Churoh, 
Nath, South Wales, Lloyd ^wen-Jona, D.P.H. Mediw 
Officer of Health for Carmarthen, to Clara, third daughter of 
the late Edward Evans, of Esgteeburb. Nath. 

FosTxa Dallas.— On Deo. 12th. at Christ Church, Brockham, M. 
Bernard Foster, M.B.C.S.Bng., L.B.C.P., D.P.H.Lond., of 
Buckeridge, Herts, younger son of Michael E, Foster, of 
Brockham, Surr^, to Gertrude Mary, elder daughter ot 
Seymour DsdUs, J.P., of Kimberley, South Africa. 

Staelxrbcbt—Gardree.— On Dee. I2th, at tbe parish chureh. 
West Kirby, Cheshire, Bernard Stahlknecht. M B , Ch.B.. a 
Ot. Borwo^, Lancs., to Ethel Cleland, only daughtM of B. B. 
Gardner, of West Kirby 

Tauhtor—Smith.— On Dec. 12tb, at St. Peter’s Church, Benge* 
worth John Godfrey Oesswell Taunton, M.B.C.S., L.B.C.P., 
of Old firompton, Cnntbam, son of the Bev. C. W. 8. Taunton, 
of Lostwithiel, to Edna ^UTtet, eldeet daughter of Mr. ana 
Mrs. Edwin Siritb, of Aldington, Eveeham. 


9^th0. 

OrrrxRS.—On Deo. 12th,'at 102, Clande Bead, Upton Park, Fssrr. 
Emma £. Oittens, mdow of tbe iate Thomas Joihos OittansL. 
M.B.C.8.E. 

Tatlob —On Deo. U, at Wargrave Houm, Berks, Boa Ann Taylor* 
of Portlethen, widow of Jama Thylor, F.B.C.S., of Wargrave^ 
aged TSyaas. > 

'^oogle 


®ke itttdial Wtm and tfirailar. 


*'SALUS POPUU SUFBEMA LEX'* 


VoL. CXXIH. WEDNESDAY, DECEMBER 2 5, 1901. No. 26. 


<S)n9tnal Cornmnnir^tons. 


A DEMONSTRATION OP CHANGES 
OCCURRING IN UTERI IN WHICH 
FIBROMTOMATA ARB PRESENT, (a) 
By E. STANMOBE BISHOP, P.E.C.9.Eng., 

PiQddent of tb« Hanchestor Clinical Society; Hon. Snrgeoa to 
Ancoata Hoepitai. 

Mr. Pribidsmt ahd Gkhtlkmih,—I twas ineTitabls 
that dnriag the evoltitioii of each an operation aa bya- 
tereotomy for flbromyoma our attention aa gyntacologiata 
ahonld be directed more especially to the varioua 
methoda proposed for carrying out that proceeding, and 
that, during the pzoceaa of pladng ^at upon a Bati8< 
factory baaia, many minor points in oonnecuon with the 
Bubject ahonld become clear to na which before were 
obscure, the full consideration of others ahonld be post- 
poned, and some should loae &e importance which pre* 
▼ionaly they appeared to poeaesa. 

Among those which, perhaps, many will feel inclined 
to consider as belonging to the laat category ia the be- 
haTionr of the uterine endometrium in presence of this 
neoplasm. If hysterectomy, more or lees complete, be 
accepted aa the most satisfactory eolation in those cases 
in which operative interference is required, the con¬ 
sideration of what may or may not be the particular 
effect upon that membrane, remored as it is with the 
rest of the organ, of a growth in the snbiaoent tissues 
wonld almost appear to be a matter of in^fferenoe—in¬ 
difference, I mean of course, to ns as operators, not as 
patholc^^ts. 

There will always remain, howerer, a certain number 
of coses in which the only apparent tamonr is a single 
one, projecting towards the central canal, or becoming 
more and more polypoid in its lumen. These cases are, 
moreorer, such as in the opinion of many do not even 
yet justify total ablation of the ntems whilst at the 
same time their symptoms—especially the one most 
pressingly attracting notice, that of great, frequently 
recurring, and increasingly exhausting heemorrbage— 
imperatively demand (ome remedy. In these cases it 
is possible that any observations, however imperfect, of 
the tissues most affected may throw some light upon 
the sitoation, induce others more competent to extend 
and amidify them, and may perhaps be of some service 
to those who have to decide how and in w^t manner 
they may best be dealt with. It is with that intention 
that I venture to bring before this Society to-night 
some photographs and specimens of the endometrium 
as I have found It in certain uteri, the subjects of this 
disease, which I have removed duiing the pastfew years. 

It can scarcely be said that authorities are agreed as 
to the condition of the endometrium, which may be ex¬ 
pected—for instance, in a case of submucous polypoid 
fibromyoma, in which the advisability of vaginal enu¬ 
cleation may b^me a question for discusaion. To the 
practical gynscologist it then becomes of interest to 
know— 

(a) Papwratd and Demonatration alven before the firitlah Oynnoo- 
loglcal Society, December 1001. 


First: What is the condition of the endometrium 
over the tumour itself ? 

Second: What is its condition on the wall of the 
ntems opposing it ? 

Third: What is its state at the angle which the pro* 
tmding mass makes at the point where it'leavee the 
nterine wall ? And 

Fourth: What is its condition in the fxmdns and wall 
above the tumour which will be left behind when once 
the polypoid mass is removed ? 

It appean probable fr<nn the foregoing references 
that this will not be the same in every case, and I do 
not bring these specimens before yon with any idea that 
their evidence will settle the question, but simply to add 
a small number to the many specimens which must be 
examined and recorded before any definite rule can be 
laid down. 

* In order not to weary you by endless and unnecessary 
repetitions, I have selected six microscopical slides, from 
a number taken from thirty different cases, which yon 
will find under the microscopes, and these I have had re¬ 
produced for demonstration with the lantern, because 
they seem most typical of the changes found. 

The first section I show yon is taken from a uterus 
removed by me by vaginal hysterectomy some time 
since (a). The patient from whom it was taken was at. 
45, and bad been married for twenty years. She had 
bad two children, the eldest at. 18, the youngest at. 18, 
and she had had three miscarriages between the two for 
no very obvious reason. For the last twelve months 
she had only been free from hamorrhage for fourteen 
days, and that about six months before operation. As 
may be imi^ned, she was extremely anamic and very 
thin. She two intramural fibroids, one tending to 
become snbperitoneal and impacted in the pelvis behind 
the uterus, neither pressing particularly upon the endo¬ 
metrium, which, however, was thick, and almost purple 
in colour. The section is taken from the fundus near 
the opening of one Fallopian tube. As yon will see, it 
shows distmotly byperplMia of tiie glandular tissue, the 
gland cells well formed, and the glands themselves 
abundant, whilst the outermost layer of epithelinm, 
where seen, is normally cylindrical and ciliated. 

The next is token from the fundus of a uterus of a 
woman, at. 44, married thirteen years, vrith no children 
or mUoarriagee. Menstruation was regular and pain¬ 
less until twelve montiks before operation, on July 8th, 
1901; used to last two to three days, but for the laat 
twelve months has increased in amount and frequency. 
Period at time of ob^rvation lasts fourteen days. Six 
weeks ^fore great pain lasting for three we^s con* 
tinnously came on and appeared at intervals since, 
There been no dysnria 

In this case two tumours existed in the posterior 
wall, and there had been pelvic peritonitis, resulting in 
a small collection of pus situated above the bladder and 
walled in ^ omentum. One of the masses was near to, 
but not pressing markedly upon, the internal wall, 
being still entirely intramural. The endometrium is 

(a) A section from the fondal extremity of the nterine 

cetiiU of another nteros shows a similar condition. 

Digitized by Google 





678 Thi Midioal Paaaa. OBIGINAL GOMMUBiOATIONS. Dbg. 26, 19ul. 


here also thicker than normal, and not only so, but 
npon both walls, both that orer and ttiat oppos^ to 
the tnmonrs, small glandular polypi were formed. The 
upper one, on the opposite waU, is first shown here, mid 
toe other can be seen in the soooeeding slide lying a 
little below the point at which the innermost tumour 
most nearly approaches the lining membrane. The 
glands are well marked, the gland epithelia normal in 
sise and intact, and the surface layer of epithelium 
is normally cylindrical and ciliated, ft was impossible 
in both these spemmens to use a sufficiently 
high power to show the last point, if we were to show at 
the same time the general features of the membrane 
itself. In the following, however, this becomes more 
imMitant, and higher powers are therefore used. 

The fonrtii specimen is taken from a uterus which 
contained two fibroid masses, one in the anterior, one 
in the posterior wall, both beginning to press npon the 
endometrium between. The patient from which this 
uterus was removed was a widow, cat. 44. She had had 
no children nor miscarriages. She had always had a 
very free flow at the menstrual periods, but had had 
marked floodings during the past twelve montha There 
had been dysnria for the li^ two or three months. 
The section shows the glands in a compressed state and 
beginning to break up. The interglandular tissue is 
also disintegrating. Very few glands in the whole 
section are still normal. The fifth, sixth, seventh, 
eighth and ninth specimens are taken from cases in 
which the growths hM become polypoid and projected 
markedly into the uterine canal and the condition of 
things in all but the next is greatly changed. A glance 
at the fifth is sufficient. It is token from the angle 
made by the polypus with the wall from which it issues. 
The glandnlu structure here dips down between the 
growto and the wall, helping to accentuate the division 
between them, and is here fairly abundant 

But it is especially the next four slides to which I ask 
your attention. These show the condition of the endo* 
metrium over the tumour itself and over the opposed 
wsdl. It is, as you will see, almost non>existent, being 
only represented by a single line of epithelial cells, 
arranged vertically to the wall respectively over each, 
and seated directly upon the mnsoular tissue beneath. 
The connective tissue basis and the deeper-seated gland 
structures are gone The endometrium is, as it were, 
spread out—opened out—over the advancing mass, and 
even the remaining cells have imdergone a distinct 
change. In parts, where the pressure is not so great, 
they remain columnar; butlower down, wheretheforce 
increases, they themselves become flattened and dwarfed 
until they approximate, altoongh I cannot find that 
they ever aoMlutely reach, the squamous type; and 
this, it most be rememberod, is befora the growth 
reaches the vagina, and whUst it is still intrsp 
uterine; of tubular formstion at points where the pressure 
is not quite so complete there is an attempt. This and 
the nert, show, I think, the final steps of the process re¬ 
markably welL In etmh you will notice that the epithe¬ 
lium re^ directly npon muscular tissue. The inter- 
glandular substance is gone, but in this, ninth, there is 
still in attempt at, or remains of glandular formation, 
the pressure being as yet, not so great. The epitb^a 
dip downwards, a^ in the centre, one complete gland 
tubule is out across, the others being still open above 
but fairly deep. In No. 8 the line of epithelium is 
simply irregnl^, pressure being greater, whilst in Nos. 6 
and 7, where pressure is grea^ still, it is entirely 
straightened out, and lies like a mere fringe on the 
surface of the tumour. 

It is curious to note that precisely the same effects 
appear to be produced by the expansile force of the 
myoma itself, aided by the contraction of the uterine 
fibres behind npon the endometrium lying over its own 
surface, and npon that which faces it on the uterine 
wall opposite. 

The evidence afforded by these sections, and many 
others similar, would appear to go some way towards 
justifying the following conolnsiona 

The presence of a fibromyomatous growth in the 
uterine tissue has an effect upon the endometrium 
lining that uterus. 


In the early stages, sad whilst still intramural, it 
tends to produce hyperplasia of the endometrium. 

When becoming sufficiently sabmueons to exert some 
pressure npon the membrane, it prodnoes oompreesion 
of the glands, with subsequent ^sintegration both of 
them a^ of the interglandolar substanoe. 

When aotnally pedypoid into the uterine oanal, the 
endometrium over the actual mass and the o^Meing 
uterine wall is reduced to a single layer of oells, which 
becomes progressively thinner in proportion to the 
pressure exert^ and approximates the sqnamona 
^rpe. 

In many of these sections blood vessels and lymphatics 
are seen imme^tely below, or within a very short dis¬ 
tance of, the proteo^g line of epitheliom. 

One practical raenlt of such observations may be 
touched upon. The use of the curette for the purpose of 
checking hsemorrbage, so much advised in earlier times, 
would seem to be justified in those stages of the disease 
which occur before the tumour becomes polypoid. The 
endometrium is at first hyertrophied, then degenerate, 
and in either case might be removed with goM effect, 
but the case is idtored when an actual myomatous 
polypus is present. Then the endometrium over the 
tumour aad opposed to it, being reduced to a mere line of 
epithelium, its removal can do no good, and may have 
very evil resolts, by laying open lymphatics, and per¬ 
mitting the entrance of micro-organisms, thua produc¬ 
ing necrosis of the tamooron the one hand and metritis 
un the other, and a glance at these slides will demonstrate 
how easily this may be done. 

But examination of these sections appears to me to 
be of interest from quite another point of view. Ihe 
question of the etiolog>f of fibromyomatoni tumours 
m* y ja«t now, to use the phraseology of the politicians, 
be looked upon as a "burning’' one. All kinds of 
theories with re^rd to it have been advanced by various 
writers, all of which are based upon observations of 
specimens of this kind. Some see in them the resnlts 
of late development of embryonic strnctures; that, of 
oonrse, means development of re mn a n ts of embryonic 
gtmotnres belonging to the snbjeot’s own person. 

The view, however, which appears to have received the 
most general acceptance of late years, and which seems 
to furnish the key to much that is perplexing and diffi¬ 
cult to understand in our experience of these growths, 
is that which ascribes the storting point of uterine 
fibromyoma to the over-developmmit of the outer walls 
of certain uterine arteries or arterioles. It is thus de¬ 
scribed by Piliet. " The eodotiieliam,” he says, " re¬ 
mains normal; the adventitia gives origin to a tone of 
embryonic calls which multiply and develop into rows 
of ooncentrioally-placed smooth mnsoolar fibres arranged 
around the vessel. The fibrons layers arise from the 
transformation of the most peripheral moscnlar layers 
which ate farthest from the vessel, and which, theie- 
fore, do not receive soffioient nonrishmeut to allow of 
their normal development. Klebs, Meslay, and Hyenne 
agree with this description of the initial stage. Elein- 
waohtor, Boeeger, and Gotteohalk mainly differed as to 
the relative size of the arteries involved, the first at¬ 
tributing it to chan^ beginning in the smallest, 
Boeeger to those whioh possess an adventitia, and 
Gottsobalk to the larger arteries. 

If this view is accepted many things become clear. 
Arteries already lie in a bed of oonnective tissue, whioh 
separates them from the musonlar fibres around. As a 
portion of the vessel enlarges this will be more and 
more compressed until it would very well form a 
band of fibrous tissue around, answering to the oapsnle, 
whioh when divided permits of the ready disenga^ment 
of the tnmour from its environment, a fact which we 
constantly note in enucleation of these masses. The 
low nutrition of fibromyomatous masses is easily xuder- 
stood if we consider that blood can only reach it in any 
quantity through its central channel, except for the 
fine vasa vasorum whioh still perforate it from without, 
and that the calibre of this central channel most be pro¬ 
gressively encroached npon by its own growth In one 
of the sections I propose to show you, this, I tiiink, is well 


Die. 25, 1001. 


ORIGINAL COMMUNICATIONS. Thb Mbdical Pbiw. 679 


illnstrated. The wborled appearanoe of the fibres oha* 
racterifitio of these neoplasms is also what might have 
been ezpecteA All ntmne arteries are conTolnted, to 
permit of the ready alteration necessary in gestation, 
and especially in partnrition. The fibres of a growth 
originating in them mnst necessarily be oonTolnt^ also. 
Even the increased growth of these tnmonrs during 
pr^nanoy, and their corresponding decrease during in- 
▼olution, is more easily comprehended if we look upon 
£bromyoma ss essentii^y a disease of the uterine yeeeels 
themselTes, and not of compaiatiTely indifferent tusnes. 
Lastly, the difference between the rapidly growing tmd 
soft tamonrs of the cervix, and the hard, more slowly 
enlarging tumours of the fundus may be explained by 
the freer and more direct supply of blood to the former 
through the lower branches of &e uterine artery. 

It must, however, be admitted that this view by no 
means meets with unqualified acceptance. MoUer 
(a^ in 1899, after examining a large number of the 
minute myomata found in the capsule of larger growths, 
disputes the conclusions of B4^ger and Oottsohalk, 
and appears to consider the question disposed of since 
he has demonstrated the entrance of more than one 
vessel into these masses. I cannot see, however, after a 
careful examination of the drawings which illustrate 
his treatise, that these are necessary any other than 
vasa vasomm, and some of his facts, as for instance that 
all the smallest tumours are entirely composed of mus¬ 
cular tissue, rather tell in favour of the theory we are 
■discussing ^an against it. 

But most observers, like himself, appear to have 
directed their attention entirely to the tnmonrs already 
formeA I beg to suggest that more information as to 
the truth or otherwise of this theory especially might 
be anticipated from a study of the uterus from which 
they have been taken. It is common experience that 
any uterus in which a flbromyoma is found is likely to 
contain others more or lees developed; that if it appa¬ 
rently only contains one, and that is removed, sooner or 
later another will be.formed. 

One of the cases from which tiie last sections 
shown were taken is a good illustration of this. 
The woman originally came to Ancoats Hospital in 
February, 1896, with a well marked single intra¬ 
mural fibromyoma, in the anterior wall, which was 
treated by vaginal myomectomy. She recovered, but 
returned in Jime of the present year with another 
single, but this time polypoid, growth of the same nature 
— i.e., five years after; but every gynseoologist has met 
with simile specimens. Now, if mis theory be indeed 
true, it is only necessary to go a step further back; and 
it will be natural to suspect that in such a ntems, even 
if no other palpable or visible masses can be detected, at 
least we ought, under the miorosoope, to find arteries 
deviating in some way from the normal j that 
here or there we should find a section of an artery in 
which hypertrophy of the median layer is commencing: 
and ao^g upon that idea, I commenced a sear^ 
through these slides for such an appearance. The results 
1 wish to lay before yon. It is for the Fellows of 
this society to say whether the slides I show, the 
originals of which will be found under the microscopes 
on the table, assist at all in arriving at some judgment 
as to the trustworthiness of Pilliet's theory. Under the 
microscopes, indeed, 1 think yon will find nearly all the 
stages from slight to great media hypertrophy, for when 
yon begin to search for them, it is astonishing how 
many yon can find in some uteri—not in all. Some of 
these were found too late for reproduction as lantern 
slides, but enough are shown, 1 think, to render the 
point clear. At the time these lantern slides of 
arteries were made 1 was unable to get photographs 
direct; they aie reproduced from drawings by a very 
clever artist. Miss Bradbury. 1 would merely s^dthat 
I have not bwn able in them to see any zone of embry- 
-onic cells, with the powers Zeiss -^th^and l«12th oil im¬ 
mersion—I have ns^ but that there is in some of these 
sections marked hypertrophy of the arterial media will, 


(n) Holler Stndien zur Etiolo^ie dee Utenu Mjome, Berlin, 1899. 


I think be admitted, whatever bearing such appearances 
may be deemed to have upon the question of etiology. 

In the first slide I have had photographed a norm^ 
artery with normal walls taken ^m one of these uteri, 
for purposes of comparison. All theee slides are taken 
with the same powers of the microscope. ^ Zeiss £. objec¬ 
tive, No I ocular, tube not drawn out or, in other words, 
magnified 280 diameters. 

In the second elide I think it will be admitted that, m 
proportion to the diameter of the artery, the media is 
decidedly thicker. The ring of intima, with its some¬ 
what nodular nudei, is well seen. 

In the third this thickening is shown to be imgular. 
On one side the wall is much more hypertrophied than 
on the other. The intima, marked by its nudei, can be 
seen on the sides of its lumen. 

In the fourth the hypertrophied wall has almost 
obliterated the lumen of the artery, but the circular ring 
of nudei from the intima is still visible. 

In the fifth, a group of arteries are seen, s^ contain¬ 
ing some blodi oorpusdes. The gradual thickening of 
the media is very well shown, from the small, almost 
normal, artery below and on the left, to the greatly and 
very irr^n>bu'^7 enlaiged artery on the right, the en¬ 
largement being entirely in the muscular wall. In eMh 

the nng of nudei showing the presence of the intima 
is to 1^ noted. 

In the sixth, a further stage of medial hypertrophy 
is shown, and this and the next, are, I think, particu¬ 
larly to be noted, in that the section in both appears to 
have passed squarely across the artery, so that there 
can be no question of the appearance as having been 
due to any obliquity in the way in which the vessel was 
cut. In an oblique section the thickness would be accen¬ 
tuated at each end of ^e artery, whereas all portions 
of the arterial wdl show an equd increase in width. 

In the seventh an artery with still thicker muscular 
wall is to be seen. The intima bridges over the irregnl^ 
enlargement, and on the right where this is seen, a di^ 
tinot thickening inwards encroaching on the lumen is 
worthy observation. The muscular fibres at each 
end appear to be blending with the uterine fibres 
arounA 

Whilst in the eighth, and last, a curiously twtuous 
artery, which has evidently been cut somewhat longitu¬ 
dinally, is shown: the intima well marked, following 
all its sinuoeities, the lumen still containing some cor- 
pusdes; the media very irregularly thickened and at 
points almost obliterating the lumen { the adventitia, 
or cellular tissue b^ in which the artery lies, isolating 
it from the surrounding tissues. 

It is curious that Qottschalk has declared that myo¬ 
mata are developed from a strongly twisted section of 
one of the larger arteries, and this particular section 
would seem to give some colour to the statement; 
though I think the other sections do not. However that 
may be, the general result of my search would appear to 
show that the arteries in a uterus which has been the 
site of a fibromyomatons neoplasm do show certain 
changes in their structure differing from the normal j 
that those changes consist mi^y of a more or lea 
irregular hypertrophy of the muscular cost, and that it 
is p^eotly possible that such hypertrophy carried to a 
sufficient extent might produce the masses or neoplasms 
which are known as fibromyomatons tumours. 

If thk is true it will be apparent that it has a very 
direct bearing upon practical questions : How far are we 
justified in retaining an o^an in which this formation 
has once been demonstrated P Shall we entirdy remove 
it, or shall we adopt the method so ably demonstrated and 
recommended here by Dr. Alexander, of Liverpool, or 
one of the many minor methods of a similar type P If 
we decide upon hysterectomy, shall it be the complete 
operation described by Mr. Christopher Martin, or the 
supra-vaginal amputation which finds so talented an 
advocate in Dr. Hey wood Smith ? All these are questions 
of so important and wide-reaching a character that I can 
only venture to suggest them to your minds. Without 
doubt very many more observations are required before 



680 I'm Midxoal Paxbs. 


ORIGINAL COMMUNICATIONS. 


Dso. 26, 1901. 


a definite answer can be given, and I can only hope that 
the few I have been able to bring before yon may excite 
far more competent minds than mine to still (nrther 
investigate the matter, so that oar present doubts may 
be set at rest. 

It only remains for me, gentlemen, to thank yon for 
the patient attention yon have given me, and to hope 
that I may have succeeded in exciting your interest in 
this, to me, fasc'nating qnestion, 

Mr. Targett said he bad examined aeotiona of 
many uterine fibroids, and thought tiiere was abun¬ 
dant evidence of thickening of the muscnlskr coat of the 
vessels and of their fibrous sheaths. After a time the new 
material became fibroid and almost devoid of nuclei. 
This degenerative change was very characteristic of 
uterine myomata, and enabled their structure to be 
easily distinguished from normal uterine tissue. As 
regarded the eadometrium he had in some oases found 
hyperplasia especially affecting the stroma; while in 
others the endometrium had l^n thinned by disten¬ 
sion, and its glandular follicles bad become disarranged, 
or even obstructed at their mouths, causing retention of 
secretion and shed epithelium in their acini. He bad 
never met with tubules lined with epithelium in the 
substance of a fibroid, and therefore did not think that 
these tumours commonly originated from congenital 
relics in the uterine vralls, as stated by some observers. 


THE SURGERY OF THE SKULL 
AND ITS CONTENTS, (a) 

By J. S. McARDLE, F.R.C.S., 

Sorgeon to &t. Tinceot’s Hospital, I>QbIiB. 

As in the operative treatment of abdominal and 
thoracic affections aseptic, in contra-diatinction to 
antiseptic, methods have led to great reduction of 
mortality, so too in dealing with the brain, its 
membranes, and osseons support a decided advance 
has been made. 

In even modem practice we often see a con¬ 
temptuous disregard for the method adopted in the 
treatment of compound fractures of the skull, and 
still if we examine the cases of death from such in¬ 
juries we find that most of them die from septic 
meningitis. If in similar fractures of the long bones 
it is necessary to deal vigorously with parts that 
have been exposed to infection, it stands to reason 
that in dealing with fractures which open up the 
diploe, and at the same time expose the dura, 
the most vigorous precautions should be taken 
in the matter first of cleansing the wound, 
and second in the establishment of a free exit 
for the products of microbio activity should 
serious inf^tion have occuired. If now we add to 
the fracture and infection an intracranial effusion of 
blood or serum so likely to favour septic complica¬ 
tions, does it not become apparent that the more 
thorough and radical the surgical procedure adopted 
the more certain will be the result 

Again, when we come to deal with injuries of the 
skull in which the element of infection is absent, 
do we not often meet cases in which excessive intra¬ 
cranial tension has been allowed to continue so long 
that serious brain lesions arise. In these cases why 
should we not work on the same lines as in the sur¬ 
gical treatment of over-tension elsewhere. 

Again, in cases of febrile affections bow many 
patients are allowed to pass into a state of coma 
irom intracranial pressure long after the general 
tissues of the l^y have satisfactorily dealt 
with the microbes. Why in those cases should we 
not relieve the brain and spinal cord of products of 
microbio action. Again, in syphilitic, alcoholic and 

(a) Paper read btfore tbe Boyal Academy of Medicine, Dublin, 
Dec. Stl), I90L 


! other diseases which cause intracranial tension, 
' why should we depend on medicinal derivation 
when the br^ can be relieved at one stroke 
by the method which I advocate. The cases 
which I desire to bring before you have convinced 
me that the department of surgery now under con¬ 
sideration has been overshadowed the brilliant 
results obtained in other surgical fiel«. 

There is one thing we shomd insist on in the treat¬ 
ment of most of these cases—that is, the drainage 
should be thorough. Many a case that seems hope¬ 
less on the table, when so placed that cranial drainage 
is perfect, advances so rapidly towards recovery tb^ 
one is astonished at the result. That asepsis is 
essential in the treatment of all injuries of the head 
anyone having experience of brain surgery must 
recognise, but it is well to remember that the 
brain is not tolerant of such fluids as carbolic acid 
and corrosive sublimate. 

Cask I.—W. G., set. 40, was admitted to 
St. Vincent’s Hospital, on December 3rd, 1890, 
when the following history was elicitedOn 
Saturday, November 15th, he fell into the bold of a 
vessel, striking the left side of his head; he was 
removed in an unconscious condition to Sir 
Patrick Dun’s Hospital, where a wound over the 
left eye was dressed. In a few hours consciousness 
returned, and he went home the same evening. The 
next day being Sunday, he rested, and on Monday 
resumed his work as coal-porter. All went well 
until Monday, December Ist, when he felt disinclined 
for work, had some sickness of stomach, and noticed 
bis left hand weak. During the evening of that day 
be experienced severe pain in the top of his head, 
and th^e weakness of the arm increased. On Tues¬ 
day, sixteen days after the accident, he found 
the left leg becoming powerless, and the following 
day be came under my care. He then had partiu 
paralysis of left arm and leg. There was a scar 
over the left eye ; pulse, 54; temperature, 96'5'^; 
pupils normal, and respond to light. Although he 
seemed stupid be answered quickly and accurately. 

I had his uead shaved, and the most careful ex¬ 
amination did not disclose any external evidence of 
injury on the right side. It was evident from the 
slow pulse and subnormal temperature, as well as 
the paralysis, that compression of the brain was 
present. I scraped away. After thoroughly irriga¬ 
ting the parts with boraoio solution, I sutured the 
dura mater, laid a medium-sized drain^ije tube across 
the wound, passing deep sutures to fix the scalp flap. 
For some time there was a copious serous oozing, 
which necessitated frequent change of the dressings, 
but late in the evening drainage seemed complete 
and at 3 a.m. on the 6th consciousness returned, the 
patient raising at the same time the arm which had 
^n paralysed, and saying to the nurse in charge, 

“ Begor, I’ve the use of myself, ma’am.” 

From this time recovery was uninterrupted, and on 
the 14th—that is, eight days after operation—the 
patient was about, the wound being soundly healed. 

Case II.—R. C., ret. 16, was brought to me by Dr. 
Fulham, of Swords, with the followmg history. He 
had been kicked by a horse in the centre of the fore¬ 
head. He was found unconscious in a stable, and 
carried to bed, the wound dressed, and stitches in¬ 
serted, all this time the patient being unconscious. 
Consciousness returned soon after, but only for a 
short time, in the st^e of seconds^ unoonsciousneea 
he was brought to m. Vincent’s Hospital, where I 
found him in the following condition : Unconscious¬ 
ness was complete, there was a marked fulness above 
the root of the nose, fluctuating, and having a sharp 
outline corresponding to where the central portion 
of the front^ bone was driven into the brain. Hia 
breathing was laboured, his pulsation slow and heavy 



Die. 26, 1901. 


ORIGINAL COMMUNICATIONS. 


Thi Mbdioal Pbbss. 681 


As tiQcooscioQBiieBB was not continuous I believed tbe 
fractured bones were loose, not exerting much pres¬ 
sure, and that tbe brain trouble was due to intra¬ 
cranial heemorrhage I trephined over the meningeal 
arterr and removed thedisc of bone which I nowexhibit 
showing that the artery had been turned b; a sharp 
projection at the neighbourh'iod of the fracture 
under ^e bone, as well as beneath the dura, blood 
was effused, and to remove it it became necessary to 
take away the portions of the frontal bone which I 
now place bemre you. The large opening formed ' 
by this operation enabled me to thoroughly relieve ' 
the brain pressure. The cost of this case is such 
that the lad who had been of a delightful tempera¬ 
ment before, became, for some months, a veritable 
demon in a short time. lu time this unfortunate 
mental condition disappeared, and he is now as you 
see him to-night—his old self agrain. 

Case III —C. H, st. 30, sustained a fall while 
riding at Roscommon races. I saw him two days later 
in the Roscommon Infirmary; he was then perfectly 
unconscious and thoroughly paralysed in the left 
side and partly so in the right. Most of the reflexes 
were present, but he had lost control of ths bladder. 
His condition improved somewhat in the following 
weeks, and he was brought to St. Vincent’s 
Hospital on August 6th in the following condi¬ 
tion He was half conscious, bad paralysis of 
speech, which after a time became somewhat clearer. 
He had contractions of flexors of left arm and leg, 
but no voluntary control of either. On October 19^ 
I opened tbe skull on the right side over the hard 
centre. The bone was very dense and over a quarter 
of an inch thick. Tbe dura was much thickened and 
pri truded without pulsation. Incision of dura was 
followed by discharge of much sero-sanguineous 
fluid, and then brain pulsation returned. 

For some days there was a free flow of this fluid, 
after which consciousness returned, and gradually be 
gained power over the leg, and later the arm became 
useful. Since that time recovery has been rapid and 
permanent. 

Case IV.—L. G.,£et. 11. fell while playing with his 
brothers, his head coming in contact with -ome metal 
steps in tbe garden. Imniediately after tbe fall, and 
when he was apparently perfectly well, he came in to 
dinner. Boring dinner be became drowsy, and later 
on he was obliged to be put to bed, when vomiting set 
in. For some weeks he was kept under treatment, 
and gradually he becnme well except for epileptic 
seizures which occurred every two or three days. 
These fits became more violent, the frequency re¬ 
maining the same until he was brought under my 
care two years later. His parents were hopeless, and 
only submitted him to surgical treatment because 
anything would be better thw to have him grow up 
in the miserable condition in which he then was. At 
first when he came under observation it was impos- 
sib e to determine the seat of brain lesion, general 
convulsions seemed to sta't without any premonitory 
symptom. On close observation it was found that 
the fit was ushered in by a deflection of tbe eyes to tbe 
right. After this all deflexes of muscles of tbe arms, 
specially those of tbe left, became marked. I opened 
toe skull on the ride side about the centre of the 
fissure of Rolando. When I reached tbe dura it 
bulged into the trephined wound. Incising it I gave 
exit to about two drachms of serous fluid, the removal 
of which started a characteristic convulsive seizure. 
I laid in a small drain and closed the wound. Tbe 
lad is here to-night to prove how sncces-fnl the pro¬ 
cedure above mentioned has been. 

Case V.—E. M., at. 13, was bronght to me from 
Newcastle West with the following history: I'ome 
years before he had fallen from the ^op of a tier of 
boxes, striking his bead against a wall in bis descent 


Some time after he became stupid, and later epi¬ 
leptic seizuj’es appeared, these increasing in fre¬ 
quency until be be^me a burden to himself and a 
nuisance to everybody near him, and the expression 
used when he was placed under my care shows how 
little was thought of bis chance of ever becoming 
useful. When I spoke of tbe gravity of the opera¬ 
tion which would m needed for bis relief his father 
said, “ Bo what you like with him, death is belter 
than to have him as he is.” The only guide I had 
to the position of his brain, in which the lesion was 
present was a curious symptom connected with his 
visual senses. He explained to me that before an 
attack came on be saw a circle of light in front of 
him, then a black cloud came down and he knew no 
more. In this case I opened the skull so that I 
could reach the angular lobe. On reaching tbe 
dura, there was an absence of brain pulsation, but 
on opening it no fluid escaped. I passed MacEwen’s 
cannula through the brain substance in three or four 
directions without result, but on passing it inwards 
and backwards towards the enneate lobe theie was a 
rush of blood-stained serum with an oily look on tbe 
surface. I did not deem it necessary to permanently 
drain tbe cavity from which this was expelled, and so 
I completely closed tbe scalp wound. This hoj had 
a characteristic fit on removal to bed, and now, three 
years after the operation, the report is that he has 
never had the slightest trouble since. 

Case VI.—F. K., est 14, came under my care 
on January 6th, 1901. Until eight months before 
be was in perfect health and was intellectually all 
right. He then contracted a severe attack of 
measles, through which be passed with some diffi¬ 
culty, and after some weeks of unconsciousness, 
when his physical strength returned it was found 
that be had lost speech, and his right leg was some¬ 
what powerless, and that bis right arm was almost 
paralysed. Under judicious management the para- 
I)tic symptoms disappeared to some extent; bis 
mental activity remained impaired, speech being 
practically absent. Believing that this was an 
instance of meningeal effusion, 1 opened tbe skull on 
the leftside a little above the convolution of Broca, re¬ 
moving tbe disc of bone which I now exhibit. There 
was no pulsation. Tbe dura bulged int’> the wound, 
and on examination of this a large amount of sero- 
sanguineous fluid escaped. There was a considerable 
amount of drainage during tbe next six days, after 
which day 'he wound healed. Three days after the 
operation he was able to repeat any word one hap¬ 
pened to mention. Ten days later voluntary speech 
: returned, and on February Ist last, then one month 
after operatiou, he left tbe hospital, rapidly im¬ 
proving both in muscular and mental development. 

Case VII.—F. K, set. 21, while riding a 
bicycle in the Park collided with another cyclist, and 
was picked up unconscious and brought to Steevens’ 
Hospital. Some wounds on bis face were attended 
to, consciousness returned, and he was allowed to go 
home to the South Circular Road, walkiut; part of 
the journey. Buring the ni^bt be became stupid, 
the next day he «as unconscious, but by tbe judi¬ 
cious treatment of Br. Patterson, of the Meath 
Hospibi], consciousness gradually returned, and I 
saw him in consultation with tnat gentleman on 
June 26th; be then bad complete paralysis of tbe 
right arm and leg, slight impediment of speech, and 
internal strabismus. The diagnosis I made was 
intracranial biemorrhage, with secondary effusion, 
and as tbe boy was rapidly disimproving I ordered 
him to hospi and that night opened bis skull in 
tbe position shown in tbe accompanying photograph, 
removing the clot which I now exhibit. This clot 
extended well under the base of the skull and tbe 
greater part of it was removed by a flat scoop and 
flushed with a thin tube. The boy left tbe hospital 

C 


D 



682 Thx M.DIC1L Pb»88. original COMMUNICATIONS. 


DSC. 25, 1901. 


on JdI^ 20th, and some weeks later he won a three- 
mile bicycle race. 

EHRLICH’S THEORY 

OP 

HEMATIC ANTIDOTES. 

By Peofbssob GRUBER, 

Of Vienna. 

The lecturer belieres that in all living protoplasm 
there is a centra! germ-structure which, chemically 
expressed, might be designated in its constitutional 
formula as a latei*al union of the atoms of which this 
very complex structure is built up. These connect- ' 
ing links hold the molecules, which may contain a 
number of such atoms, together constituting what 
Ehrlich terms “haptopbose'’ groups. These mole¬ 
cules consist of nutntive substances as well as toxic 
bodies and other derivatives of albumen. The sus¬ 
ceptibility of one cell towards another, according to 
this theory, depends upon the dose of toxin in the 
“ haptophose group.’’ When the cell contains an 
excess thereof it is considered immunised by the 
added toxin, which may have produced a new 

haptophose’’leaving the ot^an’s ceU functionally 
as healthy as before the excess was produced. This 
excessive production of the “ haptophose groups ” 
may soon act as unnecessary ballast in the circulation, 
and entirely destroy the “ toxophose group ” with ite ' 
prejudicial effect on the organism. The lecturer 
remarked that this was a hypotheiical assumption 
with few facts to support it, but be confessed that the 
whole subject was an excellent mental exercise from 
which many hypotheses might be evolved with a 
certain substratum of fact in all of them. 

Ehrlich believes the action of antitoxin on toxins 
to be purely of the nature of a chemical transposition 
of elements, and that this can be demonstrated 
according to the laws of multiples. 

Concentration and temperature largely influence 
the results, although the toxins under any condition 
have a notable power of diffusion in gelatinous 
media. An excellent parallel of this action is to be 
found in the union between saponins and cholesterin 
of the serum, in which a combination of the two 
bodies destroys the brnmolytic action of the saponins. 

It must be borne in mind, however, that the com¬ 
bination of toxin and antitoxin does not abolish 
their individual existence after neutralisation, for, if 
the mixture be heated to 68° Cent., the poisons will be 
found to be as virulent as ever, even after a consider¬ 
able period of time has elapsed. Prom this we may 
conclude that the substance is not in chemical com¬ 
bination, a fact which Behring pointed out long ago. 
Physiological and biological experiments have proved 
the fact, that although the two opposite substances 
are in combination, one of the poisons may produce 
its baneful effects after injection. We must con¬ 
clude, therefore, that the whole subject of toxins is 
far tcm complex to be intelligently discussed in the 
present state of our knowledge. 

There is another property of these toxins worthy 
of note, one too, to which Ehrlich himself draws 
attention in respect of diphtheria toxin. He 
affirms that the activity of this toxin diminishes on 
standing, or, in other words, he telle us that a larger 
dose of the toxin is required to produce the same 
results if it has been kept any length of time. He 
found that if the animal did not die a special latent 
period elapsed before tbe paralysis and cedema set 
m. This modified toxin he named toxone, and when 
tbe results were even less marked be employed the 
term toxoid. Ehrlich defines a toxoid as an organic 
poison in an organism that has missed tbe “ toxo- 
phose group ’’ while the haptophose group is still 


persistent. He assnres us that the diphtheria bac¬ 
terium produces toxin and toxone, and that tbe 
latter may become converted into a toxoid. Here 
again strange inferences may be drawn from results. 
The anti-serum contains a definite number of units, 
which we will assume produces tbe toxone results, 
viz., mderna and paralysis, which may require forty 
units in the case of a dog. In the guinea-pig 
no toxone will be found, while tbe dog has 
both toxine and toxone. Again, two diphtheritic 
solutions may be used, equal volumes of which in 
grammes as units will kill a mouse, dog, pigeon, 
or horse. This proves that it is not the toxin 
molecule we have to deal with, but s^me other un¬ 
known influence of which we yet know nothing unless 
we assume that the species of tbe animal modifies 
our experiments. The opposite of this can be found 
in tetanus. Carmine reduces tha virulence of tetanic 
saliva, since by gradually adding an aqueous solution 
water it loses its effect, or appeared to be transient in 
ite action, and requiring no more antitoxin than the 
undestroyed poison. This certainly gives colour to a 
chemical formnli similar to that of an alkali added 
to phosphoric acid, when tbe solution will not become 
alkaline until the last molecule of mono-phosphate is 
formed. 

Another property of organic poisons is their 
dotency. One-touHb of a milligramme of bacterial 
toxin will kill a man, while it would take seventy of 
strychnine. Yet, notwithstanding this lethal effect, 
the dose, or even a larger dose, will go through a 
period of incubation, lasting in some cases for many 
weeks. 

It seems also to be a recognised fact tbe more sen¬ 
sitive an animal is to tbe poison tbe more quickly 
tbe Injection is washed out of tbe blood current. 

If an animal be injected with tetanic toxin and 
antitoxin at tbe same time it will be found that the 
same quantity is required to neutralise, as in the 
laboratory experiment in vUro ; if, however, seven 
or eight minutes elapse before injecting the anti¬ 
serum tbe quantity must be largely increased until 
fifteen minutes have passed, when the serum dose 
seems to become stationary. In susceptible animals 
the poison passes so rapidly out of the circulation 
that death ensues before the anti-serum can act 
upon it. Another interesting point in regard to 
tetanus is that the pigeon is very susceptible to the 
tetanic toxin, yet it is to be constantly found in ite 
body, every organ being saturated with it, not ex¬ 
cepting the brain and spinal cord, which it attacks 
vlo^ntly. Ehrlich’s explanation is that it is then in 
I combination with other salts and thus remains 
inert in tbe body. 

Wassermann has recently confirmed this opinion 
of Ehrlich’s by examining the poison in tbe brains 
of guinea-pigs, which are also very susceptible to the 
poison, and he finds that when the toxin of tetanus 
18 extracted from the brain it is devoid of toxicity, 
although that got fiom the other organs is by no 
means inert. 

Behring, on the other band, argued that the fact 
that an equal quantity of antitoxin, applied to a mren 
quantity of toxin sufficient to pr3dnce paralysis, 
which, when mixed with an extract from the brain of 
a guinea-pig, could not be neutralised, this is a proof 
that tbe dead spinal cord is inactive till tbe celb are 
liberated. The poison can also be obtained from tbe 
brains of fowls, frogs, &c., which are also susceptible, 
by steeping tbe organ in a solution of common salt 
from which the tetanic vims can be isolated. 

Tbe incubation period is also somewhat against 
Ehrlich’s theory of the poison being anchored in 
tbe ganglionic cell after bacterial growth since 
other substances such as colchicine, lead, and 
saponin, also have incubation periods, and yet 




CLINICAL RECORDS. 


Thx Uxbical Pb>88. 683 


Pic. 26, 1901. 

comport no haptopboso or toxopboee gronpi. 
The anchoring of tbeoe toxins must take place 
within a short period after administration ; yet 
anti-sera are fotile, while tetanns may take months 
to derelop. 

A^^n, the period of incnbatiott Tarles according 
to the mode of administration, for subcntaneons and 
intravenoas injections hare mnoh longer incubation 
periods than those applied to the intra-cerebral sub¬ 
stance. Hanns Mayer has attempted another explana¬ 
tion by saying that the tetanus infection is local, 
^ectingonly the subjacentmusoles. This explanation 
is quite unintelli^ble if the poison has entered the 
hmmatic circulation, which be goes on to prore that 
it does when he tells us that the axis-oylinaers of the 
peripheral nerves are affected in the anterior home 
of the cord. 

The incubation is also short when the toxin is in¬ 
jected into the peripheral trunk of a large nerve, 
and as soon as the toxin has entered the axis-cylinder 
the anti-serum is inoperative. 

Ehrlich attributes all the deaths to exoeseive pro¬ 
duction of the lateral combinations, or the hapto- 
phose groups, which must be neutralised in the 
immunised animals by an lanti-toxin secretion which 
in many animals must be immense, as the horse 
requires 100,000 anti-toxin units to be neutralised. 

Clinical Jtlcmb. 

A CASE OF DISSEMINATED 5CLESOSI8. (a) 

By Dr. J. Maon Finkt, 

Physician and Lecturer of Clinical Medicine at Sir F. Dun’s 
Hos{>ital, Dublin. 

I AM enabled to show yon a girl, at. 22, with all the 
typical symptoms of this disease. Four years ago, at 
the age of 18, she became completely piralysed as to 
motion in arms and legs, wi^ loss of control over the 
bladder and rectum, and with the formation of large 
bedsores on sacrum and nates. No cause could be found 
for her illnesa. She was a patient for fifteen months 
in CO. Boscommon Hospital, under Dr. Blakeney, and 
left it so far recovered as to be in much the state she 
now presents. Having called attention to the rarity 
and pecnliarity of this invasion of the disease, and com¬ 
mented on the variability of its course and progress, and 
the difficulties such variability produces in the diagnosis 
of disseminated solerosis in its .earlier st^^ Dr. Finny 
pointed out the signs which were typically demon¬ 
strable on the patient, taking them teriatim 
and in the order of their prominence. 1. Paro- 
plegia .—She is just able to stend and walk a few 
steps with help, but her gait is that of spastic para¬ 
plegia, and yrt the legs present no spasms on hanming 
or on flexion and extension. The ankle clonus and knee 
jerks are very exaggerated, and Babinski’s sign of 
dorsal reflex in the right foot is present. The wrist 
and elbow reflexes are also exaggerated. Sensation is 
normal. 2. Th« bladder and rectnm are fairly well 
under control, though there is often a delay in micturi¬ 
tion, and if active aperients be taken, the bowels may 
move involuntarily. 3. TTte tremor *.—These are absent 
as the patient lies in bed; both the head, Moulders, and 
crown jerk abont in coarse tremors when an effort to , 
perform any voluntary act is made—" intentional 
tremors," such as patting out the tongue, drinking out 
of a cup, do. 4. This is slow, deliberate, and 

syllabic—“ scanning or staccato "—wiHtont slnrring or 
fibrillary tremors of lips or tongue. 5. The eye*. —Mr. 
Swanzy’s examination was to the effect that there was 
" nyst^mns, V in each eye. The field of vision mnoh 
contracted, and the onter two-thirds of each optic disc 
were pale, pointing to partial atrophy." There was no 
optic nenritis, retinitis, or choked disc. 6. A notable 
complacency with her sad lot and a cheerful conteut- 
ment with her surroundings, a festnre laid stress on by 
Gowers as very oharaoteri^o of disseminated sclerosis, 
more commonly met with in females. Mention was then 
made of the following organic nervoos diseases, which 

(») Case abown before tbe Medical Section, Aoyal Aeademr of 
Madiciue, Ireland, Dec. 13th, 1901. 1 


more or less closely may simnlate one or more of the 
salient features of disseminated aoleroaUParalysis 
^itana, general paralysis, merenrial tremors, syphiUtio 
diseases, ataxic paraplegia, intracranial tamonrs, es¬ 
pecially of the oerebeUnm, and transverse myelitis, and 
although the subject of diagnosis was not entered on or 
disonssed, a warning was entered as to riak of confound- 
ing with it hysteria, not when all the typical sym¬ 
ptoms are present, as in Dr. Finny^s case, but when&ey 
were ill-defined and varied in extent, and gravi^ 
under the inflnence of time. 

^ransactiDne nf gocutiw. 

BEITISH GTN.SCOLOGICAL SOCIETY. 

Muting hkld Dxc. 12th, 1901. 

J. A. Mahsbll Moullin, M.A., M.R.C.P, President, 
in the Chair. 

Clinical Casks and Spxcixbns. 

Da. Macnauobton - Jones showed the following 
specimens 

1. Malignant Multiloculab Ova&tan Ctbts cuh- 
PLicATiNG Utxbinb Htomata.— The patient was un¬ 
married, et. 48. Four months before oonsulting him 
she began to suffer in health, with abdominal pains and 
fr^nent bladder irritation. The periods had been 
fairly regnlar until a few months previeos to his seeing 
her, when hemorrhage set in, and oontioned inter¬ 
mittently nntil her operation. She was then greatly 
wasted in appearuce, extremely anemic, with a cardiac 
bruit. On examination fluid was detected in the peri¬ 
toneal cavity, and an enlarged and myomatous utems. 
An open diagnoeis was made of ovarian tomonr com¬ 
plicating myoma. She was operated upon on Jnly 28rd, 
when the tamonrs shown were remov^. She made an 
excellent recovery without any elevation of temperature. 
Two months after the operation she died of ascites and 
anasarca. At the openrion a lai^ quantity of ascitio 
flnid escaped. Two snbperiton^ myomata were re¬ 
moved. The ovarian oystomata were the size of small 
melons. They had the appearance of mnlU- 
locnlar colloid cystoma. The la^r had evidently 
mptnred. Mr. Targett made a miorosoopioal 
examination:—" Sections of the wall oxhibit invasion 
of the oaMole of the tnmonr with colnmnar-oelled car¬ 
cinoma, ue cells of which are arranged in tubiUar form. 
Moreover, the capsule is perforate by the growth in 
places." The fact that the larger qyst bad mptuzed 
during life would explain the rapid infection of the 
peritemeum and the death from ascites. 

2. Sabcoma ov THa Vagina. —The patient was aged 
44; married; last pregnancy twenty-two years since. 
In May, 1901, she suffered from a dis^eeable discha^ 
from the vagina. This became coostent in June, and 
more diffuse and offensive. She stated that occasionally 
what she called "pieces of flesh abont the size ct a 
walnnt" appeared with the discharge, and of late there 
had been severe bleeding on the slightest exertion. 
When he saw her she was very antemic, with a sallow 
complexion. On making an examination he found the 
vagina ^1^ with a soft, apparently carcinomatons, 
mass. This bled so profosely that it was not pos¬ 
sible to proceed, and it was only under snses- 
thesia, at the operation, that he discovered that 
the cervix nteri was fnll of the growth which 
was quite oonc«jed by it. It was then found that the 
mass was pedononlated and that it grew from the 
anterior vaginal wall behind Uie trigone of the bladder. 
Operatio^roved that it was quite free from the latter 
visous. The large pedicle was first secured with a rope 
ecrasenr and eeoon«uy with a Billroth’s damp. The mass 
having been remov^ the oantery was applied to the 
stomp. Then the snbjaoent base ^m whi^ the tomonr 
grew was ablated and the aotoal cautery applied to the 
raw surface. The wound was then covered by the 
vaginal nrucons membrane. The most careful asepsis 
was maintained and the wound healed by primary 
nnion. Report on the growth by Mr. Tai^ett: " This 
growth is a spindle-oellM sarcoma of the vagina. The 
surface is nloerated and covered with necrotic material. 

Uw 



Dxc. 25. 1901. 


684 Tbb Mxdioa^ Pbbss. TRANSACTIONS OF SOCIFTIES. 


Among the spindle'Oells there are a few lai^er poljr< | 
nuclear cells.” 

8. AdNXZAL TuKOUBS CAUStlia UNCONTROLLiBC.S 

VoHiTiKQ— Salpinoo-Oophohxctoiit. —Patient, »t. 26. 
Harried twelve montiiB. In 1900 she suffered from severe 
metrorrhagia for four months. 8he oonsulted him for 
constant sickness in November, accompanied by pains 
in the back and iliac regions. On examination he found 
an swelling at the left side, difficult to disasso¬ 

ciate from the uterus, which latter was enlarged. On 
December 6th the siolmess was worse, and with frequent 
vomiting and constant nausea. On examination the 
adnexal swelling at the left side was found much 
larger and softer. At the operation the left 
ovary, about the size of sn orange, was found 
to be cystic. This was removed. The right contained 
another growing cyst. This was resected From the 
time of the operation all sickness and vomiting ceased, 
and she is now quite well. Examination of the cy»t 
proved it to contain sanguineous fluid from intra-cystic 
hfemorrbaee. 

Dr. Hrtwood Smith questioned the propriety of the 
cautery in tbe second case over so large a surface. 

Dr. Macmauohtoi»-Jok«8 said there was no objection 
whatever; it was a delusion to suppose that a perfectly 
operation could not be conducted with the free 
use of the cautery. He had reo^ntly seen Professor 
Zweifel, of Leipsig, who was a strong advocate for the 
cautery, use it freely in a number of gynseoological 
operations, abdominal and vi^mal. 

Mr. E. Ktanmobb Bishop (of Manchester) gave a 
demonstration and read a paper on 

CHAMOBS OCCDEBINO IN UTBEI IN WHICH PIBBO- 
UTOMATA ABB PBSSBNT, 

whicn will be found in another column. 

Mr. J. H. Tabobtt had examined sections of many 
uterine flbroids, and he thought that there was abun¬ 
dant evidence of thickening of tbe muscular coat of the 
vessels and of their fibrous sheaths. After a time tbe 
new material became fibroid and almost devoid of 
nuclei. This degenerative change was very charac¬ 
teristic of uterine myomata and enabled their structure 
to be easily distinguished from normal uterine tissue. 
As regarded the endometrium, be bad in some cases 
found hyperplasia especially affecting the stroma, while 
in others the endometrium had been thinned by disten¬ 
sion and its glandular follicles bad become disarranged 
or even obstructed at their mouths, causing retention 
of secretion, and shed epithelium in their acini. He 
had never met with tubules lined with epithelium in 
the substance of a fibroid, and therefore did not think 
that these tumours commonly originated from con¬ 
genital relics in the uterine walls, as stated by some 
observers. 

Dr. MACNAuaHTON-JoNES said that endometritic 
changes were among the commonest degenerations found 
in myomata' one point he wished to emphasise, and 
that Mr. Bishop’s paper drew attention to, namely, tbe 
danger of curettage in some oases of myoma. Tbe 
operation of “foraping” was so commonly resorted to 
that it was just as wMI to remember that in certain 
forms of myoma it was worse than useless, andsi me 
women dated all their worst symptoms from the opera¬ 
tion of curettage. Beemorrhage, for instance, which 
had been comparatively trifling before, increased. 

Dr. Stanmobb Bishop replied. He hoped that Ur. 
Targett in future researches would record tbe changes 
observable in the vessels of the endometrium and the 
glandular structures. He agreed with the remarks as 
to the dangers of curettage in certain cases. 

Dr. Hacnavobtom-Jones then demonstrated several 
recent gynecological appliances, including amost useful 
flushing retractor employed by ProfesFOr Leopold for 
vaginal operations, and a new self-retaining trocar of 
Kosberle for ovariotomy He described the Zweifel 
suture, and showed the gut used in his klinik, which is 
thus prepared. It is wound on a glafs plate with 
ground edges, so as not to cut it. It is next placed in 
chromic solution for fifteen minutes (1 in 1000), and 
then washed in water. It is a second time for fifte n 
minutes placed in tbe chromic solution, and dried at a 
temperature of 80 degs. (Cent.) It is then ronde into 
rolls and subjected to 100 degs. (Cent.) The final 


drying must be complete. It is then taken out of the 
chromic acid and placed in cumol for an hour and a 
half, at a temperature of 160 degs. (Cent.) It is noir 
put into benEine of petroleum with a sterilised forceps, 
■nd the benzine is changed onoe (after half an 
hour), and fresh benzine put in. It is now 
placed in sterilised glasses, and is ready for use. 

The new bronze aluminium wire, as employed bp 
Professor Bnmm, of Halle, be bad used in sevettU abdo¬ 
minal sections, and it m^e a clean and perfect oon- 
tinuou* or interrupted skin suture, the result b*ing 
exhibited in the photograph. Professors Erdnig 
and Menge used a cotton thre^ permeated with oollo- 
dion for the same purpose. Tbe Zweifel suture was de¬ 
monstrated, as also the advantages of the use of Eocher*a 
foroeps in hysterectomy, in lieu of either tbe clamp 
method of Doyen or Zweifel. Eeference was made to a 
new mode of dressing in the abdominal toilet carried 
Out at Professor S&nger's Elinik by Dr. Eleinhans. The 
first dressing was covered with the material colaetin,” 
which hermetically closed the abdominal surface. 


EOYAL ACADEMY OF MEDICINE, lEELAND. 
Mbdical Sbction. 

Mbstino held Fbidat, Dbc. 13th, 1901. 

In the absence of th Precident, Sir C. Nixon, tbe 
chair was taken by Dr. Waltbb Smith. 


Db. Finnt read notes of a case of “Disseminated 
Soli-rosis ” in a girl (patient shown) which will be found 
under “ Clinical Eecords.” 

Dr. Gbobob PiAcoCKB read a paper on 

aBMICUOBBA AND PABOTITIB COMPLICATING A CASB OP 
DIABBTB8. 

The patient, a man, set. 64, was admitted to the 
Adelaide Hospital on .^pril 29th, 1901, soffering from 
diabetes. He presented tbe usual symptoms, loss of 
flesh, great th'rst, and polyu ia. The quantity of urine 
passed in the twenty-four hoars varied from three to 
five pints, and quantitetive analysis gave2’7 ozs.of sugar 
on May 2nd; somewhat lees on subsequent occasions. He 
continued very drowsy tbroughfut bis illness; at times 
the condition almost approached coma, and he died on 
May 28tb, just four weeks after admission. On May 
4tb he developed left-sided bemi horea, which resisted 
treatment with hyosoine, bromides and chi ral. Arsenic 
in 10 min. doses was given, and20gr8. oftrionalatnight. 
Improvement rapidly followed, and all the chorea sym¬ 
ptoms disappeared on May 13th. The value of trional 
in chorea has been alluded to in the Medinal Annual for 
1900, and also in tbe Medital Journal forNovem- 

ber2nd, 1901. The writer bad also used it with success 
in the case of a girl, set. 11. wbo was admitted to tbe 
Adelaide Hospital in January, 1901. It was suggested 
that the cause of the chorea in the present case was the 
action of some poison due to the diabetes circulating in 
the blood and acting on the nerve cel'S controlling tbe 
motor apparatus. The second oomplication, parotitis, 
first made its appesranoe on May 11th. At first it gave 
rise to little trouble, but on May 16th there was some 
elevation of temperature and the parotid gland became 
painful and tender. Tbe fever continued until tbe 
pa ient's death, but never reached a higher p >int than 
101*6^. The cause of tbe parotitis was quite obscure, 
and though a similar condition has been described in a 
variety of diseases and injuries of the abdominal organs, 
BO far its occurrence in the course of diabetes has not 
been recorded. 

Dr. 'Waltee Smith, Mr. H. 6. Cbolt, and Dr. 
Parsons discussed the paper. 

Dr. Dawson read a pap> r on 
“ OLTCOBUBIA AND INBANITT (CLINICAL STDDT). 
which we hope to publish in full in our next. 

Cases of glycosuria associated with insanity were of two 
classes—those in which tbe insanity was secondary and 
those in which the glycosuria was secondaiy, tbe first 
being rare. Be had bad one case of the first class at 
Fsrnbam House, that of a woman wbo had suffered for 
many years from polyuria and recurrent melanch«> lia, 
with general debility, the mrlanchoUa being of the type 



Dec. 25, 1901. 


TRANSACTIONS OF SOCIKTIES. The Medical Peek. 685 


deecribed chEraoteriBtio of diabetic insanity. Sbe 
had been admitted for a severe attack, and, sui^ar being 
present in the urine, was pnt on diabetic diet. The 
sugar and the mental symptoms disappeared, and she 
was discharged recovered in about two months. The 
diet has since been persisted in, and she has remained 
unusually well for at>out a year. Two other cases were 
then briefly described which probably belonged to the 
second class. In one depression dated from an attack of 
influenza; in the other, the melancholia was a second 
attack, the flrst following an injury to the head. 
Both bad glycosuria, for which they were treated, 
and recovered, so far as the acute attack was 
concerned. In four more oases glycosuria had been 
present on a few occasions only, and bad not been 
treated, the forme of mental disease being respectively 
paranoia with depressing delusions, sub-acute mania 
with a tendency to stupor, acute mania with stupor and 
unpleasant delusions, and acute confusion. In all but 
one of the seven oases a prominent characteristic was 
mental discomfort, and, when it could be tried, there 
was high blood-pressure during the acute stage. Five 
bad m^e good recoveries, and one was in a fair way to 
do so. the paranoia being, of course, incurable. In 
true diabetic insanity the mental symptoms were due 
to cerebral malnutrition. The glycosuria when merely 
symptomatic was probably purely alimentary, and 
dependent on a failure of pugar assimilation which had 
been observed to be espeoially frequent in melancholia. 
Qlycosnria did nob appear to be necessarily of bad pro¬ 
gnostic import in insanity. 

Dr. Waltbb Shitb would like to ask Dr. Dawson 
whether glycosuria was more common amonir the insane 
than the sane. Savage had found it in not more than 3per 
cent, in the patients at Bethlem Hospital; this differed 
from the experience of the Vienna physician, who found 
that 12 per cent, of the insane suffered from glycosuria. 
He woidd also like to know from Dr. Dawson if gly¬ 
cosuria gave rise to any special form of insanity. He 
was under the impresssion that it was associated more 
with melanoholiat^a exaltation. When glycosuria does 
occur in the insane, is it characterised by any special 
symptom, such aa slight polyuria ? 

Dr. Lbpeb asked what is the relationship between 
glycosuria and insanity ? Of the admissions under his 
care in Swift's Hospital 8 per cent, suffered from glyoo* 
suria. They presented none of the classic symptoms of 
diabetes, except the presence of sugar. The Hindoos 
suffer greatly, every family hsks lost some member 
through dia^tes; on the other hand the phlegmatic 
Chinese escape—of 15,000 persons examined not one 
suffered from it. 

Dr. Hates a^ spoke. 

Dr. Dawsom, in reply, stated that he looked on glyco¬ 
suria as uncommon in the insane; these were the first 
oases he had. The more common forms were melan¬ 
cholia and senile dementia. In all his oases he found 
high blood pressure. Special senses seldom affected in 
diabetes mellitns. 

Dr. J. J. Bdbqebs exhibited a specimen of unilateral 
fatty degeneration of the heart, taken from a man, tet. 
35. The left ventricle was normal, but the walls of the 
right were almost wholly fatty tissue. Fntil the 
moment of death the man made no complaint. The 
pericardium was distended with blood. The ventricles 
were covered with lymph, which was readily peeled off, 
and had a fluffy appearance. The anrioles were normal. 
The aorta was atheromatous. 

Dr. J. J. Bdboebb read notes of 

an uncommon case or suddin death: 

The case Ibring before yon this evening is one of sudden 
death from what 1 take to be a combiii stion of circum¬ 
stances which are uncommon. The patient was a poorly- 
nourished man, set. 35, a labourer out of employment. 
From the evidence at the inquest I learned he at least 
did not complain of being unwell until the fatal seizure 
came on. I presume that whilst seeking for employment 
he was noticed by some people to suddenly fall with bis 
shoulder resting against a wall, and then drop to the 
ground. The people did what they could to revive him, 
but when the ambulance arrived he was so evidently 


' dead that they took him to the Morgue instead of one 
of the hospitals. The body was, I remarked before, not 
; well nourished, but not emaciated; both lungs were 
emphysematous with a large amount of mnco pus in the 
blanched system, but exhibited nowhere cicatrices nor 
con-olidation. The pericardium was distended, on open¬ 
ing which somewhat over a pint of fluid blood and clots 
exuded, both ventricles espedally. The surfaces of the 
right ventricle were covered by reoent lymph, which 
at the time could be easily detected, and presented 
that fluffy appeaiance which yon can see faintly in the 
specimen. Before removing the heart I searched 
assiduously for the source of the hemorrhage but 
without result, nor could I find it afterwards. On 
opening the heart it will be noticed that the valves are 
in no way affected, the entire ante-wall of the right 
ventricle is principally composed of fat, there is almost a 
total absence of muscular fibre; this is very striking on 
comparing it with the left ventricle, which is fairly 
normal. Both coronary arteries are permeable. In the 
right ventricle was a clot formed at time of death. Both 
au'ioles present nothing abnormal. The aorta shows 
considerable evidence of atheroma. Although I have 
not been able to demonstrate the source of the hsmor- 
rhage, I think the cause of death is obvious. During an 
attack of acute pericarditis, associated with a previously 
diseased heart, a bleeding occurring, was sufficient 
although small in amount to cause by its presence fatal 
paralysis. I find on consulting the literature on the 
subj-^ct that bemo-pericardium is produced by two sets 
of causes, the most common being the rupture of the left 
ventricle of an aneurysm or of some vessel into its sac'; 
the second in which during the course of pericarditis of 
cancerous or tuberculous origin a bloody serum is 
exuded into the sac, and a similar effusion also in some 
cases of scurvy and purpura. In my case there was no 
trace of malignant dSsease nor tuberculosis, but it owes 
its interest as one of acute pericarditis with the very 
uncommon complication of a true hesmorrhsge, pro¬ 
bably from capillary vessels which, although com¬ 
paratively small, was sufficient on account of the 
diseased condition of the myocardium to cause sudden 
death. 

Dr. Finnt doubted Dr. Burgees’ statement that the 
change in the ventricle was due to fat. He suggested a 
new growth of some description as more probable. He 
was of opinion that a histological examination should be 
made of the heart before the case was published in the 
“ Transactions.” 

The Seotion then adjourned. 


EDINBURGH MEDICO-CHIRURGICAL SOCIETT. 
Clinical Mbetinq held Dec. 18tb, 1901. 

Dk. Andbew, Vice-President, in the Chair. 


Mb. C. 'W. Cathcabt showed a patient after drainage 
of both pleural cavities for double empyema. The em¬ 
pyema followed pnenmouia, and the only micro-organism 
present in the exudation was the pnenmocooons. The 
left pleura was drained and the right aspirated simul¬ 
taneously ; as the right Bubeeauentiy re-filled, a lib was 
resected about a week later. The patient, a lad, set. 16 
made an excellent recovery. 

Dr.'W. Allan Jamieson showed a patient who had 
been under his care for many years on account of a 
patch of lupus on the chin, which had proved very in¬ 
tractable. This summer it had been subjected to the 
Finsen light treatment, and had apparently completely 
healed. He also show^ a case of rodent ulcer, where 
the X-rays had been successfully employed. 

Mr. Albxandeb Miles showed Q) a woman who bad 
been admitted to hospital suffering from severe gastric 
hsemorrh^e. There was no previous history of ulcer. 
He opened the abdomen, and, finding an ulcer about the 
size of a five shilling piece near the pylorus—too large, 
therefore, to excise—performed posterior gastro-enteros- 
tomy. The symptoms caused by the loss of blood were 
combated by injection of saline solution into the 
peritoneal cavity and into the bowel, and the 
patient recovered completely. (2) A mun who 

Vjoo^le 




Die. 25. 190]. 


686 Thi Mssioil Pgiae. TBANSACTIONS OF SOCIETIES. 


-wfts Bent into hoapital with the history of previoiu 
ohronio partial ooetmetion of the bowel, which 
had asenmed an aonte form on the day of admission. 
The abdomen was generally tender, and visible peri¬ 
staltic movements could be seen. Asitheie waa no clue 
to the »i‘e of the obetincticn, the abdomen was oroned 
in the middle line, when the peritoneum was found 
studded with yellow tuberculous nodules, while a fibrous 
adhesion constricted the lower bowel. This wasdivided, 
the abdomen waa emptied of fiuid, and closed. During 
the convaleacenoe symptoms of pleurisy developed, and 
on the diagnosis of tubercle being confirmed by the 
examination of the exudate, the pleural sac was opened 
four weeks after the abdominal operation. Now, three 
years later, the patient enjoyed good health. (8) A 
case of excision of the rectum by Krasko’s method. The 
stricture waa about an inch and a half from the anus, 
and the tumour was adherent to the prostate. The 
patient had gained two atones in weight since the 
operation, and had partial control of the boweL 

Dr. W. G. Sth showed a case in which double ex¬ 
cision of the lachrymal eao was performed. As it was 
necessary also to remove a cataract, and as the risks of 
extraction were greatly increased by affections of the 
lachrymal apparatus, he had had the coniunctival sac 
examined bacteriologioally before touching the cataract. 
Finding that numerous pyogenic organisma were pre¬ 
sent he delayed for a month, using antiseptio lotions 
the while, and then, when the conjunctiva was aseptic, 
extracted the lens. In bis experience, epiphora never 
followed removal of the lachrymal sac. 

Mr. STii-ia showed (1) a boy after operation for recur¬ 
rent tubercle and stricture following amputation of the 
penis for tuberculous disease of the glans. (2) Four 
cases of congenital wryneck, showing the resrUts of 
treatment by the open operation. He had ^iven 
up operating subcntaneonsly, because experience 
showed that mere division of the stemo-mastoid 
was insufficient, and it was necessary to expose 
the parts freely, and cut through any deeper structure 
which prevented the head being straighteced. In the 
patients shown tiie divided etemo-mastoids had not 
rennited, but the movements of the head were not in 
any way impaired. Mr. Stiles regarded wryneck as a 
congenital deformity, and thought that the occurrence 
of hsematoma of the stemo-mastoid was not to be looked 
upon as a cause of the condition, but rather as an effect, 
the abnormally short muscle being liable to injxuy at 
birth. Miculic* had stated that in wryneck there was 
chronic myositis of the muscle, and that it was not 
sufficient merely to divide it, but that the lower tw<^ 
thirds should be excised. Mr. Stiles had not found that 
this proceeding was essential. All hie cases showed the 
usual faci^ asymmetry.andthis,bethought,supported 
the idea that wryneck was really due to some congenital 
abnormality. (8) A child, set 14 months, after opera¬ 
tion for congenit^ malformation of the anus. 

Mr. Alixjs Thomson showed a woman, set. 62, on 
whom he had performed pylorectomy for cancer three 
and a half years ago. The tumour was attached to the 
pylorus, but there were no signs of pyloric obstruction, 
BO that the only operation considered was pylorectomy— 
a gastro-enterostomy would not have g^ven any relief. 
The interest of the case was the long period which had 
elapsed aithout recurrence, and now he hoped tlmt the 
patient might be considered immune. As bearing on 
the prognosis of such cases he said that the tumour bad 
proved to be a columnar-celled epithelioma—one of the 
tas malignant, though unfortunately rarer types, of 
cancer. He bad never seen a case of infiltrating scir- 
rhns in which recurrence had been postponed for more 
(lum two years. Apart from the fact that this patient 
waa obliged to take her food in small quantities at a 
time, she bad no inconvenience whatever. 

Mr. Caikd showed a patient after operation for high 
shoulder, dne to an osseous plate developed between the 
Boapula and the vertebral border. The plate had been 
removed snb-periosteally some years ago, and ^ bad 
recurred, so that a second operation had been required. 
Such cases were extremely rare. 

Card sp'cimens.—J&r. Miles: (1) Rectum excised by 
Eraske’s method; (2) specimens of preputial calculi; 


(8) specimenB illustrating fracture-dislocation of the 
spine. Mr. Caird: (1) Specimens and photographs from 
case operated on for high shoulder; (2) oaic^ma 
transverse colon, from a case of resection and primary 
sntnre. 


NORTH OF ENGLAND OBSTETRICAL AND 
GTN.ECOLOGICAL SOCIETT. 

MnriNO BiLD AT Srifvixld, Nov. 16tb, 1901. 

The President, T. B. Gbimsdalb, M.B., in the Chsdr, 


Spkcimxms Shown. 

Db. J. H. Kxxlino (Sheffield)): 1. A semi-aolid 
ovarian tumour, probably malignant. Owing to its 
attachment to, and involvement of, the fundus uteri it 
was found necessary to remove the uterus, together 
with the growth, by abdominal hysterectomy. The 
atient made a complete recovery. 2. Uterus with 
bromyomata removed by abdominal hysterectomy. 

Mr. Pbbcival Babbbb (Sheffield) : A large subperito- 
neal fibro myoma removed with the uterus by abdominal 
hysterectomy. 

Mr. R. Favbll (Sheffield): 1. Fibromyomatous 

uterns removed by abdominal hysterectomy from a 
patient, set. 54, the indications being recent rapid in¬ 
crease of growth and profuse menorrhagia. 2. Unrup- 
tured tnb^ gestation removed by laparotomy at the end 
of the third month. 8. Ovarian dermoid removed by 
vaginal cceliotomy. 

Dr. J. W. Mabtin (Sheffield) exhibited an improved 
form of bed bath for use in douching. 

Dr. Arnold W. W. Lxa (Manchester) related a case 
of 

PBOFU8B HTDBOFBBITONXUM 

associated with fibromyomata of the uterus. The 
patient, set. 44, 5-para, had suffered from profuse, but 
painless, menstruation for three yean. During the 
fast four months the abdomen had become much dis¬ 
tended by free fiuid. The iMitient was much emaciated 
and suffered from pressure symptoms. The heai^ 
lungs, and liver were normal, and there waa no albumi¬ 
nuria. Per vaginam, the pelvis was found to be occu¬ 
pied by firm, multiple tumours, apparently of uterine 
origin. Three gallons of fiuid were removed by tapping, 
and the growths could now be felt filling up the pelvis 
and lower half of the abdomen and apparently fixM. A 
fortnight later, as the fiuid had re-accumulated, abdo¬ 
minal section waa performed. The tnmonr was uterine, 
quite filled up the pelvi^ and was adherent to the 
rectum. As removal was impossible, the ovaries and 
tubes, apparently healthy, were removed and the 
abdomen closed without dra^age. The patient made a 
rapid recovery, and six months later had regained her 
usual health. At the present time, eighteen months 
after operation, the uterine tumour had become quite 
small and mobile, and there has been no return of the 
hydroperitoneum. The points of interest are (1) the 
rarity of bydroperitoneum in cases of fibromyoma; (2) 
the absence of any obvious cause for it in this case; (3) 

I the clinical resemblance of the sympUms to those of 
malignant disease; (4) the beneficial results of removal 
of the appendages in causing shrinkage of the growth 
and cure of the ascites. 

Remarks were made by the President (Dr. Orimsdale) 
and Dr. J. E. Qemmell, and Dr. Lra replied. 

CANCER OF THE CERVIX—C.fi8ABlAN SECTION. 

Dr. J. E. Gemmell (Liverpool) described a case of 
cancer of the cervix with eight months’ pregnancy, for 
which hehsdperfcrmed Cffisarian section and abdominal 
hysterectomy. The patient, at. 42, h^ been married 
twenty-one years, with twelve pregnancies—six children, 
five abortions, and the present pregnancy. At the 
sixth month there was some bleeding. This recurred 
at the eighth month, when extensive cancer of the cer¬ 
vix was discovered. Labour came on spontaneously, 
but natural delivery being impossible owing to the con¬ 
dition of the cervix, Cmsarian section was performed, 
the fmtus removed being dead and macerated. The 
ovarian and uterine arteries were ligatured, and the 



Dio. 26, 1901. 


LUNACY DEPARTMENT. 


ThI UlDlCAL Pbiss. 687 


vtenu amputated above the cervix. The oervix was 
then removed per va^nam, after division of the 
anterior and po^rior fomioes in the nsnal way. 
It was thought there would thus be lees 
risk of peritoBMl infection than by the abdo* 
minal method. The abdomen was drained per 
vaginam. The oervix on examination was a hiM, 
soirrhus-like mass, its canal only admitting a cedar 
pencil. On section the surface was hard, white, and 
shiny. The growth involved the whole of the cervical 
walls, and completely surrounded the canal. Microscopi¬ 
cally its structure was that of a carcinoma with an 
excess of stroma. The patient made a good recovery 
from the o^ration, but two months afterwards she died 
with seoonury growths in the liver and stomach. 

The case was discussed by Dr. Arnold Lea, Dr. E. O. 
Croft, and the President (Dr. Grimsdale), and Dr. 
OiinciLL replied. 

Dr. Qodfbxt CasTia (Sheffield) read a paper on a 
series of 

COlCFLICaTlONS DVBZNO FBBaNA.NCT AND LABOUB. 

He referred to cases of placenta suooenturia, adherent 
pla'enta, and post-partnm hemorrhage, and urged that 
while the contractions of the uterus during the third 
stage should be favoured and watched, the uterus 
should not be bullied to do work which it wss not ready 
for by premature attempts at expression of the placenta. 
Two cases of labour during the course of acute croupous 
pneumonia were describe A case of convulsions 
originating daring pregnancy unassociated with albu¬ 
minuria was quoted, in which the convulsions reappeared 
in the second pregnancy. On both occasions no convul¬ 
sions occurred daring labour or the puerperium, but the 
patient has since become an epileptic. 

A discussion followed, in whicm Dr. J. E. Oemmell, 
Dr. Japp Sinclair, Mr. C. J. Wrighr, and Dr. E. O. Croft 
took part, and Dr. Godfbbt Cabtib replied. 


yuiwrg gcpurtmcnt. 


ASYLUM EEPOET8. 

Pboposid Niw Edinbuboh Astldx. 

In lunacy circles much interest is at present centred on 
this asylum which the Edinburgh District Lunacy 
Board purpose building at Bangour for their pauper 
patients. It is to be constructed on what is known as 
the “ cottage system," and the proceedings of the Board, 
who are at present at loggerheads regiming the cost, 
are e^^erly watched. We ^ve again and ag^ agitated 
against expensive asylums, and, so far as we can judge, 
this is going to prove the mort expensive one in Scot¬ 
land, both for construction and management. This 
que^on of cost is the subject of so much comment t^t 
we are inclined to think t^ motto of some asylum com¬ 
mittees must be "more expense, more honour." The 
real ^vantam accruing from this system of asylum 
construction have not yet been fully demonstrated, and 
we are just afraid it will be pushed for more than it is 
worth, and that this Board may find, too late, that they 
have overleaped themselves. At a recent meeting the 
clerk reported that the expenditure in connection with 
this new asylum to Deoembwlstlart was £85,67419s. lOd. 
The total cost of the railway alone is estimated at 
£33,000. The total cost of buildings for 600 patients, as 
estimated by the architect, is £^,230, and for 1,000 
patients, £376,840. These figures speak for themselves, 
and at a glance indicate considerable extravagance, and 
thus furnish ns with another instance of re^less and 
foolish expenditure of public oton^ in connection with 
the construction of an asylum. The plans have been 
criticised by Drs. Fraser and Maopherson, Commissioners 
in Lunacy, and, appended to the clerk’s report was a 
memorandum by them, in which they stated that 
the plana showed throughout unnecessary costli¬ 
ness in matters of detail. Instances of this were too 
numerous to individually specify, but examples were 
given, snob as mullioned windows (shown almost every¬ 
where), crow-stepped gables, string courses, and expen¬ 
sive mouldings in doorwayB,gables, Ac. The coal stores 
attached to the workshops are surrounded by stone 


balustrades, which serve no purpose. All these things 
must add greatly to the cost of the various buildings, 
and they will undoubtedly add nothing to their means 
of caring for or curing the insane. The Commissioners, 
however, also state that the plans showed abundant 
evidence of the most careful consideration with a view 
to faciliating administration and meeting the wants of 
the patients. This we are glad to learn, as it 
spealu well for the architect and the Board, and tends 
to condone for their general want of economy. 
The workshops, which would in ordinary commer¬ 
cial life be plain and simple, include some of the costly 
features already referred to. The very idea is prepos¬ 
terous, and no wonder they are estimated to cost £11,900. 
A home for thirty-six quiet, chronic prtients is esti¬ 
mated to cost £6,470, or £180 per bed. We much regret 
that a home for this class of patients, for whose care the 
simplest arrangements would suffice, should be so ex¬ 
pensive, and very wisely the Commissioners did not re¬ 
commend its erection. It is also proposed to spend £2,000 
on a mortuary. We do not require to enlarge on the 
glaring extravagance which is exhibited here, on a build¬ 
ing which sho^d be quite unobtrusive. It would be 
more to the purpose to spend two-thirds of this money 
on the full equipment of a pathological laboratory, which 
would farther the iuterests of science. It is all very 
good to make a fine outward show, but what is the 
return ? Is the recovery rate thereby increased ? Is 
the death rate diminished and the cost of maintenance 
less ? Certainly not. Why then this needless expense ? 
Then, again, will not the hard-headed ratepayer crown 
all with the question, " What have we got for our 
money f ” 

Hollowat Banatobium. 

Thx House Committee report that on January let, 
1900, the number of patients and boarders was 404, and 
on December Slst, 391; the average number during the 
year being 401. They again remind us of the fact that 
there is no eidowment, and that in developing the 
charitable working of the hospital they must necessarily 
prooeed with caution. A lu^ proportion of paying 
patients must be maintained so as to provide the means 
for admitting others on a charitable basis. The Com¬ 
mittee have Y'.Tj generously granted weekly allowances 
to the wives ana families of five men of the ordinary 
staff on active service. We are plea^ to note that tiie 
case books, which are illastrated—a pleasing feature— 
are always well commented upon by the Commissioners 
in Lunacy, and this must be very gratifying to the 
medical officers. Daring t ie year 10 general paralytics 
were admitted on the »"*le side, a higi percentage. Dr. 
Moore does not speak favourably in his report of volun¬ 
tary patients. He thinks they do not exercise a good 
influence on the other patients, and we quite ^pree with 
him. 

Dxbbt BoBonaH. 

Dr. Maophail reports that in the admissions 42 per 
cent, suffered from possibly curable forma of mentsl 
disorder, and that a less proportion than formerly 
suffered from grave forms of brain disease. He justly 
points out the tendency each year to send more senile 
and helpless cases to asylnmt. We regret to confirm 
this statement. Many cases are now sent to asylums 
which, until a few years ago, would have been oaiM for 
in their own homes or in a workhouse, and this perhaps 
accounts for much of the apparent increase of lunacy. 
The admission rate is not high— 94 admissions, 44 dis- 
ohatvee, and 44 deaths. The death rate (14*4 per cent, 
on we daily average number resideot) is high, but a 
severe epidemic of influenza indirectly accounts for 
this. A study of the causes of insanity shows that 
alcohol is responsible for 21 of the admissions. Dr. 
Maophail's report indicates evidence of efficient 
management. 


Db. Clabbnci Allbbman, a young medical man, 
died at Eotherfleld from injuries received while cycling. 
He was riding from Eotherfleld to Bridge and was 
thrown from his machine. Dr. Allerman was a lieu¬ 
tenant in the let Cinque Ports Eifle Volunteers. 


o 




688 Thb IfxmcAi. Fbkss. 


SPECIAL AETICLFS. 


Dxc. 25 , 1901. 


PTOMAINE POISONING. 

Tbs occurrence of a well marked caee of ptomaine 
poisoning on the 9tb inst. in Cork is of more than 1 'm» 1 
importance. Pour young children on Saturday momiog, 
the 7th inst., eat some tinned salmon, the tin of which 
was opened on the day before. One of the little ones, a 
girl two years and eight months old, became rery ill; 
she suffered from purging and vomiting, and finally 
died in a state of collapse early on Monday morning. 

The word ptomaine is derived from the Greek rr&na, a 
corpse. It has been defined as an alkaloid body formed 
from animal or vegetable tissues during putrefaction by 
the agency of pa^ologioal bacteria, or, more briefiy, as 
a putrefactive alkaloid. 

The fact that many distinguished chemists deny that 
ptomaines have any alkaline re-action, or are capable'of 
forming alkaloidal salts with aciis, and cannot be 
looked upon as amines, for some of them are amido- 
acids; amido-aoids like creatinin and nenrin we will not 
discnss. The word carries a certain specific meaning to 
the medical officer of public health and to the medico* 
legal jurist, though it does approve itself to chemists 
like Salkowski, or physiologists like Brieger. In 18B3 
Marqnardt isolated a crjst^line su^tanoe which in its 
action resembled conine; tince then many such bodies 
have been discovered, one of there, gadinine 
(^T ^10 obtained from decaying fish ; it is one 

of the most active and lethal of the ptomaine*. Its 
effects are those of a virulent vegetable alkaloid. 
Indeed, it was this close similarity to alkaloidal poison¬ 
ing in Italy, where for oentnries poisoning has been re¬ 
duced to a fine art., that first directed Marquardt’s 
attention to the snbject. He extracted from the body 
of a man, who was supposed to have been poisoned, a 
substance which closely resembled delphine (C,, H,, 
NO,), but which tested physiologically was found to 
differ from it. 

One of the peonliarities of gadinine is that many 
persons are nnaffected by it even in large doses, and 
others are very susceptible to its toxic properties. In Dr. 
Mann's case six persons ate of tinned salmon, but only 
one died; in this Cork case, of the four children one 
suffered. An explanation for this is offered by the state¬ 
ment that the meat packed along the outer rim of the 
bottom of the case is more unwholesome, richer in 
ptomaines, than the rest of the contents of the tin. 
But tinned meat when properly canned is a wholreome 
and nutritious diet, and it would be a misfortune 
to the poor if a prejudice were to arise against its 
use. 

The canning of meat was made the subject of a srecial 
inquiry by the Agricultural Department of the U.S.A.. 
and the report states that weight for weight tinned 
meat contains a much greater amount of nitrogenous 
material, while the proportion of fat in tinned and fresh 
meat is almost the same. 

Of the total proteid in canned meat Notter and Firth 
find that not more than 2 per cent, was indigestible. 
If, however, bad meat is ured, or the meat is badly 
cooked, or the tinning process is not properly carried 
out, there is death in the pot. 

The purchaser's best protection i^ainst danger 
is in the brand of some respectable firm; besides 
this there is the further protection of the bulging 
of the ends of the tins, which tells that the con¬ 
tents have commenced to decompose. On being opened 
the contents of the tin, on being turned out on a plate 
or deep vessel, should give off no bad smell, and should 
be free from discolouration. As a further precaution, 
all tinned meats should be cooked immediately the tin 
is opened. Tinned fish will develop ptomaines if left in 
the open tin, in twelve hours, unless they are protected 
from putrefactive dangers by some chemical agent. 
'They should never be given uncooked to children, and 
certainly not to children under seven years of age. 
Should toxic symptoms develop, they must be 
treated as they arise; there is no antidote to the 
ptomaines, and unfortunately nature’s efforts to elimi¬ 
nate the poison are too often attended by inflammation of 


the alimentary tract, which oft-times extends through¬ 
out its who’e length. Early in the attack the heart 
suffers, its contractions are imperfect, weak, and very 
frequent; all the muscles, voluntary and involuntary, 
share in the general prostration; the skin is bathed in 
sweat, which soon becomes cold and clammy; the heart 
becomes very weak, the pulse is not to be felt, and the 
patient becomes so prostrate that the vomiting ceases 
from inability of the stouiach to reject its contents ; the 
relaxed anal sphincter allows of the bowel to empty 
without effort; the patient complains of cramp in the 
calves of the legs, and death scon after releases the 
sufferer from his agony. The evil of ptomaine poisoning 
is best guarded against by the inspection of all cans of 
tinned meats offered for sale by the sanitary inspector 
from time to time, and the destruction of all 
which are in the least tjonvex at their ends. 


CENTENARIANS. 

CxNTBNABiANS, Hko BO many other prodigies- physio¬ 
logical, physical, and moral—come forth from time to 
time in definite groups. At present they are well in 
evidence. A century or so ago the authentic—or even 
physically possible—existence of a human centenarian 
was questioned by the sceptical. It was indeed abso¬ 
lutely rejected by some of the best informed in¬ 
quirers. There can be no doubt that many specimens 
claiming to belong to this class of chronological mon¬ 
sters were invented by the manufacturers of 
folk-lore and fairy tales, in the good old dsjs when 
registration of births and baptismsd records were not so 
faithfully carried out and so carefully preserved as they 
have been of recent years. Accordingly, the evidence of 
an actual centenary span of existence has been entirely 
rejected in the oases of the most miraculons specimens 
by all careful critical inquirers. But, on the other hand, 
if the noble army of centenarians has bwn reduced in 
number, the existence of a limited number bas been 
placed in a position which is historically and scientifically 
impregnable. In tbe Lancet of November 9th there 
appeared a short notice of tbe death of Mrs. Elizabeth 
Banbury, of Richmond, Surrey, at tbe super-venerable 
age of 108 years and 4 months. This interesting article 
bas bad the farther desirable effect of eliciting from Mr. 
T. E. Young, one of tbe highest authorities on this in¬ 
teresting subject, a communication which appeared in the 
following issue of our contemporary, where he mentions 
that he has, since the publication of his well-known book 
on the subject in 1899, obtained incontrovertible evidence 
of the existence of twenty two additional eases. There is 
at least this oonsdiDg consideration to soothe all of us 
in our age of universal hurry and worry that the whole 
weight of Boientifio evidence, which has been so care¬ 
fully coUeoted and so accurately collated of recent years, 
goes to prove that the span of average hnman life is 
lengthening. The additional comforts, tbe improve¬ 
ments in sanitation, and the almost universal diffusion of 
some sound vieu sof hygiene have hitherto more than com¬ 
pensated—at least in the Old World—for the effects of 
the increased speed which is now so necessary in tbe race 
for ‘'sncoesB,'’ and for the increased competition 
which growing population and the erection of 
the standard of skilled labour—mental as well as 
physical—have created In every locality and in every 
profession and oocnpation of life. So that it 
would seem that the ground is gradually sliding from 
beneath the feet of tbe ignoble army of pessimists. 
Many entbasiastio scientUte, especially those who are 
still under tbe age of forty, express with confidence tbe 
prophetic hope that before tbe end of the twentieth 
century tbe genesis tt all path<^nic microbes will be 
brought under absolnte control. If not then actuaUy 
vriped off the face of this planet, their entrance into, 
or their subsequent development in, the tissues of tbe 
human body, will have been effeotively provided against. 
Tbe progress of science during tbe nineteenth century 
does—most assuredly— givtf tu some reasonable grounds 
for such an outlook. Then tbe office of the physician will 
no longer include the cure of disease. He need only 
maintain the efficacy of his scoute and outposts to give 
warning of the approach of microsoopio enemies, if any 


Die. 25. 1901. 


GERMANY. 


Thi Midical Pbcss. 689 


happen to be still left. And all bis other enei^es may 
be devoted to the lengthening of human li'e, and the 
farther development of the physical and mental powers 
of man. Uirage-like visions of the fntnre thousand-year 
existence of Aomosapw ns willprobably loom over theheated 
sands of the desert of life as we progress in the pilgrimage 
of the twentieth century. Many conservative persons will 
still quote the inspired writer who metes out the life of 
man with the standard measure of seventy years. And 
the radical sceptic will scout the approximate record of 
the age of Methuselah by informing his opponents that 
the astronomy and chronology of the Book of Genesis 
are those which the captive Israelites learned at Babylon, 
where the“year" was measured by the moon instep of 
the sun; and, accordingly, contained but twenty-eight 
days instead of three hundred and sixty-five. 

The other conspicuous instance of centenarian 
longevity which has been so recently reported is that of 
the Dowser Lady Carew. This lady was bom in the 
County Waterford, Ireland, in the historic year of 
1798—“the year of the French " of the Western Irish, 
who nnivers^ly refer to it by this epithet from the 
fact that in that year a body of invaiding Frenchmen 
landed at Eillala, marched for Sligo, were opposed at 
Carrick-na-gat by Barloe Knott, of Battlefield, who 
rapidly marsfaalled the yeomanry of Sligo, routed the 
misguided invaders, and pursued them in their retreat 
inwards—where, meeting further opposition and no effec¬ 
tive aid from the disaffected natives, they surrendered at 
discretion in the village of Ballinamnck. The late Lady 
Carew figures prominently at another conspicuous date 
of Anglo-French history, having been present at the 
famous ball given at Brussels on the eve of the battle of 
Waterloo. This venerable lady died on the 12tb ult., 
in her 104th year, having thus lived in three centuries. 


^firmans. 

[fBOU OUB OWH COBBXBPONDSNT .3 

Biuia, T>ea 21 et, IML 

At the Medical Society Hr. G. Klemperer gave an 
address on 

Thb Obioin and Pbbvxntiom or Oxalatb Bxnal 
Calculi. 

It was a custom, he said, that when an individual 
voided a stone with acid urine to order something suit¬ 
able for the treatment of uric acid calculi. If the stone 
in question were an oxalate such treatment would be 
iDjarious and would certainly lead to recurrence. If 
the stone were really an oxalate the situation would 
be difficult, as up to the present no means had been 
determined by which a zeturn of the symptoms c )nld be 
prevented. The speaker, in association withTripstein, had 
otrried out a series of investigations in the Institute for 
Medical Di^fuosis, and had ascertained that oxalates 
were not so infrequent as bad been supposed. In sixteen 
cases oxalates were met with five times. In Israel’s 
practice 64 per cent, of the calculi were formed 
principally or in part of oxalates. The question 
of prevention wai covered by that of the origin 
of oxalate of lime. According to general opinion 
this was of alimentary origin; spinach especially 
contains a large qoantity of it, about 110 mgrm. 
in 100 grm. The gastric juice dissolved the greater 
part, and 25 to 30 mgrm. passed into the urine. 
As to what became of the remaining 75 mgrm., be was of 
opinion that it was not destroyed in the tissues. The 
greater part of the oxalate of lime was destroyed in the 
intestines, and traces only were found in the stools. He 
had injected minute doses of oxalate of lime into mice 
and dogs, and found that all passed off.smoothly in both 
animals. It was not therefore destroyed in the tissue 


changes, but what appeared in the urine was absorbed 
from the stomach. Although oxalates appearing in 
urine were of an elementary nature, the avoidance of 
vegetable and fruit in the diet could not ensure urine 
free from oxalates. The reason for this was not under¬ 
stood until Sommel, of Mnniob, showed that when 
gelatine was given 4to 15 mgrm. of oxalates were found. 
This discovery drew the speaker's attention to 
glyooool, which was known to be a solvent 
for oxalates. Now kreatine was a glycoool derivate 
that played an important part in the system. It formed 
both area and oxalic acid. The glycolic acid present 
with bile was also important, as when this was absorbed 
glyoocol became free, and the formation of oxalatee was 
possible. In the icterus of resorption also oxalic acid 
became free. These facts tended to an explanation of 
the origin of oxalates. The aim now should be not to 
avoid sabstances containing oxalatee, but to facilitate its 
Eolation in the urine. The double phosphate of soda, he 
thought, was not sufficient for the pnrpose, bat there 
was another material that acted in the right direction— 
magnesia. It had been bbown that oxalate of lime was 
soluble in salts of magnesia when heated. A milk diet 
was unsnitable, as it was poor in magnesia and rich in 
lime. If food was divided aooording to its richness or 
poverty in lime into two groups, vegetables would belong 
to tbe first, and to the latter fish and the different 
kinds of meat. Milk and ^ga were to be care¬ 
fully avoided when there was a tendency to oxa¬ 
lates. In cases with such tendency he should 
therefore recommend the avoidance of milk, eggs, 
and vegetables, and in their place recommended fieeh, 
vegetables, and farinaceous foods, and in the way of 
medicine two grains of bitter sals daily in oblateii. 

Hr. Senator considered that Klemperer’s reeolts threw 
a clear light on to a hitherto obsenre subject. In oonfir* 
mation of the statement made he obswved that children 
suffered with extraordinary frequency from oxalic cal¬ 
culi iu oonsequenoe of their milk diet rich in lime, and 
remarked on the success that had followed his treatment 
daring tbe last three years, which consisted in feeding 
with material free from lime—flesh, fish, potatoes, bread, 
and apples, a diet which corresponded on the whole to 
the principles enunciated by Klemperer. 

At the Society for Psychiatry and Nervous Diseases 
Hr. F. Krause showed a 

Cabx of Tbioxhinal Nxubaloia and CicATBix Efi- 

LXPST TBXATBD BT EXTIBFATION OF THB GaSBBBIAN 

Ganglion. 

The case was not shown as one of recovery, as it would 
take several years to effect that. Tbe pstieot was 48 years 
of age. His grandmother died in an asylum, but all other 
relatives have been free from nervous disease. Up to 
Easter, 1897, he was quite well, when he had a fall down 
some steps and struck the margin of the left orbit. Neu¬ 
ralgic pains soon followed, at first in the left supraorbital 
region, then in the infraorbital, and latterly over the 
whole of the trigeminos region; later on the occipital 
region beoame affected. Three operations had been per¬ 
formed elsewhere; in 1898 resection of tbe infraorbital 
iserve, then of the second branch. The latter operation 
was Bucceesfal for a time as regards the pain, but epi¬ 
lepsy soon after set in. At the third operation the third 
branch of tbe trigeminos was resected. This gave a nega¬ 
tive zesnlt. The patient was so depressed by pain and 


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690 ThI UiDIOiX Fbkss. 


AUSTRIA. 


Die. 25 , 1901 * 


fits th«t lart w nmm af he attempted to commit suicide. 
He was taken into the Augusta Hospital in September 
last- Here be had repeated attacks, with loss of oon- 
soiousness, cyanosis, stertor, sweating, tonic tension and 
clonic twitchings, fixation of pupil, loss of sensibility, 
and consequent somnolence. An attack could be started 
by pressure on the soar on the face. It was known tbat 
improrement followed excision of the cicatrix in suitable 
cases, but here the cicatrix was very deep, and, whatever 
was done, a cicatrix would still be left. He therefore 
decided to remove the Gasserian ganglion, so as to per* 
manently interrupt the stimulus passing to the brain. 

Since 1892 he had performed the operation thirty-five 
times, and had never seen a recurrence, fiegenerstion 
of the ganglion could not take place. The preparation 
shown contained the trunk of the trigeminus, the Gas¬ 
serian ganglion, and the stump of the second and third 
branches. So far the epileptic attacks had not returned, 
and the pain bad disappeared. There was still some 
neuralgia in the occipital region, but much milder than 
before. In reply to various speakers, he said that facial 
deformity could not always be avoided. The deformity 
observed in that case resulted from Lneke's operation. 
Spasm of the jaw was very apt to follow that; the patient 
had it, but it improved after removal of the ganglion. 
The masticatory muscles were paralysed by it, and the 
month drawn a little to one side by the action of the 
external pterygoid muscles. 

jLttjBtria. 

[frov ocb own cobbispondxnt.] 

VixsKA, Dee. 21st, 1901. 

Hot-aib Tbxatubkt. 

At the " GeeeUschaft der Aente ” fioth showed an 
apparatus which be thought would overcome the three 
difficulties against the present in use. TTi« appara¬ 
tus has a double wall which obviates the hot 
air coming into direct contact with the body, as it oiron- 
latee in the interspace, which overcomes the danger of 
burning. The apparatus can be warmed up gradually 
and is regelated by a ventilator. 

Elbctbic Expbbimxnts on Doos. 

Jellinek demonstrated a dog on which he acted with 
600 volts. As soon as the current was turned on the 
animal was attacked with opisthotonos contraction 
and paresis of the hind legs which lasted twenty 
hours, afterwards completely paralysed. Forty-eight 
hours later incontinentia alvi et uiins}; still later com¬ 
plete paralysis of motility and sensibility, with loss of 
refiex action, were prominently marked, while the de¬ 
generative reaction was quite absent. 

Three di^s later the conditions began to improve in 
the order in which they appeared. The site of the 
lesion is evidently located to the spinal cord, which may 
be either heemorrhage of the spinal structure or located 
to the meninges. It may also be a sort of ischeemia 
caused by a spastic condition of the blood vessels, or 
lastly it might be the res\ilt of a specific action of the 
electric current acting on the ganglionic cells. 

SuPFLANTlNO StITCBBS. 

Frank showed the meeting a new device for closing 
wounds without stitches. Nickel silver strips are 
rolled up with a fine point at one end, which is run 
through the lips of the wound and drawn together and 


finsJly closed with a pair of forceps. Frank a 

large number of advantages too numerous to enumerate 
here. 

TuBxBcuLors Pbofhtlaxis. 

Koonfeld showed a seriee <d objects which were manu¬ 
factured from asbestofl that can be easily sterilised in 
the fire. These comprised spoons, spittoons, mantles for 
ladies and other parts of furniture necessary in a si ck 
room. The articles are light and portable, inexhaustible 
in variety, and commended for their cheapness, as a 
spittoon will cost four hellers only, or 0*4 of a penny! 

Weinlechner asked how high a spittoon should be 
placed in a sick room for a patient, as the fioor was a 
dangerous position for it. Koonfeld thought the chest 
was a good height. 

FuBUNCDtOBra. 

At the " Dootoren-Collegium " Gersung gave a lecture 
on minor surgery which comes under the observation of 
an every-day practitioner. 

Furunculosis was a common morbid process that a wet 
compress would bring to a head, which could then be 
opened. When it was confined to the follicle a drop 
of nitric acid would be found effectual. When the pro¬ 
cess has spread infiltrating the surroundings from a 
cylindrical pxutular sac the scalpel should be inserted, 
and the necrotic tissue removed with a scoop, after which 
a little dermatol or other antiseptic may be inserted. In 
multiple cases the galvano-cautery is useful. In the case 
of children, opening and leaving them with light com¬ 
press will be found efficient. 

Cabbunclb ob Anthbax. 

This is some what allied to the former both in origin 
and treatment. It seems that the cocci gain admis¬ 
sion by the skin burrowing deep into the cellular tissue 
and affecting the skin secondarily. Poultices willsootiie 
the wide surroundings best, and when well advanced a 
cross or star incision will bs found most effectual. The 
scoop and iodoform gause will be the beet dressing. 

PANABITinM. 

This often commences in the skin, pissing on through 
entU, subontis, to the periosteum, or tendinous eht^ath- 
An early puncture for pus should be performed by 
oooaining the part and using aPravas syringe. A deep 
opening should be made, and the dressing put well down 
to the bottom of the cavity with a drainage tube. 

RBTBOFHABTNaXAL AbSCBSB. 

In opening these it is necessary to have an assistant, 
although instmmeuts have been devised in a sheath to 
modify the danger, but notwithstanding this protection 
with metallic coverings the patient will suddenly recede 
before the edge is covered. With a pair of long forceps 
the wound dilated and disohaiged, afterwards inserting 
a tampon. 

Burns. 

In case of bums fibrous dressing should not be used, 
as the fine texture becomes entangled in the terminal 
nerves, and gives nnnecessary pain. A soft, oily dressing, 
covered with gntta perchs, will be found most soothing. 

Dxbhatitis Sbbfiqinosa. 

A morbid process of the rete malpighii healing without 
leaving any scar. It should be brushed over with a 
strong solution of nitrate of silver. A compress with 
rectified alcohol is often quite efficient. Intertrigo in 
fat people may be similarly treated by sponging the 
part with rectified alcohol. 


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Die. 25. 1901. 


LEADING AETI0LE8. 


Thi Hidxoal Pbs88. G91 


^\xt dDptratmg ^keatrw. 


THE HOSPITAL POE SICK CHILDEEN, OBEAT 
OSMOND STREET. 

Cabb of Prolapsub Eicti.— Mr. Staubfibld Collibs 
demonstrated the following treatment in a oase of a 
girl, set. 2, tnffering from prolapsna recti. Sereral 
inches of bowel in a congested and somewhat nlcerated 
condition protruded. The history of the case was as 
followsThe prolapse had been down every day for 
fonr months. At first it came down during defaoation 
only, and was readily returned, but there had been 
increasing difficulty in returning it, and for the last 
week it had been down all the time, and attempts at 
reduction had not suceeded. The case bad been 
under Mr. Collier’s care in the out-patients’ room, 
and the ordinuy methods of treatment had failed. 
Mr. Collier reduced the prolapsus under chloroform, 
remarking that the anal mucous membrane formed 
no part of the prolapsus and was natural in the 
sphincter region. He then introduced the fine needle 
of an exploring syringe through the ano-ooocygeal liga¬ 
ment midway between the anus and the coccyx until he 
felt the point of the needle; behind the rectum, by 
this means, be injected into the superior pelvic rectal 
space about fonr ounces of saline solution of the strength 
of two drachms to the pint (double the strength of 
normal saline solution). The finger in the bowel now 
felt a oushiou'like distension behind and at the sides of 
the rectum. As the child came round from the anss- 
thetic it was plain that its efforts to reproduce tiie pro. 
lapse were only partially successful, although the 
sphincter was much relaxed. Mr. Collier requested 
the house surgeon, Mr. Curl, to repeat the injection at 
the end of forty-eight hours. Mr. Collier said that the 
mechanical distension would temporarily prevent the 
descent of the prolapse, and that the sal^ 
acting as an irritant would produce some induration of 
the cellular tissue, the yielding of which tissue was an 
important element in the production of prolapse. In 
this case the prolapse occurred in the course of a 
summer diarrhoea. He said he had beard that pro¬ 
lapsus recti was extremely common in famine camps 
where the very much-wasted child is suddenly placed 
on full diet; here the loss of the pelvic padding of fat 
is probably an important factor. Mr. Collier expressed 
bis intention of giving this method of treatment, 
which be considered to be harmless, an extended trial 
next summer. 

The child operated on was seen two months 
later, and was found to have no return of the pro¬ 
lapse. 


The Mortality In Foreign Cities. 

Tab following are the latest official returns, and re¬ 
present the last weekly death-rate per 1,000 of several 
of the populations:—Bombay 62, Madras 69, Brussels 

16, Amsterdam 13, Copenhagen 14, Stockholm 16^ 
Christiania 15, St. Petersbn^ 23, Hamburg 18, Munich 
22, Vienna 16, Prague 24, Buda-Pesth 17, Trieste 27, ^ 
Rome 13, Venice 25, New York (including Brooklyn) ; 

17. Philadelphia 17. 


BxeiSTxaBU fob raAKSKissiox Abmad. 

%}xt ^tbiad frwH mb (JKrailar. 

Published erety Wedneadi^ moraing, Price Sd. Poet fre^ B|d. 


AOVBBTIBBMBIITS. 

Foa On IsnsnoxWhole Page, £5 Os. Od. Half Page, 
ei lOa. Od.i Quarter Page, £lSe.;OiMHlghth,lSB. Sd. 

Fob a Bxuxa or lasemoxsWhole Page, thirteen ineertlone 
(weekly, fortnightly, or monthlyX at £8 lOe. Od. t twanty-siz 
inaertiona (weekly or fortnightly) at £8 Ss. Od. ] fif^*two 
Inaertiona (weekly) at £8 each. Half Page, thirteen ineertlone 
et 35e.: twentj-eix at 32e.: flf^-two ineertions at SOa. each: 
Qnarter-page, thirteen ineertlone at 18i. : twenty-eix ineertlone 
at ISe. s fifty-two ineertiona at 16a each. 

Small annonnoementa of Fineticea, AaaiatanoleB,Vaoattciee, Booke, 
ito.—Seren linea or under, 4a. per Ineertion | 8d. per line 
beyond. 


^ke Jflfikal fresjs mb CiroUar. 


SALUS POFCLI 8UPBBMA LBX.'* 


WEDNESDAY, DECEMBER 25, 1901. 


ACTIVE AND INERT VACCINES. 

The importance of securing efficient vaccination 
and tbe uncertainty of action of many, or at any 
rate of some, of tbe vaccine lymphs in the market, 
invest the methods of preparing these lymphs with 
special interest at the present juncture. It is urged* 
not without some plausibility, that so delicate a pro¬ 
cess of preparation ought not to be left in the hands 
of private persons, and that its preparation ought to 
be monopolised by the State. Others have urged that 
the State should at any rate exercise a close super¬ 
vision of the private institutions where vaccine is 
prepared in order to ensure, as far as is' humanly 
possible, that only' active and thoroughly trust¬ 
worthy products shall be issued to the pro¬ 
fession. It is hardly open to question that 
many of the instances in which vaccination 
has failed to protect against subsequent infection 
with small-pox are to be attributed to the fact that 
the operation has been performed with inert lymph 
and the scientific status of this protective measure 
has thereby been jeopardised. In spite of all the 
skill and labour that have been devoted to tbe study 
of the technique of vaccine producrion, no absolutely 
certain means are yet available of ensuring a con¬ 
stant and unvarying supply of really protective 
lymph. This holds good in respect of all vaccine 
laboratories, not excepting those carried on under 
Government control, and this is a strong argument 
against conferring any sort of monopoly in its pro¬ 
duction. It is a common experience, that, not¬ 
withstanding every precaution, identical methods 
do not always yield identical results. Laboratories 
are subject to periods of wbat a distinguished orator 
would call “ rank bad luck,’’ that is to say, certain 
series of inoculations of calves yield a lymph which 
proves inert. The closest supervision cannot be 
relied upon to prevent these seasons of lymph famine 


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LEADING ARTICLES. 


DbC. 25. 1901. 


692 Th> Hit>ical Pbiss. 


asd tbe sterility may affect laboratories widely dis¬ 
tant. Moreover, Government supervision implies 
the power to impose particular methods, and as the 
experts of whom the supervisory committee would 
consist would naturally consider their own 
methods the best, uniformity of method would 
be insisted upon, and the risk of concurrent failures 
would be enhanced. Lymph may be inert under 
at least three different sets of conditions; it 
may be inactive ah origine ; it may spontaneously 
lose its protective qualities in an unusually short 
space of time, or it may be subjected to vicissitudes 
of temperature, &c., which are inimical to its reten¬ 
tion of activity. Lymph which is inert from the 
beginning ought never to find its way on to the 
market, because it is the duty of every superinten¬ 
dent of a vaccine instituto to make sure, by repeated 
tests, that bis products possess the requisite degree 
of activity. Moreover, the process of sterilisation 
in respect of foreign organisms necessitates the 
lymph being kept rmder treatment for at least a 
month so that a further opportunity is provided ot 
ganging the stability of the product. Lymph kept 
for a longer period in stock should be periodically 
tested, and in this way, although the institute may 
find itself in possession of inert lymph, this need 
never be placed in the hands of practitioners. 
One other cause of loss of activity is too 
free dilution with glycerine, but directors of 
institutes may be trusted in their own interest not 
to carry the process of dilution beyond a safe pro¬ 
portion, which experience has shown to beaboutone 
part of vaccine pulp to four of glycerine and water. 
The best, indeed the only, method by which a lymph 
famine can be avoided would be by forming a sort 
of syndicate of vaccine institutions, so that when the 
tests show that the lymph in the course of prepara¬ 
tion at a particular establishment is inert a fresh 
Bupply of active material can be obtained from 
another institute not similarily afflicted. The only 
test of the efficiency of lymph is on the child, for 
lymph which may give a satisfactory reaction on the 
calf may fail when applied to the human being. 
Every specimen of vaccine lymph should be dated, 
and the origin and effects thereof carefully noted, in 
order to minimise the risk of products which have 
become inert continuing to be issued. 

INJURIES FEIGNED AND REAL IN THE 
MEDICO-LEGAL ASPECT. 

With the advances of civilisation and the increase 
of knowledge, comes, pari passu, the increase of 
skilled criminals. The engineer who invents new 
instruments, and modes of making instruments, 
finds that as well as benefiting his fellow-workers, he 
has beiped the skilled burglar. The chemist, 
who spends his days and nights in research 
finds that one of the ultimate results of his labours 
is to facilitate the murderer. The philanthropist 
who works for the spread of education finds that as 
his pet schemes advance so do forgery and its allied 
crimes. It would be hopeless, then, to expect 


that medical knowledge could escape from fur¬ 
nishing assistance to the would-be rogue or criminal 
and keep herself free from the reproach which 
is sometimes liable to overtake her sister sciences. 
Perhaps the rogue’s most favoured method of 
using medical knowledge consists in bringing a 
small quantity of it to the aid of a large degree of 
moral laxness—to use a mild term—in order to con¬ 
vert himself into the skiUed malingerer. Malingering 
in its rudiments, is probably as old as the world, but, 
as each succeeding century sees fresh changes and 
advances, so the form which the malingering takes 
becomes altered and presents fresh phases. Like 
epidemics, waves of malingering of species suited 
to the conditions present appear to sweep over 
countriea At present, perhaps, the most favoured 
species is to be found in thefeigningof injuriesall^ed 
to have been received owingto the carelessness of some 
large company, who are known to be capable of paying 
indefinite dam^es. This species of malingering has 
infested our own country for many years, and it is by 
no means strange to find that a similar evil exists in 
America. The following extract from a paper by 
Dr. Ott, of Philadelphia, brings this forcibly home 
to our readers and reminds them that they have beard 
of very similar doings at this side of the ocean : — 
A species of modem robbery, which has grown to 
enormous proportions, is found in accident cases, 
and with these the neurologist is more or less asso¬ 
ciated. Modem transportation has greatly increased 
the number of accidents, and, as these cases are sub¬ 
ject to jury trials in questions of liability and 
damages, an abuse has grown until the larger cor¬ 
porations often pay unjust claims rather than sub¬ 
mit the question to a prejudiced jury. The profes¬ 
sional complainant for damages is a modem 
production, and in our larger cities one-fourth 
of the cases possess this blackmailing character. 
The city electric lines lose from 300,000 to 600,000 
dole, annually, and many of the cases are 
tmmped up and pampered for the occasion 
by the unscmpulons collusion of lawyers 
and physicians, who agree to divide the gain 
among themselves. Observe very closely a damage 
suit at trial and cote with what detail the com¬ 
plainant's case has been mastered and how some 
innocent perversion of function is enlarged and 
given an importance, bow a trifle is made to appear 
as the most excmciating suffering and what a pos¬ 
sible or positive permanency is attached to each dis¬ 
turbed function, to influence an ignorant set of lay¬ 
men towards bringing a heavy verdict for the 
plaintiff. On the other band, note the weakness of 
the defence in the utter absence of valuable medical 
testimony or a physician who has made but one 
examination, and that in the latter part of the 
trouble, and who is now supposed to know 
as much about the case as the one in charge 
from the inception of the injui 7 to the time of trial." 
This quotation is as applicable to these countries as 
to America, save for one particular. Here, we are 
proud to to be able to say, there is no “unscrupu- 


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Dzc. 25 . 1901. LEADING ARTICLES. Tbb Mzdical Fbiss. 693 


Ions collnsion between lawyers and physicians.” The 
difficulties which beset the position of the medical 
man in these cases are the opportunities of the 
rog^e. The relative impossibility of determining 
within a short time the existence or degree of pre- 
snmably deep-seated nervous injuries, renders impos¬ 
ture possible, even in the case of the most skilled 
medical man. Dr. Ott makes suggestions of im¬ 
portance as to the means of detecting the reality or 
not of alleged injuries, and passes stem criticism on 
the present-day mode of adjudicating these most 
difficult cases. His criticism in many points coincides 
with much of what we have written on this subject 
on a previous occasion. “Imagine,” says Dr. Ott, 
“ a butcher, a baker, and a dry-goods merchant 
passing judgment upon traumatic neuroses, such as 
paraplegia, neuritis, palsies, impaired vision, and the 
various disturbances of locomotion incident to the 
graver accidents. How often in cases where the 
plaintiffs are women, who were but slightly injured 
or more likely not injured at all, is the hysterical or 
neurasthenic element produced. Medical and expert 
testimony in accident cases i^ the opprobrium of the 
profession to-day, and the soorer such questions are 
considered from a scientific standpoint the greater 
the honour will be accorded to the medical profession. 
The physician is the only one that can differentiate 
the feigned from the real sufferer, and judiciously 
pass opinion upon the nature and degree of the in¬ 
jury, and the amount of damages to be awarded. 
Let the layman confine himself to questions of 
liability alone.” 

TBB LONDON SMALL-POX EPIDEMIC. 

The apprehensions which have been expressed as 
to the future course of the epidemic of small-pox 
m the Metropolis are apparently approaching 
realisation. The first death was registered in the 
week ending August 3rd, and the total number of 
deaths to the end of last week amounted to 179. 
The returns point to a steady increase of the malady. 
During the first fifteen weeks of the outbreak the 
oases under treatment were respectively 11, 13, 41, 
74, 92,137,153,169, 175,172, 180, 284, 297, and 368. 
During the past four weeks the figures have been 
396, 427, 474, 506, and 528. There were 134 fresh 
admissions last week, as compared with 141, 
123, and 170 in the preceding three weeks. 
These facts more than warrant the vigilance and 
anxiety displayed by the various local and central 
authorities of the Metropolis with regard to the out¬ 
break. In view of the alarming and steady increase 
of the disease it may be interesting to recall some of 
the figures relating to the history of the disease in 
former London epidemics. In the year 1838 the local 
incidence of mortality from small-pox reached 31,817 
per million living. Later, in the year 1853, came 
the great disturbing factor of vaccination, which was 
then made compulsory by Act of Parliament. For 
some years, however, vaccination was administered 
in a perfunctory manner, until, in 1867, the Act was 
strengthened and rendei-ed more efficient, the deaths 


at tbat period being at the rate of 457 per million. 
In 1869 the figures fell to 87 per million, but rose 
again in 1872 to 3(/2, and in the disastrous epidemic 
of 1871 to 2,422 per million. After various fiuc- 
tuations the London rate fell to 6 per million in 1886, 
to 2 per million in 1887, and to zero in 1889. Since 
that time the remarkable return of zero has been re¬ 
corded ag^in in 1898. while the highest rate in 
epidemic years has not been more than 48. These 
figures furnish a most striking proof of the efficacy 
of modem preventive measures, of which vaccination 
must be regarded as the chief. At the same 
time it may, of course, be freely admitted that 
bettered conditions of environment, both sanitary 
and social, have contributed to the bappy result in 
question. The cpponents of vaccination are wont 
with weari-ome iteration to attribute the decline of 
small-pox solely to improved sanitary and preventive 
measures. They will perhaps within the next few 
years be able to test the truth of their theory, inas¬ 
much as the public administration is likely not only 
to persist, but also to attain a higher standard. On 
the other band, they will find ready for purposes of 
comparison a rapidly growing increment of popula¬ 
tion unprotected by vaccination, thanks to Mr. Bal¬ 
four’s retrograde Act which has complicated matters 
by the wholly gratuitous introduction of tbe 
“ conscientious objector.” Meanwhile, the close 
relations of the Metropolis to other towns of the 
United Kingdom renders tbe London outbreak an 
affair of national importance. From tbat point of 
view indeed, in these days of rapid transit, the out¬ 
break may at any moment be distributed to the 
furthest comers of the world. There is one point 
that deserves notice, even at the cost of adding some¬ 
what to the sum of the public anxiety, namely, the 
advent of the holiday season. Within the next 
week or two an enormous fluctuation of the popula¬ 
tion will take place between London and the 
provinces. It is almost too much to hope 
that small • pox will not be conveyed in 
some instances by tbe passage of infected persons. 
Tbe return of a large number of school children to 
the metropolis is, perhaps, one of the gravest features 
of the case. We hardly believe, however, tbat the 
time has arrived for any highly alarmist view of the 
situation. The authorities have grappled vigorously 
with an emergency of no common order, and the 
infectious hospital accommodation and ambulance 
service are above reproach. Last, but not least, 
tbe populace have resorted to re-vaccination in a 
fashion tbat has become almost universal, a fact 
tbat in itself offers a proof of the sound sense that 
in tbe hour of need is prone to replace the prejudice 
of the average Englishman. 

Univbbsitt Scholarships were awarded as the result 
of tbe recent B.A, B Sc., and M.B. ezaminatioas of the 
University of London—in Medicine, to C. J. Thomas; 
Obstetric Medicine, A. E. Jones; Forensic Medicine, £. 
M. Sharp. The same gentlemen also gaintd the gold 
medals. 

Digitized by vjoogie 




694 Th» Mtoioai Pbibb. 

^UsUs mt QTurrcnt %opics. 

Objectionable Quack Advertiaemente. 

Much has, from time to time, been written against 
the objectionable adTertisements which are allowed 
to appear in what are otherwise respectable and high- 
class publications. Among the many ills which 
afflict the human race, and which are seized upon by 
the unscrupulous quack for swindling the ignorant, 
are those which affect the organ of bearing. Only 
a few months ago our contemporary Truth 
courageously and completely exposed the disgraceful 
swindle known as the “ Drouet Institute,” and their 
exposure led to the removal from the list of members 
of the Royal College of Surgeons of an individual who 
allowed himself to be connected with the said Insti¬ 
tute. Tet the full-page advertisements of this body 
of charlatans are still allowed to disgrace the 
pages of respectable dailiea Similarly, despite 
numerous inquests, and actions successfully 
brought against them, the so-called Yiavl Company 
is still allowed to advertise and pursue its baleful 
way unchecked. Unfortunately, it is but two decades 
since the branch of surgery which has to do with the 
treatment of diseases of the ear became a recognised 
specialty, and therefore the laity have as yet become 
scarcely educated in the matter. Hence the ear is a 
happy hunting-ground for quacks of aU sorts. We 
could give numerous cases which have come under our 
personal observation in which sufferers have been 
robbed of various sums by the Drouet Institute when 
their diseases have been l^yond relief. Quite recently 
we met with an instance of long-standing congenital 
syphilitic nerve deafness who had paid no lees than £12 
to these quacks. Looking through the Christmas 
number of a well-known magazine we find no less 
than three advertisements of otologics! quacks. 
One man, who describes himself as “ M.D. (U.S.A) ” ; 
—a degree which, as demonstrated to the Battersea 
coroner in a cancer cure case, does not and never 
did exist-—cures ear, nose and throat troubles by 
*' aerial medication,** and gives portraits of supposed 
patients. The other two advertiaemente relate 
to ear drums, one of which at least is of a 
dangerous nature, judging by the illustration. 
Since the Legislature does not move in the matter 
of quackery and illicit practice, and since the 
General Medical Council have, as yet, no powers to 
deal with the matter, there is but one remedy 
possible. Were the respectable magazines and news¬ 
papers to combine together to refuse the advertise¬ 
ments of these gentry their ill-gotten gains would 
greatly decrease, and they would soon find it not 
worth their while to continue to trade upon the 
credulity of the public. The papers themselves 
would not suffer, for theie could be no lack of legiti¬ 
mate advertisements to fill the spaces vacated by the 
quack nostruma Some months ago one of our 
judges spoke very severely upon the subject of 
abortion-mongers* advertisements, with the result 
that these objectionable paragraphs have practically 
ceased to appear in the newspapers. We almost 


Dbc. 25, 1901. 

believe that could public expression be similarly 
given against the proclamations of other quacks the 
respectable journals would refuse them with equal 
promptitude. 

Fseoes and Flatus per Urethram. 

The difficulty of determining the cause of the 
fistula which allows the escape of intestinal contents 
through the urethra is sometimes much greater than 
might be supposed. Not only so, but the discovery 
of the site of the fistulous communication may pr^ 
sent very considerable difficulty. In many cases the 
primary lesion is so well marked, and has produced 
such definite symptoms, that the patient has 
been under observation and treatment for 
I some time before the abnormal passage of fsecee or 
flatus has occurred. Even in cases oi congenital 
communication between the intestioal and 
urinary passages, the site of communication may 
not always at first sight be apparent. It appears to 
be possible that with a normal anus a congenital 
communication with the urinary passages may exist. 

Is it possible that such a congenital communication 
may exist, and yet fseces and flatus not pass per 
urethram tor several years? The question is sag- 
gested by a case of recto-vesical fistula in a child 
reported by Dr. Sympson in the Quarterly Medical 
Journal for Yorkshire and the Adjoining Counties,” 
Unfortunately, no post-mortem examination was 
performed, but at a second operation undertaken for 
the closure of an artificial anus in the inguinal 
region, it is stated no attachment whatever 
could be found between the bladder and rectum. 
We assume that what is meant is that no communi¬ 
cation could be found. There had been no history 
of any trouble which might be considered to have 
caused the fistula. So far as the report of this very 
interesting case goes it does [not seem certain that 
the communication may not have been at the trigone 
of the bladder near the internal meatus, or even in 
the membranous urethra. 


The Indisoretions of What’a What.” 

It is a remarkable psychological fact that the aver¬ 
age layman is unable to understand that the mainten¬ 
ance of a high standard of professional etiquette is 
as much to the welfare of the community as for the 
comfort of the individual members of the profession. 
The man in the street says the ways of doctors are 
past finding out. Excuses may be made for him 
but the same cannot be said for Mr. Harry Quilter, 
the editor of What’e What, which modestly pro¬ 
fesses to be “ A guide for to-day to life as it is, and 
things as they are.” Mr. Quilter sins with open eyes. 
He gives a list of specialists he is pleased to consider 
” capable men in the various maladies alluded to.” 
We trust Mr. Quilter has not bad personal 
experience of all the ” maladies ” mentioned, al¬ 
though of the gentlemen lie considers worthy of 
being recommended he says ” we have had experience 
of them.’ We should like to know who hath made 
M r. Quilter a ruler and a judge over us in this 


NOTES ON CURRENT TOPICS. 


Digitized by Googie 



Bic. 26, 1901. 


NOTES ON OtTERENT TOPICS. 


Thb Hsdical Fuse. 695 


matter. There is mnch that is amnsing in this Ia 7 - 
man’s nonsense. One phjsician is said to have “ a 
most wonderful ear for diagnosis of all lung and 
heart complaints ’’; another, “ though enormously 
overworked is second to none.” A well-known 
alienist is said to have “ great penetration and the 
most ingenious and matter-of-fact way of potting 
awkward questions.” A curious mistake is made when 
Mr. Critchett, now Sir Anderson, is referred to as 
“the son of the late Sir Andrew.” Really Mr. 
Quilter has made a mistake in the title of his work. 
We are afraid he will not have another opportunity 
of correcting it. ’ 

The Treatment of Grave’s Disease. 

Although our knowledge of the setiology and 
pathology of exophthalmic goitre has considerably 
advanced during the last few years, the therapeusis 
of this disease has not progressed in at all the same 
degree. No single principle of treatment can be 
said to have been placed on an irrefragable basis. 
As is invariably the case when first principles have 
not been established, the list of so-called remedies is 
very extensive, and good results have been claimed 
for drugs of the moat different, and indeed often 
antagonistic, action. The Gordian knot has some¬ 
times, uuder somewhat similar circumstances, been 
cut by the surgeon, but surgical intervention in 
respect of this particular malady is at best but a pis 
alter. It is attended by a great and unavoidable 
risk to life, and its results are by no means 
uniformly satisfactory. Moreover, it is based 
on the assumption that the disease owes its existence 
to a condition of hyperactivity on the part of the 
thyroid gland, whereas in quite a number of recorded 
cases the administration of thyroid extract has 
appeared to be productive of benefit. The difficulty 
of discovering a truly curative treatment is enhanced 
by the fact that the disease is one which not unfre- 
qnently undergoes spontaneous subsidence, and this 
amelioration is very apt to be placed to the credit of 
the agent last employed. The treatment, such as it 
is, is purely symptomatic, and is directed rather to 
the alleviation of the more prominent symptoms than 
to the underlying cause. If it be due to excessive 
activity of the thyroid gland, which is far from 
proved, we still have to ask ourselves what morbid 
process underlies this exaggeration of func¬ 
tion. The only safe plan under existing circum¬ 
stances would appear to be to chaoge the habits of 
life and the environment of the sufferer. Above all 
we Tuust be careful not to interfere with any tendency 
to spontaneous recovery, and with that object in 
view no drug should be pushed to an iujurious extent 
and, indeed, not pushed at all unless it appears to be 
promoting recovery. It may well be that the group 
of symptoms included under this designation are 
dependent on more than one morbid influence, 
and if this be so we shall not attain any great 
measure of success in treatment until further light 
has been thrown on the intimate pathology of what 
must be admitted to be still a highly complex and 
obscure affection. 


Moderate Drinking and Total Abstinence. 

Although comparatively few people practise total 
abstinence, the proportion of intelligent persons who, 
theoretically at any rate, admit that total abstinence 
is compatible not only with good health, but 
with the reasonable enjoyment of life, is yearly in¬ 
creasing. Now and again someone takes up the 
cudgels in defence of the moderate drinkers with 
more or less success. Some years since it was the 
late Dr. Mortimer Granville, whose trenchant letters 
to The Times excited a good deal of interest and dis¬ 
cussion; more recently Sir Dyce Duckworth has 
publicly endorsed the view that the lives of truly 
moderate drinkers of alcohol are, on the whole, better 
and more useful than those of abstainers. When, 
however, we come to inquire into the amount of alco¬ 
hol permitted to those who claim to figure in the list 
of really moderate drinkers it must occur to everyone 
that the difference between them and total abstainers 
is not very great. Even the traditional one ounce 
and a half of alcohol seems to err on the side of 
what we may call moderate excess. Then again the 
fact that moderate drinkers lead useful lives does not 
preclude the belief that they would lead even more 
uteful lives if they abstained altogether. Moderate 
drinkers are presumably people gifted with sufficient 
self-control to hold their passions and appetites in 
leash, and, since self-control is the standard of a 
man’s moral elevation, the greater the restraint the 
greater the merit and the greater the benefit, not 
only to the individual but to the community at large. 
Many total abstainers abstain simply because they 
cannot tolerate alcohol even in moderate doses, and 
are pro tanto of an inferior physical stamina. 
Logically it hardly admits of a doubt that if those 
who could tolerate it did not avail themselves of the 
privilege their conduct would be to their own advan¬ 
tage, besides setting an excellent example to their 
weaker fellows. 

The Sucoeesion Value of Public Appoint 
ments. 

It is hardly a wise attitude on the part of a medical 
man to regard bis tenure of a public appointment as 
a marketable asset. That view has recently been 
brought home in a somewhat unpleas^mt fashion to 
a gentleman who has recently resigned the poet of 
Medical O fficer and Public Vaccinator to the 
Epping Board of Guardians. He wrote recently to 
the Board stating that be had sold his practice 
and hoped that the purchaser might become his 
successor in his public poets which had been included 
in the sale. To write a letter of that kind was indis¬ 
creet, but the gentleman in question multiplied the 
indiscretion by appearing before the Board and 
stating that if the purchaser of his prac¬ 
tice were not elected he himself would lose 
£120 by the transaction. He added that be had 
secured theinterestof the Vice-Chairman, and hoped 
that the Board would elect bis successor in the 
practice, as he wished to avoid losing the money. 
It is not Burpising that this extraordinary application 



696 Thx Medical Pubs. 


NOTES ON CURRENT TOPICS. 


Dec. 26. 1201 


waa denounced by tbe Board as an attempt to reduce 
a public office to the rank of a marketable com- 
moditj. Another candidate waa forthwith elected. 
Were vested interest of the kind contemplated by 
this eingnUrly ingenuous vendor of a medical prac¬ 
tice to be permitted the position would quickly 
become intolerable. 

Motor Cars for Consumptives. 

Anothbb argument in favour of the much- 
favoured automobile has arrived. It is pleasing to 
know that tbe fashionable car is now to serve a 
useful medical purpose. Its recent contributions 
to surgery, as all know, have not been few. 
Dr Dawson Turner, Vice-President of the Scottish 
Automobile Club, believes tbe motor car will prove a 
valuable means of affording out-door treatment for 
the consumptive. Every sanatorium is to have its , 
automobile, and a daily run is to become a part of I 
routine treatment. The pace advised is “ fully up to ' 
tbe legal limit," Along with a feeling of marked ex- I 
hilaration, an increased appetite, and improved sleep, | 
there is a “ heightened healthy glow, which after a few ' 
days’ treatment, tends to become permanent.’’ W e i 
recently had occasion to rejoice in tbe munificent 
gift of £100,000 to the Mount Vernon Hospital for 
Consumption, and doubtless before long we shall 
have the pleasure of chronicling the presentation of 
automobiles to this and all other institutions aiming 
at the restoration of the phthisical sick. Will 
philanthropists and millionaires please note? A 
word to the rich should be enough ! 

Is Plum Pudding Digestible? 

The genius of our forefathers worked out that 
king of all dishes— the English plum pudding. 
Their wisdom, however, did not end with toothsome- 
ness, for they made a food that, being both rich 
and savoury, was nevertbeless not rankly indiges¬ 
tible. Truth to say, and speaking with a full sense 
of responsibility that lies in tbe utterances of a 
medical journal upon so important a matter, plum 
pudding is not to be denied save by the weakest of 
stomachs. The mere fact of the prolonged boiling 
that is part and parcel of the solemn rites of the 
kitchen, carries the pudding far on tbe road to tbe 
digestion that is the ultimate goal and end of its 
existence. Christmas pudding, in a word, is 
digestible enough to suit all mankind, except, 
perhaps, in tbe extremes of infancy and old age. 
But—and here comes tbe saving clause—it must ever 
be borne in mind that the harmfulness of good cheer 
lies more in quantity than in quality. Where one 
fair slice of speckled pudding will bring a sense of 
comfort and goodwill to all men, two will be likely 
to upoet tbe harmony of the inner and outer man, 
while three will throw out a pressing invitation to 
the fiends of sleepleasness and indigestion and gouti¬ 
ness and other ills. To our mind little harm, we 
repeat, is done by good, sound, solid, well-made, 
well-boiled, and well-served English plum pudding. 
When the king of dishes is thrust away pell-mell on • 
top of a vast medley of meats and drinks, then there * 


can be little wonder if Nature resents the outrage on 
her arrangements as Minister of the Interior of 
mankind. Happily a little over-eating once in a 
twelvemonth is not likely to do any lasting barm— 
not even when the surfeit is of plum-pudding. 

The Cold Tub. 

The Yorltehire Daily Po»t has its attention called 
by a correspondent to what the editor facetiously calls 
that "hardy annual,” the cold tub. The writer was 
a thin, weakly man, it appears, with one foot in the 
grave, when be married and began his morning 
plunge: DOW he is hale and hearty. What does this 
mean P If the morning dip can bring strength to 
the weakling then it were simpler to " throw physic 
to the dogs,” and attend to the bathroom arrange¬ 
ments instead. Cold water, however, is not fitted 
for everyone. In its right place it is a magnificent 
tonic and bracer of the system, but it is only fit for 
the robust and for persons of active habits 
and healthy arteries. Cold tubs should be 
allowed neither to babes nor to old pe'sons. 
Even in the case of robust folk it is perhaps advis¬ 
able to take tbe chill off the bath in the depth of 
winter. It is all very well for hardened mortals to 
break tbe ice for a morning dip, but even for them 
the time must come when tbeir frames will demand 
a sybaritisb dash of warm water to temper tbe 
rigours of their watery exercise. It is not a little 
remarkable how many town dwellers keep up the 
custom of the cold bath, in spite of the lack of 
exercise that only too often falls to tbeir lot. For 
the man in chambers to lave himself in a fireless bed¬ 
room with half-frozen water in a sponge bath is a 
very different thing from getting into a plunge bath 
in a well-warmed bathroom. Finally, the cold bath 
is most excellent for those who thrive on it; 
individual experience is tbe test. 

The "Nudity” Cure. 

While medical science is painfully and laboriously 
winning its way to the goal of exactitude, a large 
field of the partly-known and of the unknown lies in 
possession of quacks. So far as tbe world at large 
is concerned there appears to be no method of so- 
rolled “cure’’ too grotesque, too revolting, too 
meretricious to be swallowed—and paid for—in 
wholesale quantities by the vulgar. One pretender 
advertises to cure rheumatism by means of a magic 
ring, and straightway be vends his fraudulent 
wares by tbe bushel. Another puffs a "cure all” in 
tbe shape of a worthless belt, and money forthwith 
pours into bis coffers, while tbe bighly-qualified 
University graduate works hard for a bare living. At 
any rate the qualified man has tbe satisfaction of 
knowing that the poverty is that of an honourable 
gentleman. Tbe “ nudity cure ” is a parasitic craze of 
Austrian origin. It is described as a method whereby 
neurasthenic patients are exposed to air and sun in a 
costume composed of "a hat and short trunks.” 
Thickets are carefully arranged so as to separate the 
sexes, and the treatment is “ completed” by a com- 
bina tion of baths, massage, gymnastics, games, and 


Diiri'r.d by 


Google 




Dec. 25. 1901. 


NOTES ON CURRENT TOPICS. 


The Medical Pbesh. 697 


Tegetarianism. The scbeme appears to te a gratni- 
touelj eccentric variation of the open-air treatment, 
which haa been tricked ont in the fantastic “ nndity ’’ 
fashion on Blrictiy commercial lines. The attempt 
to attach a curative element to the fig-leaf garb of 
our first parents in the garden of Eden is well 
worth; of the kusinesB-like ingenuitv of the latter-daj 
irregular medical practitioner. 

Railway Tube Ventilation. 

The Central London “ tube ” railway does not 
appear to have hitherto risen to the necessity of 
amending its ways in the matter of ventilation. In 
one or two of the stations, it is true, there baa been 
some sL’ght improvement attested by the free draught 
blowing down the “ lift *’ shaft and along its under¬ 
ground approaches. That happy result seems to 
have been secured simply and solely by opening the 
outlets and inlets provided in the ro^ of thesh^ In 
other stations, however, the hermetic sealing of shafts 
appears to be the guiding principle of the officials in 
charge. To take a special instance, that of the Chan¬ 
cery Lane Station. The lift, especially in the morn¬ 
ing, is often hot, stuffy, and reeking with 
the unmistakable fumes of bad ventilation. To 
make things worse the floor has often been recently 
washed and the air is heavy with stale tobacco. 
Long since we pointed out that by knocking out the 
small panes at the top of the entrance and eait doors 
the lift could be thoroughly ventilated. It seems 
clear that the shaft itself has no adequate air inlets, 
or at any rate if they are present they are not kept 
open. The Central London Railway authorities will 
do well to send an official up and down their line to 
see that all the ventilating appliances are kept in 
proper working order. It wonld be a pity were the 
popularity of this line to be spoilt by inattention to 
so important a detail as that of ventilation. Other 
towns of the United Kingdom, where tubes are in 
contemplation, will do well to bear the Metropolitan 
experiences in mind. 

The Prevention of Fogs. 

The recent long spell of fog has resulted in much 
correspondence in the daily press, and many sugges¬ 
tions have been made with a view to the removal of 
this nuisance to which Londoners are subjected. 
The matter does not concern the Metropolis 
alone, as some people appear to think, but all 
manufacturing towns in the country. We have 
seen fogs in Manchester, Liverpool, and Birming¬ 
ham, for instance, which would run a dead heat 
with the *' London peculiar.” The subject was re¬ 
cently discussed at a meeting of the Coal 
Smoke Abatement Society, and the resolu¬ 
tion was passed “ that, in the opinion of this 
meeting, the pollution of air is injurious to 
public health and vitality, destructive to works of 
art and to vegetation, and directly demoralisingto the 
inhabitants of a great city.” The meeting pledged 
itself to do its utmost to prevent the smoke nuisance, 
and thereby reduce the effect of fog. They, however* 
omitted to mention the means by which they pro- 


' posed to produce this effect. As we all know, fog, in 
the form of condensed aqueous vapour, cannot be 
prevented, but if smoke could be avoided the fogs 
would be comparatively helpless. The chief charac¬ 
teristic of carbon, which is the principal constituent of 
soot, is its capability of absorbing and retaining in¬ 
jurious substances, such assulphuric acid,sulphurated 
hydrogen and tar. The last substance causes much 
damage to works of art by coating them with a 
thick black deposit. That the other substances also 
cause destruction has been proved by examination 
of the deposits on St. Paul’s Cathedral, where much 
damage was done by a substance formed by sulphuric 
acid corroding the Portland stone. We sincerely 
hope that something will come of this meeting, but 
many of the remedies suggested in the daily Press 
are, to say the least, impracticable, and many absurd. 
In one paper a correspondent suggested driving the 
fog away from the chief streets by means of motor 
steam fans. We do not think that an army of 
motor-cars driven through the streets of Londcm 
would tend to improve the present congestion of 
traffic, even if they did succeed in driving away a 
certain amount of fog. Moreover, if the fog is 
driven from one place it is simply displaced, not 
destroyed. The only reasonable plan is to take 
measures to prevent the production of smoke. 

The Mentone Manifesto. 

In reply to many inquiries by medical men and 
others, we think it well to republish, verbatim, the 
so-called ** Mentone Manifesto,*' relative to the non 
reception there of “ consumptives.” ” For some years 
past the clientele of Mentone has undergone a com¬ 
plete change. Visitors suffering from consumption 
have become extremely rare. Habitual visitors are 
well aware of this fao^ but as the contrary opinion 
appears to be entertained in other quarters, the 
under-mentioned hotels beg to announce that they 
do not receive consumptives:—Alexandra, Ambas- 
sadeurs. Anglais, Angleterre, Beau Bivsge, Belle- 
Vue, Colonies, Europe and Terminus, Grand Hotel* 
lies Britanniques, Italie, Littoral, Louvre, Malte, 
Menton, Mont Flenri, National, Orient, Parc, 
Prince de Galles, Riviera Palace, Royal Westminster, 
Russie and A11em^:ne, Santa Maria, Turin Beau-Se* 
jour, Yenise, Victoria and Princes, Wagner, Windsor 
Palace.’’ It will be seen at once that this document is 
not,aa some have erroneously BuppoBed,sResolation or 
Ordinance of the Municipality of Mentone, autocrati¬ 
cally forbidding any special class of invalids to benefit 
by a long or short sojourn at their especially favoured 
and very beautiful town. It is simply a notification 
to physicians and others concerned that "consump¬ 
tives ” are not considered desirable visitors by the 
twenty-nine principal hotels named in their " Brad 
shaw ” advertisements. There are, however, other 
comfortable hotels, boarding establishments, and 
apartment-houses at Mentone which, doubtless, yet 
welcome all guests, even if of " consumptive ” ten¬ 
dencies. There is also a good and pleasantly situated 
" Sanatorium,” near Mentone, so that phthisical per- 


698 TBB MbOIOAL PbS88' 


NOTES ON CUBBENT TOPICS. 


sons who oontdmplate a visit to Mentone need be 
nnder no apprehension on the score of accommoda¬ 
tion. 


The Detection of Actimonj in PreBenoe 
of Arsenic. 

The quantitative estimation of antimony in pre¬ 
sence of a comparatively large proportion of aisenic 
has hitherto been regarded as one of the most diffi¬ 
cult feats in analytical chemistry. Dr. Denig^s, of 
Paris, claims to have discovereda means of detecting 
the thousandth part of a milligramme of antimony 
in presence of five hundred times its volume of an 
arsenical compound, and he recently described his 
modus operandi before the Academy of Sciences. 
The substance to be analysed is dissolved in strong 
hydrochloric acid, and placed in a platinum crucible. 
Into this a piece of tinfoil is placed, reaching to the 
bottom of the crucible, and on this is formed a bro\vn 
stain of antimony. A confirmatory test consists in 
watching the behaviour of the same hydrochloric 
solution under the microscope in contact with 
a solution containing one gramme of potassium 
iodide and three grammes of chloride of ctesium in 
ten grammes of water. If antimony be present there 
is a formation of hexagonal lamellae of the yellow 
double iodide of antimony and caesium. 


Jews and Drankennesa. 

It is often said that we are a drunken people. 
There is certainly too much evidence of the truth of 
this charge to warrant any disclmmer. Dr. Arcbdall 
Beid, in hie work on “Alcoholism,'’ claims that 
Jews under every condition of life are invariably 
sober. He thinks that this is not because they 
resist temptation, for as a race they are not particu¬ 
larly given to austerity, but because deep indulgence 
is disagreeable to them. We have made inquiries 
respecting the drinking habits of the Jewish people 
in the East End of London. So far the evidence we 
have been able to obtain quite substantiates Dr. 
Beid's statement. One medical man whose prac¬ 
tice is made up in great part of Jews, informs 
us that during the last ten years he has only once 
met with a drunhen Jew, and in that case the Jew 
as regards his general manner of life and attitude to 
the Mosaic ritual was a Gieutile. The matter is oue 
of much interest and great practical importance, and 
worthy the attention of medical men practising in 
Jewish q uarters. 

Poat-Beotal Dermoids. 

Desmoid tumours wherever found have an in¬ 
terest which is less generally extended to other forms 
of tumour. Not alone is the locality of great interest, 
especially when they are found in places which rarely 
accommodate them, but various specimens present 
many striking differences in constitution. The diffi¬ 
culty in drawing a hard and fast line between der¬ 
moids and teratomata is well illustrated by a case of 
poet-rectal dermoid tumourreoordedinthe “ Quarterly 


DSC, 26 , itfOl 

Medical Journal for Torksbire and Adjoining Coon- 
ties '* for November by Dr. Sinclair White. The short 
account is illustrate with pictures showing the 
tumour in the coccygeal region of a child, aged 
three years, and the microscopical appearances of a 
section showing true bone structure. The tnmonria 
described as containing sebaceous material, long grey 
hairs, and tao perfect incisor teeth embedded in the 
mass of dense bone. 


Academical Costume. 

The Council of the Boyal College of Surgeons, 
Ireland, has lecently adopted a distinctive gown and 
cap which may be worn by the Fellows of the Col¬ 
lege. The Council has issued the following r^olotion 
on the subject:—“ The general body of the Fellows 
are authorised to wear a black stuff Master of Arts 
gown, faced with a St. Patrick’s bine Irish 
poplin border, five inches in width, narrowing 
round the collar behind, and extending to each 
end of the gown in front. Inside of the blue 
poplin there shall be a crimson Irish poplin 
lining, five inches in width, and of similar extent as 
the blue. A black velvet college cap, with St. Fat. 
rick’s blue and crimson tassel. This gown ami cap 
may be worn at all public functions, college cere¬ 
monials, state and civic public meetings, and on all 
occasions when academical costume is worn by the 
general body of the Fellows of the Boyal Colleges of 
Surgeons of England and Edinburgh.’’ 


PEBSONAL. 


Mb.W. Hu}rrKB,H.B.,C.M.Aberd., has been appointed 
Government Bacteriologist to the Colony of Hong 
Kong. 

Mb. Geobob Lbntbal Cheatlb, C.B., F.B.C.8., has 
been appointed Surgeon to the Italian Hospital, 
Queeu’s Square, W.C. 

Bb. Ahbbobb, Birmingham, Professor of Anatomy in 
the Catholic University School of Medicine, has been 
appointed an Examiner in Anatomy to the University 
of Cambridge. 

A COKPLIUBNTABT dinner was given to Dr. F. J. V. 
Hall, of Hay Mills, on the 15th inst., to celebrate his 
snooessfnl refutation of the ohai^ made against him in 
the Solihull County Court, to which we alluded last 
week. 

Db. Gltnn, of Liverpool, on terminating his connec¬ 
tion with the Liverpool Infirmary, has been presented 
with his portrait in oils, painted by Mr. B. E. Morrison, 
and was entertained by his friends at a dinner given 
in his honour at the Adelphi Hotel. 


H.B.H. THB Princb 07 WA1.E8 has been ananimously 
nominated Chancellor of the University of Wales. 
H.B.H. has definitely consented to become President of 
the National Association for the Prevention of Con¬ 
sumption and other forms of Tabercnloais. 


Digitized by 


Google 



Bsc. 25 , 1901 . 


C0BRE8P0NDENCE. 


Thx Mxdical Fbbss. 699 


Bb. E. W^8H was last week presented with a gold 
watoh and chain and an illnminated addrees hj eome of 
the inhabitants of Abercam and the officials of the 
Piinoe of Wales Colliery (of which be was Assistant 
Medical Officer) on his leaving the neighbourhood. 

Mb. Dbakislt and Mr. A. H. W. Hnnt were last 
week elected Honorary Surgeons to the Wolverhampton 
and Staffordshire General Hospital. Mr. Deanesly was 
formerly House Sui^eon at UniversiW College Hv«pital, 
London, and Mr. Hnnt House Surgeon at Westminster 
Hcwpital. 

Thb following gentlemen have been appointed 
Assistant Medical Officers in the hospitals of the Metro* 
politan Asylums Board: Mr. D. Brewer, M.B.C.5 
Eng., L.B.C.P.Lond; Mr. C. De P. D'Amioo, M.B.Malta’ 
M.R.C.S.EDg., L.B.C.P.Lond ; Mr. C. C. LaU, M.B.i 
B.Ch.Ed.; Mr. B. Niven, M.B, B.Ch.01a8g., D.P.H. 
Camb.; and Mr. A. B. Spencer, M.B., M.B.C.8., 
LBC.P. 


[fbok oub owk cobbkbpokdbnt.] 

Thb Light Tbbathbnt or Bisbasb at thb Clinical 

SOCISTT. 

This society, which is in flourishing condition this 
year, under the presidency of Mr. Herbert Lund, held 
its December meeting at the Manchester and Salford 
Hospital for the Diseases of the Skin instead of in its 
own rooms at the Palatine Hotel. This was done by the 
kind permission of the Hospital Committee, in order 
that the members of the society might have, 
from Dr. Brooke, a demonstration of the Light 
Treatment of Skin Disease. It was explained that the 
modem treatment of lupus and other skin diseases by 
means of light is based upon influence which sun¬ 
light has bMn proved to have upon the life and growth 
of certain micro-organisms by various experiments 
made upon cultures in the laboratory. lu order to 
ascertain the effect of sunlight upon organisms living 
within the tissues, lupus was selected ^r experiment 
on account of the superficial position of the lesions it 
produces. The next step was to concentrate the rays 
of sunlight upon small areas of diseased skin by means 
of lenses. These were made of large size (those shown 
appeared to be 8 or 10 inches in diameter) and hollow, 
so as to contain water with various pigments in solution. 
The actinic rays being the valuable ones from a thera¬ 
peutic point of view, and the heat rays at the other end 
of the spectrum being apt, when oonomitrated, to bum 
the patient, the lenses are filled with blue sointiona 
which cut off the heat rays and let the aotinio arcs pass 
through. These lenses of sunshine were always and 
everywhere available and would appear to answer all 
requirements. The Einsen lamp was devised simply in 
order to provide an artificial sn^titute for direct con¬ 
centrated sunshine. As seen at the Manchester and 
Salford Skin Hospital the apparatus is briefly as fol¬ 
lows : A dynamo connects the t«>wn electrical supply 
into a current of 66 volts, and 70 or more amperes 
which works an arc lamp many times as powerful as 
those employed for lighting. Bound this are arranged 
radially several telescope-like tubes containing leases 
which concentrate the light on to a surface about an inch 
in diameter. The lenses are madeof rook crystal instead of 
glass to favour the paessge of active rays. Cooling is 
managed by allowing a stream of cold water to flow con¬ 
stantly through a portion of the tube. As the red blood 
in the tissues protects the bacilli within from actinic 
rays, just as the photographer’s red lamp shade protects 
his sensitive plates from the same rays. Something 
has to be done to keep the blood out of that portion of 
the skin which is under treatment. This is managed 


by a nurse, who presses against the patient’s 
skin during the fifty minutes or so of exposure 
to the light, a small instrument, consisting of two 
layers of crystal between which a stream of water 
flows constantly to prevent hearing. The pressure pro< 
duc« a temporary ansmia in the part, and exposes the 
b a c illi benearii to the full action of the light. The 
Ijartot lamp is a simpler arnmgement. One arc lamp 
is used for each patient, whose skin is close to it, 
pressed, for anemia, l^^inrt a transparent cooler, like a 
child's nose against a window psme. There was an 
army of patients on show, many of them with photo¬ 
graphs, which showed their condition “before and 
after" treatment in a way which speaks well for the 
v^ue of the method. Bontgen ray instruments and 
high frequency apparatus were also on view. 


Corrt0|ianbmc. 

t.We do not hold oorselTSs responsible for the opinions of oar 
correspondents.] 


SUGGESTIONS FOE THE IMPBOVEMENT OP 
THE HUMAN EACE. 

To the Sditor <tf Thb Mxdxcal Pbbss akd Cibculab. 

Sib,—W ith reference to your criticisms, p. 682 of your 
issue for the 27th last month, on Hr. Galton’s lecture, 
perait me the following suggestions:—Wealthy persons 
might leave sums in their wills in the hands of trustees, 
who should be medical men, experts on heredity, and 
men of business and experience in human nature. 

Their duties would Im the enabling, not bribing, any 
extra fit persons to marry, and if possible intermarry, 
w